AMCEBIC ABSCESS OF THE LIVER 



191 1 



debris, endothelial cells, mononuclear leucocytes (rarely polymci- 

 phonuclears), red corpuscles, haematoidin, cholesterin, and rarely 

 Charcot-Leyden crystals. The pus is usually sterile, and as a rule 

 does not contain amoebae, which are in the marginal wall of the 

 abscess, and may extend into the liver tissue for some distance 

 from the focal lesion. After the abscess has been opened, amoebae 

 may be found in the pus. The process of repair has not been fully 

 worked out, but it appears as though the granulation tissue formed 

 new connective tissue, in which new bloodvessels and proliferating 

 bile-ducts may be seen, indicating the processes which may lead 

 t o repair. 



Usually there is only one 

 abscess, but it is not uncommon 

 to find two, and there may be 

 more. The abscess is generally 

 found in the posterior part of 

 the upper portion of the right 

 lobe. It is rounded in form, 

 with walls composed of degene- 

 rated liver cells and granulation 

 tissue. Its contents may be 

 thick, creamy pus, but more 

 usually it is yellowish or brown 

 coloured. On microscopical ex- 

 amination it consists largely of 

 detritus, with a few degenerated 

 liver and pus cells. The bacteria 

 found in the pus, when it is not 

 sterile, are streptococci, staphy- 

 lococci, B. coli communis, and 

 B. pyocyaneus, and occasionally 

 some anaerobic germs. The 

 abscess varies much in size, from 

 a small hollow containing only 

 I or 2 ounces up to a huge cavity 

 with a couple of pints or more 

 of pus, while even larger have been described. The size of the 

 liver, apart from the abscess, also varies, being sometimes increased 

 and sometimes diminished. Apart from the liver abscess, 1 here are 

 usually signs of old or recent dysentery in the colon, though these 

 may be absent. There may be abscesses in other parts of the body, 

 the spleen, the brain, etc., but these are rare. 



Symptomatology. — ^There is usually a history of a previous attack 

 of dysentery, but this may be wanting. The disease begins in- 

 sidiously with signs of congestion of the liver and fever. This fever 

 is important, being irregular, sometimes remittent, sometimes 

 intermittent, sometimes with long apyrexial intervals. 



The X rays may show that the movement of the diaphragm is 

 diminished on the right side, and attention has also been called to 



