200 
TYPHOID FEVER IFT DISTRICT OF COLUMBIA. 
country, the typhoid hadllus is one of the most abundant, the result is that the intestinal 
parasites open especially the door to typhoid fever; but in other countries they produce 
inoculation with dysentery and with cholera.^ 
I thus think that the whipworm acts simply in the same way as any intestinal 
worm; and as it constitutes with Ascaris one of the most frequent parasites of the 
intestine, the result is that one ought with right to reckon with it, all the more because 
it is to-day demonstrated that it really fixes itself in the mucosa by its cephalic 
extremity, as results from some observations by Eailliet and Brumpt. I believe 
that the whipworm is able to act eventually in the etiology’ of appendicitis; but that 
is indeed rather rare (see below, p, 202). In fact, if whipworms are rather common in 
the cecum, one must admit that they are encountered very rarely in the appendix. 
Thus, of 174 appendices excised surgically and examined in the laboratory of practical 
pathology by Doctor Letulle and Doctor Weinberg, only 2, one of which was brought 
to me, contained whipworms. & If it is probable that whipworms may play a role in 
certain cases of appendicitis, I believe at least that its role is much more active in 
other intestinal affections, and particularly in enteritis. 
To summarize : The helminths and the bacteria of the intestine are inoffensive in them- 
selves, but the helminths are capable of becoming inoculating agents of the bacteria, in the 
same way as the mosquito does in malaria, or, better, in yellow fev err. cd The helminths 
may thus play a very important and generally unrecognized role in the etiologt" of 
intestinal affections, and this forms one of the most interesting cases of parasitic 
association. I am also persuaded that the day physicians begin to make systematic 
microscopic examinations of the fecal matter for eggs of parasites, they will be aston- 
ished at the rapid progress which will result in our knowledge relative to the etiology* 
and treatment of parasitic diseases of the intestine and liver. 
The following abstract of a paper (1902 ^), by Kostortzelf (1902, 
692), is taken from the Medical Xews: 
In the course of his extensive anatomical studies of the topography and pathological 
anatomy of the appendix. Doctor Rostortzeff came to the conclusion that Metchnikoff ’s 
opinion on the causative influence of worms on appendicitis can hardly be accepted . 
On the one hand, he found the parasites in a comparatively small percentage of the 
examined appendices, and, on the other, of those appendices where he found the 
parasites a great many were perfectly normal. 
Blanchard (1904, Dec. 1, 122-128) presented to the French Acade- 
mic de Medecine a general review of Guiart's work, based upon a 
paper prepared by Guiart. The paper is practically a summary of 
Guiart’s former publications on the relation of whipworms to typhoid. 
Blanchard (1904, Dec. 1, 138-140; 1905, 50-51), in discussing the 
general subject, says: 
From a strictly medical point of -vdew, the helminths are about to retake in medicine 
a role which was formerly attributed to them without question, but from which the 
progress in bacteriology has deposed them. The discovery of the pathogenic role of 
the microbes has been the origin of surprising progress in etiology", prophylaxis, and 
treatment of the infectious diseases. By a very comprehensible exaggeration, people 
a Italics not in the original. 
The whipworm was fixed through the superficial portion of the mucosa. 
c Italics not in original. 
d Guiart should not be misconstrued here as suggesting that the worms act as inter- 
rnediate hosts in the life cycle of the bacteria. 
« The original is not accessible to me. 
