196 
TYPHOID FEVEE IX DISTEICT OF COLHMBIA. 
YTasliiiLgtoii eases averaged only 0.47 -t- whipworm egg per slide, against 2 eggs per 
slide in the French statistics. 
Turning to a method of indirect comparison, it is seen that while former examina- 
tions in this laboratory (for Washington. D. C.. and for Connecticut i showed that the 
greatest percentage (13.01) of cases of whipworm infections was under 15 years of age, 
in the 200 typhoid cases examined the greatest percentage (47.5 1 of patients fell 
between the ages of 15 and 29 years, inclusive: further, the percentage of cases of 
typhoid does not vary parallel with the percentage of cases of whipworm infection in 
the other age groups. 
Comparing, in reference to sexes, the statistics of whipworm infection in the world 
at large, and in examinations made for Connecticut and for the District of Columbia 
combined, with those of the 200 tt'phoid patients examined, it is seen that whipworms 
are more common in females than in males, while of our 200 t^*phoid cases, 52.5 per cent 
were males and 47.5 per cent were females. If the comparison is restricted to the total 
he lmin thiasis of cases examined in the District of Columbia, it is slightly more favor- 
able to the theory under discussion. 
Making a similar comparison in reference to the race of patients, it is seen that in the 
200 cases of typhoid under discussion ' reduced to figures approximately in harmony with 
the general relation of the races in the population of the District ) the whites were to 
the negroes as 55.5 to 64, while in the whipworm statistics in former examinations the 
whites were to the negroes as 3.75 to 9.79. The change in our summer population 
would account for at least a part of this excess of typhoid among the negroes. 
The general conclusions are. therefore, that a study of the intestinal he lminthias is 
in 200 of the cases in the Washington tt-phoid epidemic of 1906 has not supported the 
theoiy that whipworms, eelworms. or other species of intestinal worm bear any neces- 
saiy or common relation as an inoculating agent in tj-phoid fever: and that the Anew 
recently expressed in France to the effect that the treatment and prevention of typhoid 
fever practically reduces itseK to the treatment and prevention of intestinal worms, 
especially of whipworms, does not obtain, at least so far as this locality (Washington, 
D. C.) is concerned. The question of the relation of protozoa as inoculating agents 
in typhoid is not considered in this report. 
IXTRODTJCTIOX. 
From time to time^ in medical and helminthological hteratnre, 
authors have called attention to the frequency of infection with 
intestmal worms found in cases of typhoid fever. These observa- 
tions have recently culminated iu a theory to the effect that whip- 
worms ( TncJiiiris tricMura) play an inoculating role in typhoid 
somewhat similar to that played by ffeas in bubonic plague. 
This theorv is in itself a verv alluring one. If it is substantiated, 
its effects are of far-reaching importance. Xot only would it mean 
that the prevention and treatment of typhoid would practically 
resolve itself into the prevention and treatment of whipworms, but 
a practical apphcation of the prophylactic measures might involve 
more or less of a revolution in the present methods of the disposal of 
sewage. On this accoimt it seems wise to test the theory from differ- 
ent poiats of view and in different geographic areas, lest a study of the 
subject from one point of view or in a hmited geographic area may, 
because of local conditions, lead to erroneous conclusions. 
