92 DYSENTERY 



prevalence of dysentery is determined by the extent to which fecal 

 contamination exists. The disease is most abundant when fecal dis- 

 position is most primitive. With improvement in the latter, the dis- 

 ease grows less. Thirty years and more ago, dysentery under various 

 names, such as "mucous and bloody diarrhea" and "bloody flux," 

 reaped a rich harvest, especially among children, in various sections 

 of this country. As methods of the disposal of fecal matter grew 

 more efficient, the death-rate from this disease decreased. It decreased 

 at first in cities, with the introduction of water closets, then it grew 

 less in villages in which the same improvement was inaugurated and 

 lastly its highest prevalence was in the less progressive and more 

 ignorant communities. Its dependence on ignorance and filth for its 

 dissemination is shown in the frequency of outbreaks in insane asylums 

 and especially in wards occupied by those who pollute themselves, their 

 clothing and bedding, and even the walls of their rooms with fecal 

 matter. In primitive places there are not even privy vaults, and stools 

 are deposited at random on the ground. Everything about the indi- 

 vidual home and throughout the village becomes soiled with fecal 

 matter. These are the localities in which dysentery most abundantly 

 flourishes. With typhoid fever, it has spread through camps and 

 decimated armies. It has accompanied military and civil explorations 

 even into uninhabited regions and has flourished wherever man has 

 found even a temporary abiding place and has surrounded and befouled 

 himself with his own excretions. This does not mean that it may 

 originate de novo, for it does not, but the sick and the well may long 

 harbor the bacilli in their intestines and plant it over wide regions in 

 their stools. Hands, the person, clothing, bedding, food and water 

 may bear the infection. From the dirty hands of the milker, the cook 

 or the waiter these organisms may find their way into the food. Those 

 recovering from the disease may continue for weeks as veritable cul- 

 ture flasks for the growth and distribution of this virus. Others may 

 carry the bacilli without developing the disease themselves. Flies and 

 possibly other insects aid in its distribution. While the bacilli are 

 not spontaneously generated in filth, they are widely disseminated and 

 they flourish in polluted places. 



