ENTAMCEBA HISTOLYTICA 193 



dealing with amoebae which were of the E. histolytica type, and not with 

 tissue cells, which frequently lead observers astray. How the amoebse 

 gain access to the urine is not known, but it may be surmised that a 

 secondary infection of the urinary tract has taken place, and that amoebse 

 are discharged from the lesions into the urine, where, however, they 

 undergo degeneration more rapidly than after their discharge into the 

 lumen of the bowel from the intestinal ulcers. There is no reason for 

 regarding the urinary form as a species distinct from E. histolytica, though 

 Baelz (1883), who was the first observer to see amoebae in the urine, 

 proposed the name Amoeba urogenitalis. 



Warthin (1922) observed E. histolytica in the vas deferens and the 

 lumen of the dilated tubules of the epididymis and testis. The patient, 

 a typical case of amoebic dysentery, died in spite of treatment which had 

 cleared the intestine of its infection. The amoebae were seen in section 

 of the tissues. They were mostly in clots of blood and fibrin in the lumen 

 of the dilated tubes, but in some places were invading the walls. They 

 were remarkable in that they had phagocyted not only red blood-corpuscles, 

 but also spermatozoa. Hines (1923) noted that a case of amoebic dysen- 

 tery suffered from enlarged and extremely tender seminal vesicles. 

 Seminal fluid expressed from the vesicles revealed typical active amoebae 

 with included red blood-corpuscles. 



Petzetakis (1923 and 19236) in Alexandria describes amoebic bronchitis 

 in which, without actual abscess formation, the lungs appear to be in a 

 broncho-pneumonic state. There was no evidence of liver abscess, and 

 only certain cases gave a history of dysentery. The expectoration was 

 said to contain active amoebae, which in their movements, size, structure, 

 and included red blood-corpuscles resembled E. histolytica. Those cases 

 which were free from intestinal infection responded very readily to emetin 

 treatment. It is evident that these claims require confirmation. Libert 

 (1924) states that he obtained active forms of E. histolytica in a case of 

 hepatitis by means of the duodenal tube, an observation confirmed by 

 Boyers, Kofoid and Swezy (1925). 



Several observers have recorded amoebic infections of the skin, but 

 in most cases there is little evidence that the structures described were 

 amoebae at all. Maxwell (1912) observed amoebae in fistulae about the 

 buttocks of cases in Formosa. In this instance it is not improbable that 

 amoebae had passed into the fistulae from the intestine. Engnian and 

 Heithaus (1919) gave a description and figures of what they regarded 

 as E. histolytica from ulcers on the skin of a case which was said 

 to have an intestinal infection. Judging from the figures and description 

 it is impossible to recognize the bodies as amoeba?, and it is evident the 

 authors have had little experience of these organisms. Kofoid and Swezy 

 I. 13 



