SUPPLEMENT 731 



upper extremities (Samson, Meade and Freeman, Hutchins, Sokoloff, 

 v. Harlingen, Brodier and Fouquet, Shelmire, 1 Stelwagon), on the 

 face (Sokoloff, Moorhead, Kumberg, 2 Rawnitzky, Crocker, Boas 3 ), 

 on the neck (Sokoloff), and on the body (Ehrmann, Brodier and 

 Fouquet, Kaposi, 4 Topsent 5 ). 



The duration of the affection varies very much ; it varies between 

 a few hours and some years 6 ; several times a spontaneous recovery 

 has been reported. 



The diagnosis of the disease is not at all difficult owing to its 

 peculiar appearance. 



The treatment can only consist in the removal or killing of the 

 larvae, since one cannot rely on spontaneous recovery, even if it has 

 occurred in some cases. If one should succeed in locating the larva 

 as a black spot at the end of the tract, its removal by means 

 of a needle is the simplest method (Quortrup and Boas 7 ). In 

 some instances a cure has been successfully accomplished by excision 

 of the active end of the tract (v. Neumann and Rille, Schmid). In 

 opposition to this method, which not all patients will allow, the 

 method practised by Arab women (Rille and Riecke 8 ) of killing the 

 worm with red hot needles is quite rational. Shelmire 9 used the 

 electrolytic needle for the destruction of the maggots, Stelwagon 10 

 made use of cataphoresis, by means of which he applied a sub- 

 limate solution, afterwards cauterizing with a drop of nitric acid, 

 as excision was refused. Crocker 11 and v. Harlingen 12 injected 

 small quantities of carbolic acid ; Moorhead 13 by a single freezing 

 of the skin with ethyl chloride, attained a definite cessation of the 

 attack at the active end. Hutchins 14 in one case made use of hypo- 

 dermic injection of a few drops of solution of cocaine and afterwards 

 of i to 2 drops of chloroform ; in a second case of repeated applica- 

 tions of tincture of iodide, as Lenglet and Delaunay 15 did. 



1 Shelmire, Jotirn. Ctit. Dis., 1905. 



2 Kumberg, St. Peter sb. med. Wochenschr., 1898. 



3 Boas, Monatsh.f. prakt. Derm., 1907, xliv. 



4 Kaposi, Wien. klin. Wochenschr., 1898. 



5 Topsent, Arch, de Par., 1901. 



6 [This is extremely unlikely, as the bots of Hypoderma only live for nine or ten months 

 at the most ! F. V. T.] 



7 Quortrup and Boas, Hospitalstid., 1907. 



8 Rille and Riecke, " Handb. d. Hautkrankh.," v. Mracek, 1907, iv. 



9 Shelmire, he. cit. 



10 Stelwagon, he. cit. 



11 Crocker, loc. cit. 



12 v. Harlingen, loc. cit. 



13 Moorhead, Texas Med. News, 1906. 



14 Hutchins, Journ. Cut. Dis., 1906. 



15 Lenglet and Delaunay, loc. cit. 



4 6 



