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Acanthamoeba
Keratitis
Diagnosis
and Treatment
Xuguang Sun
123
Acanthamoeba Keratitis
Xuguang Sun
Acanthamoeba Keratitis
Diagnosis and Treatment
Xuguang Sun
Beijing Institute of Ophthalmology
Beijing Tongren Eye Center
Beijing Tongren Hospital
Capital Medical University
Beijing, China
Jointly published with People’s Medical Publishing House
ISBN 978-981-10-5211-8 ISBN 978-981-10-5212-5 (eBook)

https://doi.org/10.1007/978-981-10-5212-5
The print edition is not for sale in China Mainland. Customers from China Mainland please
order the print book from: People’s Medical Publishing House.
Library of Congress Control Number: 2017964314
© Springer Nature Singapore Pte Ltd. & People’s Medical Publishing House, PR of China 2018
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
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The publisher, the authors and the editors are safe to assume that the advice and information in this book
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Printed on acid-free paper
This Springer imprint is published by Springer Nature

The registered company is Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721,
Singapore
This book is dedicated to Professor Xiaolou
Zhang (1914–1990), who set up the
Department of Ocular Microbiology at the
Beijing Institute of Ophthalmology in China.
Preface
As early as 1755, German scientist Rosel Von Rosenhof made the first observation
of a free-living amoeba in detail. However, no attention was paid to explore the
relationship between human diseases and this organism in the following two hun-
dred years. In 1958, Professor Culbertson et al. found during a vaccine safety test
that free-living amoebae could result in the infection of the central nervous system
of animals. Thus, he predicted that free-living amoebae would become one of the
pathogens of human diseases, which was confirmed by Australian scientist Fowler
M and colleagues in 1965, who reported the case of human infection caused by free-
living amoebae for the first time in the world.
In 1974, Naginton J et al. reported the first case of Acanthamoeba keratitis in the
world. In China, Professor Xiuying Jin and her colleagues from the Beijing Institute
of Ophthalmology published a case report of Acanthamoeba keratitis in
Ophthalmology in China in 1992, which was considered the first article about
Acanthamoeba keratitis published by Chinese scientists. In the subsequent 20 years,
ophthalmologists and researchers in the Department of Ocular Microbiology at the
Beijing Institute of Ophthalmology have been involved in related basic and clinical
research on Acanthamoeba keratitis. More than 300 cases of this disease on the
basis of etiological diagnosis were collected. In addition, over 170 strains of
Acanthamoeba spp. were stored in the laboratory. Moreover, a series of studies were
carried out that mainly focused on the biological characteristics of Acanthamoeba,
pathological mechanisms, clinical and laboratory diagnosis, as well as anti-amoebic
drugs and surgical treatments.
The Acanthamoeba pathogen is widely distributed in nature. But as a type of rare
ocular infection, Acanthamoeba accounts only for about 5% of the pathogens that
may lead to suppurative corneal infection according to the data from the Beijing
Institute of Ophthalmology. However, Acanthamoeba keratitis is generally consid-
ered as a type of sight-threatening keratitis that is difficult to treat. At the early
stages, Acanthamoeba keratitis usually shows atypical clinical manifestations,
which are often misdiagnosed as viral or bacterial keratitis. Moreover, there are no
approved topical anti-amoebic drugs available to date. The number of patients might
further increase due to the increasing populations using corneal contact lens in the
world. It is necessary for ophthalmological practitioners to have a comprehensive
understanding of this infection from several perspectives including characteristics
of pathogen, risk factors, clinical manifestations, diagnosis, and treatment.
vii
viii Preface
This book provides brief and concise descriptions of the basic and clinical
knowledge about Acanthamoeba keratitis with abundant figure illustrations and
typical cases to ophthalmological practitioners and researchers.
Beijing, China Xuguang Sun

Beijing, China Zhiqun Wang
2017
Acknowledgments
On the occasion of publishing this book, we would like to express our sincere grati-
tude to Professors Xiuying Jin and Wenhua Zhang from the Department of Ocular
Microbiology at the Beijing Institute of Ophthalmology and the Beijing Tongren
Ophthalmology Center. We are grateful for the important preliminary work that they
along with their colleagues have done in the diagnosis and treatment of Acanthamoeba
keratitis, which paved the way to further in-depth and continuous research on this
disease in China.
We also greatly appreciate the invaluable support given by colleagues of the
corneal group in the Beijing Tongren Ophthalmology Center in providing surgical
therapy of Acanthamoeba keratitis. In addition, we express our sincere thanks to
Professor Bin Li and his colleagues from the pathology laboratory of the Beijing
Institute of Ophthalmology for their ardent assistance in corneal pathological diag-
nosis and research on Acanthamoeba.
Furthermore, we express our heartfelt gratitude to the doctors and graduate stu-
dents of the Beijing Institute of Ophthalmology, including Aixue Zhang, Rui Gao,
Xiaoyu Zhang, Jinghao Qu, and Li Li, who put in great efforts in proofreading and
verifying statistics of the data in this book.
Finally we also express our thanks to all the Acanthamoeba keratitis patients
who have gone through our treatments for their understanding of and cooperation
with our clinical studies.
Contributors: Wei Chen, Shijing Deng, Min Gao, Chao Jiang , Ran Li, Qingfeng
Liang, Chang Liu, ShiyunLuo, Chen Zhang, Xiaoyan Zhang, Yan Zhang, Yang
Zhang
ix
Contents
1 Epidemiology�� 1
1.1 Incidence in Developed Countries and Regions �� 1
1.2 Incidence in Developing Countries and Regions�� 2
References�� 3
2 Etiology �� 5
2.1 Biological Characteristics of Free-Living Amoeba�� 5
2.2 Acanthamoeba spp. �� 6
2.2.1 Trophozoite �� 6
2.2.2 Cyst �� 9
2.2.3 Classification of Acanthamoeba �� 13
2.2.4 Genotyping Identification of Acanthamoeba Strains
in the Natural Environment�� 17
2.3 Naegleria spp. �� 18
2.3.1 Trophozoite �� 18
2.3.2 Cyst �� 19
References�� 20
3 Pathological Mechanisms and Immunological Reactions�� 23
3.1 Pathological Mechanisms �� 23
3.1.1 Adhesive Attraction to the Corneal Epithelium�� 24
3.1.2 Non-contact Cytolysis Induced by Protease �� 24
3.1.3 Contact-Dependent Cytolysis �� 25
3.1.4 Apoptosis Mediated by Acanthamoeba�� 25
3.1.5 Cytokines�� 25
3.2 Immunological Reactions �� 27
3.2.1 Non-specific Immunoreaction�� 28
3.2.2 Specific Immunoreaction�� 28
3.2.3 Preventive Immunoreaction�� 29
References�� 30
4 Clinical Manifestations�� 33
4.1 General Conditions �� 33
4.1.1 Distribution Characteristics of Ages�� 33
xi
xii Contents
4.1.2 Distribution Characteristics of Genders�� 34

4.1.3 Distribution Characteristics of Occupations �� 34
4.1.4 Risk Factors�� 34
4.1.5 Seasonal Morbidity �� 35
4.2 Clinical Symptoms�� 35
4.3 Clinical Signs�� 36
4.3.1 Early Stage�� 36
4.3.2 Advanced Stage�� 41
4.3.3 Late Stage�� 46
4.4 Coinfection�� 49
4.5 Complications �� 49
4.5.1 Anterior Uveitis�� 49
4.5.2 Intraocular Hypertension or Secondary Glaucoma�� 50
4.5.3 Anterior Scleritis�� 50
4.5.4 Complicated Cataract�� 50
References�� 51
5 Diagnosis and Differential Diagnosis �� 53
5.1 Diagnosis of Acanthamoeba Keratitis�� 53
5.1.1 Clinical Diagnosis�� 53
5.1.2 Etiological Diagnosis�� 53
5.2 Differential Diagnosis of Acanthamoeba Keratitis �� 62
5.2.1 Key Points for Differential Diagnosis
of Acanthamoeba Keratitis from Viral Keratitis �� 62
5.2.2 Key Points of Differential Diagnosis
of Acanthamoeba Keratitis from Fungal Keratitis�� 63
5.2.3 Key Points of Differential Diagnosis
of Acanthamoeba Keratitis from Bacterial Keratitis�� 64
References�� 65
6 Laboratory Examination�� 67
6.1 Method of the Cornea Sample Collection�� 67
6.1.1 Sample Collection for the Cornea Smear
Cytology Examination�� 68
6.1.2 Sample Collection for the Culture of Acanthamoeba �� 68
6.2 Conventional Methods of Examination�� 68
6.2.1 Smear Cytological Examination of the Corneal Scraping�� 68
6.2.2 Cultivation of Acanthamoeba �� 79
6.2.3 Test of In Vitro Susceptibility to Acanthamoeba�� 84
6.2.4 Histopathological Examination�� 85
6.2.5 Flagellation Test�� 85
6.3 Special Examination Methods�� 86
6.3.1 Special Staining Methods �� 86
6.3.2 Electron Microscope Examination�� 89
6.3.3 Molecular Biology Examination�� 91
References�� 92
Contents xiii
7 Treatment of Acanthamoeba Keratitis�� 93

7.1 Anti-amoebic Drugs�� 93
7.1.1 Aromatic Diamidines�� 93
7.1.2 Cationic Biguanide Disinfectants �� 94
7.1.3 Imidazoles �� 95
7.1.4 Aminoglycosides�� 96
7.1.5 Drug Susceptibility �� 96
7.1.6 Effect of Glucocorticoids�� 97
7.1.7 Novel Anti-amoebic Drugs Investigated �� 98
7.2 Clinical Therapeutic Principles and Regimens �� 99
7.2.1 Therapeutic Principles�� 99
7.2.2 Therapeutic Regimens�� 100
7.3 Surgical Management �� 101
7.3.1 Debridement and Cautery of the Corneal Ulcer �� 101
7.3.2 Excision of Necrotic Tissues of the Corneal
Lesions and Amniotic Membrane Transplantation �� 102
7.3.3 Corneal Transplantation�� 104
7.4 Typical Case Reports�� 105
7.4.1 Case 1: Bilateral Acanthamoeba Keratitis Related
to Orthokeratology�� 105
7.4.2 Case 2: Acanthamoeba Keratitis Related
to Vegetant Trauma �� 108
7.4.3 Case 3: Acanthamoeba Keratitis Coinfected with Fungal
Infection�� 109
7.4.4 Case 4: Acanthamoeba Keratitis Caused by
a Splashed Insect�� 110
7.4.5 Case 5: Acanthamoeba Keratitis Related
to Orthokeratology�� 112
7.5 Dispensing Method of Anti-amoebic Eye Drops in Hospital �� 113
References�� 114
About the Authors
Xuguang Sun is chair and professor in the Department of

