the causation of the disease, sucli communications are always full of interest. As evidences of the vagueness of our know-
ledge regarding the etiology of hepatic abscesses, we quote from Caylej7, who, writing so late as 1893, on this subject and its connection with dysentery, says that both diseases "are dependent on the same general causes, such as heat of climate, malaria and so oil." The majority of are equally vague. Dr. Boyd of Grenada, one of those who have written recently on the subject, revives the theory that malaria is the proximate cause of abscess of the liver, and states that this belief
other authors
almost all the medical men practising in that country. We do not fancy that this theory will nowadays find much countenance is shared
by
amongst
medical
men
in India. No
satisfactory
brought forward to prove this theory. On the contrary, so far as India is concerned, there is no reason to believe that hepatic abscesses are more commonly met with
evidence has
ever
been
in malarious districts than in disease is
certainly
a
very
others,
rare
and the
complication
of
malarial fevers. The amoebic origin of the disease, championed by Dr. Windsor in The Lancet, is certainly worthy At the same time we of careful consideration. do not consider that Dr. Windsor has presented at all a strong case for this theory, and his arguments some
are
based
on
several false
of his statements
with facts.
In
are
premises,
not in
whilst
accordance
with the
dealing
comparative to the disease in liability question, he states that as civilisation in India increases, so does the f requency of tropical abscess of
different
races "
among the richer and more leisured class of natives." Dr. Windsor does not give his authority for this statement, and it is certainly not in accordance with the experience of most surgeons. It is members of the lowest class of natives who are specially prone to the disease, and it is of extreme rarity amongst the upper classes. Dr. Windsor
seems
the authorities
ABSCESS OF THE LIVER.
Sevekal communications dealing with the subject of hepatic abscess have appeared of late in the English medical journals, and the notes
considerable number of cases have been published from time to time during the past few years. In view of the importance of the subject, and our want of any exact knowledge regarding of
a
to have
gathered
the idea from
has consulted, that a very large proportion of cases of single hepatic abscess are associated with dysentery, and he goes as far as to state that "the abscess followwhom he
is usually large, single, etc." In this statement, he will find himself at issue with most Indian Surgeons of experience.
ing dysentery
making
He believes it to be an indisputable fact that whilst dysentery is an invariable complication
THE INDIAN MEDICAL GAZETTE,
262
of
cases
of
of
cases
of
multiple abscess, a great proportion single abscess have been free from
concomitant disease of the bowel. This being the case, it follows that although O certain forms of dysentery, as well as hepatic abscess, may be due to one and the same cause* antecedent
or
?
yet the
diseases
two
are
not
necessarily alwa37s together. Dr. Windsor inclines to the that there is one particular variety of
associated view
dysentery which
is
presence of amoebfie, and that it is this form that is often associated with, and causative of, hepatic abscess. It
being
due to the
assumed that such amoebae
are
usually
through the mestrange that natives
introduced into the intestine dium of food
or
drink,
it is
of India, who are proverbially careless regarding the purity of the water that they drink, are not more prone to these amoebic diseases, if we may
amongst which, according to this theory, hepatic abscess must be classed. Yet there is no doubt that Europeans are much more prone to hepatic abscess than natives. Neither Dr. Windsor, nor any others who uphold the same theory, have attempted to explain away this difficulty. Dr. Windsor, it is true, appears to consider that predisposing causes play a powerful part in the causation of liver abscesses, and it is possible that call them so,
he may natives such
the
explain as
comparative immunity
due to the
absence,
of
in their cases, of
When we come to consider what these so-called predisposing conditions are, we find that they are almost purely
predisposing
causes.
speculative, not to say vague, in character. The most potent predisposing cause, in the opinion of Dr. Windsor, is alcohol, and in drawing attention to this feature of the subject, he speaks of the lives of in and lazy, sedentary Europeans India, their over-indulgence in rich food and alcohol." This picture of the European in India is as un"
true
as
it is
common
So far
England.
as
amongst
our
Englishmen
brethren in
in India
are
concerned, they tend rather to over-indulgence in sports and athletics, and they are, as a rule,
abstemious in the The cause
matter of alcohol.
of
alcoholism, as a predisposing liver, has proved a stumsuccessive writers on the subject,
question
of abscess of the
bling block
to
who all appear to have inherited a belief in this bogey, and none of them have taken the trouble to enquire into its reality, or otherwise, We have the least
never seen
degree
any statistics which tend in
to bear out the
theory, whilst
the
on
entirely
[.July
other hand, opposed to it.
1898.
everyday experience
is
To return to the
subject of the direct causation hepatic abscess, we would say that, so far as true cases of multiple abscess are concerned, everything points to their being pj'semic in origin, as all the factors necessary for such a of
condition
are
present in cases of this nature, septic inflammation of the intestine
that is to say, and septic thrombosis of the the
course
of such
cases
venous
radicles of
the
Moreover,
portal systems.
clinical
is characteristic of pyaemia.
