Distribution 605 



The pilgrimages and great festivals of the Hindoos and 

 Moslems, by bringing together enormous numbers of people 

 to crowd in close quarters where filth and bad diet prevail, 

 cause a rapid increase in the number of cases during these 

 periods and facilitate the distribution of the disease when 

 the festivals break up. Probably no more favorable con- 

 ditions for the dissemination of a disease can be imagined 

 than occurs with the return of the Moslem pilgrims from 

 Mecca. The disease extends readily along the regular lines 

 of travel, visiting town after town, until from Asia it has 

 frequently extended into Europe, and by steamships plying 

 foreign waters has several times been carried to our own 

 continent. Many cases are on record which show conclu- 

 sively how a single ship, having a few cholera cases on 

 board, may be the starting-point of an outbreak of the 

 disease in the port at which it arrives. 



The most recent great epidemic of cholera began in 1883. 

 From Asia it spread westward throughout Europe, extended 

 by means of the steamship lines to numerous of the large 

 ports, of which Hamburg in Germany suffered most acutely, 

 and even extended to some of the ports of Africa and America. 

 Russia probably suffered more than any other European 

 country, and it is estimated that in that country there were 

 no less than 800,000 deaths. During 1911 the disease 

 again appeared in Europe and invaded the countries along 

 the Mediterranean coasts. 



Specific Organism. The discovery of the spirillum of 

 cholera was made by Koch while serving as a member of a 

 German commission appointed to study the disease in Egypt 

 and India in 1883-84. Since its discovery the spirillum has 

 been subjected to much careful investigation, and an im- 

 mense amount of literature, a large part of which was stim- 

 ulated by the Hamburg epidemic of 1892, has accumulated. 



Distribution. The cholera spirilla can be found with 

 great regularity in the intestinal evacuations of cholera 

 cases, and can often be found in drinking-water and milk, 

 and upon vegetables, etc., in cholera-infected districts. 

 There can be little doubt that they find their way into 

 the body with the food and drink. Cases in the literature 

 show how cholera germs enter drinking-water and are thus 

 distributed ; how they are sometimes thoughtlessly sprinkled 

 over green vegetables offered for sale in the streets, with 

 infected water from polluted gutters; how they enter milk 

 with water used to dilute it ; how they appear to be carried 