Ocular Microbiology at Beijing Institute of Ophthalmology
and also works at the Beijing Tongren Ophthalmology Center.
He has been engaged in clinical and research work on the cor-
neal diseases and infectious ocular diseases since 1986.
Zhiqun Wang is associate chief technician in the

Department of Ocular Microbiology at Beijing Institute of
Ophthalmology and also works at the Beijing Tongren
Ophthalmology Center. She has been working at the clinical
laboratory for Ocular Microbiological research work since
1989.
xv
Epidemiology
1
In 1974, the first case of Acanthamoeba keratitis was reported in scientific literature
[1]. Although group occurrences of this disease have been reported from certain
regions, Acanthamoeba keratitis is still generally considered as a type of rare dis-
ease compared to bacterial and fungal keratitis, as listed in Table 1.1.
After the 1980s, the clinical cognition and laboratory diagnosis level of this dis-
ease was gradually improved. In addition, the population of corneal contact lens
wearers rapidly increased. As a consequence, the diagnosed cases of Acanthamoeba
keratitis increased significantly. It has been observed that the incidence of
Acanthamoeba keratitis differed among the countries or different regions of the
country, which is mainly associated with the population of corneal contact lens
wearers, risk factors, climate, sanitation state of tap water, the distribution and viru-
lence of Acanthamoeba strains, etc. [2].
1.1 Incidence in Developed Countries and Regions
The statistical report in 1989 showed that the estimated incidence of Acanthamoeba
keratitis was 1.36 per million in the United States of America [3]. The annual incidence
of this disease in England and Wales was 1.26 (1997–1998) and 1.13 (1998–1999) per
Table 1.1 Distribution of pathogens in suppurative keratitis from 1989 to 2006 in Beijing Institute
of Ophthalmology
No. examined No. culture Culture positive Percent
Pathogen samples positive rate % (%)a
Bacteria 5995 1161 19.37 40.09
Fungus 4735 1602 33.83 55.32
Acanthamoeba 572 133 23.25 4.59
Total 11,302 2896 100.00
Percent (%): No. culture positive/Total no. culture positive × 100%
a
© Springer Nature Singapore Pte Ltd. 1

& People’s Medical Publishing House, PR of China 2018
X. Sun, Acanthamoeba Keratitis, https://doi.org/10.1007/978-981-10-5212-5_1
2 1 Epidemiology
million adults, respectively. Among the population of corneal contact lens wearers, the
incidence increased dramatically to 31 and 27 per million in England and Wales,
respectively, 88% of which were hydrogel contact lens wearers [4, 5]. The annual inci-
dence of Acanthamoeba keratitis was one per 40,000 people in New Zealand as
reported in 1995 [6] and was 33 per million in Hong Kong (1997–1998) [7].
In developed countries and regions, corneal contact lens wear is the first risk fac-
tor for Acanthamoeba keratitis. With the popularization of knowledge concerning
contact lenses and popular application of effective lens care solution, gradual
decrease was observed in the number of cases of this disease since 1995 [8].
1.2 Incidence in Developing Countries and Regions
According to a report from South India, the incidence of Acanthamoeba keratitis

among elderly patients was 1.4% with no relation to corneal contact lens wear.
Across the whole Indian subcontinent, only 4.5% of Acanthamoeba keratitis patients
showed the correspondence between the disease and the wear of contact lens [9, 10].
Xiuying Jin et al. from Beijing Institute of Ophthalmology reported a case of
Acanthamoeba keratitis in 1992, which was the first case of this disease in Mainland
of China. By the end of 2008, approximately 300 cases were reported in Chinese
medical journals [11]. From 1991 to 2015, 304 cases of Acanthamoeba keratitis on
the basis of etiological diagnosis were collected by Beijing Institute of
Ophthalmology, as reported in Table 1.2. Among these, 53.8% of the cases were
related with ocular traumas and 29.1% with corneal contact lens wear [12].
Therefore, different from that in developed countries, the first risk factor of the
disease in developing countries was ocular traumas, especially vegetal traumas, or
the splash of contaminated water, followed by corneal contact lens wear. Up to now,
there is no published epidemiological data about the incidence of Acanthamoeba
keratitis in Mainland of China.
Table 1.2 304 cases of Years No. cases Percent (%)

Acanthamoeba keratitis 1991–1995 13 4.3
diagnosed by Beijing Institute
1996–2000 34 11.2
of Ophthalmology from 1991
to 2015 2001–2005 80 26.3
2006–2010 80 26.3
2011–2015 97 31.9
Total 304 100.0
References 3
References
1. Naginton J, Watson PG, Playfair TJ, et al. Amoebic infection of the eye. Lancet.
1974;2(7896):1537–40.
2. Ibrahim YW, Boase DL, Cree IA. Factors affecting the epidemiology of Acanthamoeba kerati-
tis. Ophthalmic Epidemiol. 2007;14(2):53–60.
3. Poggio EC, Glynn RJ, Schein OD, et al. The incidence of ulcerative keratitis among users of
daily-wear and extended-wear soft contact lenses. N Engl J Med. 1989;321(12):779–83.
4. Seal DV. Acanthamoeba keratitis update-incidence, molecular epidemiology and new drugs
for treatment. Eye. 2003;17(8):893–905.
5. Radford CF, Minassian DC, Dart JK. Acanthamoeba keratitis in England and Wales: inci-
dence, outcome, and risk factors. Br J Ophthalmol. 2002;86(5):536–42.
6. Murdoch D, Gray TB, Cursons R, et al. Acanthamoeba keratitis in New Zealand, including
two cases with in vivo resistance to polyhexamethylene biguanide. Aust N Z J Ophthalmol.
1998;26(3):231–6.
7. Lam DS, Houang E, Fan DS, et al. Incidence and risk factors for microbial keratitis in Hong
Kong: comparison with Europe and North America. Eye (Lond.). 2002;16(5):608–18.
8. Morlet N, Duguid G, Radford C, et al. Incidence of Acanthamoeba keratitis associated with
contact lens wear. Lancet. 1997;350(9075):414.
9. Sharma S, Gopalakrishnan S, Aasuri MK, et al. Trends in contact lens-associated microbial
keratitis in Southern India. Ophthalmology. 2003;110(1):138–43.
10. Kunimoto DY, Sharma S, Garg P, et al. Corneal ulceration in the elderly in Hyderabad, South
India. Br J Ophthalmol. 2000;84(1):54–9.
11. Gao M, Sun XG. Pathogenic free-living amoebic keratitis in China. [Article in Chinese].
Zhonghua Yan Ke Za Zhi. 2006;42(1):64–7.
12. Li L, Liang Y, Zhang C, et al. Etiological study suppurative keratitis. Recent Adv Ophthalmol.
2008;28(10):749–52.
Etiology
2
Free-living amoeba refers to a group of amoebic protozoa that are able to survive
and reproduce with their own biological metabolism system instead of living within
the host. The majority species of free-living amoeba existing in the environment
does not induce the human infections, while a few species may survive and repro-
duce within insects, animals, and human beings under different kinds of conditions.
They are called as facultative parasites. Subsequently, these species of free-living
amoeba also termed as pathogenic free-living amoeba or an opportunistic pathogen
medically, which may cause certain diseases in animals and humans [1].
2.1 Biological Characteristics of Free-Living Amoeba
According to taxonomy, amoeba is a type of unicellular protozoa with a simple

biological structure, belonging to protozoan phylum, Lobosa class, and Amoebida
order. There are mainly two medicine-related categories of amoebas, including par-
asitic amoeba and free-living amoeba.
Free-living amoeba is widely distributed in diverse natural environments as well
as man-made environments. Free-living amoeba has been isolated from various
natural water sources (such as lakes, rivers, seas, etc.), soil, dust, dirt, decayed
plants, and suspended particles in the air. Besides, free-living amoeba also has been
isolated from the bodies of insects, fishes, amphibians, reptiles, and other healthy
and dead animals. In addition to the natural environments, free-living amoeba has
been isolated from distilled water bottles, swimming pools, sewage pipes, tap water
system, air conditioning units, and so on. Moreover, it has been discovered even
from dental clinics, hospitals, dialysis units, and corneal contact lenses and their
cases [2, 3]. This wide distribution of free-living amoeba suggested that people
commonly encounter this organism in their routine lives.
© Springer Nature Singapore Pte Ltd. 5

& People’s Medical Publishing House, PR of China 2018
X. Sun, Acanthamoeba Keratitis, https://doi.org/10.1007/978-981-10-5212-5_2
6 2 Etiology
Pathogenic free-living amoeba related with ocular infections mainly includes

