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tissues. If I remember rightly (the account was given to me orally, 
not in writing, and possibly I may not get all minor particulars in 
proper sequence), it was not considered advisable to anvesthetize the 
patient, and her sufferings from the parasite and the surgical opera- 
tions can be better imagined than described. 
Twice or three times in as many days the physicians worked as long 
as they were able at the removal of the larvee, until they had over two 
hundred in alcohol. Some of these were taken from behind the tonsils, 
entirely out of sight, by means of peculiarly curved forceps directed with 
the most accurate knowledge of the anatomy of the parts. In the mean- 
time, suicidal mania had developed and the sufferer entreated her at- 
tendants to be allowed to end her life, even arguing with the doctor on 
the advantages which would accrue to her family, to say nothing of the 
relief to herself, if she were dead. Dr. B. said that he had since learned 
that all patients affected with Screw Worms required careful watching to 
prevent suicide, which, under the circumstances, is not at all surprising. 
On the eighth day no more larve eould be discovered and the patient 
seemed greatly relieved. Under the prescribed treatment the inflamma- 
tion rapidly subsided, and in the course of a few weeks recovery was 
complete without any permanent injury to any part. 
The specimens of larvee shown me were nearly all full grown, but, 
excepting the expulsion of those which first betrayed the nature of the 
trouble, none were ejected by sneezing or came awaynaturally, although 
they undoubtedly would have done so in the course of another day. 
I inquired if any of the extracted larve had been placed in earth to 
develop, but the doctor said, ‘“‘ No; not being an entomologist, the sub- 
ject was too revolting for him to care to pursue it further.” As to the 
origin of the attack, the lady had an indistinct recollection of some dis- 
turbance while taking a day time nap, perhaps in a hammock or near 
ap open window, but could not recall the fact of any insect attempting 
to enter her nose. In this case there was no catarrh or other cause of 
offensive breath so far as thfe doctor was aware. This case led Dr. B. to 
make inquiries as to the frequency of such attacks, and he learned that, 
with patients treated at the City Hospital, many of whom probably often 
slept in the daytime in the open air, the trouble was not unusual. As 
a favor to me he recently obtained the following statistics, which I copy 
from his note: 
The Assistant Superintendent of the City Hospital tells me that he remembers about 
six cases of Screw Worm invasion in the summer of 1888; four in 1889; three in 1890, 
and one, so far, during the present summer. One of these cases (1890) died from 
the exhaustion of the attack, and one died from another disease while affected with 
the worm. Others recovered, but with great mutilation. Several cases, especially 
those of 1888, came from Texas, but some were generated in this vicinity. 
Two cases of human attack by this insect were reported in the papers 
this summer from.as far north as Wisconsin. 
The practical lesson from this account is not to sleep out of doors in 
the daytime with the face uncovered. 
