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dilations, contractions, and cicatricial formations of the bowel; other 
types of infection and of dysentery, such as the specific bacterial, gangre- 
nous, diphtheritic, catarrhal, and miscellaneous types ; and those terminal 
‘ones to be seen in nephritis and other constitutional diseases. 
Dilation of parts of the colon are frequently encountered and almost 
general dilation is occasionally observed post-mortem. The latter condi- 
tion may also be diagnosed during life. Whether they are either general 
or local, dilations are made possible by the relaxation of the circular and 
~ longitudinal muscular bands of the intestine. In advanced cases the 
bowel takes on the appearance of a smooth tube with partial or complete 
absence of the ruge and folds. The picture is rather that of a post- 
dysenteric process than that of a complication during the active stages of 
the disease. However, it is also seen as a complication at times. One 
patient who died recently in St. Paul’s Hospital showed this condition 
in a marked degree. The amcebic disease was probably of several years’ 
duration, and death was due to an acute streptococcal dysentery lasting 
only a few days. At autopsy, the width of the opened bowel measured 
on an average 15 centimeters, and in the cecum it reached 20 cen- 
timeters. The clinical manifestations of such dilation are interesting. 
When it occurs early in the disease it is usually, if not always, associated 
with troublesome gas collections in the bowel and a tendency to constipa- 
tion, but as an after effect, the sprue diarrhcea is its constant associate. 
Deep, undermined ulceration is rarely found in an intestine of this nature 
and it does not appear, as might be supposed, that intestinal irrigation 
has to do with its production. 
Cicatricial contraction from healed amcebic ulcerations is observed less 
frequently in the Philippine Islands than it is stated to be in other parts 
of the world. It is occasionally seen in a moderate degree, and sometimes 
to such an extent as to cripple the bowel function, but on the whole it 
is of but little importance as a complication in this country. 
Other dysenteries and bowel diseases complicate ameebiasis with great 
frequency and have not received the careful study which their importance 
merits. The acute bacterial dysentery (Shiga) has not been very fre- 
quently encountered in the Philippine Islands for some years, but there 
have been undoubted cases where it has complicated the ameebic infection 
and others where it has preceded or followed such disease. The combina- 
tion is an exceedingly difficult one to treat; the pathologie picture is 
modified and the diagnosis difficult on account of the tedious methods 
necessary for the isolation of B. dysenterie from the stools. ‘The serum 
reaction is not of very great clinical value. The bacteriology of all of 
the acute dysenteries is not known, but there surely are organisms, in 
addition to Shiga’s bacillus, which under proper conditions play an 
important etiological role. It is also likely that this group is greater in 
the Tropics than in the temperate zones, and also possible in these 
regions that there is an increased virulence of some of the well-known 
