Preface

It is said that the family physician of the bygone age could follow his patient from ‘creation to cremation’. If nothing else, this, atleast provided opportunity of studying the life history of a disease. In comparison, the present day consulting physician’s contact with the patient is a brief encounter usually confined to an exchange of a diagnostic label and a shopping list of drugs in return for substantial fees.
If a physician wants to study the life history of a disease, he would have to obtain fragments of information from here and there: from outpatient departments, from wards, from pathology laboratories and the post moretm halls. Record keeping, being what it is in our country, he has to spend time personally in various departments to chase with perseverance and perspicacity various threads of the life history of a disease in which he is interested.
In my case, my primary clinical interest being cardiology, my curiosity in amoebic liver abscess was aroused on attending a post mortem of a patient having an unsuspected rupture of the left lobe amoebic abscess into the pericardium. Subsequent to this, during one of my sabbaticals, I spent my entire time in the post mortem rooms looking up cases of amoebic liver abscess. During another such period of ‘refreshing and recharging’, I spent several months at Radiation Medicine Centre of BARC, one of the few outstanding nuclear medicine departments which would compare favourably with any similar department in any other part of the world. A large referral of patients suspected of amoebic abscess drifts towards a nuclear medicine department. My stay at Radiation Medicine Centre provided me with a splendid opportunity of studying large number of these patients clinically and observed various liver images obtained in different patients.
I could continue my association with liver scanning when nuclear medicine facilities became available at Jaslok Hospital. In 1976, I was appointed in charge of liver scanning at the nuclear medicine unit of Sir J.J. Group of Hospitals, Bombay where I could study hundred of patients of liver abscesses every year in depth and at leisure and virtually chase them to the operation theatre whenever surgery was done on any of the patients. While the surgeon lanced the abscess, I kept on working with the lenses of my camera to prepare a unique portfolio of rare cases and events in the life history of amoebic abscess. This monograph derives most of its pictorial material from such cases at J.J. Hospital and Jaslok Hospital.
In the monograph I have put together many things that I have learnt over the years from various sources. The process of educating oneself about a specific disease in the course of a busy clinical practice is like editing a move film. Little pieces are produced helter-skelter without any kind of inter-relationship between each scene. A bit is acquired while examining patients, some in post mortem, a lot in laboratories and a large amount from reading of literature. It is the final editing that puts the story together in the film; my role has been the same in writing this book. Different disjointed scenes are put together in some kind of design so as to make the reader enthralled by a clinical condition which has always enthused me personally because of its wide sweep and ramification in almost all medical disciplines.
How intestinal amoebiasis spreads to the liver is a major enigma of immunology. Its diagnosis most of the times lies in a simple clinical examination and remembering that it can exist ‘as a disease in all disguise’ but in a complicated case the diagnosis may involve sophisticated inventory of investigations such as NM, ULTRASOUND and CAT. Its treatment is simple and cure always customary so much so that treatment is employed most often even when no disease is present. About 15 years ago, I published a paper on amoebic hepatitis. Today, I hesitate in recognising such an entity and feel that this diagnostic connotation is usually an excuse to start anti-amoebic treatment.
My previous experience in writing has been with two practical clinical guides for general practitioners. In this monograph, I have studied one disease in depth but in every chapter I have kept the general practitioner in mind and provided, wherever possible, guidelines that would help him in diagnosis and treatment of his patients.
Hepatic amoebiasis is extremely common in this country but surprisingly enough there is hardly any comprehensive literature on this condition originating from this country. I have tried to cover this lacuna, at the same time knowing fully well that my capabilities as an author are limited to do full justice to this subject. I hope, my feeble attempt in the form of this monograph will be viewed by my friends with some indulgence and by others with some trepidation. "Friends ‘look thru’ a telescope, ‘envy’ thru’ a microscope."
I could never have accomplished this without help from many. For my wife it has been a labour of love. My children had virtually turned into task masters but at the same time made it as comfortable as possible for me to work. Dr. R. D. Ganatra in his gentle unassuming coaxing way has always kept me from giving up this venture. I can go on endlessly naming many others and still running the risk of missing few but my deep sense of gratitude would not rest easy till I at least mention Dr. T. R. Motwani, Dr. T. E. Udwadia, Mr. P. Ramanathan, Dr. R. R. Pai, Dr. D. K. Ray of Ciba-Geigy Research Centre, interns Selma D’Lima, Joe Dias and secretary Prateema for their help, guidance and encouragement. All of them together have produced a significant space occupying lesion in my heart for which there is no aspiration or remedy.
I am also most thankful to Dr. Sircus, who has so generously contributed the Foreword to this book. It is a great personal privilege to have introduce this book. I hope that the monograph is worthy of its subject.

As T.S. Eliot decries,
"where is the wisdom we lost in knowledge?
where is knowledge we lost in information?"

This book has lot of information, few morsels of knowledge and occasional bits of wisdom. Nothing would satisfy me more than knowing that the few who read this monograph were helped in their quest towards clinical wisdom.

Bombay, July 1979

O. P. KAPOOR