201 



tissues. If I rcineinbcr ii«ilitly (tlir iiccouut was oivcii to me orally, 

 not ill wiitinji, and i»ossibly I may not j;>et all iiiiiioi- jtarticulars in 

 proper seciuence), it was not considered advisable to anu'stlietize the 

 l»atient, and her sutteiinj»s from tlvc parasite and the surgical opera- 

 tions can be better imagined than described. 



Twice or three times in as many days the physicians worked as long" 

 as they were able at the removal of the larvte, uutil they ha«l over two 

 hundred in alcohol. Some of these were taken from behind the tonsils, 

 entirely out of sight, by means of peculiarly curved forceps directed with 

 the most accurate knowledge of the anatomy of the parts. In the niean- 

 tinu', suicidal mania had <leveloi)ed and the sufferer eutreated her at- 

 tendants to be allowed to end her life, even arguing with the doctor ou 

 the advantages which would accrue to her family, to say uothiug of the 

 relief to herself, if she were dead. Dr. B. said that he had since learned 

 that all i)atients affected with Screw Woruis rec^uired careful watching- to 

 prevent suicide, which, under the circumstances, is not at all surprising. 



On the eighth day no more larva3eould be discovered and the patient 

 seemed greatly reheved. Under the prescribed treatment tlie inflamma- 

 tion rapidly subsided, aud in the course of a few weeks recovery was 

 complete without any permanent injury to any part. 



The specimens of larvae shown me were nearly all full grown, but, 

 excepting the expulsion of those which first betrayed the nature of the 

 trouble, none were ejected by sneezing or came away naturally, although 

 they undoubtedly would have done so in the course of another day. 

 I inquired if any of the extracted larvfe had been ])laced in earth to 

 develop, but the doctor said, " No; not being an entomologist, the sub- 

 ject was too revolting for him to care to pursue it further." As to the 

 origin of the attack, the lady had an indistinct recollection of some dis- 

 turl)ance while taking a day time nap, i)erhaps in a hammock or near 

 an open window, but could not recall the fact of any insect attempting 

 to enter her nose. In this case there was no catarrh or other cause of 

 oftensive breath so far as the doctor was aware. This case led Dr. B. to 

 make inquiries as to the frequency of such attacks, and he learned that, 

 with patients treated at the City Hospital, many of whom probably often 

 slept in the daytime in the open air, the trouble was not unusual. As 

 a favor to me he recently obtained the following statistics, \vhicli I copy 

 from his note: 



The Assistant Superiiiteudeut of the City Hospital tells me that he remembers about 

 six eases of Screw Worm invasion in the summer of 1888; four in 1889; three in 1890, 

 and one, so far, during the present summer. One of these cases (1890) died from 

 the exhaustion of the attack, and one died from another disease while affected with 

 the worm. Others recovered, but with great mutilation. Several cases, especially 

 those of 1888, came from Texas, but some were generated in this vicinity. 



Two cases of human attack by this insect were reported in the i)apers 

 this summer from as far north as Wisconsin. 



The practical lesson from this account is not to sleej) out of doors in 

 the daytime with the face uncovered. 



