10 MISC. PUBLICATION 631, U. S. DEPT. OF AGRICULTURE 



On taking the towel from the patient's head the nurse observed fly larvae, 

 which had been forced into activity by the treatment, crawling over the towel, 

 hair, and down the cheeks. The nurse estimates that she killed twenty-five or 

 thirty larvae in the hour and a half she spent in removing them and still the 

 hair and scalp remained full of them. Back of the ears the mass of living larvae 

 was so great that they could almost have been spooned out. At this time the 

 patient complained of a buzzing in the ears similar to that occurring when the 

 ears are full of water, and said that she could not hear. The nurse then used 

 toothpick swabs to remove the great quantity of larvae found in the pinnae of 

 the ears. 



Infestation of wounds may result fatally, especially when the 

 etiological agent is Wohlfahrtia ??iagnifica, Callitroga americana, or 

 Chrysomya beszwna. The seriousness of the infestation depends upon 

 the species involved, the number of parasites, the depth and extent 

 of the damage, and the part of the body affected. 



Though entrance is usually made through a sizable wound, it is not 

 necessarily so. Callitroga americana may infest a minor injury, such 

 as a scratch, a stubbed toe, or a cut received from trimming ingrowing 

 toenails. Sheep and lambs often become infested through wounds 

 caused by needlegrass (Stipa spp.). In fact, the maggots have been 

 shown to be capable of entering the unbroken skin of guinea pigs 

 and rabbits, and at least one human case of what appears to be this 

 infestation has been recorded (Mazza and coworkers, 87). Wohlfahr- 

 tia magnifica is said to enter wounds as small as those made by the 

 bite of a tick. Secondary infestation by various species may take 

 place through leprous, cancerous, syphilitic, and other types of sores 

 and lesions. 



The presence of maggots in wound tissue, however, does not always 

 indicate a dangerous condition. Many of the Sarcophagidae, Calli- 

 phoridae, and Muscidae found in wounds are merely scavengers, and 

 their presence may be actually beneficial. The widespread use of 

 certain strains of blowfly and sarcophagid maggots in surgical treat- 

 ment of suppurating wounds in the 1930 ? s is a testimonial of this. 

 The fact that what is supposedly a single species, for example Phaenicia 

 sericata, may under certain circumstances be a scavenger and under 

 others a serious parasite is hard to explain. The subject needs a great 

 deal of further research. 



MYIASIS OF THE NOSE, MOUTH, AND ACCESSORY SINUSES 



Two types of myiasis affecting the nose, mouth, and the accessory 

 sinuses are known. The more serious of these, called peenash in India 

 and bicheiro in tropical America, is caused chiefly by Callitroga ameri- 

 cana, Wohlfahrtia magnifica, and Chrysomya bezziana; it often ac- 

 companies myiasis by the same species of a head injury, ulcer, lesion, 

 or other traumatism. It usually begins with tickling or prickling sen- 

 sations and a general feeling of uneasiness in the nasal region. The 

 patient often reports having experienced a fly entering the nose at such 

 a time that he Avas powerless to interfere, or having slept in the open 

 during the daytime. The nose and face quickly become swollen, and 

 intense headaches, usually accompanied by fever, develop. The breath 

 becomes bad, and a discharge consisting of a mixture of pus and blood 

 is passed through the nose. The patient is in intense pain, more 

 severe at times, but more or less constant. If untreated, severe infesta- 

 tions often result in death. The septum of the nose may fall in, 



