thoroughly applied will soon effect its removal. Lotions, as a rule,
are to be preferred, inasmuch as they are more cleanly and more
satisfactory. Washing the parts involved frequently with green soap
(sapo viridis) and warm water is to be advised as an adjuvant, and will
in some cases suffice to remove the disease. Alkaline baths, three or
four ounces of carbonate of sodium or potassium to thirty gallons of
water, are also useful. Various parasiticides are employed. Sulphite or
hyposulphite of sodium, a drachm to the ounce; corrosive sublimate, two
or four grains to the ounce of alcohol and water; sulphurous acid, pure
or diluted; a saturated solution of boric acid; Vleminckx's solution,
diluted with three to six parts of water,--are among the most useful.
Sulphur and ammoniated mercury ointments, carbolic acid, ten to twenty
grains to the ounce of lard, may be mentioned as serviceable. The
frequency of application depends upon the extent and obstinacy of the
disease, once or twice daily usually sufficing. After the disease is
apparently cured treatment should be continued, although less actively,
for a few weeks or a month, in order that a relapse may be avoided.
Scabies.
Scabies, or itch, is a contagious animal parasitic disease, due to the
Sarcoptes scabiei, characterized by the formation of cuniculi, papules,
vesicles, and pustules, followed by excoriations, crusts, and general
cutaneous inflammation, and accompanied with itching. The amount of
disturbance depends upon the duration of the disease and the
sensitiveness of the skin. The itch mite (Acarus scabiei, Sarcoptes
scabiei, or Sarcoptes hominis) through contagion finds its way upon the
skin, and begins to burrow its way through the upper layers of the
epidermis. The female only is found within the epidermis, the male, as
generally supposed, never penetrating the skin. As the female burrows
she lays a varying number of eggs, a dozen or more; by this time the
burrow, or cuniculus, has usually attained its full length of several
lines. It is to be seen as a narrow whitish or yellowish linear
epidermic elevation, as a rule irregular and tortuous, and with a
dotted or speckled look. It contains the female, its excrement, and a
variable number of eggs. In a short time the ova are hatched, and the
mites are rapidly multiplied. New burrows appear and are to be seen in
all stages of development, and thus the disease progresses.
According to the sensitiveness of the skin will the lesions produced in
consequence of the irritation of the mite vary. Usually, inflammatory
points, papules, vesicles, pustules, and excoriations are to be seen
scattered over the regions involved. The hands, especially the sides of
the fingers, {727} are almost invariably the parts first attacked, the
mite gradually invading other parts of the body, as the anterior
surfaces of the wrists, forearms, elbows, and arms, the axillary folds,
about the mammæ in females, between the buttocks, about the penis, the
inner sides of the thighs. The face and scalp are never invaded, except
in infants. Itching is a marked symptom, usually worse at night. In
well-advanced cases the secondary symptoms, such as papular elevations,
vesicles, impetiginous and ecthymatous pustules, which are often torn
by the scratching invoked, the crusts and excoriations of various
characters, and a variable amount of cutaneous inflammation, with
infiltration and pigmentation, taken together with the presence of
burrows, constitute a clinical picture of the disease. In many cases
the cuniculi are in a great measure obliterated by the scratching;
their remains, however, may usually be detected. In persons with
eczematous skin true eczema may be developed.
The disease is due solely to the presence of the itch mite. It is met
with in persons of all ages and in every station of life, but for
obvious reasons is more common and its ravages more marked among the
poor. It is encountered in all parts of the world, but is especially
frequent in the various European countries. In the United States it is
comparatively infrequent, and is seen chiefly in the seaboard cities,
and many of the cases can be traced to direct importation from abroad.
