18 



i'rom the liver area to below tKe umbilicus. ' The bowels were- 

 confined.' She ' had been ill for one year', with 'pain about the 

 region of the liver ' ; but she did not ' admit that she had ever 

 had any looseness of the bowels'. 'The ordinary symptoms of 

 dysentery were, as far as could be ascertained, altogether absent.' 

 In hospital she was constipated, and died 8 days after admission. 



At the imst-mortem examination a large single abscess, con- 

 taining about 1 gallon of pus, was found in the right lobe of the 

 liver. ' The upper part of the large intestine was in a state of 

 ragged ulceration, such as occurs in dysentery. It ceased abruptly 

 at the edge of the ileo-caecal valve. The absorbent glands in the 

 neighbourhood were red and swollen.' 



Though no amoebae were described in the pus from the abscess 

 or in the ulcers in the gut, the symptoms and lesions recorded 

 are so typical, in every way, that it is hardly possible to doubt 

 that this was a case of E. histolytica infection. 



Nearly 20 years later, Dickinson (1881) recorded a second 

 case. The patient was a man — a lath-splitter, aged 36 — who 

 was also admitted to St. George's Hospital. On admission he 

 was ' febrile ', with a ' temperature ranging pretty regularly from 

 about 98° in the morning to 102° in the evening '. He was found 

 to be suffering from severe dysentery, which was followed by 

 a liyer abscess. The disease ended fatally ' 38 days after the first 

 symptom '. Previous to this illness the patient had enjoyed 

 good health, and it is stated that he ' had never left England '. 



At the autopsy, ' the large intestine presented from end to end 

 a patchwork of dysenteric ulcers, separated by narrow ridges of 

 thickened mucous membrane. The ulcers were very irregular in 

 size and shape ; they were for the most part deep, some exposing 

 the muscular coat of the bowel. . . . The small intestine was 

 healthy. The liver contained a large single abscess which held 

 about four ounces ; it lay in the back part of the right lobe near 

 its upper and posterior surface. The shape was irregular, its 

 walls ragged, and without lining membrane.' 



After discussing the post-moTtem findings, Dickinson says : 

 ' I think we have no choice but to look upon the ulceration and 

 the abscess as cause and effect, and upon the portal vein as the 

 connexion.' He thus came very near to what is probably the 

 correct interpretation, for I have no doubt that this also was 

 a case of E. histolytica infection. Everything recorded is abso- 

 lutely typical of amoebic dysentery and liver abscess. It requires 

 only the finding of amoebae in the abscess and the ulcers to 

 make the description complete. Such a discovery, however, 

 could hardly have been expected at the time when Dickinson's 

 observations were recorded. 



Moore s case. — -In the year in which the preceding case was 

 recorded, another probable case of E. histolytica infection was 

 briefiy noted by Norman Moore (1881). His patient was a little 

 girl, aged 3-i years, admitted to St. Bartholomew's Hospital, 

 where she died about 5 weeks after admission. ' The child had 

 never been out of London.' She had two abscesses in her liver. 



