stimulants, and carefully tended. Frequent irriwith chlorine solution and loose packing
gations
A
with iodoform gauze were adopted. The morning after admission, although a great deal of time had been spent removing the maggots the evening before, about 30 additional ones were taken out. After this no more living spec:mens The following is a short history were found. of the case:?
G&SE
/
/
OF MYIASIS OF THE FRONTAL AND ETHMOIDAL SINUSES AND
THE ORBIT. By
v
R.
m-b., ch.
E. WRIGHT, MAJOR,
Superintendent, Government Ophthalmic Hospital, Madras-
With
an
Entomological Note
By W. S- PATTON,
(Edin.)>
h.b-
MAJOR, I-M.S.
the 23rd November, 1920, a Hindu named Rangamma, aged 30, was led into the out-patient department of the Government Ophthalmic Hospital, Madras, as she was unable to see. She had an offensive odour, and her on unwrapping a cloth from the region of forehead, the reason was obvious. The supraand orbital inter-orbital region from the external angular process on the left to f in. beyond the middle line on the right, was represented by a large gutter full of muco-pus and grey sloughing material, alive with maggots. Not only had the skin of the brows been destroyed over this area, but the glabella, nasion, and left superciliary ridge had disappeared, together with the orbital plate of the frontal bone on the left and part of that on the right. The lacrymals had disappeared, and the ethmoid Thewas undergoing carious destruction. frontal sinuses above, the ethmoid cells and nasal fossae below, and the apex of the right orbit behind were involved in the base of the ulcer. The dura was not exposed. The eye-balls both were bounded the ulcer externally, proptosed and pushed to the temporal sides, the left more so than the right. The corneas were covered by the oedematous upper lids, which drooped owing to the severance of their attachments above, and to the inner side. The left cornea showed a large central ulcer, the right On
woman
healthy. Right eye vision?fingers
was
at
one
foot.
Left eye vision=P. L. The upper and right margins of the ulcerated area were markedly elevated, being composed of shelved away into a gummatous mass which healthy tissue high up on the forehead. There was a copious discharge from the anterior nares. The patient was very weak, her pulse feeble and the temperature sub-normal. She was admitted into hospital and the foul smelling cavity cleaned with permanganate solution, up by irrigation turpentine applications, cutting away of sloughs, and removal of the maggots with forceps, about 50 of which were extracted in this way. She was put to bed and given liquid diet and
The woman is a resident of Valpadi, in the Guntur district. Her first recollection of her complaint was that she had left-sided headache a year ago. Gradually the eye-brows and eyelids became swollen. Her sight was good until some months ago when she went to a doctor, who opened the swelling, after which an ulcer developed. She had a discharge from the nose when she went to the doctor, and this gradually increased. She did not have any fever. She is married and had four children: the first two died shortly after they were born, the second two are alive. She tends cattle in the fields, and they are housed at night close to where she sleeps. The maggots first made their appearance three days before she came to hospital. She does not
j
*
know of any other person in that locality having been affected with maggots. Her husband died some years ago. There is no history of syphilis, and the Wassermann reaction is negative. The living maggots were sent to Major Patton at Coonoor, who very kindly identified them, and has written a short note on the fly to which they belong. It is interesting to note that this is the fifth case of frontal sinus disease communicating with the orbit, which has been admitted to the Government Ophthalmic Hospital within the last two months. Two were syphilitic and two chronic catarrhal.
VENEREAL PAPILLOMA:
Feb., 1921.]
'
is still in hospital and is doing The prognosis is good for life, but fairly it is improbable that the left eye will be of any use as the muscular attachments are destroyed, She may and the cornea is badly ulcerated. get useful vision with the right eye, and muscular action may be partially restored, as apparently the muscles of the eye-ball are not involved in the necrotic process. In addition to the local treatment referred to above, the patient is, of The
patient
well.
course, receiving energetic The accompanying ment. some
anti-syphilitic photograph
treat-
gives
idea of the extent of the ulcerative process. Entomological Note. sent me two
batches of living others preserved in spirit and the case described collected from to be the mature larvre all above; they proved of Chrysomyia bczsiana Villeneuve. It will be remembered'that this fly is the specific-myiasis Calliphorine of India,
Major Wright
larvce, as formalin,
producing
well
as
only depositing
its ea(rs in the diseased tissues of man and animals. A complete description of it will be found in a recent number of the Indian Journal of Mcdical Research.
This case is of peculiar interest, for it is clear that the eggs were laid directly on the ulcerated surface and not in the nose, although the patient had a purulent discharge from the nostrils for some time. A nasal discharge often attracts the female besziana to oviposit just inside the nostrils, and the larvae penetrate into the various sinuses connected with the nose. Further, it should be noted that, though the larvae must have been very near the brain tissue,
VISUVALINGAM.
59
enter the skull. And this the fact that the larvae of besciana do not penetrate bone or cartilage, and that when these structures are destroyed, it does not mean that they have actually eaten their way through them. Their destruction can only be brought about by dissolution through the action of bacterial ferments. All muscid larvae only feed on fluid food, the substances or tissues on which they are feeding being dissolved by salivary and bacterial ferments. The patient only noticed the larvae three days before coming to the hospital for treatment, so that the eggs must have been laid at least ten days, earlier. Removal of the larvae in this case was a comparatively easy matter, as they had not migrated into the nose and antrum.
they did emphasises
not
gations
A
with iodoform gauze were adopted. The morning after admission, although a great deal of time had been spent removing the maggots the evening before, about 30 additional ones were taken out. After this no more living spec:mens The following is a short history were found. of the case:?
