Excerpts from Conversations with Pathologists

Sebastian Lucas

PROFESSOR OF CLINICAL HISTOPATHOLOGY AT GUY’S, KING’S AND ST THOMAS' HOSPITAL, LONDON

 I was looking at a bowel biopsy, a rectal biopsy, late on a Friday afternoon when the rest of the department had gone home. It was the drought summer of 1976, June, and the case history said: 30 weeks pregnant, severe diarrhoea, query proctitis, query cause. It was a white woman, aged about 30. The usual diagnosis would be: nothing, or ulcerative colitis, or one of the standard diseases. But I looked at this biopsy and it wasn't any of these. It was inflamed, but it actually had amoebae in. Now I'd never seen amoebae before, but I knew what they should look like because I was vaguely interested in infectious diseases even then. So I looked at a book and there was a picture of amoebae. I looked down the microscope and there they were, and I said to myself: this has to be amoebic colitis; I've never seen this before, but that's clearly what it is. So I rang up the houseman who was a friend of the surgeon who'd sent it, and I said, "This is amoebiasis." What she answered was actually unprintable! Because, she said, the woman was in theatre at that moment having her colon taken out because it was perforated. And I said: "Oh…is she going to live?" "No, she's got peritonitis and she's probably not going to live." And she didn't.

[...] the point is that they thought she had ulcerative colitis and put her on steroids. That's what you do if it's ulcerative colitis or Crohn's disease. But if you've got amoebiasis it's the worst thing you can do, because the disease just rips off, perforates the bowel and you die.  And what on earth is a pregnant, 30-year-old who's never left North London doing having amoebiasis, which is a tropical disease? 

So I did a bit of further investigation. [...] That what had happened was that his wife hadn't felt like cooking and so the neighbours cooked something for her and passed it over the fence. Very nice of them! This is in North West London somewhere, and they had just come in from Bombay, and so basically it was on their hands. [...] In those days there was an amoebiasis research unit in the hospital for tropical diseases, which was run by an extraordinary guy who I met once.  Anyway, I rang him up, and I gave him a potted version of this story, and I said, "There's no question about the cause of death, it was amoebiasis. And I'll never forget what he said. "This doesn't happen in the United Kingdom," he retorted and put the phone down! So the second message of the story is: "Don't always believe what old experts say!"

Bibliografia:

Sebastian Lucas - Full Transcript Interview (link)

A Matter of Life and Death: Inside the Hidden World of the Pathologist, Sue Armstrong, Canongate Books, 2010.

(Un grazie speciale a Francesco, che mi ha prestato il libro prima di leggerlo lui stesso...io non lo avrei fatto!).