Allahabad Dispensary

Dobri, Churhar, an aged punkah coolie, complained of epistazis on the 19th October 1879. He waa given iced water to use, tannic acid as a snuff, Tincture Ferri Perchlor. was given internally ; elevation of the aims and cold to the spine and^ rest 111 a horizontal position were all tried without avail. On the 21st, as he was very weak, I determined to pass a Belloc s sound and to plug the posterior narcs. Next morning, about 22 hours after plugging the nostrils, as the plugs were offensive, I removed them. When the posterior plug was removed, four large and lively maggots were found in it, and during the day ten escaped from the nose. On the 21st Pulv. Ergot, grs. x. was given every fourth hour, and on the 22nd, three powders, each grs. xxx. 24 maggots escaped on the 23rd and 25 on the 24th ; on the 25th they were not counted, but were probably fewer than on the previous day. On the 23rd I used a nasal douche, driving a continuous stream of fluid in at one nostril and out at the other with Arnold and Sons' ' Simplex' enema, which for use in India is much superior to Higginson's, since the spring and other parts are metal, with the exception of a piece of tubing, which is easily replaced when worn out. The mouth was gagged open with a cork so that the man breathed through it, Professor Weber of Halle having many years ago discovered that when a person breathes through the mouth, the soft palate completely shuts off the nasal from the buccal cavity. At first I injected a weak solution of Tinct. Ferri and common salt, about a drachm of each to a quart of water, and afterwards salt alone, as recently recommended in the Lancet, II.-78, p. 535, where injections of simple water are said to be painful, because they cause oedema of the mucous membrane, while a weak saline solution is soothing and painless. No hemorrhage recurred after the plugging, but the eyelids and face began to swell and the bowels had not been moved for three days. On the 24th he was ordered Mag. Sulph. dr. ij., Tr. Ferri Perchlor. H\,60, Ammon. Chi or. gr. xx., Aq. fl^ ij. every 3 hours, and on the 25th a dose of blackseed and ginger. The swelling subsided on the bowels acting freely, and no more maggots were seen after this date.