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organisms, perhaps caused by their changed environment, and also a 
decreased resistance on the part of the patient. The possibility of the 
influence of symbiosis with animal parasites on the virulence of such 
organisms as the colon bacillus needs to be elucidated. Whatever the 
etiologic factors may be, it is a fact that the engrafting of acute dysentery 
on an old ameebic process is of quite frequent occurrence in the Philip- 
pine Islands. The character of the ameebic lesion is too far removed 
from those seen in such conditions as to admit of any other interpreta- 
tion than a double etiology. Diphtheritis, gangrene, folliculitis, etc., 
are common complications and bear little or no relation to ameebic etiol- 
ogy. The ulcerations in the terminal dysenteries in nephritis, diabetes, 
splenomegalies, cirrhosis of the liver, and other diseases may, as pointed 
out in previous publications, complicate amcebiasis and alter the ia 
picture, pathology, and prognosis very materially. 
Finally, there remains to be mentioned here the association of intestinal 
parasites, such as paramecia, strongyloides, oxyuris, trichomonas, circom- 
onas, megastoma, tenia, trichuris, ascaris, and others with amcebe. Some 
of these parasites, particularly Balantidium coli and Strongyloides intes- 
tinalis, are now quite generally acknowledged to be pathogenic parasites, 
but many others are likewise considered to be harmless. However, I 
believe the almost unanimous concensus of opinion of the careful, exper- 
ienced workers in Manila is voiced in the statement that some of these 
so-called harmless parasites are disease producers. For example, many 
men here recognize a diarrhoea caused by monads. Several types of these 
parasites, when present in large numbers, are very intimately connected 
with chronic diarrhoea and they are surely much more important than 
they are generally considered to be. 
Megostoma entericum (Lamblia intestinalis) deserves particular notice. 
It is often found and, when encountered in great numbers, it is always 
associated with chronic diarrhoea, which disappears with the destruction 
of the parasites. In my opinion, this flagellate bears a decided causative 
relation to the diarrhea. Even the Trichuris trichuria certainly produces 
small, hemorrhagic spots where it adheres to the mucosa of the cecum 
and some of these, as in a case now being studied, are closely associated 
with very early ameebic lesions. Whatever pathological significance may 
be attached to these parasites in general, some of them, particularly the 
actively motile ones, such as monads, surely aggravate ameebic ulcers in 
which they may be present. 
Perforation of intestinal ulcers is one of the very frequent complications 
of untreated and of fatal cases, but is comparatively rare when proper 
therapy has been instituted early and followed persistently. These per- 
forations may occur in various places and give rise to acute general 
peritonitis, localized peritonitis, or abscess formations. 
Strangulation of either the large or small intestine may occur from 
several causes. Partial or complete strangulation from external pressure 
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