i624 THE MYIASES AND ALLIED CONDITIONS 



feeding excites a violent reaction on the part of the body, which can 

 be exemphfied by the fever, the discharge, the pains, etc. 



Morbid Anatomy. — ^The morbid anatomy includes the destruction 

 of the nose, pharynx, hard and soft palates, larynx, etc. Fistulous 

 channels may be seen packed with larvse and extending in all 

 directions. 



Symptomatology. — Some couple of days after a person suffering 

 from a chronic catarrh, foul breath, or ozsena, has slept in the open, 

 or has been attacked by a fly when riding or driving — i.e., when the 

 hands are engaged — signs of a severe catarrh appear, accompanied 

 with inordinate sneezing and severe pain over the root of the nose 

 or the frontal bone. Quickly the nose becomes swollen, and later 

 the face also may swell, while examination of the nose may show the 

 presence of the larvae. Left untreated, the patient rapidly becomes 

 worse, and pus and blood are discharged from the nose, from 

 which an offensive odour issues. Cough appears as well as fever, 

 and often some delirium. If the patient lives long enough, the 

 septum of the nose may fall in, the soft and hard palates may be 



Fig. 723. — Chrysomyiamacellavia: Larva. (X4-) (After Blanchard .) 



pierced, the wall of the pharynx may be eaten away, exposing the 

 vertebrae, and even the hyoid bone may be destroyed. By this 

 time, however, the course of the disease will have become quite 

 evident by the larvae dropping out of the nose, and if the patient 

 continues to live all the larvae may come away naturally. 



Diagnosis. — ^Any case with the history of a fly having darted 

 into the nose should be assumed to be a case of nasal myiasis until 

 proved by careful nasal examination not to be so. The onset of 

 pecuhar sensations at the root of the nose and along the orbital 

 processes, together with the signs of an aggravated nasal catarrh 

 occurring in the endemic region especially in the months of July to 

 October, when the fly abounds in the Southern United States, 

 makes the diagnosis probable, and this becomes a certainty on finding 

 a larva by examination or douching. The onset of the severe 

 symptoms will clear the diagnosis if not evident at an earlier stage. 



Prognosis. — The prognosis is always serious, as it is difficult to 

 be sure that all the larvae have been removed. 



Treatment. — ^The best treatment is to douche out the nose with 

 chloroform water or a solution of chloroform in sweet milk (10 to 

 20 per cent.), and to follow this with douches of mild antiseptics. 



