INTESTINAL WOEMS IN TYPHOID FEVEK. 
197 
The outbreak of typhoid fever in Washington, D. C., during the 
summer months of 1906, has given me an opportunity to test the 
theory in this locality and to compare my results with results pub- 
lished for France and Italy. In this study I have had a certain 
advantage over my European colleagues, for not only have I had a 
larger number of cases for comparison, but in analyzing the cases it 
has been possible to draw a comparison between two races of patients, 
whites and negroes. 
In order to understand the points at issue, it will be well to quote 
extensively from certain European authors, especially from Guiart, 
the chief exponent of the theory involved. 
As will be seen from the extracts, typhoid is not the only disease 
which comes up for consideration. I have not, hov/ever, had an oppor- 
tunity to study the other maladies (appendicitis,® cholera, etc.) from 
the point of view of intestinal helminthiasis. 
As will be seen also from the extracts, the theory in question may 
be summarized as follows: There are certain pathogenic bacteria 
which do no harm in the lumen of the intestine; but if parasitic 
worms (especially whipworms or eelworms) happen to be present, 
these parasites wound the mucosa of the intestine, and the bacteria 
gain access to the system through the wounds ; thus clinical typhoid 
is dependent upon the presence of a wounded mucosa, and as the 
whipworm represents the most common intestinal worm, this is 
usually the inoculating agent of typhoid. This I believe is a fair 
statement of the theory. 
In considering the subject it would seem logical to expect that, if 
the theory be correct, not only must we find that practically all 
typhoid patients harbor intestinal worms (especially whipworms), 
but we can go further, namely, since we know that one sex (female) 
in man presents a higher intestinal helminthiasis than does the other, 
also that whipworms and eelworms are more common in persons of 
certain age groups (under 15 years) than at other ages, and finally 
that whipworms especially are more common in the negro than in the 
white, we may naturally expect, in accordance with the theory, that 
in any given locality the cases of typhoid will be correspondingly 
more common in the sex (female), at the ages (under 15 years) and 
in the race (negro) presenting the highest percentage of intestinal 
helminthiasis in question. 
There are several articles (Metchnikoff, 1901; Matignon, 1901a, 
1901b; etc.) in recent medical literature on the presence of worms 
in the appendix or on their relation to appendicitis. They are 
a Through the kindness of Dr. George Tully Vaughan and Dr. D. Percy Hickling, 
of this city, I have been able to examine several cases of appendicitis for intestinal 
worms. While the results were negative, the statistics are not extensive enough to 
justify any generalizations. 