Acanthamoeba spp. of Acanthamoebida family and Naegleria spp. of
Dimastiamoebidiae. Acanthamoeba spp. is the most common pathogen for ocular
infection, but a very few cases of corneal infection caused by Naegleria spp. were
reported previously [4].
2.2 Acanthamoeba spp.
Acanthamoeba is the most common amoebic protozoan that induces ocular infec-
tion and usually exists in polluted soil or water sources. There are two forms of
Acanthamoeba in its life cycle, i.e., an active trophozoite and a dormant cyst, which
can transform each other under a given condition, as shown in Fig. 2.1.
2.2.1 Trophozoite
Trophozoite is the active form of Acanthamoeba protozoa, and trophozoite can

reproduce by binary fission in optimal growth conditions and produce human infec-
tions under a given condition. Under light microscope, trophozoite is often round or
oval in shape with a diameter of 15–45 μm (average 20 μm). The trophozoite often
exhibits active movements with continuous changes in its shape. Thus, various
shapes of trophozoite can be observed under a light microscope.
Excystment Nucleus
Excystment
Nucleus
Wall of cyst
Trophozoite of Acanthamoeba Cyst of Acanthamoeba
Fig. 2.1 There are two forms of Acanthamoeba in its life cycle, i.e., an active trophozoite and a
dormant cyst, which can transform each other under a given condition
2.2 Acanthamoeba spp. 7
a b
Lobopodium
Spinousprocess
Cell nucleus
Air vacuole
Fig. 2.2 (a, b) Trophozoites of Acanthamoeba with cell nucleus, spinous process, and air vacuole
(×1000)
Trophozoite is covered by a thin cell membrane, and the cytoplasm of trophozo-

ite contains various components, including much lipid droplet, food vacuole, and
liquid vacuole. Abundant mitochondria can be observed clearly in the cytoplasm of
trophozoite. The cell nucleus with a diameter of 6 μm is usually located in the center
of trophozoite cell, and its nuclear chromatin is hypochromatic. A round and com-
pact nucleolus with a diameter of 2.4 μm can be detected in the middle of the cell
nucleus and is surrounded by transparent banding area. Nucleolus and its transpar-
ent banding area comprise the characteristic cellular structures for Acanthamoeba
[5], which are also the important structural marker in the diagnosis of clinical
microbial morphology (Fig. 2.2).
When the growth conditions are optimal, i.e., abundant food supply and suit-
able temperatures, the movement and metabolism of trophozoite will become
very active. There are many spiculate protuberances stretching from the surface of
the cell membrane, which are called spinous processes. Spinous process is one of
the important cellular structures that distinguish Acanthamoeba spp. from
Naegleria spp. Normally, a fan-shaped pseudopodium (also called as lobopodium)
is formed on the side of cell along which the trophozoite moves. Under light
microscope, the lobopodium is transparent without granular materials, as shown
in Fig. 2.2.
Under a transmission electron microscope, the cell membrane of trophozoite can
be divided into three sub-layers. In the cytoplasm, freely distributed ribosomes,
tubular structures, aggregated fibrils, varying amounts of Golgi apparatus, smooth
and rough endoplasmic reticulum, phagocytic vacuole, and liquid vacuole or con-
tractile vacuole can be observed. In addition, an abundant mitochondria, lipid drop-
lets, lysosomes, and glycogen granules are also found in the cytoplasm. On some
circumstances, other kinds of microorganisms such as symbiotic bacteria may be
detected in the cytoplasm [2]. Using the scanning electron microscope, trophozoite
is round, oval, or irregular in shape with a diameter of around 15–45 μm. Its surface
is rough with a large number of cone-shaped and spinous processes (Fig. 2.3).
8 2 Etiology
Fig. 2.3 Trophozoite is round, oval, or irregular in shape with many cone and spiculate processes
on its surface (×4000)
Fig. 2.4 Trophozoite reproduces by binary fission (×4000). Two daughter trophozoites are formed
Trophozoite reproduces by binary fission (as illustrated in Fig. 2.4) with an aver-
age fissiparity cycle time of about 10 h (ranging from 6 to 24 h). During the early
prophase of binary fission, the cell nucleolus firstly ruptures itself and gradually
disappears. Subsequently, the metaphase of binary fission starts in which chromatin
forms a banding shape in the equatorial region and then is divided into two parts.
Next, during the interphase, the centrosome in the shape of dense long column
Fig. 2.5 Binary fission

state of Acanthamoeba
trophozoite (by white
arrow ×3000)
appears in the cytoplasm adjacent to the cell nucleus and adheres to tubular struc-
tures. The following phase of binary fission is the anaphase where chromatin in the
form of dense and fine fibers immigrates and arrives at two poles of the cell. During
the last phase (i.e., telophase), cell nuclear membrane reemerges, and this mem-
brane surrounds two newly formed cell nuclei and then two cell nuclei separated
along with the completion of cell division [3, 6], as demonstrated in Fig. 2.5. Finally
two daughter trophozoites are formed.
Active Acanthamoeba can move freely and slowly in the direction of lobopo-
dium, and its average mobile velocity in aqueous medium is estimated as 50 μm/
min. Trophozoite generally feeds on bacteria, fungi, and other protozoa or marine
algae for their survival. There are mainly two feeding methods: (1) food cup sucking
and (2) phagocytizing liquid through pinocytosis (Fig. 2.6).
2.2.2 Cyst
In unfavorable conditions, i.e., desiccation and nutrient and oxygen deficiency,

Acanthamoeba trophozoite can transform into a cyst gradually that is the relative
dominant state of Acanthamoeba with very low metabolism rate, but it has powerful
resistance to the natural environment as well as man-made environment. At the
early phase of transforming, trophozoite gradually becomes smaller in size and
more spherical. At the same time, trophozoite’s mobility decreases and finally stops
moving. Along with the dehydration of the cytoplasm, trophozoite begins to secrete
and form a dense double-wall structure. Through prophase or immature period, i.e.,
pre-cyst or immature cyst (Fig. 2.7), trophozoite transformed into a mature cyst
finally, and the duration of complete transformation from trophozoite to mature cyst
generally needs several days.
10 2 Etiology
Fig. 2.6 Huge

“pinocytotic vesicles” of
Acanthamoeba trophozoite
(shown by white arrow
×3000)
Fig. 2.7 Pre-cyst.

Acanthamoeba trophozoite
loses its pseudopodium
and spinous process and
becomes spherical in shape
(×1000)
Nucleolus
Cell Nucleus
Cyst is generally round or oval in shape with a diameter of 10–25 μm. The mature
cyst has a dense double wall, a wrinkled outer wall, and a smooth inner wall, and the
latter has various shapes, such as polygon, circle, star, or triangle (Fig. 2.8a–e). The
cytoplasm of a cyst contains a lot of dense granules comprised of abundant food
particles, lipid droplets, glycogen, mitochondria, etc. The nucleus realm is not obvi-
ous, but porphyritic nucleolus can be observed clearly. The outer and inner walls
normally are separated by a transparent band space. At some locations, the inner and
outer walls of the cyst form opercula in the center of the ostioles, where excysting
trophozoites will exit from. Depending on different strains of Acanthamoeba, the
structure, amount, and distribution of the ostioles on the surface of double-walled
cysts vary. The ostiole acts as the channel by which the cysts could monitor the
a b c
d e f
Fig. 2.8 (a–e) Cysts with dense double wall in various shapes (outer wall and inner wall). (f)
Trophozoites excysts through the ostiole, with an empty double-wall shell without any contents in
cyst (black arrow) (×1000)
external environment changes. Cysts begin to transform to trophozoite gradually

under favorable conditions; the immature trophozoites emerge from cyst through
the ostiole, leaving an empty double-wall shell without any contents in it (Fig. 2.8f).
During the culture of Acanthamoeba in laboratory conditions, it takes from 10 to
24 h to finish the process of transformation from cyst to trophozoite. At present,
initiation factors and mechanism of such transformation remain unclear.
Under the transmission electron microscope, typical double-wall structures of
cyst can be observed. The outer wall is filled with fibrous wrinkled matrix material in
distinct parallel structure. By contrast, the inner wall is a smooth polyhedron and
composed of fine fibrils. These two layers of walls are separated by a structureless
transparent band space (Fig. 2.9a). The ostioles formed by the fusion of the inner and
outer walls usually arrange in the equatorial plane of the cyst. More specifically, the
ostioles of pathogenic Acanthamoeba cysts show the microcrater-like type (Fig. 2.9b).
Under scanning electron microscope, the cyst is round with a diameter of around
10–25 μm. The surface of the cyst appears plicate, wavy, or wrinkled. Several
slightly concave annular spinous foramens (the ostioles) can be observed on the
capsule wall within certain intervals. The spinous foramens (the ostioles) are the
pathway of Acanthamoeba immature trophozoites during excystation (Fig. 2.10).
When the cover of spinosum foramen dissolves, Acanthamoeba immature tropho-
zoite emerges from cyst through this pore and transforms into mature trophozoite
(Fig. 2.11). After excystation, the empty shell of the cyst is left behind (Fig. 2.12).
12 2 Etiology
a b
Fig. 2.9 (a) Cyst with the typical double-wall structure (×4000). (b) The microcrater-like ostiole
of the cyst (black arrow) (×4000)
Fig. 2.10 The surface of

the cyst appears plicate or
wavy with the ostiole of
the cyst (black arrow)
(×5500)
The metabolic rate of Acanthamoeba is rather low during its cystic period, which is
almost in “hibernation” state. A cyst can withstand various physical and chemical
factors in the environment, i.e., cold, heat, desiccation, a variety of disinfectants
containing chlorine, and antibacterial drugs generally used. It has been shown that
Acanthamoeba cyst can still survive in conditions with pH 3.9–pH 9.75 and tem-
perature from −20 °C to 42 °C [7]. The cysts of some pathogenic Acanthamoeba
strains, such as A. castellanii, can tolerate the temperature of 65 °C for 5 min or
remain alive after being frozen and dissolved repeatedly for five times. In addition,
it is able to resist the exposure of 250 K rad gamma ray radiation and the ultraviolet-
B radiation of 800 mJ/mm2. In the natural environment, cysts generally can remain
viable for several years while maintaining their pathogenicity. In very special cases
Fig. 2.11 Excystation of

