Microscopically, the necrotic abscess wall shows amoebae in its depths but necrosis of the surrounding tissue beyond the zone of the amoebae is noticeable which would suggest the elimination by the amoebae of some toxic substance. There is an absence of polymorphonuclear infiltration around the abscess. Surrounding the abscess wall there is a zone of marked hyperaemia. Amoebae may be found in this area as well as in the abscess wall. If the liver abscess is not treated by emetine or with this drug and some surgical procedure the tendency is for rupture to occur and Cyr’s statistics show that of 159 cases rupture occurred as follows: lungs 59, pleural cavity 31, peritoneal cavity 39, intestines 8, stomach 8, vena cava 3, kidneys 2, bile ducts 4, pericardium 1 and externally 2. SYMPTOMATOLOGY Although the statistics would indicate that a history of amoebic dysentery has been obtained in only from 60 to 90% of cases of liver abscess, yet, when we consider that amoebic lesions of the large intestines have been frequently noted at autopsy in those who had never shown symptoms of dysentery during life, we are forced to believe that amoebic lesions of the appendix or large intestines are necessary factors in the production of liver abscess. Consequently, a history of amoebic dysentery is one of the most important points to consider in the making of a diagnosis of tropical liver abscess. =Tropical Liver.=—There is also much evidence to be obtained from statistics and otherwise to support the view that the amoebic infection of the liver is only possible in a person whose liver has been functionally impaired. To this condition the designation tropical congestion of the liver or simply tropical liver has been applied. There is much to support the view that, in the tropics, the intestines and liver take the place of the thoracic organs in being subject to congestion. In temperate climates excesses and exposure to debilitating influences result in coryza or pneumonia. In the tropics we have diarrhoea and congestion of the liver. Tropical liver is recognized by vague digestive troubles, high-colored urine, loss of energy, irritability, with a sensation of fullness in the region of the liver which is generally described by the patient’s statement that he feels his liver. There may be pain referred to the right shoulder and the liver may be tender on palpation. By the discontinuance of alcohol and highly spiced foods, with treatment by phosphate of soda or sodium sulphate, together with general care of the health, the patient may recover completely. Rogers recognizes a condition which he terms the _pre-suppurative stage of amoebic hepatitis_ in which the amoebae from dysenteric lesions have lodged in the portal terminals of the liver but in which abscess formation has not taken place.