569 
the Philippine Islands and came under my care in the Army and Navy 
Hospital at Hot Springs, Arkansas. It was impossible to determine 
which disease antedated the other, but the clinical evidence of the double 
infection was conclusive. The particularly interesting feature in both 
of these cases was the parallelism between the clinical manifestations and 
the blood changes and the bowel symptoms. Temporary improvement in 
the dysentery was also closely followed by an improvement in the 
anemia, 
A CASE OF LEUK®MIA AND AM@BIC DYSENTERY.—One may be men- 
tioned in connection with these two instances : 
This case, like each of the former two, occurred in a discharged volunteer 
American soldier who had served in the Spanish-American war in Cuba and 
in the Philippine Islands, and who came under my observation during my 
service in the Army and Navy Hospital at Hot Springs, Arkansas. The apparent 
interdependence of the two diseases in this instance was most striking and was 
studied and confirmed by the late Major Walter Reed, to whom the patient 
was referred. The dysentery was undoubtedly contracted in Cuba, and enlarge- 
ment of the spleen was first noticed about eighteen months later, while the 
patient was serving in the Philippine Islands. The history of the dysentery 
was the usual one of alternating diarrhea and constipation, abdominal soreness, 
and loss of weight. The enlargement of the spleen was progressive. When he 
came under observation there was moderate emaciation, great. weakness, shortness 
of breath, and slight jaundice. The dysentery was very active. There were 
from ten to fifteen stools per day, associated with some blood’ and mucus, and 
numerous ameebe. The spleen was very large, extending to the pelvic brim 
below and beyond the median line to the right. A blood count showed splenic 
leukemia with 460,000 white cells. As was mentioned when the two cases of 
primary anemia were discussed, the interdependence in this case between the 
amoebic and leukemic diseases was decidedly marked, and improvement or 
exacerbation of one disease was followed by a like procedure in the other. This 
same general feature has been noticed recently in the study of splenomegaly. 
There have occurred a number of cases of a combination of amebiasis with 
splenomegaly, and the association sometimes seems a close one. 
CHRONIC RHEUMATISM, both of the articular and muscular types, 
is very frequently met with in Manila and in many instances seems to bear 
a very definite relation to ameebiasis as well as to other severe disturbances 
of the stomach and bowel. Even where alcohol and other recognized 
causative factors have been eliminated, we still have a frequent associa- 
tion of the two diseases which is hard to explain without acknowledging 
some form of interdependence. The rheumatic condition is particu- 
larly apt to develop in cases of ameebiasis of long standing, and it often 
shows clinical intensity corresponding to and varying with the condition 
of the bowel. In other instances, an old rheumatic condition is rendered 
much worse by an intercurrent dysentery. The clinical evidence is very 
strongly in favor of dysentery being in some way responsible for one 
variety of the symptom complex termed chronic rheumatism. 
THE NERVOUS sysTEM, as in the case of chronic rheumatism, often 
shows disturbances intimately associated with amoebic dysentery. Allen 