It is markedly contagious. The Sarcoptes scabiei is almost microscopic
in size, appearing as a yellowish-white rounded body. The male is but
half the size of the female, and is rarely met with, apparently having
no direct part in producing the cutaneous disturbance seen in the
disease. The full-grown female, as may be determined by microscopical
examination, is ovoid or crab-shaped, the dorsal surface convex and the
ventral surface flattened, the back being studded with a varying number
of short, thick spines and several long spike-shaped processes, all
with their points directed backward. The head is small, rounded, or
oval, without eyes, and closely set in the body, and is provided with
palpi and mandibles. There are eight legs, four situated close to the
head and four posteriorly. The entire parasite scarcely exceeds a fifth
of a line in length. The female mite is to be looked for at the blind
end of a burrow or at the roof of a vesicle.
Scabies when fully developed may usually be recognized without
difficulty. The pathognomonic symptom is the presence of the parasites
or the burrows. In the early stage cuniculi are not yet fully formed,
but often the mite may be extracted from a recent vesicle. Burrows are
usually most typically seen upon the sides of the fingers. The
distribution of the eruption, however, is, in most cases, a sufficient
basis for a diagnosis, the fingers, hands, flexor surface of the
wrists, elbows, axillæ, buttocks, penis, mammæ in females, being
especially invaded. It may be remembered also that the face and scalp,
except in infants, are not involved. The multiform nature of the
eruption is one of its prominent characteristics. It is a progressive
disease. A history of contagion is often obtainable. It is to be
distinguished from vesicular and pustular eczema and pediculosis. The
more or less discrete vesicles and pustules of scabies, the localities
affected, its progressive course, and the presence of burrows and a
history of contagion will serve to differentiate from eczema.
Pediculosis corporis involves the covered portions of the surface only,
and the {728} regions usually involved are different from those invaded
in scabies. In scabies the hands are almost invariably the parts first
and most markedly involved. The characters of the lesions are also
different.
The disease yields rapidly to proper treatment. Various remedies are
employed for the destruction of the parasite and its ova. The most
common, and one that is thoroughly efficient, is sulphur. It is usually
prescribed in ointment, one to four drachms to the ounce. In irritable
skins, or where the secondary dermatitis is marked, the weaker
proportions are advisable. A proportion of two drachms to the ounce is
the average strength, and will be found suitable for the majority of
cases. For children a drachm to the ounce is sufficiently strong; in
these cases a half drachm of balsam of Peru may be added. This latter
remedy is of itself a parasiticide. A compound sulphur ointment, known
as Hebra's modification of Wilkinson's ointment, frequently employed
abroad, is made up as follows:
Rx. Sulphuris sublimatis,
Olei cadini, aa. drachm ij;
Cretæ præparatæ, drachm iiss;
Saponis viridis,
Adipis, aa. ounce j.
Styrax is another balsam that is destructive to the itch mite, used in
the proportion of one part to two of lard. Naphthol, a drachm to the
ounce of ointment, is, according to Kaposi and others, an especially
reliable remedy, possessing the advantages of being without color or
odor, and also favorably influencing the dermatitis. Usually,
especially in sensitive skins, it may be prescribed in rose-water
ointment; in others the following formula, which has been well spoken
of by Kaposi, may be employed: Rx. Naphthol, 15 parts; pulv. cretæ
alb., 10 parts; saponis viridis, 50 parts; adipis, 100 parts.
Before beginning the remedial applications the patient is to take a
soap-and-warm-water bath. The ointment is then rubbed into every
portion of the body with the exception, in adults, of the head. The
localities favored by the parasite should receive special attention.
About an ounce of ointment is required for an application. It is to be
so applied twice daily for three days, and then a soap-and-water-bath
is to be taken. The itching becomes less marked after the first
application, but may persist in a mild degree for several days after
the ointment has been discontinued. The secondary dermatitis produced
by the parasite and the scratching usually subsides soon after the
removal of the cause; if slow, it is to be treated with mild and
soothing applications, such as are employed in the treatment of eczema.
Pediculosis.
Pediculosis, phtheiriasis, or lousiness, is a contagious animal
affection, characterized by the presence of pediculi and the lesions
which they produce, together with scratch-marks and excoriations. Three
varieties of pediculi, or lice, infest the human body, differing both
in their male and female forms, and each variety inhabiting a different
portion of the body. The three varieties are--pediculus capitis,
pediculus corporis, and pediculus {729} pubis. They obtain nourishment
by a process of suction, in so doing giving rise to a minute wound, in
consequence of which a small amount of blood and serum exudes; more or
less hyperæmia and infiltration may occur, giving rise to marked
itching, and the scratching induced results in excoriations. The
varieties of pediculosis are designated according to the names of the
species of pediculi.
