I removed the nose entirely. Very roughly, the removed mass may be said to consist of the skin and cartilages of the nose. On its posterior aspect it is crowded with insects. The tissue is irregularly thickened, and here and there spots of ulceration, with a general, pale red, grey and green unhealthy appearance. A very scanty, semi-transparent, bad smelling discharge covers these spots. The ascending portions of the superior maxillary bones stand out as two white pillars among the soft moist sloughy tissue that is now exposed. The cartilaginous portion of the septum narium has been entirely obliterated, and in the parts presented to view there are large numbers of these worms wallowing in the disorganised tissue. The muscles of the upper lip, the subcutaneous tissue in the central and internal portions of the orbicularis palpebrarum, the sockets of the eyes, and the base of the skull are infected by these insects. The general condition of this patient conti-
causing this,
A CASE OF DEATH BY MAGGOTS.
By Surgeon
Thomas Mayne,
Left Wing,
2nd
Regt., M.N.L
admitted August 12th, 1873, is a low caste native grass-cutter, age about 50, with a wife and family, whose habits have been very irregular aud extremely dirty. He is indeed a wretched looking specimen of humanity, with a face swollen generally, so that his lips, nose, and eyelids are enormously enlarged and puffy, and these have an erysipelatous blush. He is not able to see. On enquiry from him it is found that he has had a running from the nose for some time past, and lie states also that it began at Bellary several months hack. Looking at the man, it appeared as if he was suffering from a large tumour occupying the nasal and supra-maxillary cavities. It became a question what this was. When he opened his mouth, a circular opening about the size of a pea with healed edges could be seen in the centre of the soft palate; old syphilis ? Passing the forefinger into the left nasal meatus a very diseased condition is found. On either side the passage is very much altered. The septum narium has become obliterated. There appear to be sinuses with ulceration, and the ascending portions of the superior maxillary bones are denuded of periosteum. There is a very offensive and watery discharge. August 13th.?Hospital Assistant Cunthasawmy has brought away by injections several fully-formed live specimens of the oestrus hominis, small white insects varying in size from 6 to 4 lines, and on myself injecting I succeeded in removing some more, but I failed entirely in discovering whence they came. rlhe swelling of the face gives him a most hideous look, and makes it painful to observe him. So offensive was the smell from the nose of the patient that ho had to be removed into a ward. separate 15th.?Patient much troubled by flies. These persist in hovering over him, and his caste people have forsaken him ; moreover, his wife and children cannot bear to come near him, and his food is brought to the door of the ward and there left. after a large amount of deodorants had been used, another examination was made. The ala of the left side of the nose was found to be sloughing, and the attachment was thereupon incised, so that that portion of the cavity within could be viewed; more parasites escaped, but it was not discovered
Patient,
To-day,
from what spot they camo. 18??. ?The non-appearance of a discharge, and the extremely offensive 3mell that is given off, point to sloughing internally,
and it is only on the application of large quantities of the solution of the permanganate of potash that this very distressing effluvimn can be overcome. visit.?Ho is much tormented by the flies, and two more maggots have dropped from the nose. There is considerable irritation in the nose. The ward has been white-washed. is about appear in the dark, but something serious to happen, as there is evidence externally of further sloughing, and this is at the-internal angle of the left orbit. 20th.?So much interest belonging to the case, and the condition of the nose altering for the worse, a consultation was obtained with the Deputy Surgeon-General, Nagpur Force, and with W. A. Smith, M.D., 2nd Madras Cavalry. ?Dr. Tribe thought that it was a remarkable case, and that he bad not seen one of the kind for many years. Operative interference was suggested to remove the nose. 21sf.?On the left side of the bridge of the nose two white spots were noticed, and on examination these were found to be larvse. This morning sloughing has much extended, and now there is a line of sloughy tissue from the first slough right across the bridge of the nose to the internal augle of the right orbit, and at my evening visit, in order that it might be seen what was
Evening
Things
Burgeon-Major
nues
good.
23rd.?The maggots are much fewer, and are smaller in size. 24th.?To-day no maggots seen. lie came under observation first 011 the 12th August 1873, and the last note I have of him is on the 25th August 1873. Here my notes end. He died about a week afterwards, and I saw him the night before he expired. I was called suddenly to him, and he was convulsed and lying on the floor of the ward. Usually he sat when I visited him. His breathing and pulse were much quickened, and the skin felt clammy. He appeared as if dying. Theso little worms I thought had been overcome, as they were noticed to get gradually less in number and size, but I had to remove one far back in the upper part of the pharynx on the afternoon before he died, and I saw another I could not reach at the base of the skull. The manner in which he died led me to supposo that the nerve centres had become infected. Unfortunately a post-mortem examination could not be made, the caste prejudices being in the way. In this case the application of very strong remedies, I do not think, would have been successful. The parts were daily cleansed, and the forceps had to be continually used. Deodorants and disinfectants had to be largely resorted to. Various substances were used to kill the maggots, and these were very successful, but unfortuuately they had goc out of reach. I have to return my thanks to Dr. W. Arnold Smith for many valuable suggestions in conducting the case.
causing this,
A CASE OF DEATH BY MAGGOTS.
