INTESTINAL WORMS IN TYPHOID FEVER. 
203 
having found anything in two cases he advised operation. But in the other two cases, 
having found the eggs of ascaris in one case and [561] the eggs of whipworms in the 
other, he ordered santonine for the former and thymol for the latter. The cases of 
appendicitis ceased as if by enchantment, and since then have not reappeared. One 
of these cases occurred three years ago, the other one year ago. * * * 
We are persuaded that all of the cases of familial and of recuirent appendicitis are amenable 
to anthelmintic medication.^ We believe even that one should have recourse to this 
medication before every operation. In fact, in one of the foregoing cases, which was 
operated because of negative results in the fecal examination, the young patient 
passed a male ascaris the day after the operation. Later doses of santonine were with- 
out effect, but the presence of this single male ascaris permits us to explain at the 
same time the appendicitis and the lack of eggs. 
VTiat has just been said of appendicitis can be extended also to typhoid fever. 
WTiether one considers this affection as produced by the bacillus of Eberth or by the 
cobacillus, one scarcely explains how the bacillus is able to pass the bander, which 
the intestinal epithelium offers to it, in order to implant itself in the mucosa. Further, 
if the bacillus acted alone, one would not understand why, in a population drinking the same 
contaminated water, so few people are in reality affected. On the other hand, if one 
admits that the inoculation occurs by the intermediary of intestinal parasites, the facts are 
very easily explained. t> One understands very well the so striking coincidence of tj’phoid 
fever wdth ascarids and whipworms. We ought not to be astonished if the cases were 
numerous in which anthelminthics acted favorably in these affections; they acted, 
without doubt, by preventing the auto-inoculation of the malady. 
Such is the theory advanced by one of us (Guiart) in 1901, treated again in 1902, 
and again in 1904, in a report presented [562] to the French Colonial Congress. Find- 
ing himself at Brest during the months of August and September of the same year, 
at the beginning of an epidemic of typhoid, he resolved to try to verify his hypothesis. 
Permitted to examine the patients under treatm-ent at the hospital, he examined the 
fecal material of 12 typhoids and in 10 of them he found constantly the eggs of whipworms, t) 
It sufficed to make 3 microscopic preparations [in each case]. He was thus able to 
find from 1 to 21 eggs in the 3 slides, and for all an average of 2 eggs per slide. VTien 
one recalls that in verminous appendicitis it is often necessary to make a dozen prep- 
arations before finding an egg of a parasite, and that each microscopic preparation 
necessitates an extremely small amount of fecal matter, one understands that to 
find so easily the eggs of whipworms in the typhoids, it is necessary that the adult 
worms be particularly abundant in the intestine. 
There remain the two patients in whom he did not find the whipworm eggs. One of 
these, dying, 6 living whipworms were found in the cecum. Was there an interruption 
in the oviposition or were they only male worms? These are the two probable hypothe- 
ses which could not be verified, however, as he (Guiart) was not present at the 
autopsy. There remains a last negative case, wdiich did not come to autopsy, but 
which perhaps finds its explanation in the foregoing. 
The parasite, at Paris at least, is never so frequent or abundant; it was important to 
know whether it showed the same frequency in the other soldiers under treatment at the hos- 
pital. Guiart examined the fecal matter of 4 individuals. * * * In the fu’st 3 he did 
not find a single egg, despite many preparations. In the other he found 1 egg [563] in 6 
slides, a low proportion when one considers that the typhoids presented an average of 
“ In view of the difficulty encountered in expelling whipworms from the intestine, 
Guiart ’s interpretation of this case is not altogether convincing, especially since he 
gives no record to show that the whipworms were actually expelled. — C. W. S. 
& Italics not in the original. 
c It will be noted that Guiart looks upon the water as the chief source of typhoid 
fever, see above, p. 119. 
