To the Editor: A recent case seen in an emergency department of a large urban hospital may have finally settled the tormenting and age-old question concerning the best method of removing Periplaneta americana, the common cockroach, from the ear canal. Numerous methods have been described in the medical literature, the most popular of which appears to be placement of mineral oil in the canal and subsequent manual removal of the creature. More recently, lidocaine spray has been suggested as a more effective approach to this problem.

A patient recently presented with a cockroach in both ears. The history was otherwise noncontributory. We recognized immediately that fate had granted us the opportunity for an elegant comparative therapeutic trial. Having visions of a medical breakthrough assuredly worthy of subsequent publication in the Journal, we placed the time-tested mineral oil in one ear canal. The cockroach succumbed after a valiant but futile struggle, but its removal required much dexterity on the part of the house officer. In the opposite ear we sprayed 2 per cent lidocaine solution. The response was immediate; the roach exited the canal at a convulsive rate of speed and attempted to escape across the floor. A fleet-footed intern promptly applied an equally time-tested remedy and killed the creature using the simple crush method.

However humble the method, and despite our small study population, we think we have provided further evidence justifying the use of lidocaine for the treatment of a problem that has bugged mankind throughout recorded history.

K. O'Toole, M.D.
P.M. Paris, M.D.
R.D. Stewart, M.D.
University of Pittsburgh School of Medicine

R. Martinez, M.D.
Louisiana State University

To the Editor: The excitement was unbearable. "There's a girl with a bug in her ear!" the nurse had exclaimed. "Looks like a cockroach to me!" It was all we could do to keep from running to the patient's bedside. "Grab the lidocaine!" we shouted. This was the moment we had been waiting for. We had seen the reports, but did it really work?

As we burst into the room, we could see the young woman writhing from the combined sensations of movement and pain in her ear canal. One of us tok a look, confirming the nurse's diagnosis, while the other filled a 3-cc syringe with 2 percent lidocaine solution. With hurried anticipation we sprayed the drug briskly into the ear canal and quickly jumped back, fully expecting the beast to come hurtling forth at first contact with the noxious substance.

Nothing. "Increase the dosage," we shouted, filling a 10-cc syring. Still nothing. "Get that sucker outa my ear!" the patient screamed. What a brilliant idea! We grabbed a 2-mm metal suction tip and attached it to a wall suction apparatus with a negative pressure of 120 cm of water. Then we gently passed the tip into the ear canal, taking care not to occlude the canal and risk tympanic-membrane barotrauma. Shloop! "Got him!" we exulted. Sure enough, there he was, plastered to the suction tip like a fly to flypaper. After a repeat examination of the canal and a few drops of Cortisporin solution, the patient was on her way.

We recommend suction as a safe and efficacious method for removing insects from the ear canal when other methods fail.

Jonathan Warren, M.D.
Leo C. Rotell, M.D.
State University of New York
Health Science Center

Products with insects such as insect burgers have not yet proved to be a great success. Bakery products with insect fat are more likely to be appreciated, because the insects are merely a form of fat substitute.

"A valuable source of food supply remains untouched in the ground, and might be drawn upon to advantage if popular ignorance and prejudice could be overcome," said Dr. Leland O. Howard, chief of the Government Bureau of Entomology.

"I refer to the common white grub. Every small boy who goes fishing is familiar with it, because it makes exceptionally good bait. But even he does not know that it is the larva of the lively and brisk-flying insect which we call the June bug.

"The white grub is good to eat. It makes an excellent broth. Prepared in a salad, like shrimp, in the French fashion, with mayonnaise dressing, it is delicious. White grubs in a stew are first rate, resembling crab meat in flavor.

"I am able to recommend them because recently, in the Department of Agriculture, we have eaten them cooked in various ways. A quantity of them was shipped to Washington from Indiana in glass jars of salty water for the purpose of the experiment, and the job of devising ways to prepare them appetizingly for the table was assigned to the nutrition division of the Office of Home Economics.

"There the experts in practical home cookery took them in hand, removed their entrails and washed them, thus converting them into a raw material as clean and nice as shrimp meat or crab meat. A number of persons, invited to eat the broth, salad and stew made from them, found all three most appetizing. For stew the grubs were heated with a little water, and milk, butter, salt and pepper were added.

"Perhaps you imagine that it would be difficult to collect enough white grubs for table purposes. But that is not so. Over wide areas in the Middle West and elsewhere the soil is full of them. They can be turned up by thousands with a spade in a few minutes."

We can eat worms with zest!