subjective symptoms whatever. Moreover, many patients suffering from liver abscess forget, or fail to mention, the occurrence of a previous dysenteric attack, or may mislead the physician by describing such an attack as " diarrhœa." Further, at postmortem examinations, dysenteric lesions of a superficial and apparently trifling character are often either not sought for, or are overlooked, or have disappeared; moreover, it is now well ascertained that the amœbæ may be present without producing definite intestinal lesions. Consequently, although the evidence of antecedent dysentery may not be forthcoming in a proportion of cases of liver abscess, it must not be concluded that in these cases there has been no dysentery or amœbic infection.
In a masterly paper McLeod, after a very careful and critical analysis of certain figures bearing on this subject, concludes that dysentery is a factor in nearly every case of tropical liver abscess. In 40 cases of the disease observed in Shanghai he had positive evidence of dysentery in all except one; and even in this case, as recovery ensued, there was no certainty that dysenteric lesions had not been present. Perhaps McLeod's conclusions are somewhat too sweeping I confess, however, that they are, in the main, in harmony with my own experience. Doubtless they apply to liver abscess as met with in Shanghai and, probably, in many other places. It "is just possible, however, that what holds good for one place may not hold good for all places, and that Bombay, for example, may differ in this respect from Shanghai. In the Sanitary Commissioner's Report, above referred to, it is stated that in 2 (3 per cent.) instances only, out of 74 cases of liver abscess occurring in the Bombay Presidency in the period 1888-94, were there dysenteric associations. It is difficult to believe that, did it always exist, so important and evident a circumstance as dysentery had been overlooked in 72 out of 74 cases. It is equally difficult to believe that the liver abscess of Bombay is associated with dysentery in only 3 per cent, of cases, whilst, according to the same authority, in the whole of