Acanthamoeba. The empty
shell of the cyst is left
behind (white arrow), and
immature trophozoite
emerges from the ostiole
(red arrow) (×4000)
Fig. 2.12 Round hole and

the cover of foramen are
observed on the empty
shell of the cyst after
excystation, as indicated
by the white arrow (×5000)
of Acanthamoeba keratitis, it has been reported that cysts can remain in the corneal
tissues for up to 3 years [8].
2.2.3 Classification of Acanthamoeba
A total of 25 types of Acanthamoeba have been detected so far, at least 10 types

of which may induce human keratitis, including A. polyphaga, A. castellanii,
A. culbertsoni, A. hatchetti, A. rhysodes, A. lugdunensis, A. quina, A. griffini, A.
astronyxis, and A. triangularis. In particular, A. castellanii and A. polyphaga and
A. culbertsoni show the strongest pathogenic potential, which is assumed to be
14 2 Etiology
related with their adhesion ability to the corneal tissues, reproduction speed, and
specific enzymatic activity [1].
• Morphology Classification: The shape of Acanthamoeba trophozoites displays a

large variety because of their continuous movement, thus making it difficult to be
considered as a basis for classification. However, morphological structures of
Acanthamoeba cysts are relatively stable that differ by certain degrees among
different groups of cysts. Therefore, Acanthamoeba is conventionally classified
based on the morphological characteristics of the cyst forms. In 1967, Page cat-
egorized Acanthamoeba as an independent genus [8]. After a decade, Pussard
and Pons classified Acanthamoeba genus (18 species in the time) into three
groups according to morphology of the cyst forms in 1977. Subsequently, this
classification scheme gained acceptance (Table 2.1) [1].
Group I: The sizes of cysts are relatively larger of which the average diameter is
18 μm or more than 18 μm. There is a broader gap between the outer and inner
walls. The outer wall is relatively smooth or wrinkled, whereas the inner wall
shows a star-like shape (Fig. 2.13). There are four species in this group includ-
ing A. astronyxis, A. comandoni, A. echinulata, and A. tubiashi.
Group II: Eleven species were placed in this group which are widely distributed
and commonly isolated in the natural and man-made environments. Usually
the average diameter of cysts is less than 18 μm. The outer wall is usually
wavy or mammilla, and the inner wall often forms different shapes including
star-like, polygon or triangle, and round or oval. The distance between the
outer wall and inner wall varies (Fig. 2.14).
Table 2.1 Classification of Morphology group Name of types

Acanthamoeba based on Group I A. astronyxis
morphology
A. comandoni
A. echinulata
A. tubiashi
Group II A. castellanii
A. mauritaniensis
A. polyphaga
A. lugdunensis
A. quina
A. rhysodes
A. divionensis
A. paradivionensis
A. griffini
A. triangularis
A. hatchetti
Group III A. palestinensis
A. culbertsoni
A. lenticulata
A. pustulosa
A. royreba
Fig. 2.13 Group I: the

size of cysts in this group
is relatively larger with the
wrinkled outer wall
(×1000)
Fig. 2.14 Group II: the

average diameter of cysts
in this group is less than
18 μm (×1000)
Group III: The average diameter of cysts is also less than 18 μm. The outer wall
is thin with or without wrinkles, and the inner wall is smooth with three to five
angles (Fig. 2.15). There are five species in group III, including A. palestinen-
sis, A. culbertsoni, A. lenticulata, A. pustulosa, and A. royreba.
16 2 Etiology
Fig. 2.15 Group III: the

outer wall of cyst is thin,
and the inner wall of cyst
is smooth (×1000)
In 1991, Visvesvara G.S. added A. tubiashi in group I and A. hatchetti in group II

into the classification of morphology [9]. The pathogenic Acanthamoeba mainly
belongs to group II. Besides, A. culbertsoni of group III is also pathogenic [10].
• Classification of Genotype: Currently the most conventional classification

scheme under the level of genus is based on the genotypes of Acanthamoeba. In
other words, Acanthamoeba is categorized by the differences of DNA sequences
among various strains belonging to the same genus. According to the most com-
monly used 18S rDNA genotyping, Acanthamoeba is subdivided into 19 geno-
types, i.e., T1–T19.
• Among confirmed genotypes of Acanthamoeba, at least ten genotypes (including
T2, T3, T4, T5, T6, T10, T11, T13, T15, and T16) were found to cause corneal infections
in humans. Especially, genotype 4 (T4) is the most frequently detected genotype
that causes Acanthamoeba keratitis [11–13].
Yan Zhang et al. isolated Acanthamoeba strains from Chinese patients suffering
from the keratitis and analyzed these strains with 18S rDNA genotyping. They found
that most of the pathogenic strains inducing the keratitis in China belonged to T4
genotype, and occasionally T3 genotype was isolated from very few cases [14]. In
2010, Lixin Xie et al. investigated the genotypes in 14 Acanthamoeba strains
responsible for keratitis, and they found that all of isolated strains were T4 genotype
[15]. Table 2.2 reports the relationship between 18S rDNA sequence-based geno-
types and groups categorized by morphology.
Table 2.2 Genotypes based Morphology groups Genotypes

on 18S rDNA sequence vs. Group I T7, T8, T9, T17
morphology groups
Group II, III T1–T6, T10–T16
In 2014, Chao Jiang et al. in Beijing Institute of Ophthalmology identified geno-

types of 100 Acanthamoeba strains that caused Acanthamoeba keratitis clinically.
Out of 100 Acanthamoeba strains, 99 strains belonged to T4 genotype (99%) and 1
strain to T11 (1%). Furthermore, a total of 27 subtypes were identified among the
strains belonging to T4 genotype, in which subtypes of T4/41 and T4/31 were most
frequently detected. In addition, four novel T4 subtypes that have not yet been
reported in gene pool were detected and named as T4/42, T4/43, T4/44, and T4/45,
respectively (in press).
Up to now, three genotypes of Acanthamoeba, i.e., T4, T11, and T3, which caused
keratitis, were reported in the Chinese mainland, and among these three genotypes,
T4 is the most common pathogenic genotype, and T4/41 and T4/31 are the most fre-
quently identified subtypes.
• Genotyping Methods: The genotyping methods for Acanthamoeba that are cur-
rently applied are mainly as follows:
1. 18S rDNA sequence typing
2. 2. mtDNA-restriction fragment length polymorphism (mtDNA-RFLP) typing
Because the method of whole rRNA 18S gene sequence typing is sophisticated
and time-consuming, 18S rDNA sequence typing is applied more widely.
Booton et al. optimized the sequencing position of the JDP1-JDP2 PCR products
to obtain a reliable and simplified genotyping method [16]. Loci 29 and 29-1 were
detected in the sequence of PCR products through the amplification of Acanthamoeba
18S DNA (18S ribosomal RNA gene, Rns) by PCR primer JDP1-JDP2. Locus 29 is
a highly conserved sequence, whereas locus 29-1 is frequently mutated. Currently,
locus 29-1 is named as DF3 (Diagnosis Fragment 3) that provides information for
genotype identification of Acanthamoeba.
Thus, the application of PCR amplification sequencing on the partial sequence of
Acanthamoeba 18S rRNA that contains DF3 through specific primer JDP1-JDP2 is
the most frequently used Acanthamoeba genotyping method [11].
2.2.4 enotyping Identification of Acanthamoeba Strains

G
in the Natural Environment
Acanthamoeba is widespread in the natural environment. The identification of

Acanthamoeba genotypes enables us to trace the source of infectious pathogens and
determine the risk factors of Acanthamoeba keratitis. The studies have reported that
Acanthamoeba can be isolated from tap water, rivers, hot springs, soil, dust, air, and
healthy and dead animals and frequently isolated strains of Acanthamoeba belonged
to T4 genotype [17–26].
18 2 Etiology
In 2014, 42 samples from tap water and 30 samples from the lake water in Beijing
districts were collected for the isolation of amoeba in Beijing Institute of
Ophthalmology. After culture of amoeba for 14 days, the growth of amoeba was
observed in 14 samples (33.3%) among the 42 tap water samples, and growth of
amoeba was also detected in 14 samples (46.7%) among the 30 lake water samples.
PCR amplification sequencing was applied to amoeba strains by using universal
amoeba primers, Hartmannellidae-, Naegleria-, and Acanthamoeba-specific primers,
respectively. The results of sequencing showed that from tap water samples, eight strains
belong to Hartmannellidae, and two strains belonged to Naegleria and Acanthamoeba
(T4 genotype), respectively. From lake water samples, 1 Vahlkampfia strain, 2
Acanthamoeba strains (T4 genotype), and 11 Hartmannellidae strains were found. The
results in this study indicated that amoeba existed in both tap water and lake water in
Beijing districts. The most common isolated strains belonged to Hartmannellidae, fol-
lowed by Acanthamoeba. Moreover, the positive isolated rate of amoeba from lake
water samples was higher than that from tap water samples. Because tap water might be
used abnormally for rinsing corneal contact lenses in some of the cases, it is considered
as one of the risk factors which were related to Acanthamoeba keratitis in China.
In addition to morphological and genetic classification schemes, alternative meth-
ods such as the application of isozymogram or monoclonal antibody were also uti-
lized to categorize Acanthamoeba. The analysis of these classifications provided the
molecular biological basis for exploring the relationship between Acanthamoeba
genotypes and pathogenicity as well as anti-amoeba drug sensitivity.
2.3 Naegleria spp.
Among Naegleria spp. that cause human diseases, Naegleria fowleri protozoa were
extensively studied, which mainly infect the human central nervous system and
subsequently cause fatal meningoencephalitis. However, a few cases of human cor-
neal infections caused by Naegleria fowleri have been reported.[4].
Naegleria fowleri is usually isolated from freshwater and exists in two forms,
i.e., trophozoite and cyst in natural conditions. Different from Acanthamoeba spp.,
trophozoite of Naegleria spp. can transform into a third form (called as flagellum)
in distilled water, which is an important biological characteristic structure in dif-
ferential diagnosis for etiology.
2.3.1 Trophozoite
The size of trophozoite of Naegleria fowleri amoeba is relatively small with a diam-
eter of 8–30 μm, and the trophozoite usually is round or oblong in shape. Its move-
ment is active, but no spinous process is formed on the surface of the trophozoite.
The characteristic morphological structure is the blunt round pseudopodium (also
called as lobopodium).
Under light microscope, the cytoplasm of Naegleria fowleri trophozoite is gran-
ular and contains plenty of liquid vacuoles, contractile vacuoles, and food vacuoles.
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large room originally used for breakfasting parties, continued in
existence for many years, and was not pulled down till 1865.
[Walford, v. 45., ff.; Walpole’s Letters, ii. 212, 23 June, 1750; The
Connoisseur, No. 68, 15 May, 1755; Low Life, 1764; Davis’s
Knightsbridge, 253, ff.; Notes and Queries, 3rd ser. viii. 166; Angelo’s
Picnic (1834), s.v.]
VIEWS.
1. The north front of Jenny’s Whim Bridge and the Old Public
House at the foot of the Bridge, water colour drawing, 1761. Crace,
Cat. p. 311, No. 58.
2. “A west view of Chelsea Bridge” (showing Jenny’s Whim).
Boreman pinx. Lodge sculp. (1761), W. Coll.; Crace, Cat. p. 311, No.
59 (cp. Walford, v. 43).
CROMWELL’S GARDENS,
Afterwards FLORIDA GARDENS, BROMPTON
Cromwell’s Gardens consisted of grounds immediately adjoining

