SUPPLEMENT 727 



insects contained in the dejecta. Another clinically important factor 

 is the passing of the larvae in batches. While for some time no larvae 

 may appear in the stools, they may suddenly be ejected in great 

 numbers, either because the conditions of feeding are not suitable, 

 or because medicaments remove them from the intestine. The 

 haemorrhage is ascribed by Schlesinger and Weichselbaum directly 

 to lesions of the mucous membrane caused by the larvae ; in the case 

 reported by these writers there were found shreds of tissue as well as 

 pus in the stool. The pains occurring spontaneously in the abdomen 

 are at times influenced by position and attitude of the body, often 

 they were more violent after rest and after evacuation of the bowels ; 

 often they were continuous, but in that case less intense ; pressure on 

 the abdomen is generally little felt. The condition of the blood was 

 in two cases (Pasquale 1 and Schlesinger and Weichselbaum) a marked 

 chlorotic one. The state of nutrition seems almost always to suffer 

 with prolongation of the disease, but in Peiper's 2 cases this was not 

 so. The condition of the appetite was in some instances good, in 

 others very bad. A frequent symptom is headache of a migraine-like 

 character and neuralgic pains in different parts. 



Schlesinger and Weichselbaum's case shows that there are forms 

 of myiasis intestinalis which, after prolonged sickness, lead to death, 

 and that in consequence of the formation of intestinal abscesses 

 stricture of the intestine may arise from the subsequent formation of 

 a scar. 



The question of the mode of infection is interesting ; in this 

 month, nose and anus must be considered. The most frequent way 

 is certainly by means of food on which flies have laid their eggs, or 

 which is permeated with young maggots. This may be raw (especially 

 grated) meat, cheese, fruit, salad, milk, cabbage, cold farinaceous 

 foods, raspberries. When the stomach is affected, when the gastric 

 juice has lost acidity and power of digestion, the larvae will be able 

 to stay and develop more easily. According to Csokor, 3 if the eggs 

 get into the gastro-intestinal canal of man with the food, the delicate 

 stages of the young larvae would certainly not survive the action of 

 the gastric juice. Salzmann 4 assumed that the invasion occasionally 

 occurred through the rectum, the larvae creeping into the anus while 

 the person is asleep. Wirsing accepts this method of infection for 

 two of his cases, where it was a question of the infection of an infant. 

 Salzmann 4 reports a case where the maggots of Anthomyia 5 scalaris 



1 Pasquale, Centralbl.f. Bakt., 1891. 



2 Peiper, " Fliegenlarv. als gelegentl. Parasiten d. Menschen," Berlin, 1900. 



3 Csokor, Wien. klin. Wochenschr., 1901, p. 129. 



4 Salzmann, Wurttemberg. med. KorrespondenzbL 1883, liii. 



3 [This is presumably Homalotnyia (Fannia) scalaris. F. V. T.] 



