el 
548 
II. 
The second heading is of much greater importance and includes such 
diseases as malaria, beri-beri, Bright’s disease, specific bacterial dysentery, 
tuberculosis, chronic rheumatism, certain nervous affections, and other 
diseases, some of which will also be duly considered under the third and 
fourth headings. 
Mararta.—This is far the most important disease in this second 
class. True malarial dysentery is recognized by many writers, but, en- 
tirely apart from this, the association of a simple, malarial infection with 
amcebiasis is very frequent, and the combination of the two makes each 
disease much more refractory to treatment than is either one alone. The 
symptomatology is also much modified and, in cases in which, in addition, 
liver abscess is suspected, the diagnosis is often very difficult. In these 
combined infections of malaria and dysentery, the treatment of the former 
affection alone often causes an improvement of the ameebic disease of the 
bowel, and quinine irrigations usually give satisfactory results in both, 
although obviously, in severe cases of malaria, the administration of 
larger doses of quinine is also advisable. 
BerrBert is endemic in the Philippine Islands and is frequently 
associated with amoebic and other parasitic infections of the intestine. 
Without questioning a specific, infectious etiology for beriberi, I would 
call particular attention to the favorable influence which treatment di- 
rected to the removal of intestinal parasites often has upon the course of 
the co-existent neuritis. Beriberi also exerts a bad influence on the 
ameebic infection, and if, as is claimed by some writers, changes are neces- 
sary in the intestinal wall before amcebw can produce lesions, clinical and 
pathological observation would suggest beriberi as being one of the 
diseases in which such primary changes of the intestine would occur. 
M. Herzog, of this Bureau, has also called attention to this point in a 
paper read before the Manila Medical Society, February 8, 1906. 
BrigH?’s DISHASE.—Marked disturbance of kidney function, and 
even organic changes therein, may directly complicate the ameebic infec- 
tion, and these will be discussed under the third heading, but, apart from 
this, there is the rather frequent association of established Bright’s disease 
(of alcoholic or other etiology) with amebiasis. Such a conjunction is 
a particularly difficult one to treat, because of the increased intensity of 
both diseases when combined, above that which would be expected from 
either alone. This increase becomes very pronounced in uremia. 
III. DIRECT COMPLICATIONS. 
Liver Apscess.—Ameoebie abscess of the liver is of rather frequent 
occurrence in the Tropics and subtropics and is encountered sporadically 
in nearly all parts of the world. More than 95 per cent of all liver 
abscesses seen in the Philippine Islands are of this variety. 