(and perhaps at one time belonging to) Hale House, Brompton, a
mansion popularly known as Cromwell House from a tradition,
seemingly unfounded, that the Protector or his family had once
resided there. Some of the entrance tickets of Cromwell’s Gardens
consisted of rude imitations of Oliver’s pattern-shillings, and had his
effigy on the obverse.
The Gardens were in existence at least as early as 1762,[248] and
in 1776 they are described as frequented by fashionable gentlemen
of Kensington and the West End, and by various ladies who were
apparently not always of irreproachable character. Brompton was
then and long afterwards in the midst of gardens and nurseries, and
was noted for its salubrious air. Cromwell’s Gardens were within a
pleasant rural walk from the Park, Chelsea and Knightsbridge. The
grounds were neatly kept: there were “agreeable” arbours for
drinking tea and coffee, and in one part of the garden trees, curiously
cut, surrounded an elevated grass plat. Their retired situation
rendered them (in the opinion of the “Sunday Rambler”) “well
adapted for gallantry and intrigue.”
Music of some kind seems to have been provided, and at one
time equestrian performances in the open air were exhibited by
Charles Hughes, the well-known rider, who in 1782 founded with
Dibdin the Royal Circus, afterwards the Surrey Theatre. The
admission was sixpence,[249] and the gardens were open at least as
late as nine at night.[250]
In 1781 (or 1780) the gardens were in the hands of Mr. R. Hiem, a
German florist, who grew his cherries, strawberries, and flowers
there. About that time he changed the name to Florida Gardens,[251]
erected a great room for dining in the centre of the gardens, and
opened the place to the public at a charge of sixpence. A bowling-
green was formed and a band (said to be subscribed for by the
nobility and gentry) played twice a week during the summer. An air-
balloon and fireworks were announced for 10 September, 1784. It
was a pleasant place where visitors could gather flowers, and fruit
“fresh every hour in the day,” and take the light refreshment of tea,
coffee, and ice creams, or wine and cyder if they preferred it. Hiem
specially recommended his Bern Veckley as “an elegant
succedaneum for bread and butter, and eat by the Noblesse of
Switzerland.” However, like many proprietors of pleasure-gardens,
he subsequently became bankrupt, between 1787 and 1797 (?).
Maria, Duchess of Gloucester, having procured a lease (before
September 1797)[252] of the place, built there a villa, at first called
Maria Lodge, then Orford Lodge, at which she died in 1807. Shortly
after 1807 the premises consisting of about six acres were
purchased by the Rt. Hon. George Canning, who changed the name
of the house to Gloucester Lodge, and lived there for many years.
The house was pulled down about 1850 and the ground let on
building leases. Part of Courtfield Road, Ashburn Place, and perhaps
other streets, occupy the site of Gloucester Lodge which stood
immediately south of the present Cromwell Road, and west of
Gloucester Road near the point where the Gloucester Road
intersects Cromwell Road.
[Sunday Ramble (1776); A Modern Sabbath (1797), chap. vii.;
Faulkner’s Kensington (1820), pp. 438, 441; Lysons’s Environs,
supplement to first ed. (1811), p. 215; Wheatley, London P. and P. s.v.
“Cromwell House” and “Gloucester Lodge”; Fores’s New Guide
(1789), preface, p. vi.; The Public Advertiser, 10 July, 1789; The
Morning Herald, 7 July, 1786; and newspaper cuttings in W. Coll.]
VIEWS.
There seem to be no views of the Cromwell and Florida Gardens.
There is a view of the garden front of Gloucester Lodge in Jerdan’s
Autobiography (1852), vol. ii. frontispiece.
VI
SOUTH LONDON GROUP

BERMONDSEY SPA GARDENS
The Bermondsey Spa Gardens owe such celebrity as they

attained to the enterprise of their founder and proprietor, Thomas
Keyse, a self-taught artist, born in 1722, who painted skilful
imitations of still life and exhibited pictures at the Royal Academy.
About 1765 he purchased the Waterman’s Arms, a tavern in
Bermondsey, together with some waste ground adjoining, and
opened the place as a tea-garden, exhibiting there a collection of his
own pictures. At that time, and for several years in the present
century, Bermondsey was surrounded by open country.
About 1770 a chalybeate spring was discovered in the grounds,
and Keyse’s establishment thereupon acquired the name of the
Bermondsey Spa Gardens. Keyse was a cheery, ingenious landlord,
remarkable among other things for his preparation of cherry-brandy.
In 1784 he obtained a license for music from the Surrey magistrates,
and spent £4,000 in improvements. The gardens (covering not less
than four acres) were opened during the summer months on week-
day evenings and Sundays, and the price of admission on week-
days was a shilling. Each visitor was, however, given on entering a
metal check,[253] which was exchanged for refreshments to the
extent of sixpence. On special occasions the admission was half-a-
crown or three shillings.
In the gardens were the usual arbours and benches for tea-
drinking. The space before the orchestra was about a quarter of the
size of that at Vauxhall, and on the north-east of the garden was a
lawn of about three acres. A row of trees leading from the entrance
to the picture gallery was hung at night with lamps of red, blue,
green, and white, in humble imitation of the Grand Walk at Vauxhall.
[254]
Jonas Blewitt, one of the most distinguished organists of the latter