PEDICULOSIS CAPITIS.--This is a condition due to the presence of the
pediculus capitis, or head louse. This pediculus is seen, as a rule,
upon the scalp only; in feeble and bedridden individuals it is, at
times, seen upon other parts of the body. It is an insect of a grayish
color, and varies in length from one and a half to three millimeters,
the female being larger than the male. It is oval in shape, consisting
of head, thorax, and abdomen, the last named occupying more than half
its length and made up of seven clearly-defined segments, marked off
from one another by deep notches. The thorax is broad, and from its
sides project six legs, each one hairy and provided with a crab-like
hook at its extremity. The head is somewhat triangular, with a pair of
short, five-jointed antennæ and two black, prominent eyes, and
furnished with a sucking apparatus. They are extremely prolific, the
progeny of a single louse numbering several thousands in about eight
weeks. The eggs, or nits, are deposited upon the hairs near the roots;
several may often be found on a single shaft. If seen on the hair some
distance from the scalp, it is due to the fact of the hairs having
grown since the nits were deposited. They are pyriform, whitish bodies,
about one-fourth of a line in length, securely glued to the hairs,
hatching out in five or six days. The young become capable of
reproduction in three weeks. According to the duration of the affection
and the habits of the individual, they are to be seen in small or large
numbers. They may be found upon the scalp or crawling over the hair,
the occipital region being especially favored. Pediculosis capitis is
commonly seen in children, and it is also not infrequent in women; it
is met with usually among the poorer classes. The irritation from the
attacks of the pediculi upon the scalp gives rise to scratching,
resulting in serous and purulent oozing, which, mixed with blood and
dirt, mats the hair and forms crusts. In marked cases the hair soon
acquires a disgusting odor. An eczematous condition is soon brought
about. Excoriations, vesicles, and pustules may often be seen beyond
the limits of the scalp, upon the back of the neck and shoulders, and
upon the forehead. From the constant irritation, intolerable itching,
loss of sleep, etc. the general health may finally suffer. Pediculosis
capitis may be recognized without difficulty. The ova, or nits, may be
seen even at a distance, and the parasites themselves may always be
detected if a search is made. An eczematous eruption of the occipital
region in children and women, especially of the poorer classes, should
always give rise to suspicion and an examination. This condition is
often a result of pediculosis, but it is to be remembered also that an
eczema of the scalp may have at first existed, furnishing a favorable
habitat for the parasites.
Treatment is satisfactory; with ordinary care the condition may soon be
removed. Cutting the hair, though facilitating treatment, is not
necessary. The main object is the removal or destruction of the
parasites and their ova; this accomplished, the irritation and
excoriations will soon {730} disappear or yield to simple treatment.
The best plan is with ordinary petroleum. The parts should be saturated
with it and then bandaged, care being taken to prevent the oil from
running down the neck or on to the face. The dressing is to be allowed
to remain on about twelve hours, usually over night, and the scalp
washed with soap and water in the morning. One or two applications, if
thoroughly made, are sufficient. An oily solution of naphthol, 5 per
cent. strength, has been well spoken of. Tincture of cocculus Indicus
is also a reliable application. Ointments may be employed in place of
lotions, but are not so cleanly or, as a rule, so satisfactory. In some
cases, however, where an eczematous condition exists, especially if the
hair is short, they may be employed with good results. An ointment of
staphisagria, or one of white precipitate, twenty to sixty grains to
the ounce, may be referred to. Oleate of mercury, in solution or
ointment, 20 to 30 per cent. strength, is also serviceable. The
parasites and nits are usually destroyed by any of these applications;
the latter, however, remain clinging to the hair. Their removal may
soon be brought about by applications of alcoholic lotions, diluted
acetic acid or vinegar, alkaline lotions, and the use of a fine comb.
