One very characteristic symptom consists in the peculiar swelling of the face, which is extended either over the whole or only one half of it, and may alternate with attacks of erysipelas (Brokaw[1110]).
The discharge from the nose is of special diagnostic value. It consists of a blood-stained serous matter or blood-stained fluid, which is perpetually trickling from one or both nostrils. The larvæ especially choose the anterior portions of the nasal cavity, where they can be seen lying in groups together at the base of the choanæ. The consequence of this is that the soft palate becomes intensely swollen, and this in turn makes swallowing very difficult; speech is impeded, and the voice acquires a nasal intonation. Symptoms of fever become more or less pronounced according to the number of larvæ present, and according to the nature and constitution of the individual. The appetite is in abeyance throughout the whole duration of the illness, and sometimes there is the onset of slight attacks of diarrhœa.
If the larvæ are not removed in good time there follows excessive destruction of the interior of the nose and of the turbinals; and the whole nasal framework undergoes disintegration, frequently, too, the velum palati, so that the larvæ come into sight in the oral cavity. Individuals thus severely attacked succumb through exhaustion, symptoms of meningitis (cerebral abscess) or septicæmia (Prima[1111]). Twenty-one out of thirty-eight cases recorded (collected) by Maillard[1112] died.
The method of prophylaxis is self-evident from what has been stated. On bright summer days neither the healthy nor those suffering from diseases of the nose should sleep during the day-time in the open or in public habitations; sufferers from nasal diseases should pay special attention to this.
Treatment consists in the removal of the larvæ; this, however, is not always easy.
With regard to the methods which have proved to be effectual in the destruction of living larvæ and their expulsion from the nose, strongly smelling and easily diluted fluids come first, such as alcohol, eau-de-Cologne, and ether, which should kill the creatures when injected into the nostrils. The earlier physicians, such as Salzmann,[1113] Honold,[1114] and Henkel,[1115] have seen good results from the use of these methods, whilst Mankiewicz[1116] and Goldstein[1117] obtained no results whatever. Kimball’s[1118] careful investigations have shown that a decoction of bitter herbs recommended by Behrends[1119] (tansy, wormwood) have just as little effect as the tobacco decoction employed by Boerhave[1120] and Kilgour.[1121] The sternutatories employed by the older physicians are entirely neglected. Delasiauve[1122] experienced good results from the inhalation of the smoke of paper cigarettes, which were soaked with a solution of 2·0 pot. arsenic in 30·0 distilled water. Whilst, according to Kimball, balsam of Peru had no effect on the larvæ, Mankiewicz succeeded in removing the larvæ from the nose with the help of that drug. Turpentine steam or mixtures of turpentine employed by Indian physicians have not been very effectual according to Moore,[1123] Kimball and Goldstein. Success has been attained in some cases by the use of insufflations of calomel (Roura,[1124] Cerna,[1125] Schmidt[1126]) or of iodoform (Pascal[1127]). Joseph[1128] recommends concentrated alum solution being sniffed up into the nose as very effectual. Sublimate and carbol solutions do not appear to be very successful (Kimball, Moore, Goldstein), whilst benzine inhalations (Pierre[1129]) have shown better results. Scheppegrell[1130] strongly recommends injections of oil which kill the larvæ, while it is perfectly harmless to the nasal mucosa. Cesare[1131] employed nasal lavages with solutions of salicylate of soda with good results, and Calamida[1132] lavages with physiological saline solution. Bresgen[1133] recommends the nose being cocainized and the larvæ being removed with a pincette. Roorda-Smit[1134] cocainized the nose, then insufflated calomel and plugged the nose with a gauze tampon dusted with calomel. After two hours fifty-six larvæ crawled out along the plug. Continuation of the treatment resulted in a complete cure.
Injections of chloroform water (Jourdran[1135]) or chloroform inhalations, or injections of pure chloroform into the nose, have proved the most effectual (Goldstein,[1136] Osborn,[1137] Jourdran, Durham,[1138] Jennings,[1139] Kimball,[1140] Mackenzie,[1141] Oatmann,[1142] Zarniko,[1143] Antony,[1144] Folkes[1145]). Camphorated carbolic solutions are very well spoken of: Grayson[1146] states that these kill the larvæ immediately. Some authors have removed the larvæ with forceps (Goldstein[1147]), others with pincettes; thus Brokaw extracted 200 fragments with the forceps, Pascal eighty fragments with the pincettes, and Wolinz[1148] also appears to have removed the larvæ with forceps.
Greater operative measures than these do not appear to have been undertaken in latter days; yet Morgagni[1149] states that the army surgeon, Cæsar Mogatus, at Bologna, first trephined the frontal sinus and then extracted a “worm” from it.
Larvæ of other Muscidæ have come under observation much more rarely (Cheval[1150] [larvæ of Galleria mellonella[1151]], Bond,[1152] Dumesnil[1153] [larvæ of Piophila casei]). Species of the genus Scolopendra (Myriapoda), which all shun the light and seek their food during the night—which consists of animal and vegetable substances—frequently make their way into the nasal cavities of people when asleep. They are found not only in the nose, but in the accessory cavities. In the chapter on the “Parasites of the Nose”[1154] we have collected striking instances, but we have omitted to mention the observation made by Bertrand[1155] (Scolopendra in sinus maxillaris) and that made by Bergmann[1156] (Scolopendra in sinus frontalis). In the same chapter some remarks are made as to the occurrence in the nose of earwigs, caterpillars, scorpions and termites, as well as of animals which have not been identified.
The larvæ that develop in the auditory meatus penetrate the membrana tympani, destroy the middle ear and may produce meningitis and intracranial suppurations. In one case Vesescu[1157] extracted seven living larvæ from the ear with the aid of a thin pair of pincettes. Köhler[1158] recommends the infusion of drops of ol. terebinth. to destroy the larvæ, Quintano[1159] the insufflation of the following powder: Oxid. hydrarg. rubr., sulfur., āā 1·0 grm., pulv. gi. arab. 8·0 grm.; Lesbini[1160] recommends tincture of iodine. In the case reported by Henneberg[1161] the larvæ were those of Lucilia cæsar.