half of the eighteenth century, composed the music of many songs
for the entertainments at the Spa.[255] The Spa poets were Mr. J.
Oakman and Mr. Harriss. Songs of hunting, drinking, and seafaring
took their turn with ditties full of what may be described as sprightly
sentiment. The other music[256] consisted of burlettas, duets, and
interludes, performed by vocalists of only local fame. In a burletta
called the ‘Friars,’ certain nuns who had been forced by wicked
guardians to take the veil, make their escape with the assistance of
two friars. These reverend men, after singing an anacreontic song,
divide the gold which the ladies have given them as their reward,
and the whole concludes with a chorus. The words of the burlettas
and songs were printed in little books, sold for sixpence at the bar
and in the exhibition room.[257]
An occasional display of fireworks took place, and the gardens
and a cascade (introduced about 1792) were illuminated.[258] From
time to time there was a representation of the Siege of Gibraltar by
means of fireworks, transparencies and bomb shells.[259] The
apparatus for the Siege, which was designed by Keyse himself, was
set up in a field divided from the lawn by a sunk fence, the rock
being fifty feet high and two hundred feet long. The blowing up of the
floating batteries and the sinking of boats in ‘fictitious water’ were
(we are assured) ‘so truly represented as to give a very strong idea
of the real Siege.’
A permanent attraction was the Gallery of Paintings, an oblong
room described as being about the same size as W. M. Turner’s
studio in Queen Anne’s Street. Here were exhibited Keyse’s pictorial
reproductions of a Butcher’s Shop and a Greengrocer’s Stall and
many other paintings, including a Vesuvius, and a candle that looked
as if it were really lighted.
On the whole, the Bermondsey Spa appears to have been a
respectable, though hardly fashionable, resort, which brought its
proprietor a moderate income and supplied harmless, if not very
exalted, means of recreation.
It being not unnecessary to provide for the safe convoy of the
visitors after nightfall, Keyse inserted the following advertisement in
the newspapers:—“The Spa Gardens, in Grange Road,
Bermondsey, one mile [the distance is rather understated] from
London Bridge; for the security of the public the road is lighted and
watched by patroles every night, at the sole expense of the
proprietor.” The lighting and patrolling were probably somewhat
mythical, but no doubt the announcement served to reassure the
timid.
J. T. Smith, the author of A Book for a Rainy Day, has left a
graphic description of a visit that he paid on a bright July evening of
1795. The popularity of the gardens was then waning, and on
entering he found no one there but three idle waiters. A board with a
ruffled hand within a sky-blue painted sleeve directed him to the
staircase which led “To the Gallery of Paintings,” and he made a
solitary tour of the room.
The rest of the visit may be described in Smith’s own words.
“Stepping back to study the picture of the ‘Greenstall,’ I ask your
pardon,’ said I, for I had trodden upon some one’s toes. ‘Sir, it is
granted,’ replied a little, thick-set man, with a round face, arch look,
and closely-curled wig, surmounted by a small three-cornered hat
put very knowingly on one side, not unlike Hogarth’s head in his print
of the ‘Gates of Calais.’ ‘You are an artist, I presume; I noticed you
from the end of the gallery, when you first stepped back to look at my
best picture. I painted all the objects in this room from nature and still
life.’ ‘Your Greengrocer’s Shop,’ said I, ‘is inimitable; the drops of
water on that savoy appear as if they had just fallen from the
element. Van Huysum could not have pencilled them with greater
delicacy.’ ‘What do you think,’ said he, ‘of my Butcher’s Shop?’ ‘Your
pluck is bleeding fresh, and your sweetbread is in a clean plate.’
‘How do you like my bull’s eye?’ ‘Why, it would be a most excellent
one for Adams or Dollond to lecture upon. Your knuckle of veal is the
finest I ever saw.’ ‘It’s young meat,’ replied he; ‘anyone who is a
judge of meat can tell that from the blueness of its bone.’ ‘What a
beautiful white you have used on the fat of that Southdown leg! or is
it Bagshot?’ ‘Yes,’ said he, ‘my solitary visitor, it is Bagshot: and as
for my white, that is the best Nottingham, which you or any artist can
procure at Stone & Puncheon’s, in Bishopsgate Street Within.’ ‘Sir
Joshua Reynolds,’ continued Mr. Keyse, ‘paid me two visits. On the
second, he asked me what white I had used; and when I told him, he
observed, ‘It’s very extraordinary, sir, how it keeps so bright. I use the
same.’ ‘Not at all, sir,’ I rejoined: ‘the doors of this gallery are open
day and night; and the admission of fresh air, together with the great
expansion of light from the sashes above, will never suffer the white
to turn yellow. Have you not observed, Sir Joshua, how white the
posts and rails on the public roads are, though they have not been
repainted for years; that arises from constant air and bleaching.’
‘Come,’ said Mr. Keyse, putting his hand upon my shoulder, ‘the bell
rings, not for prayers, nor for dinner, but for the song.’
“As soon as we had reached the orchestra, the singer curtsied to
us, for we were the only persons in the gardens. ‘This is sad work,’
said he, ‘but the woman must sing, according to our contract.’ I
recollect that the singer was handsome, most dashingly dressed,
immensely plumed, and villainously rouged; she smiled as she sang,
but it was not the bewitching smile of Mrs. Wrighten, then applauded
by thousands at Vauxhall Gardens. As soon as the Spa lady had
ended her song, Keyse, after joining me in applause, apologised for
doing so, by observing that as he never suffered his servants to
applaud, and as the people in the road (whose ears were close to
the cracks in the paling to hear the song) would make a bad report if
they had not heard more than the clapping of one pair of hands, he
had in this instance expressed his reluctant feelings. As the lady
retired from the front of the orchestra, she, to keep herself in
practice, curtsied to me with as much respect as she would had
Colonel Topham been the patron of a gala-night. ‘This is too bad,’
again observed Mr. Keyse, ‘and I am sure you cannot expect
fireworks!’ However, he politely asked me to partake of a bottle of
Lisbon, which upon my refusing, he pressed me to accept of a
catalogue of his pictures.”
Keyse died in his house at the Gardens on 8 February, 1800[260]
and his pictures were subsequently sold by auction. His successors
in the management of the Bermondsey Spa failed to make it pay,[261]
and it was closed about 1804.[262] The Site, now in Spa Road, was
afterwards built upon.
[Lysons’s Environs, vol. i. (1792), p. 558; Smith’s Book for a Rainy
Day, p. 135, ff. under “1795”; G. W. Phillips’s History and Antiquities of
Bermondsey, 1841, pp. 84, 85; Dict. Nat. Biog. art. “Keyse”; Walford,
vi. 128, 129; Histories of Surrey; E. L. Blanchard in the Era Almanack
for 1870, p. 18; Rendle and Norman’s Inns of Old Southwark, pp.
394–396; A Modern Sabbath (1797), chap. ix.; Kearsley’s Strangers’
Guide to London (1793?); Fores’s New Guide (1789), preface, p. vi.;
Picture of London, 1802, p. 370, where “the pictures of the late Mr.
Keys” are mentioned; “Public Gardens” Coll. in Guildhall Library,
London; Description of some of the Paintings in the Perpetual
Exhibition at Bermondsey Spa, Horselydown (circ. 1785?) 8vo. (W.
Coll.). Song-books (words only) of Bermondsey Spa, W. Coll.]
VIEWS.
A pen and ink sketch of Bermondsey Spa and a portrait of Keyse
were in J. H. Burn’s Collection, and at his sale at Puttick’s were
bought by Mr. Gardner (Notes and Queries, 6th ser. i. 506).
ST. HELENA GARDENS, ROTHERHITHE
These gardens were opened in 1770, and in May 1776 music and
dancing were advertised to take place there in the evenings.
Towards the close of the century the Prince of Wales (George IV.)
and various fashionable people are said to have occasionally visited
the place. St. Helena’s was a good deal frequented as a tea-garden
during the first thirty years of the nineteenth century,[263] chiefly by
the dockyard population of the neighbourhood. In 1831 fireworks and
other entertainments were introduced on the week-day evenings and
the place was for some years styled the Eastern Vauxhall. In 1832
the gardens occupied about five acres and a half, and in this year
the performers advertised included Mr. G. R. Chapman “from the
Adelphi and Astley’s” as organist and musical director, Mrs. Venning,
“from the Nobility’s Concerts,” Miss Wood, “the Infant Prodigy, only
six years of age,” and Miss Taylor who performed “many difficult airs
on that delightful instrument, the Musical Glasses.” Concerts,
dancing and other amusements continued till about 1869 when the
gardens appear to have been closed.
St. Helena Tavern and Tea Gardens.
Rotherhithe.
In 1874, the gardens passed into the hands of Messrs. W. H. and
J. R. Carter who erected an orchestra and a dancing platform, and
provided music and fireworks for an admission of sixpence. The
gardens had fallen into a neglected state, but the walks were once
more well laid out, and the old chestnut trees, the elms and planes
were still standing.
ORCHESTRA AND DANCING-PLATFORM, ST. HELENA GARDENS, circ. 1875.
The gardens ceased to exist in 1881 and were eventually built
over.[264] The site was to the west of Deptford Lower Road, and just
south of Corbett’s Lane and the present St. Helena Road. St.
Katharine’s Church (consecrated 18 October, 1884) in Eugenia Road
(south of St. Helena Road) stands on part of the site.
[Newspaper cuttings, W. Coll.; and see notes.]
VIEWS.
1. The entrance to the St. Helena Tavern and tea-garden, water-
colour drawing, signed R. B. 7 June, 1839 (W. Coll.).
2. Admission ticket in white metal. Size 1·5 inch. Nineteenth
century, circ. 1839? (British Museum). Obverse: View of the entrance
to the tavern and gardens (similar to No. 1); in foreground, two posts
supporting semi-circular board inscribed “St. Helena Tavern and Tea
Gardens. Dinners dress’d”: in exergue, “Rotherhithe.” Reverse:
“Refreshment to the value of sixpence” within floral wreath.
3. Lithographed poster of the St. Helena Gardens, circ. 1875,
showing the orchestra, dancing-platform, and gardens illuminated at
night (W. Coll.).
FINCH’S GROTTO GARDENS
Finch’s Grotto Gardens situated on the western side of St.

George’s Street, Southwark, near St. George’s Fields,[265] derived
their name from Thomas Finch, a Herald Painter, who, having
inherited from a relation a house and garden, opened both for the
entertainment of the public in the spring of 1760. The garden
possessed some lofty trees, and was planted with evergreens and
shrubs. In the centre was a medicinal spring over which Finch
constructed a grotto, wherein a fountain played over artificial
embankments and formed “a natural and beautiful cascade.” The
spring enjoyed some local celebrity, and was recommended to his
patients by a doctor named Townshend, who resided in the
Haymarket and afterwards in St. George’s Fields. In our own time Dr.
Rendle has described the water as “merely the filtered soakage of a
supersaturated soil,” which could be obtained almost anywhere in
Southwark.
A subscription ticket of a guinea entitled the holder to such
benefits, as Finch’s spring conferred and gave admission to the
evening entertainments that were introduced from about 1764. The
ordinary admission was a shilling, raised on special nights to two
shillings. The gardens were open on Sunday when sixpence was
charged, though the visitor was entitled for his money to tea, half a
pint of wine, cakes, jelly or cyder.
ADMISSION TICKET, FINCH’S
GROTTO.
An orchestra containing an organ by Pike, of Bloomsbury, stood in
the garden, and there was another orchestra attached to a large
octagonal music-room decorated with paintings and festoons of
flowers. This Octagon Room was used for occasional balls and for
the promenade and concert on wet evenings.
The place appears to have been respectably conducted, but there
is little evidence that it was ever a modish resort, in spite of the
assertion of the country-bred Mrs. Hardcastle[266] that no one could
“have a manner that has never seen the Pantheon, the Grotto
Gardens, the Borough and such places where the nobility chiefly
resort.”[267]
The vocal and instrumental concerts which took place every
evening in the season (May-September) were of a creditable though
not very ambitious character. About fifteen hundred persons are said
to have been present on some of the Freemasons’ nights and on the
benefit nights of the performers.
Mrs. Baddely.
Numerous singers and instrumentalists were engaged,[268] of
whom the best known are Robert Hudson the organist, Miss Snow
and Thomas Lowe. Sophia Snow, the daughter of Valentine Snow,
sergeant trumpeter to the King, married Robert Baddeley the
comedian, who introduced her to the stage at Drury Lane in 1765. As
Mrs. Baddeley, she became notorious for her beauty and intrigues.
She had some powers as an actress in genteel comedy and her
melodious voice made her popular at Ranelagh (from 1770) and
Vauxhall.
Lowe was the well-known tenor singer of Vauxhall and lessee of
Marylebone Gardens from 1763 to 1768. Becoming bankrupt in
1768, he was glad to accept engagements at the humbler Finch’s
Grotto. He was announced to sing in August 1769, and appeared
under the designation of Brother Lowe at one of the Freemasons’
Concerts at the Grotto.
Finch died on October 23, 1770, and his successor, a Mr.
Williams, advertised the place as Williams’s Grotto Gardens. The
concerts were continued and among the musical entertainments
were Bates’s “The Gamester” (1771) and Barnshaw’s “Linco’s
Travels.”[269]
The programmes of entertainments under Finch and Williams
included concertos on the organ, pieces for horns and clarionets,
Handel’s Coronation Anthem, an Ode to Summer with music by
Brewster, and songs, such as “Thro’ the Wood, Laddie”; “Water
parted from the Sea”; “Oh what a charming thing is a Battle”; “British
Wives”; “O’er Mountains and Moorlands”; “Cupid’s Recruiting
Sergeant” (with drum and fife accompaniment); “Swift Wing’d
Vengeance,” from Bates’s Pharnaces; “Shepherds cease your soft
complainings;” a satirical song on Garrick’s Stratford Jubilee; “Hark,
hark, the joy inspiring horn”; “The Season of Love,” sung by Mr.
Dearle, (1765):—
Bright Sol is return’d and the Winter is o’er,
O come then, Philander, with Sylvia away.[270]
Fireworks were occasionally displayed, and when a ball was

