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Suppurative Peritonitis was present. The pus and necrosed material from the interior of the abscess were examined bacteriologically but with a negative result. From the peritareal cavity, however, pure cultures of Bacillus coli com- munis were obtained. There was no trace of Dysentery.
Case No. 3. This case is similar to the foregoing. It occurred in an unknown Chinese male, aged about 40 years. The abscess was right sided, occupy- ing practically the entire right lobe. Acute suppurative Peritonitis was present. From the pus, Bacillus coli communis was obtained.
Chronic Dysentery was found in the large intestine.
Case No. 4. This case is interesting as it occurred in a young child. An unknown Chinese female, aged about 3.
A large abscess was found in the right lobe, presenting the usual typical appearance. In addition to this, several small abscess cavities about the size of a peu, were found scattered throughout the remaining parenchyma of the liver.
No trace of Dysentery was present.
Acute Catarrhal Pneumonia was found in both lungs.
No micro-organisms were found in the pus or walls of any of the abscesses. Case No. 5. An unknown Chinese female, aged about 10.
Multiple small abscesses, very variable in size were scattered throughout the entire substance of the liver. These presented the appearances typical of abscess of the liver.
No micro-organisms were found in the pus or walls of the abscess.
There was no trace of Dysentery.
Right sided acute fibrinous Pneumonia was present.
Remarks.
These cases are brought forward owing to the several points of interest con- nected with their pathology, and also from the lessons which may be drawn from them from a clinical and pathological point of view.
The etiology of so called liver or tropical abscess is by no means thoroughly understood.
The occurrence of an inflammation, e.g., Hepatitis, ending in the production of pus, must, in the light of modern views of inflammation, be put down to the action of micro-organisms. Yet when we examine the literature in regard to this subject. we become lost in our zeal to attribute the production of such an abscess to any of the micro-organisins so far described.
In all of the cases which have been examined by me, no micro-organism was isolated which could reasonably be brought into causal relationship with the
disease.
In the cases which ended by the bursting of the abscess into the peritoneal cavity, micro-organisms of the colon group were always found, but these, judging from what is now known in regard to the abdominal cavity, must be regarded as secondary and not as exciting agents of the process under discussion.
Particular regard was paid to the examination of the walls of such abscesses, owing to the prevalence of opinion that protozoa have to do with the production of the disease, but in each case a negative result was obtained.
In one of my cases, No. 3. evidences of Dysentery were present, but mieros- copic examination for amoebae or bacteria was entirely negative.
In Cases Nos. 4 and 5, multiple small abscesses were found, but in neither cuse was any trace of Dysentery discoverable. This is rather important as, accord- ing to the general trend of opinion, large solitary abscesses occur idiopathically, while multiple small abscesses develop in conjunction with Dysentery.
It is evident, that although bacteriological examination was made of each of these cases recorded, absolutely no evidence could be obtained as to the erviting cause of the disorder The etiology, therefore, in each individual case is by no means obvious. The presence of interstitial nephritis and pericellular hepatic cirrhosis in