PEDICULOSIS CORPORIS.--Pediculosis corporis is due to the presence of
the pediculus corporis, or body louse (more properly pediculus
vestimenti, or clothes louse), resembling in its shape and anatomical
structure the head louse, but is larger, measuring from one to four
millimeters: the female is also larger than the male. Its period of
growth and reproductive powers are also as great. In color, when devoid
of blood, it is dirty white or grayish. The eggs are similar to, but
larger than, those of the pediculus capitis. It dwells in the clothing,
trespassing upon the integument only to obtain nourishment, where it
may, when existing in numbers, often be surprised in the act of drawing
blood or crawling over the surface. The ova are deposited in the folds
and seams of the clothing, in which localities also the parasites are
usually found. The excoriations, therefore, are to be seen especially
about those portions of the body which are closest to these parts of
the clothing, as, for example, about the neck and shoulders, the waist,
hips, thighs, etc. The primary lesions consist of minute reddish puncta
with slight areolæ, the points at which the pediculi have drawn blood.
Not infrequently, instead of simple hemorrhagic points, a wheal marks
the site of attack; at times also papules, pustules, and even
furuncles, result. Intense itching is set up, and as a consequence
excoriations, scratch-marks of various kinds, and blood-crusts are to
be seen. Eventually, from the long-continued irritation and hyperæmia,
a brownish or blackish pigmentation results. The affection is met with
chiefly among the poorer classes, in the middle-aged and elderly;
children are seldom attacked. It is not common in this country. The
presence of the ova or the pediculi in the seams and folds, the
characteristic reddish puncta, and the multiform lesions and
excoriations upon the regions above named are sufficiently diagnostic.
It is not to be confounded with pruritus and scabies, in which diseases
the distribution and causes of the lesions are altogether different.
As the pediculi live in the clothing, treatment consists in their
destruction, by baking or boiling of the wearing apparel, and in
ordinary attention to cleanliness. Repeated examinations should be
made, so that no pediculi or ova are permitted to remain. Alkaline
baths, three to four ounces of {731} sodium bicarbonate to the bath,
and lotions similar to those employed in the treatment of pruritus,
will allay the itching and aid in the removal of the secondary lesions.
In those cases where the patient cannot immediately subject the clothes
to the above treatment an ointment of staphisagria, made by digesting
two drachms of the powder in an ounce of hot lard and straining, may be
applied to the skin.
PEDICULOSIS PUBIS.--Pediculosis pubis is a condition due to the
presence of the pediculus pubis, or crab louse. It is the smallest of
the three varieties, measuring from one to two millimeters. It has a
short, rounded, flat body, and an oval head, which is furnished with
two long, five-jointed antennæ and a pair of inconspicuous eyes. The
thorax, which is small and imperceptibly merged into the abdomen, is
provided with six jointed, hairy legs with hooked claws. The margins of
the abdomen are slightly indented, and from it projects eight stubby,
prehensile feet armed with bristles. It is more or less translucent,
and of a yellowish-gray color. As in the other varieties, the female is
larger than the male. It is liable to escape detection on account of
its translucency, and the fact that it is apt to remain seated near the
roots of the hairs, clutching the hair with its head downward and
buried deep in the follicles. The ova are similar in construction, but
smaller than those of the other varieties; they may be readily seen
attached to the hairs in the same manner. The excrement, minute reddish
particles, may be detected lying around the bases of the hairs. It
infests adults chiefly, being usually contracted through sexual
intercourse. Although its favorite habitat is the region of the pubes,
it may also infest the axillæ, the sternal region of the male, the
beard, eyebrows, and even eyelashes. The amount of irritation
varies--at times insignificant, while in other cases it is severe.
