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streptococci types. It is of course most often observed in the terminal 
dysenteries occurring in the course of Bright’s disease, diabetes, etc. 
Formerly this complication was seen more often in the Philippine Islands. 
Its disappearance has been due largely to the better care and treatment 
it is possible to give patients now than it was formerly. It is not clear 
or probable that Cancrum oris is directly associated with a specific infec- 
tious colitis in any form; it appears rather to be more dependent upon 
constitutional conditions. 
Stomatitis and esophagitis occur more frequently as after effects of 
the disease, but sometimes do exist during its. earlier stages. Superficial 
ulceration of the mucosa is the usual type of both these conditions and 
they are apparently always associated with lesions in the stomach and 
small bowel. Clinically, these are very important complications because 
they often are present before the gastritis and enteritis are marked enough 
to indicate the general condition of the tract. The appearance of the 
stomatitis is always a signal for more careful treatment, or the general 
condition of sprue will be the sequel. 
Stomach disorders are particularly frequent in Manila and naturally 
are often associated with amcebic disease in a casual manner. However, 
in addition to this, there is more frequent and undoubtedly mutually 
dependent association between the two conditions, particularly in the 
later stages of a prolonged ameebic infection. The stomach symptoms 
which most interest us here are those of gastritis, gastralgia, and gas- 
tric ulcer. Gastralgia is particularly frequent and may be present 
with but a mild ameebic infection. The different types of gastritis 
with achylia gastrica and hyperchlorhydria are seen and gastric ulcer 
is relatively more frequent than in other diseases. All these condi- 
tions, together with nausea and indigestion, are undoubtedly made worse 
by rectal irrigations. In gastric ulcer it may occasionally be necessary, 
if indeed not always wise, to suspend large colon irrigations. In two cases 
of this combination recently studied in St. Paul’s Hospital, gastric hemor- 
rhages ceased with suspension of the colon irrigation which was being 
employed in the treatment of the dysentery. Hyperchlorhydria is, as 
a rule, also much aggravated by colon lavage. 
Enteritis occurs with about the same regularity and in the same class 
of patients as does gastritis. In addition to the stomach troubles, it is 
one of the most important complications of the disease because of the 
ultimate results due to lack of assimilation of food. Reversed peristalsis 
from local treatment of the dysentery is not uncommon and often very 
annoying. 
Renal complications, and particularly hemorrhoids, are frequent, while 
fissures and fistulas occur less often. Hemorrhoids are usually aggra- 
vated by treatment, and in some instances seem to owe their origin to it. 
Complications of the large bowel are perhaps the most interesting and 
frequent, and the least written about. Particularly may be mentioned 
