198 
TYPHOID FEYEB IX DISTKICT OF COLUMBIA. 
not reviewed in this paper, as typhoid fever is the question espe- 
cially at issue. From cases reported in literature it seems difficult 
to exclude parasitic worms as at least occasional factors in appendi- 
citis. Metchnikoffs advice to make fecal examinations in all cases 
can do no harm and may do good. It seems rather early to general- 
ize on this subject, either positively or negatively. 
HISTORICAL REVIEW. 
Turning now to the arguments and views presented in favor of the 
theory, we may note the f ollo^viug : 
Guiart (1899a, 1000-1002) says: 
It is probable that all of the epidemics of verminous fever of former times -vere in 
reality only epidemics of ascariasis of tj^^hoid form, or perhaps of tj-phoid fever accom- 
panied by helminthiasis. But Davaine did not sufficiently explain the association 
of the infection and of ascarids, and in a recent vork an Italian author, Demateis 
(1899a), shows that certain of the interpretations of Davaine ought not to be accepted 
to-day and that the ascarids are not simple foreign bodies contained in the intestines, 
but that they are endowed with ver^^ energetic movements, which become accentu- 
ated under the influence of an elevation of febrile temperature, and that they are able 
to become very dangerous for the host who harbors them. We accept fully this opin- 
ion, adding that not only is the fever able to provoke the pathogenic action of the 
ascarid, but this latter by its presence alone is able to provoke the fever by giving 
rise to alterations in the intestine which are able to serv*e as ports of entr\" to the 
infection. 
Certain authors have indicated that at the points where the ascarids attach it is not 
rare to obseix’e a slight softening of the intestinal mucosa and a fine vascular injection 
similar to that of erethematous enteritis. Lerotix has shown further, in an intestine 
containing 83 ascarids, small points, having the appearance of punctures, surrounded 
by a small red circle. Finally, in cases of ascariasis of the dog, Friedberger and 
Froehner also report, at the plane of the tumefied and catarrhal mucosa, numerous 
small rounded blackish points, at the center of which is an ulcerative depression sur- 
rounded by a salient zone. But Davaine does not admit that these lesions can be 
due to the action of the ascarid, because the jaws [lips] of the parasite would not be 
able, according to him, to act on an object situated in front of them, but only on an 
object introduced into the buccal orifice. This opinion has not been accepted so 
positively by ever\’one, and I have recently had [1001] occasion to observe a fact 
which permits me to be more affirmative. 
In the cruise of the Hirondelle, in 1888, the Prince of Monaco captured, near the 
Azores, a dolphin, the stomach of which contained a veix^ great number of Ascaris 
conocephaliis Krabbe, which were given to me awhUe ago to determine. Certain of 
these parasites were affixed to the mucosa, and the cephalic button, profoundly 
incrusted in the tissues, was covered with a sort of rather deep cupula, presenting 
asperities sufficient to permit the worm to fix itself solidly with its teeth. * * * 
This cupula is a veritable mold of the cephalic extremity ol the ascaris, and it is deep 
enough so that the mucosa is seriously wounded at this point. These lesions are cer- 
tainly identical with those observed by Leroux in man and by Friedberger and 
Froehner in the dog. But the cephalic armature of Ascaris conocephaliis is absolutely 
similar to that of Ascaris lurnbricoides of man. It is, then, ver\" probable that what one 
makes the other is also able to make, and we are consequently in the right in admit- 
ting that Ascaris is perfectly capable of cutting the intestinal, or at least the stomachal. 
mucosa. 
