| 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 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 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 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.