THE ALLEGED ROLE OF INTESTINAL WORMS AS INOCULAT- 
ING AGENTS IN TYPHOID FEVEIfr 
By Ch. Wardell Stiles,® Ph. D., D. Sc., 
Chief of Division of Zoology, Hygienic Laboratory, United States Public Health and 
Marine- Hospital Service. 
SUMMARY. 
According to a theory recently advanced in France intestinal worms (especially 
whipworms) form the inoculating agent in typhoid much in the same way that fleas 
inoculate bubonic plague. The theory is based upon the high percentage of whip- 
worms reported for typhoid cases by some authors and upon the fact that intestinal 
worms may wound the mucosa; it is assumed that the uninjured mucosa forms an 
impassible barrier to the bacteria which, however, may pass through these wounds. 
The theory claims that typhoid bacilli in the intestines are harmless unless parasitic 
worms, or some other wounding agents, are present. Accordingly, the treatment and 
prevention of typhoid reduces itself essentially to treatment and prevention of para- 
sitic worms, especially of whipworms. The theory is extended to appendicitis, cholera, 
and certain other intestinal diseases. 
More recently, the theory is also extended to include parasitic protozoa as inocu- 
lating agents in intestinal diseases, but so far as typhoid is concerned no definite 
statistical data are presented in support of this extension. As the fresh, warm, stools 
should be examined to test this phase of the subject fairly, and as conditions were not 
favorable for such examination in the present instance, this protozoan phase of the 
subject could not be consistently studied in the present report. 
The Washington epidemic of typhoid in the summer of 1906 presented the possibility 
of putting to a practical test the verminous side of this exceedingly alluring theory. 
The results of the study have failed to confirm the theory, for 92.5 per cent of the 
patients showed no infection with intestinal worms, while only 15 of them (7.5 per 
cent) showed a total of 16 infections (8 infections per hundred) of which 14 cases (7 per 
cent) showed whipworm infection. This represents an increase of only 1.3 infections 
(0.65 infection per hundred persons) over what we expected to find in the general 
intestinal helminthiasis, and an increase of only 1.32 per cent over what we expected 
to find in whipworm infections. Considering the very wet season we have had, and 
especially in view of the negative findings in 92.5 per cent of the patients, these slight 
increases can hardly be considered of importance. 
In comparing the severity of the verminous infections (as judged by the number of 
eggs present) with that reported for typhoid by Guiart in France, it was found that the 
® In making the 2,000 microscopic examinations involved in preparing this paper, I 
have been aided by Passed Asst. Surg. Joseph Goldberger, David G. Willets, Ph. B., 
and Arthur E. Paterson, Ph. B. 
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