491 
patients in Korea, in the Japanese army in Manchuria, among the Rus- 
sian troops in Port Arthur and the sailors from the ships of the Baltic 
fleet which had capitulated, but in the epidemic in Tokyo and some of 
the provinces of Japan the other varieties were met with in much the 
greater number of patients; indeed, the original bacillus was identified 
in only a few of the approximately 200 cases which occurred during the 
outbreak of the past year in Tokyo. Dr. Amako, in the same year, in an 
epidemic which raged in the city of Kobe, encountered a very interesting 
experience. In Kobe dysentery first made its appearance in July, at 
first with a few sporadic cases in different parts of the city, and in these 
the varieties of the original dysentery bacillus were encountered exclus- 
ively ; however, in the beginning of August very large numbers of infec- 
tions occurred in the western portions of the municipality and among 
these the original organism itself was almost the only one met with, and 
beginning with this time it was detected in dysentery patients in the 
most diverse districts of the city, so that subsequently, not only the 
original dysentery bacillus but also its varieties appeared side by side 
throughout whole sections of the city. After this time the infections 
with the original bacillus gradually diminished in number until, finally, 
toward the end of the epidemic the varieties were the only ones which 
could be observed. (See Table V.) 
It is my opinion that the bacillus first described in 1898, the date 
when my investigations on dysentery were begun, was present in by far 
the greater number of cases, because, if this were not the case, I would 
have encountered many difficulties in its study, for at that time I inves- 
tigated hundreds of cases of dysentery by bacteriological methods and 
in almost all I isolated from the stools of the patients the dysentery 
bacillus which I then discussed in the literature, its identification 
being chiefly by means of the agglutination reaction (for the greater part 
with rabbit immune serum). My original stem is the non-acid forming 
one, identical with Kruse’s bacillus. This identity was entirely ac- 
cidental. The bacillus discovered in Manila in 1900 by Flexner and by 
Strong is acid forming, but, on the other hand, the organism which was 
kindly sent to me from Manila by Dr. Strong in the past year, was non- 
acid forming and therefore it is likewise purely accidental that the acid- 
forming variety was first discovered in the latter city. In this connection 
the opportunity should be taken of mentioning cases in which the original 
bacillus as well as the varieties have been encountered simultaneously. 
Gay and Duval report three such instances in acute dysentery in adults, 
Hastings two, and finally Duval and Shorer six in the summer diarrhee: 
of infants. 
Finally, the dysenteries which are caused by the varieties of the bacil- 
lus on the whole seem to take a milder course than those occasioned by 
the original stem, although a tolerably high mortality also occurs with 
the former, as will be seen from table. 
