202 
TYPHOID FEVEK IN DISTEICT OF COLUMBIA. 
considerable role in the etiology of diseases of the intestine and of the liver in the same 
way that insects do in the etiology of infections of the blood. They act especially as 
inoculating lancets, and according to the \drulence of the microbic species of the intes- 
tine, one finds himself naturally in the presence of affections of variable gravity. If, 
in fact, the inoculated agent is slightly pathogenic, it is sufficient to expel the intestinal 
worms in order to see the symptoms decrease and disappear that is the triumph of anthel- 
minthic medication. If, on the contrary, the microbes inoculated in the mucosa have a 
true specificity, the disease continues its evolution, even after the evacuation of the parasites; 
hut at least one prevents constant auto-inoculation and one is able to prevent the infection 
from becoming chronic. These are facts of a more general application, applicable as 
well to comparative pathology and to human pathology. It is thus that Professor 
Moussu has shown the action of the strongyle of sheep in the inoculation of bovine 
pasteurellosis. We completely adopt his conclusions, and we protest against the pres- 
ent views which consider as inoffensive the parasites which are able to inoculate fatal 
infections. These infections are bacterial, it is true, but they would not occur if the para- 
sites did not exist. \558\ It is thus the latter which are in reality the more important 
agent, a * * * 
[559] We are going to attempt to show that what the ectoparasites (mosquitoes, etc.) 
are capable of doing on the surface of our body, the endoparasites are capable of doing 
in our intestine. 
One admits at present that a simple puncture of a needle is able to open the door to 
pathogenic bacteria, that the bite of a flea is able to inoculate plague, that of the mos- 
quito malaria, filariasis, and yellow fever. How, then, is one able to admit that a para- 
site is able to produce lesions of the intestinal mucosa and is able to open with impu- 
nity the blood vessels without ever opening the door to infection? But the content 
of the digestive tube does not pass exactly for an aseptic medium. The most abundant 
microbe of the fecal material being the colon bacillus, it is this which will be most 
often inoculated, and thus can be explained certain enterites of the child or of the 
adult, general or partial, and among these appendicitis. 
[560] In France there was a general laughter when Metchnikoff claimed that append- 
icitis could be produced by intestinal worms; to-day, still, one sees the smile of pity 
on the part of medical students when in examination they are questioned in regard to 
the role and diagnosis of the intestinal worms in appendicitis. The opponents of the 
theory base their position on the fact that appendices are removed daily without find- 
ing the slightest intestinal worm. As if the worm had to penetrate into the appendix 
in order to produce appendicitis! The surgeon is not surprised, however, that a small 
wound on the foot results in an inguinal adenitis. The skin and the intestine are two 
tissues of the same origin: why refuse to one what is admitted for the other? It seems 
to us logical to admit that a parasite fixing itself in the intestine can inoculate at this 
point, into the mucosa, pyogenic bacteria which are transported by the lymphatics 
in the neighboring lymphoid tissue, and as this lymphoid tissue is especially abundant 
in the appendix, the bacteria inoculated in the region of the cecum are very naturally 
going to result in an inflammation of the appendix. It is thus that all intestinal worms 
able to live in and attach themselves to the cecum are able to be a cause of appendici- 
tis. These will nearly always be ascarides or whipworms. Further, since Metchni- 
koff ’s communication, and despite the detractors, the facts have multiplied singularly. 
It is permitted to think that in a little while the intestinal worms will be considered 
not only as the cause of some rare cases of appendicitis, but perhaps as the most frequent 
etiologic factor. One of us (Guiart) has had occasion to observe flve cases of appendi- 
citis in persons around him. In the first case an acute appendicitis was definitely 
cured after the spontaneous expulsion of an ascarid. In the four other cases the fecal 
material was sent to him for examination for the presence of intestinal worms. Not 
Italics not in the original. 
