INTESTINAL WOBAIS IN TYPHOID FEVER. 
199 
If now we consider well that the parasite lives in the midst of the intestinal mate- 
rial — that is, in a septic medium — we understand that the ulceration produced by 
the bite of the parasite will easily be able to become inflamed and to result in an 
abscess, or even to give rise to various enterites, for instance, under the action of 
Bacterium coli, or of the t^’plioid bacillus. We now understand then better the coin- 
cidence, so striking sometimes, of t^'phoid fever and [1002] of Ascaris, and that all the 
better because the etiolog>" [source of infection] is in reality the same, and for the two 
should be sought in the impurity of the drinking water. In cases of enteritis of 
t^-phoid form one ought, then, especially in cases of doubtful bacteriologic diagnosis, 
to make a microscopic examination of the fecal material, and if one flnds Ascaris eggs 
one ought to administer santonine. 
In another paper Giiiart (1900f, 70-81, fig. 1) gives a brief histor- 
ical review of certam epidemics in which Ascaris Jumbricoides was 
reported as common. He elaborates slightly on his earlier (1899a) 
paper, and refers to the possibility of Ascaris as an inoculating agent 
in t;vphoid. 
Giiiart (1901a, 307-308) in a later paper says: 
This week M. Metchnikoff has just presented to the Academy of Medicine [Paris] a 
very interesting communication and one which has made considerable stir in the 
medical world, because it concerned appendicitis. * * * i am very glad, so far 
as I am concerned, to see that Metchnikoff confirms the ideas which I myself have 
advanced here, a little over a year ago, on the role of Ascaris as an inoculating agent 
in intestinal affections. Our two communications constitute in reality two specific cases 
of a general law: That of the action of intestinal worms as inoculating agents of certain 
intestinal affections. 
I do not wish to return here to what I have said apropos of the role of Ascaris and 
what has just been confirmed by Metchnikoff. But in regard to the whipworm, it 
is now three years that, in my lectures on parasitology before the medical school, I 
have insisted on its frequency in the cecum and on the important role which it ought to 
play in the inflammatory maladies of this region; in fact, it fixes itself in the mucosa by its 
thin extremity and thus becomes an inoculating agent of the first order. About eighteen 
months ago, I gave this question to M. Brumpt, preparateur of Professor Blanchard’s 
laboratory, to study during his ‘“passage” [term?] in the hospitals. Only once did 
he encounter whipworms in the appendix ; but in the necropsies on t>q)hoid cadavers 
he very frequently found whipworms attached in the superficial portion of the mucosa 
of the cecum. M. Brumpt has not yet published his observations, and as he is at 
present traveling in Central Africa, I have thought it well to speak of them here. 
I hope that I shall not be interpreted as saying that I consider the whipworm as the cause 
of typhoid fever;o that would be as much of an exaggeration as to interpret Met- 
chnikoff as saWng that this worm is the specific cause of appendicitis. Its true role is 
as follows: Our intestine harbors a very rich bacterial flora and many pathogenic bacteria 
are found there; but fortunately, in the normal state, the intestinal epithelium offers to 
them an insuperable barrier. It is in reality, like our external shin, always soiled with 
bacteria; but it does not let the bacteria penetrate except in case of a cut or a wound. Thus, 
in the intestine, the pathogenic bacteria remain without action, if the mucosa is not abraded 
by a foreign body or by a solid particle ingested with the food, or is not injured by some 
worm living in its lumen. In fact, this worm, fixing itself on the mucosa in order not to 
be removed by the fecal material, wounds the mucosa and the conditions change; the bacteria, 
inoculated by the parasite, develop under the mucosa, and will produce, according to the 
case, an enteritis, an appendicitis, a simple abscess, or even a peritonitis. Since, in our 
a Italics not in the original. 