given, the place was illuminated at a cost of about five pounds, and
horns and clarionets played till twelve in the garden. In 1771 and
1772 a grand transparent painting forty feet wide and thirty high, with
illuminations, was displayed. Over the centre arch of this
masterpiece was a medallion of Neptune supported by Tritons: on
each side were two fountains “with serpents jetting water,
representing different coloured crystal.” On one wing was Neptune
drawn by sea-horses; on the other, Venus rising from the sea; and
the back arches showed a distant prospect of the sea. In June 1771
a representation was given “of the famous Fall of Water call’d Pystill
Rhiader near the seat of Sir Watkin Williams Wynne, Bart., in
Denbighshire.”
Apparently these entertainments failed to pay the proprietor and in
1773 (?) he pulled down the grotto over the spring and rooted up the
shrubs to form a skittle ground in connection with the tavern, which
still continued to be carried on.
About 1777 the “messuages and lands known as the Grotto
Gardens” were purchased for the parish of St. Saviour’s, Southwark,
part of the ground being used for the erection of a workhouse and
part for a Burial Ground (consecrated in 1780). In 1799 the
Workhouse was sold to Mr. John Harris, hat manufacturer, and M.P.
for Southwark in 1830, who used it as his manufactory and
residence. Some relics of the old Grotto were to be found many
years after the closing of the Gardens, notably the Octagon Room,
which was converted into a mill and at one time used as the armoury
of the Southwark Volunteers.
In 1824 “a very large and old mulberry tree” was standing at the
end of a long range of wooden tea-rooms formerly belonging to the
gardens and converted into inferior cottages. Behind the cottages
was a water-course derived from Loman’s Pond dividing them from a
field, once part of the gardens, though only occupied at that time by
dust and rubbish.
The tavern attached to the Gardens continued to be carried on
under the sign of the Grotto till 28 May, 1795, when it was destroyed
by fire. The new tavern erected in its place bore the sign of The
Goldsmith’s Arms, and afterwards of the “Old Grotto new reviv’d.”
In the front of this house was inserted a stone bearing the
inscription:—
Here Herbs did grow
And Flowers sweet,
But now ’tis call’d
Saint George’s Street.[271]
This building was removed for the formation of the present

Southwark Bridge Road in 1825 and a public house named The
Goldsmith’s Arms—still standing—was built on the western side of
the new road, more upon the site of the old Grotto Gardens. The
main site of the gardens is now occupied by the large red-brick
building, which forms the headquarters of the Metropolitan Fire
Brigade.
[Wilkinson’s Londina Illustrata, vol. ii., “Finch’s Grotto Gardens”;
Manning and Bray’s Surrey, iii. 591; Brayley and Mantell’s Surrey, v.
371; Rendle and Norman’s Inns of Old Southwark, 360–364; Walford,
vi. 64; newspaper cuttings, W. Coll.]
VIEWS.
The only view is one of the second tavern published in Wilkinson’s
Londina Illustrata, 1825:—
“South-east view of the Grotto, now the Goldsmith’s Arms in the
Parish of St. George’s, Southwark.” This shows the inscription: “Here
Herbs did grow.”
CUPER’S GARDENS
Cuper’s Gardens, a notable resort during the first half of the last
century, owe their name and origin to Boyder Cuper, who rented, in
the parish of Lambeth on the south side of the Thames opposite
Somerset House, a narrow strip of meadow land surrounded by
water-courses.
About 1691 or earlier he opened the place as a pleasure garden
with agreeable walks and arbours and some good bowling-greens.
As an old servant of the Howard family he obtained the gift of some
of the statues that had been removed when Arundel House in the
Strand was pulled down. These, though mutilated and headless,
appeared to the proprietor to give classic distinction to his garden,
and they remained there till 1717, when his successor, a John
Cuper, sold these ‘Arundel Marbles’ for £75.[272]
During the first twenty or thirty years of the last century, Cuper’s
was a good deal frequented in the summer-time. A tavern by the
waterside, called The Feathers, was connected with the grounds.
It is not certain that music and dancing were provided at this
period, and the company appears to have consisted chiefly of young
attorneys’ clerks and Fleet Street sempstresses, with a few City
dames, escorted by their husbands’ ’prentices, who (perhaps after
paying a visit to the floating ‘Folly’) sat in the arbours singing,
laughing, and regaling themselves with bottle-ale.[273]
The place was popularly known as Cupid’s Gardens, and is even
thus denominated in maps of the last century. This name is
preserved in the traditional song, once very popular, “’Twas down in
Cupid’s Garden”:—
’Twas down in Cupid’s Garden
For pleasure I did go,
To see the fairest flowers
That in that garden grow:
The first it was the jessamine,
The lily, pink and rose,
And surely they’re the fairest flowers
That in that garden grows.[274]
In 1738 the tavern and gardens were taken by Ephraim Evans, a

publican who had kept the Hercules Pillars opposite St. Dunstan’s
Church, Fleet Street. During his tenancy (1738–1740) he improved
the gardens and erected an orchestra in which was set up an organ
by Bridge. A band played from six till ten and Jones, the blind Welsh
harper, was engaged to perform selections from Handel and Corelli.
The admission was then and thenceforward one shilling, and the
gardens were opened on Sunday free of charge.[275] It was
announced that care would be taken to keep out bad company and
that no servant in livery would be admitted to walk in the garden.
View of the Savoy, Somerset House and the Water entrance to
Cuper’s Garden.
From a picture in the Collection of
The Revd. Philip Duval, D.D. & F.A.S.
There was a back way to the gardens leading from St. George’s
Fields, and watchmen were appointed “to guard those who go over
the fields late at night.” The favourite approach, however, was by
water, and the visitors landed at Cuper’s Stairs, a few yards east of
the present Waterloo Bridge. The season lasted from April or May till
the beginning of September.
Evans died on 14 October, 1740,[276] but the tavern and gardens
were carried on by his widow. It was under the spirited management
of the widow Evans that Cuper’s Gardens especially flourished, and
her advertisements figure frequently in the newspapers (1741–
1759). ‘The Widow,’ as she was called, presided at the bar during
the evening and complimentary visitors described her as “a woman
of discretion” and “a well-looking comely person.” By providing good
music and elaborate fireworks, she attracted a good deal of
fashionable patronage. The Prince and Princess of Wales visited the
place and some of Horace Walpole’s friends,[277] Lord Bath and Lord
Sandys, for instance, both of whom had their pockets picked there.
The well-dressed sharper was, in fact, by no means unknown at
Cuper’s. One night in 1743 a man was caught stealing from a young
lady a purse containing four guineas, and while being taken by a
constable to Lambeth was rescued by a gang of thieves in St.
George’s Fields. On the whole, Cuper’s was looked upon as a
decidedly rakish place at which a prudent young lady was not to be
seen alone with a gentleman.[278]
For the evening concert of 16 June, 1741, Mrs. Evans announced
“a new grand concerto for the organ by the author, Mr. Henry
Burgess, junior, of whom it may be said without ostentation that he is
of as promising a genius and as neat a performer as any of the age.”
Composers better known to fame than Mr. Henry Burgess, junior,
were also represented. The programme, for instance, of one July
evening in 1741 consisted of “The Overture in Saul, with several
grand choruses composed by Mr. Handel”; the eighth concerto of
Corelli; a hautboy concerto by Sig. Hasse; “Blow, blow thou wintry
wind,” and other favourite songs composed by the ingenious Mr.
Arne, and the whole concluded with a new grand piece of music, an
original composition by Handel, called ‘Portobello,’ in honour of the
popular hero, Admiral Vernon, “who took Portobello with six ships
only.” On other occasions there were vocal performances (1748–
1750) by Signora Sibilla and by Master Mattocks. The Signora was
Sibilla Gronamann, daughter of a German pastor and the first wife of
Thomas Pinto, the violinist. She died in or before 1766. Mattocks,
who had “a sweet and soft voice,” was afterwards an operatic actor
at Covent Garden. Mrs. Mattocks sang at the gardens in 1750.
After the concert, at half-past nine or ten, a gun gave the signal
for the fireworks for which the place was renowned.
On 18 July, 1741, the Fire Music from Handel’s opera, “Atalanta,”
was given, the fireworks consisting of wheels, fountains, large sky-
rockets, “with an addition of the fire-pump, &c., made by the
ingenious Mr. Worman, who originally projected it for the opera”
when performed in 1736. The Daily Advertiser for 28 June, 1743,
announced that “this night will be burnt the Gorgon’s head ... in
history said to have snakes on her hair and to kill men by her looks,
such a thing as was never known to be done in England before.” For
another night (4 September, 1749) the entertainment was
announced to conclude with “a curious and magnificent firework,
which has given great satisfaction to the nobility, wherein Neptune
will be drawn on the canal by sea-horses and set fire to an
Archimedan (sic) worm and return to the Grotto.”
In 1746 (August 14) there was a special display to celebrate “the
glorious victory obtained over the rebels” by the Duke of
Cumberland, consisting of emblematic figures and magnificent
fireworks, with “triumphant arches burning in various colours.” In
1749 (May) there was a miniature reproduction with transparencies
and fireworks of the Allegorical Temple that had been displayed in
the Green Park on 27 April, 1749, to commemorate the peace of Aix-
la-Chapelle. At the opening of the gardens on April 30 for the season
of 1750, the edifice from which the fireworks were displayed was
altered “into an exact model of that at the Hague, made on account
of the General Peace.”
The season of 1752, practically the last at Cuper’s, lasted from
May till near the end of September. The principal vocalist was Miss
Maria Bennett.[279] The fireworks and scenic effects were novel and
elaborate. A song commemorating the Prince of Wales’s birthday
was “shown curiously in fireworks in the front of the machine.” The
fireworks building, when the curtain was withdrawn, disclosed a
perspective view of the city of Rhodes—sea, buildings, and
landscape, with a model of the Colossus, from under which Neptune
issued forth and set fire to a grand pyramid in the middle of the
canal. Dolphins spouted water; water-wheels and rockets threw up
air-balloons and suns blazed on the summit of the building.
On one occasion the crowd near the fireworks was so great that a
gentleman took up his position in a tree, and when St. George and
the Dragon came to a close engagement and the clockwork began to
move the arms of St. George to pierce the Dragon, he let go his
hands to clap like the rest and fell headlong upon the bystanders.
[280]
The ‘Inspector’ of the London Daily Advertiser took his friend the
old Major, to Cupid’s Gardens (as they were still called) on a
pleasant August evening in this year. The Major was delighted with
all he saw. “Now I like this. I am always pleased when I see other
people happy: the folks that are rambling about among the trees
there; the jovial countenances of them delight me ... here’s all the
festivity and all the harmless indulgence of a country wake.”[281]
The country wake element was in evidence late in the evening,
and constables stationed at the gate had occasionally to interfere.
One night, for instance, a pretty young woman, accompanied by a
friend, promenaded the gardens dressed as a man wearing a long
sword. No small sensation was caused in the miscellaneous
company, which included a physician, a templar, a berouged old lady
and her granddaughter, and the sedate wife of a Cheapside fur-
seller. “A spirited young thing with a lively air and smart cock of her
hat” passed by. “Gad,” said she, as she tripped along, “I don’t see
there’s anything in it; give us their cloathes and we shall look as
sharp and as rakish as they do.” “What an air! what a gate! what a
tread the baggage has!” exclaimed another.
But the days of Cuper’s were numbered. In the early part of 1752
the statute-book had been dignified by the addition of 25 George II.,
cap. 36, entitled, “An Act for the better preventing thefts and
robberies and for regulating places of public entertainment and
punishing persons keeping disorderly houses.” By section 2 of this
enactment it was required that every house, room, garden, or other
place kept for public dancing or music, &c., within the cities of
London and Westminster, or twenty miles thereof, should be under a
licence. The Act took effect from December 1, 1752, and the
necessary licence for the season of 1753 was refused to the
management of Cuper’s Gardens. The widow Evans complained
bitterly that she was denied the liberty of opening her gardens, a
misfortune attributed by her to the malicious representations of ill-
meaning persons, but which was really owing, no doubt, to the
circumstance that Cuper’s was degenerating into the place which
Pennant says he remembered as the scene of low dissipation.
Meanwhile Mrs. Evans threw open the grounds (June 1753) as a
tea-garden in connection with the Feathers, and the walks were
“kept in pleasant order.”
In the summer of 1755 entertainments of the old character were
revived, but they were advertised as fifteen private evening concerts
and fireworks, open only to subscribers, a one guinea ticket
admitting two persons. It is to be suspected that the subscription was
mythical, and was a mere device to evade the Act. However, a band
was engaged, and on June 23 loyal visitors to Cuper’s
commemorated the accession of King George to the throne by a
concert and fireworks. Clitherow, who had been the engineer of
Cuper’s fireworks from 1750 (or earlier), was again employed, but
had to publish in the newspapers a lame apology for the failure of
the Engagement on the Water on the night of August 2 (1755), a
failure which he explained was not due to his want of skill but “owing
to part of the machinery for moving the shipping being clogg’d by
some unaccountable accident, and the powder in the ships having
unfortunately got a little damp.”
From 1756–1759 Cuper’s Gardens were again used as the tea-
garden of the Feathers. There was no longer a Band of Musick but
(as the advertisements express it) “there still remains some harmony
from the sweet enchanting sounds of rural warblers.”
The last recorded entertainment at the place was a special
concert given on August 30, 1759 by “a select number of gentlemen
for their own private diversion,” who had “composed an ode alluding
to the late decisive action of Prince Ferdinand.” Any lady or
gentleman inspired by Prussian glory was admitted to this
entertainment on payment of a shilling.
For several years the gardens remained unoccupied, but from
about 1768 three acres of them were leased to the firm of Beaufoy,
the producers of British wines and vinegar. The orchestra, or rather
the edifice used from 1750 for the fireworks, was utilised for the
distillery. Dr. Johnson once passed by the gardens: “Beauclerk, I,
and Langton, and Lady Sydney Beauclerk, mother to our friend,
were one day driving in a coach by Cuper’s Gardens which were
then unoccupied. I, in sport, proposed that Beauclerk, and Langton,
and myself, should take them, and we amused ourselves with
scheming how we should all do our parts. Lady Sydney grew angry
and said, ‘An old man should not put such things in young people’s
heads.’ She had no notion of a joke, sir; had come late into life, and
had a mighty unpliable understanding.”[282]
PLAN OF CUPER’S GARDENS.
J. T. Smith[283] tells us that he walked over the place when

