The localization of the affection is very varied; the primary seat has been observed on the glutei muscles (Lee, Kengsep, Morris,[1228] Rille, Seifert) and their surroundings (Stelwagon, Hamburger, Bruno), on the lower extremities (Stelwagon, Lenglet and Delaunay, Hutchins, Moorhead, Lee, Crocker, Schmid,[1229] v. Harlingen), on the upper extremities (Samson, Meade and Freeman, Hutchins, Sokoloff, v. Harlingen, Brodier and Fouquet, Shelmire,[1230] Stelwagon), on the face (Sokoloff, Moorhead, Kumberg,[1231] Rawnitzky, Crocker, Boas[1232]), on the neck (Sokoloff), and on the body (Ehrmann, Brodier and Fouquet, Kaposi,[1233] Topsent[1234]).
The duration of the affection varies very much; it varies between a few hours and some years[1235]; several times a spontaneous recovery has been reported.
The diagnosis of the disease is not at all difficult owing to its peculiar appearance.
The treatment can only consist in the removal or killing of the larvæ, since one cannot rely on spontaneous recovery, even if it has occurred in some cases. If one should succeed in locating the larva as a black spot at the end of the tract, its removal by means of a needle is the simplest method (Quortrup and Boas[1236]). In some instances a cure has been successfully accomplished by excision of the active end of the tract (v. Neumann and Rille, Schmid). In opposition to this method, which not all patients will allow, the method practised by Arab women (Rille and Riecke[1237]) of killing the worm with red hot needles is quite rational. Shelmire[1238] used the electrolytic needle for the destruction of the maggots, Stelwagon[1239] made use of cataphoresis, by means of which he applied a sublimate solution, afterwards cauterizing with a drop of nitric acid, as excision was refused. Crocker[1240] and v. Harlingen[1241] injected small quantities of carbolic acid; Moorhead[1242] by a single freezing of the skin with ethyl chloride, attained a definite cessation of the attack at the active end. Hutchins[1243] in one case made use of hypodermic injection of a few drops of solution of cocaine and afterwards of 1 to 2 drops of chloroform; in a second case of repeated applications of tincture of iodide, as Lenglet and Delaunay[1244] did. v. Harlingen[1245] allayed the affection in his first case by rubbing in sapo viridis and tar, in Kensep’s[1246] case the cure seems to have been accomplished by an ointment containing resorcin, in Meade and Freeman’s[1247] case by a 20 per cent. ichthyol paste. In our case we made exclusive use of Lassar’s paste; within four weeks a cure resulted, probably spontaneously, since one cannot ascribe any essential effect to this paste.
APPENDIX ON PROTOZOOLOGY,
Comprising Notes on Recent Researches, Formulæ of some Culture Media, and Brief Notes on General Protozoological Technique.
BY
H. B. FANTHAM, M.A., D.Sc.