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XXXIV] Evidence tends to show that liver abscess is the sequel or associate of amœbic dysentery— a disease practically confined to warm climates ; not of bacillary dysentery, the usual form of dysentery occurring in temperate and some warm climates. Etiology,— Relation to dysentery.— There can be no question as to the existence of an intimate relationship between dysentery and liver abscess. Numerous and well-authenticated statistics, as well as everyday experience, attest this. In 3,680 dysentery autopsies made in various tropical countries, and collated by Woodward, 779 (21 per cent.) revealed abscesses of the liver. To quote recent Indian experience: According to the Annual Report of the Sanitary Commissioner with the Government of India for 1894, out of 465 European soldiers who died from dysentery in India during the period 1888-94, 161 (35 per cent.) had, in addition to dysenteric lesions, abscess of the liver. Conversely, in Egypt, Kartulis, in an experience of over 500 cases of liver abscess, elicited a history of dysentery in from 55 to 60 per cent.; Zancarol, also in Egypt, in 444 cases, elicited a similar history in 59 per cent.; and Edwards and Waterman, in 699 collated cases, elicited a like history in 72.1 per cent. During the period 1870-95, of 45 cases of liver abscess treated at the Seamen's Hospital, 'Greenwich, and collated by Mr. Johnson Smith, postmortem evidence or a distinct history of dysentery was obtained in 38 (84.4 per cent.).

These figures are conclusive as to the existence of an intimate relationship between dysentery and liver abscess. There is good reason, however, for believing that, while they represent the truth, they do not represent the whole truth, and that the association is even more frequent than they indicate. As has been pointed out by McLeod and others, the occurrence of antecedent dysentery in cases of liver abscess is very often overlooked; for, without a postmortem examination, it may be impossible to pronounce definitely on this point in every instance. It is also well known that extensive dysenteric ulceration may be present and yet give rise to no active