occupied by the Beaufoys, and saw many of the old lamp-irons along
the paling of the gardens, humble reminders of the days when the
walks of Cuper’s Gardens were “beautifully illuminated with lamp-
trees in a grand taste, disposed in proper order.” In 1814 part of the
ground was required for making the south approach to Waterloo
Bridge. The “fireworks” building and the rest of Messrs. Beaufoys’
works were then taken down and the Waterloo Road, sixty feet in
width, was cut through the three acres, thus passing through the
centre of Cuper’s Gardens which had extended up to the site of the
present St. John’s Church (built in 1823) opposite Waterloo Station.
The Royal Infirmary for Children and Women erected in 1823 on
the eastern side of the Waterloo Road stands on (or rather over) the
centre of the site of the gardens. The Feathers was used during the
building of the bridge for the pay-table of the labourers, and when it
was taken down (about 1818?) its site was occupied by a timber-
yard, close to the eastern side of the first land-arch of the Waterloo
Bridge.
The public-house now called the Feathers, standing near the
Bridge and rising two stories above the level of the Waterloo Road
was built by the proprietor of the old Feathers in 1818.
[Wilkinson’s Londina Illustrata, vol. ii. “Cuper’s Gardens,” Public
Gardens Coll. in Guildhall Library, London (newspaper cuttings, &c.);
Charles Howard’s Historical Anecdotes of the Howard Family (1769),
98, ff.; Pennant’s Account of London, 3rd ed. 1793, 32–34; Musical
Times, February 1894, 84, ff.; Hone’s Every Day Book, i. 603; E.
Hatton’s New View of London, 1708, ii. 785; Lysons’s Environs, 1792,
i. 319, 320; Walford, vi. 388, 389; The Observator, March 10, 1702-3;
newspaper cuttings, W. Coll.]
VIEWS.
1. View of the Savoy, Somerset House, and the water entrance to
Cuper’s Gardens, engraved by W. M. Fellows, 1808, in J. T. Smith’s
Antiquities of Westminster, from a painting (done in 1770, according to
Crace, Cat. 188, No. 219) by Samuel Scott.
2. Woodcuts in Walford, vi. 391, showing entrance to the gardens
(the back entrance) and the “orchestra” during the demolition of the
buildings; cp. ib. 390. Walford also mentions, ib. p. 388, a view
showing the grove, statues, and alcoves, of the gardens.
3. Water-colour drawings of Beaufoys’ and Cuper’s in 1798 and in
1809 (Crace, Cat. 648, Nos. 49, 50).
4. Wilkinson, Lond. Illust. (1825), vol. ii. gives three views, Pl. 155,
view of the Great Room as occupied for Beaufoys’ manufactory, with a
plan of the gardens; Pl. 156, another similar view; Pl. 157, view of the
old Feathers Tavern.

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4.1.2 Distribution Characteristics of Genders���������������������������������� 34

7 Treatment of Acanthamoeba Keratitis��������������������������������������������������� 93

Xuguang Sun is chair and professor in the Department of

Zhiqun Wang is associate chief technician in the

1.1 Incidence in Developed Countries and Regions

© Springer Nature Singapore Pte Ltd. 1

1.2 Incidence in Developing Countries and Regions

According to a report from South India, the incidence of Acanthamoeba keratitis

Table 1.2 304 cases of Years No. cases Percent (%)

2.1 Biological Characteristics of Free-Living Amoeba

According to taxonomy, amoeba is a type of unicellular protozoa with a simple

© Springer Nature Singapore Pte Ltd. 5

Pathogenic free-living amoeba related with ocular infections mainly includes

2.2 Acanthamoeba spp.

Trophozoite is the active form of Acanthamoeba protozoa, and trophozoite can

Trophozoite of Acanthamoeba Cyst of Acanthamoeba

Trophozoite is covered by a thin cell membrane, and the cytoplasm of trophozo-

Fig. 2.5 Binary fission

In unfavorable conditions, i.e., desiccation and nutrient and oxygen deficiency,

Fig. 2.6 Huge

Fig. 2.7 Pre-cyst.

external environment changes. Cysts begin to transform to trophozoite gradually

Fig. 2.10 The surface of

Fig. 2.11 Excystation of

Fig. 2.12 Round hole and

2.2.3 Classification of Acanthamoeba

A total of 25 types of Acanthamoeba have been detected so far, at least 10 types

• Morphology Classification: The shape of Acanthamoeba trophozoites displays a

Table 2.1 Classification of Morphology group Name of types

Fig. 2.13 Group I: the

Fig. 2.14 Group II: the

Fig. 2.15 Group III: the

In 1991, Visvesvara G.S. added A. tubiashi in group I and A. hatchetti in group II

• Classification of Genotype: Currently the most conventional classification

Table 2.2 Genotypes based Morphology groups Genotypes

In 2014, Chao Jiang et al. in Beijing Institute of Ophthalmology identified geno-

2.2.4  enotyping Identification of Acanthamoeba Strains

Acanthamoeba is widespread in the natural environment. The identification of

2.3 Naegleria spp.

Cromwell’s Gardens consisted of grounds immediately adjoining

SOUTH LONDON GROUP

The Bermondsey Spa Gardens owe such celebrity as they

Jonas Blewitt, one of the most distinguished organists of the latter

Finch’s Grotto Gardens situated on the western side of St.

Fireworks were occasionally displayed, and when a ball was

This building was removed for the formation of the present

In 1738 the tavern and gardens were taken by Ephraim Evans, a

Beijing, China Xuguang Sun

4.1.2 Distribution Characteristics of Genders�� 34

7 Treatment of Acanthamoeba Keratitis�� 93

1.1 Incidence in Developed Countries and Regions

1.2 Incidence in Developing Countries and Regions

2.1 Biological Characteristics of Free-Living Amoeba

2.2 Acanthamoeba spp.

2.2.3 Classification of Acanthamoeba

2.2.4 enotyping Identification of Acanthamoeba Strains

2.3 Naegleria spp.