572 
a distinct disease. I have already called attention to this fact in pre- 
vious publications, and several additional years’ experience have con- 
firmed the first observations. This condition is fairly common in the 
Philippine Islands and is becoming more so as the years go by and 
we follow our old, chronic, gastro-intestinal cases to later stages and the 
autopsy table. It is a clinical picture arising early or late in a variety 
of wasting diseases, particularly in those actively attacking the gastro- 
intestinal tract. However, this condition only interests us in this paper 
in its connection with ameebic disease, which, however, includes the major- 
ity of cases encountered in the Philippine Islands. It may appear some- 
what early, but more usually late in the amcebiasis and often long after 
all evidences of the amoebic infection have disappeared. It is particularly 
liable to develop in those cases of ameebiasis complicated by disturb- 
ances of the stomach and small bowel, which have already been discussed. 
The symptomatology is so simple and has been so frequently described 
that it need not be noticed here. The salient points in the pathology 
were given by Woolley and Musgrave. A more complete study of both 
symptomatology and pathology would lead to a consideration of the 
diseases concerned in its multiple etiology; such a consideration has 
always been avoided by those classing it as a distinct disease. It is 
one of the most intractible conditions to treat which is found in the 
Tropics. This might be expected when we remember the principal 
pathologic changes found at autopsy, particularly the enlarged, thin- 
walled intestine, with atrophied cystic and often papiloid condition of 
the mucosa of the whole gastro-intestinal tube and the relaxation and 
partial destruction of the muscular bands of the bowel, which leave it 
elongated (often increased in length to 2—4 meters), enlarged in diameter, 
and without its natural folds and ruge. Change of climate is necessary 
in most well-established cases in order to secure satisfactory results in 
treatment. Chronic gastro-enteritis does not of course always give rise 
to symptoms of sprue. This depends somewhat upon the nature of the 
etiologic factor and more upon the character of the fermenting bacteria, 
yeasts, and other substances multiplying in the bowel. 
Abdominal pain and soreness persisting for years after amoebiasis, is 
quite a common sequel, and this condition is particularly frequent in 
patients who have had severe and prolonged attacks. It is undoubtedly 
due to areas of chronic adhesive peritonitis formed during the active 
stages of the disease. ‘The symptomatology varies with the character and 
location of the adhesions. The clinical features may resemble a chronic 
appendicitis, when at autopsy none is found. Pains in the region of the 
liver, spleen, stomach, ovaries, and many other locations are met with. 
By far the most common character of the pain is one of general abdominal 
soreness, which is increased when the patient is in the erect posture and 
is relieved by his lying down. Just the reverse of this is also seen, in 
