THE FLIES THAT CAUSE MYIASIS IN MAN 9 



gratory forms, larvae infesting the intestinal and urogenital tracts, 

 forms infesting the head passages, and bloodsucking forms (Bishopp, 

 Laake, Brundrett, and Wells, 17). A similar but somewhat more ex- 

 tended classification has been used by Townsend and others. Such a 

 classification, as indicated by Patton, has the objectionable feature that 

 many species of flies will fall into two or more categories, but it will 

 better serve the needs of the physician who must make a diagnosis and 

 prescribe treatment. 



The classification used in this work is as follows: Traumatic 

 (wound) myiasis; myiasis of the nose, mouth, and accessory sinuses; 

 aural myiasis; ocular myiasis, internal and external; myiasis of the 

 anal region and vagina ; myiasis of the bladder and urinary passages ; 

 furuncular, dermal, or subdermal myiasis; creeping, dermal, or sub- 

 dermal myiasis; and enteric (gastrointestinal, gastric, or intestinal) 

 myiasis. In addition to the forms of true myiasis, attacks by blood- 

 sucking larvae are also considered as a related phenomenon. 



TRAUMATIC (WOUND) MYIASIS 



Infestation of wounds in man and animals by dipterous larvae is 

 common. Often the infestation is benign, as when festered, mal- 

 odorous wounds are attacked by secondary invaders which confine 

 their activity to the diseased tissue, but when primary parasites or 

 secondary invaders that burrow below the superficial necrotic tissues 

 are present, results can be and often are serious. The literature 

 abounds in case histories and general accounts; the following will 

 serve as examples. 



Galli-Valerio (J/3) cites a case of myiasis so serious that it resulted 

 in the amputation of a hand. A farmer in Valais, Switzerland, suf- 

 fering from actinomycosis complicating a wound on the left hand, had 

 been given a treatment which had reduced the ailment to a small 

 nodule. After returning to field work, the patient noticed that the 

 nodule had become ulcerated, and one day he squeezed a large number 

 of maggots out of the wound. In spite of Galli-Valerio's advice, the 

 condition was allowed to progress to the point that, when a surgeon 

 was finally consulted, the hand had to be amputated. Maggots were 

 reared and found to be Lucilia caesar. 



Onorato (96) cites a case in which a young man of 18, injured by a 

 blow received from the backfire of a gun, had lain for several days in 

 a comatose state and was finally brought to the hospital in a critical 

 condition. Maggots of Phaenicia sericata had invaded the scalp wound 

 produced by the injury and had formed numerous ulcers on the thorax ; 

 in addition, they had invaded the oral and nasal cavities, exposing the 

 maxillary and palatine bones in several places, eating away the floor 

 of the nasal cavity to the bone, and perforating the tympanum of the 

 right ear. In spite of the severe injury, the patient recovered. 



The action of the maggots may cause intense pain. Stewart {US) 

 gives a case history of the infestation of a malodorous, suppurating 

 scalp sore by Phormia regina. The patient was admitted to the hos- 

 pital for treatment of the sores, and after the second treatment with a 

 supersaturated sulphur wash — 



. . . the patient became very restless, working the fingers into the palms of her 

 hands and alternately putting her hands to her ears. Soon she began to scream, 

 acted frantic, and became nearly delirious. She was given a sedative without 

 effect. 



