INTESTINAL WORMS IN TYPHOID FEVER. 
201 
have wished to attribute everything to the microbes, and this was a singular solace 
for medicine, to find at last in them the explanation of pathogenic phenomena which, 
since centirries, obstinately refused to deliver up their secret. Far he it from me to 
contest the capital role which these infinitely small organisms play in the production of 
diseases, hut I am clearly of the opinion that often they are not harmful except because they 
are preceded in their nefarious work hy various parasitic worms which open for them the 
way and permit them to exercise their evil work.o- 
Guiart has recognized that Ascaris conocephalus produces in the intestinal mucosa 
of the dolphin ratl.er profound erosions, thanks to the three powerful nodules with 
which its mouth is armed; Ascaris lumhricoides acts proportionately the same in man. 
And indeed clinicians have often noticed, without attaching to this fact the importance 
which it merits, the existence of more or less numerous ascarids in individuals suffering 
from intestinal affections, especially from typhoid fever. Roederer and Wagler in 
1760 observed at Goettingen a severe [51] epidemic of typhoid fever, or of morhus 
mucosus, as they said, in the course of which they discovered the whipworm; this 
parasite was found in abundance in the intestine of persons on whom they were able 
to make an autopsy. We are not ignorant that at a very recent epoch Professor Metch- 
nikoff has recognized that this same helminth was the frequent but not exclusive 
cause of appendicitis. 
Does this mean that the helminths are infectious? Not at all; their pathogenic 
role is indubitable, but in a way it is only preparatory. The ascarid, we have seen, 
erodes and ulcerates the intestinal mucosa; the ravages experienced by the latter 
are still more giuve when it is attacked by whipworms, hookworms, and other hel- 
minths which, armed or not with hooks, pierce through it and sink into its interior 
down to contact with the blood capillaries. There is thus produced a series of very 
minute openings, through which the pathogenic microbes, which are so frequently 
found as saprophytes in the intestine of persons in good health, are able to invade 
the organism and cause the infection. One might therefore proclaim this aphorism: No 
intestinal infection without parasitic worms to open u'p the way for the infectious microhes.<^ 
Niclot (1905, Jan. 15, 322-323) reports two cases of typhoid in 
which whipworms were found. 
Spezia (1905, Oct. 16, 460) found whipworm eggs in 17 out of 19 
cases of typhoid cases in Italy; the preparations averaged 3 eggs to 
a slide. In view of these results, compared with exaruinations he 
made in other diseases, Spezia is led to agree with Guiart regarding 
the importance of whipworms in typhoid. 
Vivaldi & Tonello (1905, 1362-1363; 1906, 136) examined the 
stools of 50 typhoid cases in Italy, and found that 80 per cent, showed 
whipworm infection; in 50 cases of other diseases they found 42 per 
cent, whipworm infection and 25 healthy persons presented 32 per 
cent, whipworm infection; the infections in the typhoid cases were 
3 to 4 times as great as those in the other cases. The typhoid patients 
also presented 11 Ascaris, 4 Oxyuris, and 2 hookworm infections. 
Guiart & Grimbert (1906a, 557-567), in discussing the relations 
of intestinal worms to the human economy, say that the worms may 
act — 
3. By inoculating in the mucosa of the intestinal tract pathogenic bacteria which 
are able to exist in the contents of the intestine. Thus the intestinal worms play a 
Italics not in the original. 