By Surgeon
Thomas Mayne,
Left Wing,
2nd
Regt., M.N.L
admitted August 12th, 1873, is a low caste native grass-cutter, age about 50, with a wife and family, whose habits have been very irregular aud extremely dirty. He is indeed a wretched looking specimen of humanity, with a face swollen generally, so that his lips, nose, and eyelids are enormously enlarged and puffy, and these have an erysipelatous blush. He is not able to see. On enquiry from him it is found that he has had a running from the nose for some time past, and lie states also that it began at Bellary several months hack. Looking at the man, it appeared as if he was suffering from a large tumour occupying the nasal and supra-maxillary cavities. It became a question what this was. When he opened his mouth, a circular opening about the size of a pea with healed edges could be seen in the centre of the soft palate; old syphilis ? Passing the forefinger into the left nasal meatus a very diseased condition is found. On either side the passage is very much altered. The septum narium has become obliterated. There appear to be sinuses with ulceration, and the ascending portions of the superior maxillary bones are denuded of periosteum. There is a very offensive and watery discharge. August 13th.?Hospital Assistant Cunthasawmy has brought away by injections several fully-formed live specimens of the oestrus hominis, small white insects varying in size from 6 to 4 lines, and on myself injecting I succeeded in removing some more, but I failed entirely in discovering whence they came. rlhe swelling of the face gives him a most hideous look, and makes it painful to observe him. So offensive was the smell from the nose of the patient that ho had to be removed into a ward. separate 15th.?Patient much troubled by flies. These persist in hovering over him, and his caste people have forsaken him ; moreover, his wife and children cannot bear to come near him, and his food is brought to the door of the ward and there left. after a large amount of deodorants had been used, another examination was made. The ala of the left side of the nose was found to be sloughing, and the attachment was thereupon incised, so that that portion of the cavity within could be viewed; more parasites escaped, but it was not discovered
Patient,
To-day,
from what spot they camo. 18??. ?The non-appearance of a discharge, and the extremely offensive 3mell that is given off, point to sloughing internally,
and it is only on the application of large quantities of the solution of the permanganate of potash that this very distressing effluvimn can be overcome. visit.?Ho is much tormented by the flies, and two more maggots have dropped from the nose. There is considerable irritation in the nose. The ward has been white-washed. is about appear in the dark, but something serious to happen, as there is evidence externally of further sloughing, and this is at the-internal angle of the left orbit. 20th.?So much interest belonging to the case, and the condition of the nose altering for the worse, a consultation was obtained with the Deputy Surgeon-General, Nagpur Force, and with W. A. Smith, M.D., 2nd Madras Cavalry. ?Dr. Tribe thought that it was a remarkable case, and that he bad not seen one of the kind for many years. Operative interference was suggested to remove the nose. 21sf.?On the left side of the bridge of the nose two white spots were noticed, and on examination these were found to be larvse. This morning sloughing has much extended, and now there is a line of sloughy tissue from the first slough right across the bridge of the nose to the internal augle of the right orbit, and at my evening visit, in order that it might be seen what was
Evening
Things
Burgeon-Major
nues
good.
23rd.?The maggots are much fewer, and are smaller in size. 24th.?To-day no maggots seen. lie came under observation first 011 the 12th August 1873, and the last note I have of him is on the 25th August 1873. Here my notes end. He died about a week afterwards, and I saw him the night before he expired. I was called suddenly to him, and he was convulsed and lying on the floor of the ward. Usually he sat when I visited him. His breathing and pulse were much quickened, and the skin felt clammy. He appeared as if dying. Theso little worms I thought had been overcome, as they were noticed to get gradually less in number and size, but I had to remove one far back in the upper part of the pharynx on the afternoon before he died, and I saw another I could not reach at the base of the skull. The manner in which he died led me to supposo that the nerve centres had become infected. Unfortunately a post-mortem examination could not be made, the caste prejudices being in the way. In this case the application of very strong remedies, I do not think, would have been successful. The parts were daily cleansed, and the forceps had to be continually used. Deodorants and disinfectants had to be largely resorted to. Various substances were used to kill the maggots, and these were very successful, but unfortuuately they had goc out of reach. I have to return my thanks to Dr. W. Arnold Smith for many valuable suggestions in conducting the case.
![[Infested sore by native maggots].](/assets/img/hold.png)
