352 THE ALCALIGENES— DYSENTERY— TYPHOID GROUP 
Dissemination and Prophylaxis.— Nothing is known of the method of 
dissemination of B. alcaligenes. It appears to be an organism whose 
portal of entry is the gastro-intestinal tract. Carriers have never been 
satisfactorily demonstrated. Prophylaxis is precisely the same as that 
for other intestinal organisms. 
THE GROUP OF THE DYSENTERY BACILLI. 
The term dysentery as it is used in the clinical way includes at 
least tw^o entirely distinct entities: Amoebic dysentery, a semi-acute 
or chronic infection caused by an amoeba, which is usually restricted 
to the tropics and subtropics; and an acute type caused by members 
of the dysentery bacillus group, more frequently encountered in 
temperate zones. The latter type not uncommonly assumes epidemic 
proportions, but occurs sporadically as well. Japan has suffered 
greatly in the past from the ravages of bacillary dysentery. Ogata 
and Eldridge^ state that 1,1.3G,0G7 cases with 257,289 deaths occurred 
in that country during the period between 1878 and 1899 inclusive. 
The mortality, which varied markedly from year to year, averaged 
22.6 per cent of all cases. The disease appears to be rare in England, 
but it has been reported in Germany.^ The Atlantic seacoast cities 
of the United States have experienced epidemics of the disease, but 
the inland cities appear to have been relatively free from it. During 
inter-epidemic years mild, atypical, sporadic cases and moderate 
numbers of bacilli carriers (both of the Shiga and Flexner types of 
organisms) have been discovered.^ 
The most virulent of the dysentery bacilli was isolated and described 
by Shiga"* during the great epidemic of 1897 to 1898 in Japan. Flexner^ 
recovered an organism which he believed was identical with the Shiga 
bacillus from cases of dysentery in the Philippines. Later studies of 
this organism by Martini and Lentz^ revealed specific differences in 
agglutinins from the Shiga bacillus, and Lentz^ showed that the 
Shiga bacillus did not ferment mannitol; the Flexner bacillus ferments 
this alcohol with the production of acid. Later intensive studies of 
bacillary dysentery bacilli by Park and Dunham, Hiss and Russell, 
and others confirmed the work of the earlier observers and added 
several strains to the group, which differ from the Shiga and Flexner 
strains both with respect to their specific agglutinating powers and 
their cultural reactions. The principal cultural reactions of the 
more prominent Gram-negative intestinal bacteria, including not only 
1 Quoted in Public Health Reports, 1900, 15, 1. 
2 Kruse: Deutsch. med. Wchnschr., 1900, 26, 637. 
5 Kendall: Boston Med. and Surg. Jour., 1913, 169, 754; May 20, 1915. 
* Centralbl. f. Bakteriol., 1898, 23, 599; 24, 817, 870, 913. 
5 Ibid., 1900, 28, 625. 
« Ztschr. f. Hyg., 1902, 41, 540. 
7 Ibid., 1902, 41, 559. 
