The parasites are of two kinds, animal and vegetable.
The principal animal parasites are the Acarus scabiei, or itch mite; the Pediculus, or louse; the Cimex lectularius, or bedbug; the Pulex irritans, or flea; and the Pulex penetrans, or chigoe.
The bite of the Cimex lectularius causes a hyperaemic papule with a small red spot in the centre. That of the flea produces a little circular erythematous spot, which exhibits a dark speck in the centre, that marks the wound made by the insect. The chigoe attacks the feet and hands, entering the skin beneath the nails or betwixt the toes, or upon some portion of the extremities, either by a channel made for itself, or by the ducts of the skin; its tracks can sometimes be traced as an elongated brown spot.
The application of a lotion of glycerine and water, of each 3jj, and tincture of calendula 3j will be found very useful in allaying the irritation in the case of the first two. The treatment of chigoe disease consists in dilating the original channel of entrance, and carefully removing the chigoe bodily; after which apply an ointment composed of lard and salt.
Certain caterpillars, if they get upon the skin, may excite urticaria also.
Children of lymphatic temperament who are not kept clean, are poorly nourished, or insufficiently clothed, and live in rooms badly ventilated, are particularly liable to vegetable parasitic diseases; and unless measures are adopted to remove the exciting causes and predisposing conditions treatment is unsatisfactory and relapses are frequent. The patients should be isolated whenever practicable.
The varieties are: Tinea favosa, or favus; tinea tonsurans; tinea circinata; tinea versicolor; and onychia parasitica.
Phthiriasis is the name applied to the affections produced by the invasion of the there well known varieties of pediculus- namely, the head-louse, body-louse, and pubic or crab louse.
The nature and appearance of these insects are so well known that we need not describe them. The first of these infest the scalp; the second confines itself to the non-hairy portions of the surface; and the third prefer the pubic region, but may be met with wherever the hairs are short, but avoiding the scalp.
This affection occurs most frequently in children, more rarely in women, and almost never in men. The insect (bediculus capitis) finds its most congenial abiding-place in the hair of children, where it lays its eggs, and attaches them by a kind of cement to the shafts of the hair. The eggs take but a few days to hatch, and in a short time the parts may become pretty thickly settled. Then derive their nourishment from the skin, and by their presence produce considerable itching and lead to a corresponding amount of scratching. In children predisposed to eczema they not infrequently lead to the development of this affection.
The diagnosis is, of course, readily made, as inspection of the scalp will quickly reveal the presence of the insects and their ova, if at all abundant. In doubtful cases the fine-tooth comb will soon settle the question.
The treatment, of course, involves the removal of the insects and their ova, usually called “nits.” In children, clipping the hair as close as possible, or perhaps shaving it, is, of course, the quickest way of relieving the patient of these pests. When this is not practicable, the scalp should be thoroughly washed with tincture of staphisagria, or with ordinary kerosene oil. A few applications will kill the living insects, but do not appear to destroy the vitality of the ova. These should be removed as far as possible with the fine-tooth comb. Many., however, will still remain, and the best way to get rid of them will be to go over the scalp carefully and clip the shafts of all the hairs to which they are attached. The head should be washed for a week or ten days, for fear some of the eggs may have escaped detection. It is almost needless to say that soap and water, freely used, are essential adjuvants to the means just mentioned.
The following is a very excellent application: Rx. Ol. Staphisagriae, z3j.
Ol. Limonis, dr.j.
Ol. Amygdalae, z3iv.
M. Sig.: Apply to the affected parts daily.
This affection is very rarely met with in young persons, and is found most frequently in middle and advanced life, and especially in the feeble and ill-fed, and among the frequenters of prisons and cheap lodgings. Though sometimes met with in women, nine-tenths of the cases are among men.
The pediculus corporis does not lodge upon the body, but infests and breeds among the folds of the under-garments, from which hiding places it sallies forth to seek its nourishment from the skin. This it pierces with the sucker, and continues to feed until gorged with blood. These insects excite at times a lively, and most annoying itching, and lead to vigorous scratching. In cases that have lasted for any length of time, the skin gradually darkens, even to the color of a mulatto.
Diagnosis.-After a little experience a case of phthiriasis will, in most cases, be recognized at a glance, and should always be proved by a careful search for the insects. Strip the patient, if possible, and then examine not his skin, but his shirt, and, as a rule, you will find the pediculi, of present, without difficulty.
Treatment.-Soap, water, and clean clothes are all that are necessary. The old clothes should be destroyed, or thoroughly disinfected by boiling or baking.
The pediculus pubis affects a preference for the pubic region of both sexes, but is not confined to this locality; but in women may also be met with in the axillary region and in the eyebrows, and in men among the chest hairs and in the beard and whiskers. It rarely gives rise to as much irritation as the other varieties of pediculus, and its presence is often discovered accidentally. The insect attaches its eggs to the hairs like the pediculus capitis, and adheres to them itself or to the skin in the most tenacious manner by the aid of its crab-like claws.
