In 1783 the Medical Commentaries received a striking communication on a curious subject: worms in the nose. It came from a surgeon based in Jamaica, Mr Thomas Kilgour:
A Gentleman of Montego-bay in Jamaica, aged twenty-six, of a middle stature, and robust make, about the middle of July 1777, complained for three days, of a slight obtuse pain, in his right upper jaw-bone, root of the nose, eye, and forehead of the same side.
On the fourth day this became unbearable, with shooting pains through his teeth and the entire right side of his face.
He applied next morning to an assistant of Mr Thomas Brown, an expert surgeon in this place, to extract the tooth, in which he felt the greatest uneasiness, imagining his complaints originated from it. The tooth was perfectly sound, and its extraction was attended with no alleviation of the pain. At night he took an opiate, but it afforded no relief. I was desired to visit him next day. He then felt inexpressible agony and distress. The eye and right side of the face were much inflamed, but little swelled. From the right nostril there distilled, in large drops, a thin dark coloured ichor, of a very offensive smell; similar to the discharge from a carious bone, but more disagreeable.
‘Ichor’ is an archaic term referring to a thin watery or blood-tinged discharge. Mr Kilgour examined the nostril but could see no ulcer or other source of this liquid. He concluded that there must be some infection in the sinuses, and that it was finding its way out of the body via the nose.
The case being alarming, and the fever considerable, we called for the assistance of Dr Murray, who readily agreeing to our opinion of a collection of matter being formed in the maxillary cavity, a perforation was made into it, through the socket from which the tooth was extracted. But no discharge of matter followed the perforation, nor did the pain in the least abate. On the contrary, it continued to increase more and more at the root of the nose; and, about an hour after the operation, there were voided from the right nostril, two insects, in appearance like the maggots formed in putrid meat.
On placing the patient in the light, a vast number were perceived in motion at the upper part of the nostril. I introduced a forceps, and took out three or four at a time; and, in the course of that day, upwards of thirty. They were in general three-fourths of an inch long, and one-eight thick, composed of rings, suddenly tapering towards the tail, and had a large brownish head. In extracting, they made a strong resistance with what served them instead of feet, and gave a sensation to my hand like a file drawn across a soft body. When taken out, they were very lively, and crawled about in the open air a long time before they died.
The surgeons conferred, and came to the conclusion that the maggots had been laid in a fresh ulcer caused by gonorrhoea, from which the patient suffered. They began to treat him with mercury, which was thought to be toxic to insects. Two mercury compounds were used: one as an oral medicine, the other powdered and blown into his nostrils.
Having a particular regard for the patient, I staid several hours with him, and was much disappointed in finding neither the fumigation nor injection to have the smallest effect in mitigating the pain, or destroying the insects. I therefore set about some experiments to find out a remedy capable of killing them, and happily, in a little time, discovered one that proved successful; but previous to this attempt, that the mercurial solution might have the fullest justice done it, I put a few of the insects into it, and found them at the end of an hour as lively as ever; a clear proof they were not of a species to be affected by oils or mercury.
Disappointed by this failure, Mr Kilgour attempted a little experiment.
The trials I made upon them were as follow; I took five wine-glasses; into each glass 1 put two of the maggots; into one glass, I poured a strong decoction of chamomile and wormwood; into another, vinous tincture of opium; into the third, rum; into the fourth, I blew tobacco-smoke; and into the last, I poured a decoction of tobacco.
‘Decoction’ is a method of preparation which involves mashing and then boiling a substance to extract its essential oils and other chemicals.
The bitter decoction gave them no disturbance. The tincture of opium, at its first application, threw them into violent motion; but in a short time they recovered and moved about at their ease. The rum killed them in about ten minutes. The tobacco-smoke, in a few blowings, shrivelled them to death; and the tobacco-decoction instantly convulsed and destroyed them.
Next day, by consent of Dr Murray and Mr Brown, the tobacco-decoction was injected into the nostril, and the fumigation and mercurial injection laid aside… At first the tobacco-decoction gave a good deal of pain ; but, in a little time, it became pleasant and agreeable, sensibly correcting the foetor, and bringing away the insects in great numbers, and in a very weakly state. After using it a few days, seldom more than half-a-dozen a-day were voided, and these frequently dead.
The numbers involved were amazing: Mr Kilgour estimated that more than 200 maggots were removed from his nose in all.
At length, after a course of ten days, numbers being extracted by the forceps, and falling out of themselves, sometimes dead, sometimes alive, a white transparent substance, near two inches long, and a quarter of an inch broad and flat, with three large insects in it, was brought out by the forceps, upon which the pain greatly abated, and from that time the insects disappeared. In a few days more the abrasions of the membrana Schneideriana [the lining of the sinus cavity] were healed up, and before the middle of August, the patient was able to go to the mountains to recover his strength.
It would be interesting to know what the mysterious ‘white transparent substance’ was. Mr Kilgour noted that the patient had long suffered from nosebleeds, and wondered whether it was the debris of an old haemorrhage which had solidified around some structure in the sinus. This sounds implausible; but what do I know?