The causation of the
single,
so-called
tropabscess, the}" are not produced b}*- the presence of pyogenic or putrefactive organisms, is said by some writers to have been conclusively proved. On the other hand, the amoeba coli is certainly found in the discharge of some of these abscesses. What part, if any, the latter animal bears in the production ical
is not
so
clear.
or
That
of the abscess, has not been demonstrated.
ledge regarding the etiology of hepatic abscesses, we quote from Caylej7, who, writing so late as 1893, on this subject and its connection with dysentery, says that both diseases "are dependent on the same general causes, such as heat of climate, malaria and so oil." The majority of are equally vague. Dr. Boyd of Grenada, one of those who have written recently on the subject, revives the theory that malaria is the proximate cause of abscess of the liver, and states that this belief
other authors
almost all the medical men practising in that country. We do not fancy that this theory will nowadays find much countenance is shared
by
amongst
medical
men
in India. No
satisfactory
brought forward to prove this theory. On the contrary, so far as India is concerned, there is no reason to believe that hepatic abscesses are more commonly met with
evidence has
ever
been
in malarious districts than in disease is
certainly
a
very
others,
rare
and the
complication
of
malarial fevers. The amoebic origin of the disease, championed by Dr. Windsor in The Lancet, is certainly worthy At the same time we of careful consideration. do not consider that Dr. Windsor has presented at all a strong case for this theory, and his arguments some
are
based
on
several false
of his statements
with facts.
In
are
premises,
not in
whilst
accordance
with the
dealing
comparative to the disease in liability question, he states that as civilisation in India increases, so does the f requency of tropical abscess of
different
races "
among the richer and more leisured class of natives." Dr. Windsor does not give his authority for this statement, and it is certainly not in accordance with the experience of most surgeons. It is members of the lowest class of natives who are specially prone to the disease, and it is of extreme rarity amongst the upper classes. Dr. Windsor
seems
the authorities
ABSCESS OF THE LIVER.
Sevekal communications dealing with the subject of hepatic abscess have appeared of late in the English medical journals, and the notes
considerable number of cases have been published from time to time during the past few years. In view of the importance of the subject, and our want of any exact knowledge regarding of
a
to have
gathered
the idea from
has consulted, that a very large proportion of cases of single hepatic abscess are associated with dysentery, and he goes as far as to state that "the abscess followwhom he
is usually large, single, etc." In this statement, he will find himself at issue with most Indian Surgeons of experience.
ing dysentery
making
He believes it to be an indisputable fact that whilst dysentery is an invariable complication
THE INDIAN MEDICAL GAZETTE,
262
of
cases
of
of
cases
of
multiple abscess, a great proportion single abscess have been free from
concomitant disease of the bowel. This being the case, it follows that although O certain forms of dysentery, as well as hepatic abscess, may be due to one and the same cause* antecedent
or
?
yet the
diseases
two
are
not
necessarily alwa37s together. Dr. Windsor inclines to the that there is one particular variety of
associated view
dysentery which
is
presence of amoebfie, and that it is this form that is often associated with, and causative of, hepatic abscess. It
being
due to the
assumed that such amoebae
are
usually
through the mestrange that natives
introduced into the intestine dium of food
or
drink,
it is
of India, who are proverbially careless regarding the purity of the water that they drink, are not more prone to these amoebic diseases, if we may
amongst which, according to this theory, hepatic abscess must be classed. Yet there is no doubt that Europeans are much more prone to hepatic abscess than natives. Neither Dr. Windsor, nor any others who uphold the same theory, have attempted to explain away this difficulty. Dr. Windsor, it is true, appears to consider that predisposing causes play a powerful part in the causation of liver abscesses, and it is possible that call them so,
he may natives such
the
explain as
comparative immunity
due to the
absence,
of
in their cases, of
When we come to consider what these so-called predisposing conditions are, we find that they are almost purely
predisposing
causes.
speculative, not to say vague, in character. The most potent predisposing cause, in the opinion of Dr. Windsor, is alcohol, and in drawing attention to this feature of the subject, he speaks of the lives of in and lazy, sedentary Europeans India, their over-indulgence in rich food and alcohol." This picture of the European in India is as un"
true
as
it is
common
So far
England.
as
amongst
our
Englishmen
brethren in
in India
are
concerned, they tend rather to over-indulgence in sports and athletics, and they are, as a rule,
abstemious in the The cause
matter of alcohol.
of
alcoholism, as a predisposing liver, has proved a stumsuccessive writers on the subject,
question
of abscess of the
bling block
to
who all appear to have inherited a belief in this bogey, and none of them have taken the trouble to enquire into its reality, or otherwise, We have the least
never seen
degree
any statistics which tend in
to bear out the
theory, whilst
the
on
entirely
[.July
other hand, opposed to it.
1898.
everyday experience
is
To return to the
subject of the direct causation hepatic abscess, we would say that, so far as true cases of multiple abscess are concerned, everything points to their being pj'semic in origin, as all the factors necessary for such a of
condition
are
present in cases of this nature, septic inflammation of the intestine
that is to say, and septic thrombosis of the the
course
of such
cases
venous
radicles of
the
Moreover,
portal systems.
clinical
is characteristic of pyaemia.
The causation of the
single,
so-called
tropabscess, the}" are not produced b}*- the presence of pyogenic or putrefactive organisms, is said by some writers to have been conclusively proved. On the other hand, the amoeba coli is certainly found in the discharge of some of these abscesses. What part, if any, the latter animal bears in the production ical
is not
so
clear.
or
That
of the abscess, has not been demonstrated.
