138 REVIEW — TROPICAL IIEDIOINK, KTC. 



Myiasis— Sudan, and Mr. King deals with it in his section of the Third Report. In the same number 

 contitmcd of the journal tlioro is an account of the fly from a medical standpoint, written by 

 Major Smith. Ho says : — 



The larva of the Tiiinbu fly Ijurrows beneath tlie skin of human beings and otlier animals, .'iiid becomes 

 stationary. The cavity in which it lives is not cut off from tlie external air ; au opening is always left, and in or 

 near this the posterior end of the maggot lies. When mature it drops out, burrows into the ground and becomes 

 a pupa. 



Experimenting with immature larvae, Smith found the flics to appear on the sixteenth 

 and seventeenth days. 



In the human being the appearance of the lesion produced Ijy the larva is that of a raised, reddish patch ; 

 on a clean washed skin it looks something like an urticarial wheal. At some part of this swelling will be seen a 

 tiny opening, or a moist spot, perhaps a blackish mark, according to how much, if any, of the larva is presenting 

 at tlie opening, and to the stage of growth. In some eases, where the skin has not been washed, pus may 

 have exuded and scabljed around the orifice, so that the appearance is that of a broken boil. There is inteu.se 

 itching in and around the .sjjot. Strong pressure towards the opening forces the larva out easily enough, so 

 that in adults familiar with the fly the larva does not get a chance to grow very big, unless it happens to be in a 

 part whore the sufferer cannot see what is wrong. In neglected children and helpless people the larva is able to 

 grow to its full size. In such cases there is usually suppuration in the cavity, and it is common, on ejecting the 

 intruder, to see a bleb of pus follow it out. No serious results are known to ensue, but an avenue is provided for 

 the entry of germs. 



" Tumbu " have been found in men, dogs, monkeys, rats and imported guinea pigs. 



In European.s, who are not commonly attacked, the scrotum is a usual site, in negro 

 natives the head, but no part of the body is exempt. Babies are often affected. The 

 ordinary and commonest mode of infection is undoubtedly from the ground. 



Blenkinsop' also has some notes on this disease as it occurs in Sierra Leone. He 

 mentions that multiple infection is common, and that in Europeans the upper parts of 

 the thigh and the buttock arc favourite sites for the larvce. This favours the view tliat 

 tliey are often acquired at the latrine. He describes the lesions as resembling fuiunculi 

 and being at times extremely painful. Examination of the central area of the inflammatory 

 zone reveals the presence of some black matter, the excrement of the larva immediately 

 beneath the skin surrounding the minute breathing aperture. On pressure over this spot 

 intense pain results. In ordinary cases the pain is paroxysmal. Irritation may lead to 

 abscess formation. Blenkinsop gives the following as serving to differentiate the lesions 

 from boils : — 



(1) The presence of the black e-xcrement ; (2) the pain caused by gentle and continuous pressure on the 

 breathing aperture; (3) the paroxysmal character of the pain, which is generally unaccompanied by throbbing. 

 As regards treatment, the larva can usually be easily removed entire with the point of a surgical needle, and the 

 small wound should then be w.ashed out and dressed antiseptically. If suppuration has occurred, free incision is 

 necessary. 



Blenkinsop notes that a plaster of soap and sugar caused the larvte to appear at the 

 surface in less than twelve hours, and considers that this result was probably due to 

 blocking of the breathing aperture with the plaster. 



Lelean^ has an interesting article on Myiasis, and we quote here his notes on 

 treatment : — 



In a gusano worm the larva of a " mosquito-like " fly found in Guatemala, the natives (1) occlude the orifice 

 of the cavity in which the larva is contained by a piece of stamp paper ; the air-breathing parasite, being thus 

 asphjrxiated, can be expressed; (2) cover the aperture with a tobacco-leaf, the nicotine poisoning the grub. 



Dr. Polker uses a hypodermic of chloroform which so paralyses the larvae that he has by this means expressed 

 as many as fourteen in less than two minutes, a velocity which commands respect. The Dermatobia noxialis 

 (screw-worm) is killed in the frontal sinus by carbolic injections of 2 per cent, solution. 



In the auditory meatus the larvse often cause so much tenderness as to make mechanical extraction impassible. 

 A little calomel blown into the meatus is said to cause their death and spontaneous extrusion. 



Lieutenant-Colonel J. Smith, writing of Indian experience, found maggots ingested in mangoes most difficult 

 to dislodge, a fact not to be wondered at when they survived five minutes' immersion in pure carbolic acid. One 

 patient passed from fifty to a hundred larvre daily for twelve months, and intensely feared their eating through 

 the intestine. One case was cured by encmata tcrcbinthinse ; another was on butea frondosa, and in a third- 

 parasiticides having no effect — scybala were produced by opium, and the embedded maggots came aw.ay by 

 subsequent use of purgatives and encmata. 



Finally, in huts infested by diptera, if cones of dried pyrethrum powder be burnt, the flies fall stupefied to 

 the floor, whence they can be collected and burnt. 



' Austen, E. E. (January, 1908), "The Tumbu Fly {Cordylobia anthropophaga, Qrlinberg)." Journal of the 

 Royal Army Medical Corps. 



'' Lelean, P. S. (January 30th, 1904), "Notes on Myiasis." British Medical Joiumal, Vol. I. 



