204 
TYPHOID FEVER IN DISTRICT OF COLUMBIA. 
7 eggs in 3 preparations — that is, an average fourteen times as high. The existence of 
this egg in the patient with an amputation would explain, perhaps, an attack of dysen- 
teric nostras from which he had formerly suffered. 
It was thus demonstrated that numerous whipworms existed in the intestines of typhoids, 
although these same worms are rare and not very abundant in healthy persons or in persons 
with nonintestinal affections.^ 
From new observations made at Paris, it results that whipworms abound in the intestine 
of typhoids, except in children^ where the inoculating agent seems to be generally the ascarid.^ 
These facts have in reality been known a long time. Since 1792 [? date], Roederer and 
Wagler gave under the name of morbus mucosus the first account of an epidemic of 
typhoid fever, which they attributed to the large number of the intestinal worms which 
they encountered at the autopsies. These worms, already seen by Morgagni, but new 
for them, were nothing but whipworms, which they described under the name Tri- 
churis [1761]. In 1807, Pinel in his Nosographie philosophique indicated that it is 
necessary always to suspect the existence of intestinal worms in mucous fevers. 
Rokitansky expressed an opinion analogous to that of Roederer and Wagler. For Ras- 
pail, the term typhoid would be synonymous with an excessive infection [pullula- 
tion] with whipworms in the intestine. Finally, Davaine himself has noted the strik- 
ing abundance of whipworms in typhoid fever. This last observation has a special 
interest in that Davaine, in denying any infectious role to the intestinal worms, 
urged the present medical conceptions. A number of good observers have thus been 
struok by the frequency of whipworms in the intestine of typhoids and have admitted 
a relation between the helminths and the infectious malady. 
For us, our opinion is the following: An individual whose intestine is free from intestinal 
worms may drink [564] with impunity contaminated water. But if this same water reaches 
an intestine containing whipworms, as these {in order to draw the blood with which they 
nourish themselves) penetrate into the intestinal mucosa with their pointed anterior end, 
they inoculate, at the same time, the bacteria into the mucosa, and they give rise to the infec- 
tion. One thus understands better why, in a population drinking contaminated watei', 
there are in reality so few individuals attacked; these are the persons who harbor intestinal 
worms, and more particularly the whipworms. How, otherwise is it to be explained that 
the bacillus is able to pass the barrier which the intestinal epithelium offers, c It is very 
evident that an ascarid, a fly larva, or any parasite capable of wounding the intestine 
may act in the same way, but as the whipworm is the most common intestinal worm 
and at the same time that which wounds the mucosa the most deeply, it results that 
this is the one which should be nearly always incriminated. 
One might object that the lesions of typhoid fever are found especially in the small 
intestine, while the whipworm is considered a normal parasite of the cecum. It is 
indeed exact that the adult whipworm fixes itself to the mucosa of the cecum, but it is 
known, since the experiments of Davaine, that the egg with the embryo hatches out in 
the stomach. It is thus permitted to suppose that the first stages of the free [parasitic] 
life are passed in the small intestine and that one is able, consequently, to observe 
in the latter the whipworms in different stages of development. In fact, Wrisburg 
has found them in the duodenum, and his observation is especially interesting in that 
he says that he has seen them enter, with one of their extremities, into the orifice of 
the glands of [565] Peyer and of the mucous follicles. Further, Heller has seen several 
a Italics not in the original. 
& See, however, p. 210 of this report. 
cSee Thebault, 1901, 353: “This interesting observation is very demonstrative; it 
concerns a young ghl who was accustomed to eating cheese in which the larvae of Pio- 
phila casei were swarming.” 
<^In connection with this phase of the subject, Guiart does not cite the experi- 
ments with tubercle bacilli and fat. 
