THE PSEUDO-PARASITISM — OF — DIPTERA IN MAN — OR — IYI YIOSIS. BY HUGO SUMMA, A. M., M. D., PROFESSOR OF PHYSIOLOGY, HISTOLOGY AND PATHOLOGY, ST. LOUIS COLLEGE OF PHYSICIANS AND SURGEONS. SAINT LOUIS. WEISS & MACCALLUM, PRINTERS AND BINDERS, 3741 & 3743 N. BROADWAY. 1889. To my Teacher o yoi) Zien)ssei) Prof. Hu£ 7 PRIVY COUNCELLOR, This small pamphlet is affectionately dedicated by THE AUTHOR THE PSEUDO-PARASITISM — OF — DIPTERA IN MAN OR M Y I O S I S. BY i Hugo Stimma, A. IV!., M\ IT., PROFESSOR OF PHYSIOLOGY, HISTOLOGY AND PATHOLOGY ST. LOUIS COLLEGE OF PHYSICIANS AND SURGEONS. PREFACE. ''pHE following three articles were first published in the April, May and June 1889 numbers of the St. Louis Medical and Surgical Journal. Since the publication of Mr. Hope in the year 1840 it is the first time that this special medical object has been sub- jected to a closer investigation. I hope to have added some grains to the magnificent edifice of medical science. THE AUTHOR. St. Louis, August, 1889 3 ARTICLE I. STATISTICS. In the February, 1881), number of the St. Louis Medical and Surgical Journal, a note of our esteemed confrere, l)r. F. L. James, was published on Anthomyia Canicularis, the larv® of which were found in the vagina of a young lady suffering from nymphomania. As I have some knowledge and experience concerning the matter in ques- tion, I have taken the liberty of adding some interesting points to the above cited article. In order to solve the question on the parasitism, or better, pseudo-parasitism of diptera in man, it is necessary to emphasize the fact that only such reports should be taken into consideration in which the animal found in any portion of the human body has been either classified by an authority (entomologist), or in which we are ourselves enabled to classify the larv® from a detailed description, or better, from the illustrations fur- nished with the reports. At the beginning of my article I would like to state that the literature of this subject is not at all scanty, as Dr. James supposed it to be. When we confine ourselves to the accounts of diptera in man, we must, first of all, state that, with the probable exception of the so-called Oestrid®, all other larval forms of diptera are only pseudo-parasites. Even the larvae of different species of Oestrid® only occasionally occur in man. A very clear article, full of sharp criticism on pseudo-parasites, was written by my teacher in Zoology, the well-known Prof. Karl Theodor Ernst von Siebold, for the second volume of Rudolph Wagner’s “Ilandwcerterbuch der Physiologie,” a classical work in its time. In this work Siebolcl distinguishes three classes of pseudo-parasites from a practical standpoint: 1°. The first class includes such animals as only occasionally live in places which are inhabited by true parasites. 2°. A second class is formed by those animals which have been sup- posed inhabitants of other animals, but of which this latter is not certain. 3°. The third class of pseudo-parasites are those objects which, without being animals at all, have been considered parasites. These “pseudo-paras- ites fictitii” are especially useful in warning us and proving the fact that the truth, often being obvious, may only be recognized with difficulty. It is only the first class that will be considered here. To it belongs the larvae of various diptera which live on and eat decomposed animal substances fresh or decaying vegetable matters; that is, they seek, with preference, localities having a bad odor. Thus they may enter, as it is very easily understood, the human body, in a so to speak, active and passive manner. When they come in the neighborhood of a person with a foul smelling disease (for instance, diseases of the eyelids, ears, nose, flux albus, ulcers of the skin, abscesses, etc.), they are attracted by the odor and lay either their eggs or their maggots 1 near the diseased part. This is the more active way of invasion. On the other hand, the eggs and small maggots of dipterous insects are i. The different species of Sarcophagineae do not lay eggs, but bear maggots. swallowed by man, especially during the hot season. Under certain circum- stances, these ingested fly-maggots continue to live in the digestive tract, but are later on expelled by vomiting or in the faeces, after having grown and having irritated too much the digestive canal. A number of well observed cases of this kind have been reported in the following works: 1°. Hope, F. W., F. R. S., On insects occasionally found in the human body. (Transact, of the Entomolog. Society, 1840, Vol, II., p. 266, et. seq). This is the most valuable paper on this subject up to that time. I11 this the whole is brought together in a tabular form, so that the kind of insect, the local affection and various other particulars can be seen at a glance. Hope proposed to adopt the term Canthariasis for the diseases which origi- nate with coleopterous insects, whether in the perfect or larval state; that of Myasis for those caused by dipterous larvae, while he restricts the term of Scholechiasis to those resulting from lepidopterous larvae. Of the first (including two cases arising from the earwig), he enumerates cases; the seven. 