which is a universally recognized cause of hepatic disturbance— over-indulgence in stimulating food and alcoholic drinks— that constitutes this predisposing cause. Intemperate habits and exposure, doubtless, lead to a special liability in men to a hyperæmia and congestion of the liver tissue by which its resistance to pathological influences is impaired. In these circumstances, pathological influences which in the healthier condition of the organ— such as we assume to exist more generally in natives and in European women and children— would have been successfully overcome, gain the upper hand and lead to suppurative disintegration of the organ. In support of this view we have the statement of Waring that 65 per cent, of liver abscesses observed by him were in alcoholics ; and it is also said that when the native takes to European habits in the matter of eating and, especially, of drinking, his liability to liver abscess is greatly and proportionately increased.
I conclude, therefore, that in the vast majority of instances the exciting cause of liver abscess is amœbic dysentery: the predisposing cause, hyperæmic, congestive, or degenerative conditions incidental to tropical life, supplemented by such things as exposure and unphysiological habits in eating and drinking.
Supplementary causes.— It is conceivable that in a highly predisposed liver exciting causes other than dysentery, such as a blow or sudden aggravation of chronic congestion by chill or excess, may suffice at times to determine suppuration. Liver abscess is most prone to develop at the commencement of the cold season. Further, one can conceive that in a hyperæmic liver struggling to resist dysenteric suppurative influences some third condition, such as the blow, chill, or surfeit referred to, may contribute to or determine the formation of abscess which, in its absence, might have been averted.
Briefly stated, the causes of liver abscess are, first, predisposing— hyperæmic and degenerative conditions of the liver; second, exciting— amœbic dysentery, or dysentery combined with chill, dietetic excess, or traumatism.
