712 PATHOGENIC MICROORGANISMS 



sewage and garbage disposal have not been developed to a satisfactory 

 extent. 



Dysentery epidemics also are more apt to occur during the hot and 

 dry parts of the year when flies are prevalent. It is a mistake to think 

 of the disease only as occurring in epidemics, since organisms of the 

 dysentery group probabty cause a great many sporadic cases and small 

 group attacks of diarrheal diseases which in their clinical manifestations 

 cannot be strictly classified as dysentery." Thus, numerous small group 

 outbreaks have been studied in America and Europe, occurring either 

 in cities sometimes, as in those studied by Kruse and others, in public 

 institutions as insane asylums and orphanages, and in connection with 

 such outbreaks a great many dysentery-like organisms have been 

 described. At times, however, the disease has caused widespread 

 epidemic outbreaks, and Castellani and Chalmers 36 mention great 

 epidemics which occurred in Europe in 1538, 1777, 1779, and 1834. In 

 its epidemic form it is particularly a disease of armies. Vincent and 

 Muratet 37 state that a destructive epidemic took place in the English 

 Armies in 1415 after the battle of Agincourt. There were serious epi- 

 demics in the armies of the Allies during the Crimean War, during the 

 American Civil War, during the Franco-Prussian War, the Russo-Turkish 

 and the Russo-Japanese War. Considerable dysentery morbidity occurred 

 in the South African War, and during the recent World War the disease 

 was prevalent among all the armies fighting on the Eastern and Western 

 fronts. In speaking of the dysentery morbidity under war conditions, 

 it is always important to remember the almost insuperable difficulties 

 which render accurate diagnosis of the disease almost impossible. Also, 

 it is likely that large epidemics are rarely caused by a single dysentery 

 type. 



In 1905 Amako 38 studied the epidemics which occurred in the town 

 of Kobe and from 743 cases isolated dysentery bacilli in 526. During 

 this single epidemic he found 5 different types of dysentery bacilli, 

 the first type being the typical Shiga bacillus, the second being a mannite 

 fermenter, the fourth and fifth fermenting maltose and dextrin, the 

 third having no effect upon maltose and dextrin but fermenting sac- 

 charose like the fourth and fifth. He found the first type in 108 cases, 

 the second in 202, the third type in 9, the fourth in 169, and the fifth in 



36 Castellani and Chalmers, Text- book of Tropical Medicine. 



37 Vincent and Muratet. Dysentery, etc., Military Med. Manual, Univ. of London 

 Press, 1917. 



w Amako, Zeit. f. Hyg., 60, 1908, 93. 