2 thirty-eight of the second , sixty-four ; of third, 2°- Koch, Ammon’s Monatsbertcht fuer Medicin, Augenlieilkunde und Chirurgie. 1838, Vol. I., p. 642. 3°. Tiedemann, von lebenden Wuermern und Insecten in den Geruchs- organen, p. 19. As far as I know, only members of the Muscidae of the Diptera order have been found as pseudo-parasites, and among those more especially members of the following classes of Muscidae. a. Sarcophagineae represented by Sarcophaga chrnaria, S. latifrons. b. Muscinae represented by Musca (seu Calliphora) vomitoria, M. stab- ulans, M. domestica. c. Anthomyidae represented by Anthomyia3 scalaris, A. canicularis, A. cuniculina. Whilst the various species of the two first named classes prefer animal sub- stances in a more or less decaying state, the members of Anthomyidae are attracted, as is partly expressed by their name, by decomposing vegetable matters. Therefore, it may be a priori supposed that the former are at- tracted by badly smelling discharges from natural cavities of the human body (nose, ear, vagina), or from suppurating or gangrenous ulcers, whilst the Anthomyidae enter the intestinal tract with the nourishment. And really, as far as I can gather from the literature, I find this line of 2. Confer: Kirby; Wm. and Spence, W., Introduction to Entomology, Philadel- phia, 1S46. 3. It is better to spell Anthomyia than Anthomya. The name was given to this family by its first exact observer,the German Entomologist Meigen, and means flower-fly (Blumen- fliegen),from anthos-flower and muia-fly. The latter word is written mua only by Photius. It is therefore more correct to name the disease “myiasis” (better still “myiosis”) than “myasis.” Illustrations may be found in Meigen, Systematische Beschreibung der bekannten Euro- paeischen zweifluegeligen Insecten. Halle 1851, VII., Bde mit 74 T. Bouche, Naturgeschichte der Insecten. Berlin 1834, Taf. vi.. Fig 3-7. Farre Arth. On the minute anatomy of the larva of Anth. canicularis Meig, with 1 plate. Transact. Royal Microsc. Society, p. 51-57. 1841. reasoning veritied. To the cases already reported in the above quoted general works4 I may add a. Sarcophaga latifrons, found by Taschenberg5 “in a very painful ulcer of the ear.” b. Sarcophaga Wohlfahrti, observed by I)r. Thomas and Loew 6 in the nose of an old lady. c. Sarcophaga carnaria in the nose reported by Wohlfahrt7 and Froriep 8. d. Musca vomitoria has been found in the external meatus of the ear of persons 9 suffering from stinking otorrhoea, reported by Voigt , Troscliel 10 and Thienemann 11. The larval forms of various species of Anthomyidae that have been so far reported have only been observed in the stomach and intestines. the 12 Exceptional cases are Weruicke-case, reported by Dr. F. L. James , of the larvae of Anthomyia canicularis in the vagina and that of Salzmann13 of the larvae of Anthomyia scalaris in the urethra of a man. While the latter case is the first undoubted one as to the occurrence of fly- larvae in the urinary organs, cases of the former kind have already been ob- served. Ule-Wagner 11 speaks of the vagina as a stopping place for the larvae of Diptera, but without any special reference to any particular species. An- other case of unclassified maggots, as thick as a quill, found in the vagina of a woman suffering from fluor albus was reported in the “Medizinische Vereinszeitung” of 1844, p. 175. The opinion of Dr. Wernicke, cited in Dr. James’ note (p. 78), that larva; of Authomyidse“do not remain in the small intestine” seems to me not quite correct. For I myself 15 saw a case in which the larval forms of A. cuniculina were vomited. The larvae of Anth. canicularis were expelled in the same way in a case of Prof. Eisner, of Kcenigsberg. The diagnosis was made by 6. Siebold' Ule-Wagner cites Meschede 17 and Gerhard 18, and says: “In very rare cases larvae of Diptera pass to the stomach, remain there alive for sev- eral days and may cause intense catarrh of the stomach.” 19 Cases of dipterous larva; found in the faeces occur more frequently. Sie 4- To these may be added: Grube Ad. UeberVorkommen von Sarcophaga-maden in den Augen und der Nase des Menschen. Archiv fuer Naturgeschichte, 1853, Bd.