202 



TROPICAL MEDICINE AND HYGIENE 



A strong permanganate of potash lotion is often effective, 

 but turpentine and water is more so. If the larvae are 

 removed early the irritation soon subsides. If the nature 

 of the case is not recognized in some forty-eight hours or 

 so, the cellulitis will have greatly increased, there will be 

 a black discharge from the nostrils, the skin over the 

 bridge of the nose perforated, and symptoms of general 



FlG. 78. Chrysomyia macellaria. 



septicaemia and possibly of meningitis. The larvae will 

 probably be seen readily, but as their heads are buried 

 deep in the tissues are less readily removed. Treatment 

 should be on the same lines in the hope that necrosis and 

 suppuration in the ethmoid cells have not been set up. 

 If the patient survives, in another forty-eight hours or so 

 the larvae, now fully mature, will escape naturally, as they 

 do not pupate in their host. They escape by the nares as 

 a rule, or through the perforation in the bridge of the 



