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the iutergluteal furrow, about 2 or 3 iuches from tip of coccyx, and two 

 other similar, though smaller elevatious on the left side of the same fur- 

 row aud closely adjoiniug one another. The first, which was the most 

 prominent, was elevated at its highest portion about one-quarter of an 

 iuch from th.e level of the surrounding skin, and presented a circular area 

 of inflammatory hardness which measured about IJ inches in diameter. 

 Upon careful and minute inspection the largest furunculoid mass was 

 found to present in its most elevated and central portion a minute ori- 

 fice, which might admit the point of a coarse bristle. The other two 

 swellings presented also one central point each, where a little puriform 

 crust had become fixed, indicating the original seat of puncture aud 

 entrance to the larval sinus. 



Trusting to the patient's account of himself, we proceeded to the ex- 

 traction of the parasites — a procedure which the patient urgently re- 

 quested. Guided by the orifice in the elevation I cut with the point of a 

 bistoury into the very center of the swelling, but discovered, however, 

 that by simply cutting vertically I had not incised the cavity wherein 

 the larvae lay concealed, and was obliged to again incise obliquely and 

 to the right in order to expose the parasitic burrow. This oblique di- 

 rection of the larval sinus I found to be constant in each of the three 

 "stings." I found that the larvse were lodged immediately under the 

 derma proper, so that in getting at them, in order to expose them thor- 

 oughly, I had to cut completely through the skin, which, in the gluteal 

 region is particularly thick. It was discovered also that a simple in. 

 cision was insufficient to remove the larvse, and that digital expression, 

 and this very forcibly applied, was necessary in order to induce them 

 to relinquish their stronghold. In fact, the two last larvae were removed 

 more by this means than by incision, the orifice of the sinus having 

 been simply incised in order to enlarge the orifice of exit, and the parts 

 expressed by pinching them in a fold of skin. The patient stated that 

 in Honduras the natives usually rid themselves of these unpleasant 

 guests by applying hot tobacco ashes to the parts and following this 

 up by digital exi^resslon. This is a rather general treatment for para- 

 sitic dermal affections in Latin -American countries where tobacco is 

 always on hand. In our patient's case we cauterized the cavity or sinus 

 left by the evacuation of the larvae with pure carbolic acid, for fear that 

 the septic products of larval nutrition might tend to create inflamma- 

 tory mischief. I was led to this precaution because of the unfortunate 

 results which followed the extraction of similar parasites in another 

 case, that of a Frenchman, also from HonduraSj who was admitted in 

 the same ward during my absence, about twelve months before, and 

 who nearly succumbed to a most violent and disastrous attack of erysip- 

 elas, which supervened immediately after the slight traumatism inflicted 

 in the extraction. The larvae had been deposited in the inner surface 

 of the left arm, and from this point the inflammation spread on all sides, 

 swelling up the whole extremity and left thoracic region. Subcutaneous 

 6591—1^0. 3 2 



