The most frequent complication of dysentery in the Philippine Islands is malaria. A malarial spleen and active malarial parasites were found in 4 out of 66 eases of chronic aincebic dysentery which came to autopsy, and once in 12 eases of subacute (non-amcebic) dysen tery. In 157 cases of chronic and sub acute dysentery among soldiers sick in the First Reserve Hospital, Manila, in which blood examinations were made, the malarial parasites were found in 36, or in nearly 23 per cent. J. J. Curry (Boston Med. and Surg. Jour., Feb. 21, 1901).
When the first case of amcebic dysen tery was found in Johns Hopkins, very careful inquiries were made as to the patient's possible connection with things tropical. NOW, however, that many cases have been seen there is no ques tion that the disease may occur in those who have never been outside of Balti more. The disease has been observed especially in children and others who have taken gutter-water or who have had their hands covered with material from the gutters when eating. It would seem, then, that the frequent anacebm seen in such water have some connection with the pathogenic arncebm. -MacRae (Proceedings Amer. Med. Assoc.; Med ical _News, June 14, 190'2).
Complications. — Involvement of the peritoneum in the chronic cases with deformation of the intestine bas already been mentioned; through the formation of adhesions definite kinking of the bowel may result. Perforation of the bowel, leading to peritonitis, is a rela tively-rare complication, and peritonitis without previous perforation apparently still rarer. Small Immorrhages in the intestinal mucosa, in the region of the ulcers, are frequent, but large hmmor rbages seem uncommon. In one of Coun cilman and Lafleur's cases about one hun dred and twenty-five cubic centimetres of clotted blood were passed per rectum on the last day of illness. far the most important complications are abscess of the liver and of the liver and lung. A very important, but unusual, sequel of liver-abscess is perforation of the inferior vena cava. Flexner has described two such cases. Although the data at hand for computing the frequency of amcebic abscess of tbe liver in endemic dysentery are, as yet, too few to admit of definite conclusions, yet, according to Kartulis (based on observation of 500 cases of liver-abscess), 55 to 60 per cent. were of dysenteric origin; Councilman and La fleur found liver-abscess 6 times in 15 cases, Kruse and Pasquale times in 57 cases of amoebic dysentery. Kartulis
states that liver-abscess, which is so com mon a complication of endemic dysen tery, is infrequent in the epidemic form. Hence the statistics of British and French physicians covering this subject, in which the proportion of 1 case of liver abscess for every 4 or 5 of dysentery oc curring in the East, probably relate chiefly to the amcebic form.
llepato-pulmonary abscess occurred four times in Councilman and Lafleur's cases. Following pulmonary abscess, pleurisy and pyothorax or pyopneumo thorax (Flexner) may supervene. The amcebce were found in the contents of the hepatic and pulmonary abscesses and pyothorax. In abscess of the lung the org,anism appears in the sputa. Kartulis has encountered abscess of the brain and spleen in amcebic dysentery; in neither situation was he able to demonstrate amcebce.
The question of the existence of amcebic hepatic abscess without evidence of previous intestinal lesions is still an open one. Kruse and Pasquale mention two cases, but admit that they are not conclusive. Flexner has described an un doubted case. The etiology of the so called idiopathic, or tropical, liver-ab scess is still wrapped in obscurity.
Results of examination in a case of abscess of the liver following dysentery in which the anmeba was found in the pus drained from the abscess. The anmehm front the abscess were somewhat larger than those described by Kartulis; they were circular, sometimes ovoid, but while in movement had an irregular outline. The alterations in contour and change in locality were as remarkable as in some forms of pond anicebm. Motion continued active for hours; in two in stances for ten hours. In the stools the ammbre were rare in the brownish liquid; more frequent in the small slonglis passed. In form and other characters they were like the organisms in the pus from the liver-abscess. Osier (Johns Hopkins Hosp. Bull., vol. i, No. 5).
Statistics showing that suppurative hepatitis is almost always the conse quence of dysentery; there is but a single pathogenic element concerned in the production of both diseases. Proof: if dysenteric Poems containing living amcebre be injected into the rectum of cats typical dysentery will be produced, the animals dying usually in from thirty nine hours to nine days, though some may survive and even recover; 7 out of 11 of those injected showed amcebm in the evacuations. The classical altera tions of dysentery were found at au topsy. Zancarol (Le Progrs MCA., June 15, '95).