19 



' one in the right lobe as large as a small orange, and one in the 

 left lobe of the size of a filbert.' The abscesses had ' very definite 

 boundaries ', and the neighbouring liver-tissue appeared healthy. 

 ' The whole of the large intestine was extensively ulcerated ' ; 

 and it is further recorded that the child ' had been ill ten months 

 with diarrhoea, and for about two months there were slime, blood, 

 and general, symptoms of dysentery '. 



Though little else of importance is recorded, it seems highly, 

 probable that this was another case of amoebic dysentery and 

 liver abscess — due to E. liistolytica — in a person who had never 

 left Britain. 



The case of Saundhy and Miller. — ' A case of amoebic dysentery 

 with abscess of the liver in a patient who had never been out of 

 England ' was described some years ago by Saundby and Miller 

 (1909) in Birmingham. This was another fatal case. Their 

 patient was a man — a cycle-rim maker who had lived in the 

 Birmingham district all his life. From the clinical description and 

 the recorded post-mortem findings, the case appears undoubtedly 

 to have been one of amoebic abscess of the liver, with typical 

 amoebic ulceration of the large bowel. No history of dysentery is 

 recorded, but it is stated that 'four days after admission'' the 

 patient ' passed a stool containing a considerable quantity of 

 blood' — which apparently was not examined microscopically — ■ 

 and thereafter he had ' no more diarrhoea '. The liver abscess 

 was 5 in. in diameter, in ' the posterior part ' of the liver, 

 and contained 'brownish-red pus and masses of necrosed liver 

 substance '. Amoebae were found in the pus, from which no 

 bacteria were cultivated ' in ordinary media ', and sitailar amoebae 

 were present in the intestinal ulcers. The authors identified 

 them as ' the Entamoeba histolytica (Schaudinn) ', though un- 

 fortunately this organism cannot be recognized in their description 

 and figures. There can be little doubt, however, on other grounds, 

 that this was really a case of E. histolytica infection. 



Saundby and Miller claimed that theirs was 'the first ob- 

 servation of the kind which has been recorded in Great Britain ' ; 

 and it appears probable that it was, indeed, the first such case in 

 which amoebae were actually found. They appear to have thought 

 that the patient contracted his infection from some ' imported ' 

 case of amoebic dysentery: but they adduced no evidence in 

 support of the suggestion. They concluded that ' the disease, 

 although no doubt imported into this country from time to time, 

 rarely spreads ; that it may do so, however, when circumstances 

 favour it, seems to be established by the present case'. The 

 authors could hardly have written this last sentence if they had 

 known all that we now know concerning the occurrence of 

 E. histolytica in Britain. 



Marshall's case. — This is another comparatively recent case, 

 described by Marshall in 1912. The patient was a ploughman, 

 aged 28, living near Dunbar. He had never been out of Scotland. 

 He was admitted to the Royal Infirmary, Edinburgh, ' suffering 

 from chronic diarrhoea ', which had begun about seven weeks 