Pediculosis pubis may be mistaken for pruritus or eczema, but an
examination will disclose the ova, and if carefully sought for the
pediculi may always be found, usually near the roots of the hair,
looking not unlike dirt-specks or freckles; the excrement may also be
detected. For their removal any of the lotions or ointments mentioned
in the treatment of the other varieties may be employed. A lotion of
corrosive sublimate, two to four grains to the ounce of alcohol or
water; infusion of tobacco; 10 to 20 per cent. ointment of oleate of
mercury; ammoniated mercury ointment; a 5 to 10 per cent. oily solution
or ointment of naphthol,--are all efficient. The parts should be washed
with soap and water twice daily, and the remedy applied after each
washing. In order to ensure complete destruction of the ova the
applications should be continued for some days after the pediculi have
been destroyed.
* * * * *
LEPTUS.--Two species of leptus are met with as attacking man: Leptus
Americanus (American harvest mite) and Leptus irritans (irritating
harvest mite, harvest bug, mower's mite). The former is a minute,
brick-red colored, elongate, pyriform creature with six legs, barely
visible to the naked eye. Its favorite sites of attack are the scalp
and axillæ, partly burying itself in the skin, giving rise to a small
inflammatory papule. The latter species is more common, differing from
the former merely in having a roundish oval form. It buries itself in
the skin, giving rise to inflammatory papules, vesicles, and pustules.
Its sites of predilection are the ankles and legs. The minute red mite
met with especially about {732} blackberry-bushes in the low grounds of
Pennsylvania, New Jersey, and Delaware is probably the same species.
Both varieties are common, during the summer, in our South-western
States. For treatment a weak sulphur ointment or ointments of the other
mild parasiticides may be employed.
* * * * *
PULEX PENETRANS, OR RHINOCHOPRION PENETRANS.--This creature--the
sand-flea, known also as chigoe, chigger, and jigger--is almost
microscopic in size, closely similar to the common flea, but has a
proboscis as long as its body. It is common in tropical countries, and
also met with in our Southern States. It (the impregnated female)
burrows into the skin, depositing the ova, resulting in inflammatory
swelling, large vesicles or pustules, and even ulceration. The toes,
especially beneath and alongside of the nail, and other parts of the
feet are the regions attacked. The treatment consists in extraction; it
usually comes away in the form of a sac about the size of a small pea,
its size due to the distension of the abdomen with ova. As a preventive
the essential oils are used about the feet.
* * * * *
FILARIA MEDINENSIS.--This parasite, the guinea-worm, known also as
dracunculus, is only encountered in tropical countries. The young bore
into the skin and subcutaneous tissue, in which their growth takes
place; sooner or later marked inflammation is produced, resulting in
painful furuncular tumors, which finally break, showing the presence of
the worms. The lower extremities, especially the feet, are the favorite
regions of attack. The worm varies from several inches to three feet in
length, according to its age, and is one-half or three-fourths of a
line in thickness. The treatment consists in extracting the worm inch
by inch, from day to day, as soon as discovered, care being exercised
not to break it. Poultices may be applied.
* * * * *
CYSTICERCUS CELLULOSÆ.--This affection is characterized by rounded or
ovalish, smooth, elastic, firm or hard, movable, pea- to hazelnut-sized
tumors, more or less numerous, usually seated just beneath the skin,
new tumors showing themselves from time to time. After reaching a
certain size they may remain stationary. Although not painful upon
pressure, spontaneous pains may be complained of. Microscopical
examination reveals the cysticerci.
* * * * *
OESTRUS.--This parasite (known also as breeze, gad-fly, and bot-fly) is
met with in Central and South America, and also in other countries. The
neck, back, and extremities especially are liable to be attacked. The
ova are deposited in the skin, and there result inflammatory, boil-like
tumors or swellings with a central opening, from which issues a sanious
fluid; or the lesion may assume a linear, tortuous, or serpiginous
form. Sooner or later the grub is detected, and may be easily squeezed
out or extracted.
* * * * *
DEMODEX FOLLICULORUM.--This microscopic parasite (also known as
steatozoon, entozoon, acarus, and Simonea, folliculorum) is to be found
in the sebaceous follicles. It is harmless, giving rise to no
disturbance. It is worm-like in form, made up of a head, thorax, and a
long abdomen. {733} It is more apt to be found in those with thick,
greasy skins. Several of them often exist in a single follicle.
* * * * *