G&SE
/
/
OF MYIASIS OF THE FRONTAL AND ETHMOIDAL SINUSES AND
THE ORBIT. By
v
R.
m-b., ch.
E. WRIGHT, MAJOR,
Superintendent, Government Ophthalmic Hospital, Madras-
With
an
Entomological Note
By W. S- PATTON,
(Edin.)>
h.b-
MAJOR, I-M.S.
the 23rd November, 1920, a Hindu named Rangamma, aged 30, was led into the out-patient department of the Government Ophthalmic Hospital, Madras, as she was unable to see. She had an offensive odour, and her on unwrapping a cloth from the region of forehead, the reason was obvious. The supraand orbital inter-orbital region from the external angular process on the left to f in. beyond the middle line on the right, was represented by a large gutter full of muco-pus and grey sloughing material, alive with maggots. Not only had the skin of the brows been destroyed over this area, but the glabella, nasion, and left superciliary ridge had disappeared, together with the orbital plate of the frontal bone on the left and part of that on the right. The lacrymals had disappeared, and the ethmoid Thewas undergoing carious destruction. frontal sinuses above, the ethmoid cells and nasal fossae below, and the apex of the right orbit behind were involved in the base of the ulcer. The dura was not exposed. The eye-balls both were bounded the ulcer externally, proptosed and pushed to the temporal sides, the left more so than the right. The corneas were covered by the oedematous upper lids, which drooped owing to the severance of their attachments above, and to the inner side. The left cornea showed a large central ulcer, the right On
woman
healthy. Right eye vision?fingers
was
at
one
foot.
Left eye vision=P. L. The upper and right margins of the ulcerated area were markedly elevated, being composed of shelved away into a gummatous mass which healthy tissue high up on the forehead. There was a copious discharge from the anterior nares. The patient was very weak, her pulse feeble and the temperature sub-normal. She was admitted into hospital and the foul smelling cavity cleaned with permanganate solution, up by irrigation turpentine applications, cutting away of sloughs, and removal of the maggots with forceps, about 50 of which were extracted in this way. She was put to bed and given liquid diet and
The woman is a resident of Valpadi, in the Guntur district. Her first recollection of her complaint was that she had left-sided headache a year ago. Gradually the eye-brows and eyelids became swollen. Her sight was good until some months ago when she went to a doctor, who opened the swelling, after which an ulcer developed. She had a discharge from the nose when she went to the doctor, and this gradually increased. She did not have any fever. She is married and had four children: the first two died shortly after they were born, the second two are alive. She tends cattle in the fields, and they are housed at night close to where she sleeps. The maggots first made their appearance three days before she came to hospital. She does not
j
*
know of any other person in that locality having been affected with maggots. Her husband died some years ago. There is no history of syphilis, and the Wassermann reaction is negative. The living maggots were sent to Major Patton at Coonoor, who very kindly identified them, and has written a short note on the fly to which they belong. It is interesting to note that this is the fifth case of frontal sinus disease communicating with the orbit, which has been admitted to the Government Ophthalmic Hospital within the last two months. Two were syphilitic and two chronic catarrhal.
VENEREAL PAPILLOMA:
Feb., 1921.]
'
is still in hospital and is doing The prognosis is good for life, but fairly it is improbable that the left eye will be of any use as the muscular attachments are destroyed, She may and the cornea is badly ulcerated. get useful vision with the right eye, and muscular action may be partially restored, as apparently the muscles of the eye-ball are not involved in the necrotic process. In addition to the local treatment referred to above, the patient is, of The
patient
well.
course, receiving energetic The accompanying ment. some
anti-syphilitic photograph
treat-
gives
idea of the extent of the ulcerative process. Entomological Note. sent me two
batches of living others preserved in spirit and the case described collected from to be the mature larvre all above; they proved of Chrysomyia bczsiana Villeneuve. It will be remembered'that this fly is the specific-myiasis Calliphorine of India,
Major Wright
larvce, as formalin,
producing
well
as
only depositing
its ea(rs in the diseased tissues of man and animals. A complete description of it will be found in a recent number of the Indian Journal of Mcdical Research.
This case is of peculiar interest, for it is clear that the eggs were laid directly on the ulcerated surface and not in the nose, although the patient had a purulent discharge from the nostrils for some time. A nasal discharge often attracts the female besziana to oviposit just inside the nostrils, and the larvae penetrate into the various sinuses connected with the nose. Further, it should be noted that, though the larvae must have been very near the brain tissue,
VISUVALINGAM.
59
enter the skull. And this the fact that the larvae of besciana do not penetrate bone or cartilage, and that when these structures are destroyed, it does not mean that they have actually eaten their way through them. Their destruction can only be brought about by dissolution through the action of bacterial ferments. All muscid larvae only feed on fluid food, the substances or tissues on which they are feeding being dissolved by salivary and bacterial ferments. The patient only noticed the larvae three days before coming to the hospital for treatment, so that the eggs must have been laid at least ten days, earlier. Removal of the larvae in this case was a comparatively easy matter, as they had not migrated into the nose and antrum.
they did emphasises
not
