INTESTINAL WORMS IN TYPHOID FEVER. 
205 
times in the small intestine some specimens which seemed to be smaller than those 
in the cecum. Werner and Bellingham have found them in the lower portion of the 
ileum; Davaine says that they have sometimes been found in the small intestine; 
finally, Bavay assures us that he has frequently encountered them in the small intes- 
tine of typhoids. 
Further, even supposing that the whipworms live only in the cecum, the contra- 
diction w®uld be only apparent. The researches of numerous authors have established 
that, in fact, the inoculation of animals with cultures of the typhoid bacillus, even by 
intravenous or by intraperitoneal injection, is able to produce intestinal lesions. 
With greater right we ought not to be astonished to observe these lesions as a result 
of the inoculation of the bacillus in the region of the cecum. That which it is important 
to retain is that typhoid fever is an infectious microhic malady, with intestinal port of 
entrance, and that it is the whipworm, an intestinal parasite, which, in the majority of 
cases, opens the door to the infection.^' 
The practical consequences of these observations are of the highest importance. In fact, 
if in typhoid fever the initial etiologic agent is only the whipworm, it is that which it is 
necessary to attack.O' Ordinarily, one contents himself, forewarned, to treat expectantly 
and one respects with the greatest care the intestine, for fear of increasing the ulcera- 
tion; but the whipworms continue their inoculations, and thus by this method one 
does that which is necessary to augment the infection. 
Thus, we conclude as follows: In presence of any febrile enteritis, even before knowing 
whether the serum-diagnosis is positive and whether it is necessary to incriminate Eberth’s 
bacillus, one should institute, as soon as possible, the anthelminthic treatment and evacuate 
the intestine, in order to expel at the same time the microbes and the worms and to prevent 
the constant auto-inoculation of the patient. It would evidently be better to make an 
examination of the fecal matter and to vary the treatment {thymol, santonine, etc.) according 
to the eggs of the worms encountered. But, in practice, since it is nearly always [566] the 
whipworm, one may content himself with instituting as rapidly as possible the anthelmin- 
thic treatment with thymol:(^ * * * 
What we have just said of the intestinal worms could be extended to all the parasites 
of the intestine, to the infusoria and the flagellates, as well as to the larvae of insects, and 
in general to all parasites able to produce alterations of the mucosa. We know, in fact, 
one observation in which the larvae of the cheese fly were able to produce an intestinal 
hemorrhage and caused an affection with a typhoid course, which was cured by the 
expulsion of the larvae. 
If these facts are confirmed and multiplied, the parasites of the intestine are going to 
retake the preponderating place which the intestinal worms formerly occupied in 
pathology. * * * 
In an earlier paper, Guiart (1905, Jan. 15, 175-186) presents practi- 
cally the same argument which he brings forward in Guiart and Grim- 
bert (1906a), but he amplifies his arguments slightly in regard to the 
protozoa as inoculating agents in intestinal bacterial infections. 
In connection with this amplification it may be pointed out that 
protozoa of various kinds are exceedingly common in the intestine. 
While admitting that certain protozoa are certainly capable of injur- 
ing the mucosa, there are others in connection with which this patho- 
genic action has not yet been demonstrated. It is therefore in the 
interest of conservatism to await rather convincing proof before 
unreservedly accepting protozoa as a very common inoculating 
agent. 
a Italics not in the original, 
