718 THE ANIMAL PARASITES OF MAN 



more or less severe periods. Violent headaches in the frontal and 

 buccal regions are almost always present in this complaint; they are 

 experienced either only on one side or on both simultaneously ; 

 sometimes the pain is extended to the lower jaw and region of the 

 neck, following the whole extent of the trigeminal nerve. The 

 inflammation of the nasal mucosa produced by the penetration into 

 it of the larvae extends right into the frontal sinus and antrum. 

 Simultaneously the patients, at the height of their trouble, suffer 

 from persistent sleeplessness and severe vertigo, so that they reel and 

 cannot walk straight ; excessive sneezing always sets in at the com- 

 mencement. The larvae immediately spread over the nasal mucosa to 

 seek a place suitable to feed, and irritate the nasal mucous membrane 

 by the tickling sensation they produce. Later the patients frequently 

 sneeze when the maggots move to and fro. 



One very characteristic symptom consists in the peculiar swelling 

 of the face, which is extended either over the whole or only one half 

 of it, and may alternate with attacks of erysipelas (Brokaw 1 ). 



The discharge from the nose is of special diagnostic value. It 

 consists of a blood-stained serous matter or blood-stained fluid, 

 which is perpetually trickling from one or both nostrils. The larvae 

 especially choose the anterior portions of the nasal cavity, where they 

 can be seen lying in groups together at the base of the choanae. 

 The consequence of this is that the soft palate becomes intensely 

 swollen, and this in turn makes swallowing very difficult ; speech is 

 impeded, and the voice acquires a nasal intonation. Symptoms of 

 fever become more or less pronounced according to the number 

 of larvae present, and according to the nature and constitution of the 

 individual. The appetite is in abeyance throughout the whole dura- 

 tion of the illness, and sometimes there is the onset of slight attacks 

 of diarrhoea. 



If the larvae are not removed in good time there follows excessive 

 destruction of the interior of the nose and of the turbinals ; and the 

 whole nasal framework undergoes disintegration, frequently, too, the 

 velum palati, so that the larvae come into sight in the oral cavity. 

 Individuals thus severely attacked succumb through exhaustion, 

 symptoms of meningitis (cerebral abscess) or septicaemia (Prima 2 ). 

 Twenty-one out of thirty-eight cases recorded (collected) by Maillard 3 

 died. 



The method of prophylaxis is self-evident from what has been 

 stated. On bright summer days neither the healthy nor those suffering 



1 Brokaw, j^Seifert, in Heymann's "Handb.," p. 595. 



2 Prima, "These de Paris," 1881. 



3 Maillard, " These de Montpellier," 1870. 