The diagnosis is to be made by the discovery of the insect, but, having been found in its favorite seat, thorough examination of all other parts of the body liable to be infested should not be omitted.
The treatment of this affection involves the employment of some anti-parasitic application, and the one most in vogue is the common “blue ointment.” When, however, the patient will consent to it, shaving of the affected parts is to be preferred. The affection is most frequently contracted during sexual intercourse, but may be derived from wearing infected clothing, or sleeping in an infected bed The patient’s under-clothes and bed-clothes should be boiled or baked, in order to destroy the insects;and their eggs.
Psorospermosis may be defined as a condition of the skin of varied lesion, but characterized by the presence of “psorosperms.” The psorosperm is a living animal parasite, which infests the human skin as well as the bodies of some of the lower animals, and consists of a roundish or oval cell, containing one or more nuclei; the nucleus occupying but a small portion of the cell, the plasmic portion of which is extremely transparent and structureless.
Much doubt exists among dermatologists as to the nature of this affection; and but little is known positively concerning it.
Scabies is a contagious affection of the skin characterized by the development of vesicles, pustules, and other lesions on the skin, and caused by the presence of an animal parasite, known as the Acarus scabiei.
The affection usually commences by the appearance of small, non-umbilicated vesicles on the hands and between the fingers, accompanied with severe itching. The itching leads to scratching, and as a consequence transfer of the affection to other parts of the body with which the hands are brought in contact. Very early in the disease, then, we will find it appearing on the penis, on the breasts in women, and on the feet in children. From these parts it may spread over the greater part of the surface, more profoundly on the anterior than posterior parts and avoiding the face and scalp.
The vesicles above mentioned may be termed the primary lesions of the disease, but are usually followed in a few days by others secondary to the irritation produced by the insect, and to the effects of the finger nails. These new lesions may be papular or pustular in character, and may even assume distinctly eczematous characters, or develop into a true eczema in those predisposed to this affection. On the penis the lesions are usually papular. None of these features are absolutely pathognomic. There is, however, a lesion which is met with in no other disease, and which when found renders the diagnosis absolute. This is a fine, grayish line frequently terminating in a vesicle, and found between the fingers more frequently than elsewhere. It is called the acarian burrow. When an impregnated female acarus finds lodgment on the skin, she immediately seeks a place in which to deposit her eggs. This she accomplishes by boring beneath the epidermis and laying an egg, and then advancing in a straight or slightly curved line for several days until ovulation is complete. She then dies, and her decomposing remains give rise to a vesicle or pustule. When the eggs hatch, the young find their way to the surface, and as soon as they assume the adult form copulate, and the impregnated females commence to burrow as did their mother before them. A sharp needle-point, if guided by a sharper eye, will sometimes extract the acarus from her nest. The male acarus never burrows, and is very rarely detected.
Etiology.- Scabies is one of the few diseases of which we can say that we absolutely know the cause; and yet there is no chapter in medical history more interesting that that which concerns the etiology of this affection.
The acarus is exceedingly minute, and when first hatched has but six legs. It soon assumes its adult form, however, with eight legs; and the sexes are easily distinguished by the fact that in the female the four posterior legs are furnished with projecting hairs, while in the male two of these legs terminate in suckers instead of hairs.
Diagnosis.- The diagnosis of scabies should not in most cases be difficult. The early vesicles on the hands are either to be found, or the patient may tell you that the affection commenced with small “watery pimples.” Next, examine the penis, and you will rarely miss finding papules on the glans or papules or vesicles on the cutaneous surface. Rather good-sized isolated pustules about the wrists are commonly present, and in women you usually find an eczematous eruption around the nipple. If on inquiry you find that one or the other of the patient’s associates is suffering from a similar trouble, and that he has slept with him or worn his clothes, you may be fully confident of the diagnosis.
The mere presence or the intensity of the itching can not be relied on to establish the nature of the disease, as in several other affections, intense pruritus is a marked feature; and this is notably the case in phthiriasis, produced by the pediculus corporis, or body louse. The papules or other lesions on the penis should not be mistaken for lesions of venereal origin.
To briefly sum up, then, the diagnostic points are:
1. A history of contagion.
2. the development of minute papulo-vesicles or vesicles, spreading on contiguous portions of the skin or on parts habitually handled by the patient (never in patches but in rather a scattered manner.)
3. Itching, worse at night and becoming progressively worse as larger areas become invaded by the itch-mite.
4. Sites of predilection shown by the disease. They are the webs of the fingers, the front of the wrists, the anterior edges of the axillae, the mamma, the penis, the abdomen and groins, the toes and feet. Flexor surfaces are more involved than extensor.
5. That the face remains free from the disease, except in the case of infants at the breast.
6. That it has taken about three weeks for the disease to involve the whole surface.
7. That old cases show all the lesions that can possibly be produced by disease of the skin, expressed by the term multiformity of lesions.
8. Incidentally-numerous scratch-marks.
9. The itch-mite and its canaliculi.
Treatment – However distressing the present symptoms, the patient may be confidently assured of speedy relief. This may be most promptly brought about by adopting the following somewhat vigorous treatment: Put the patient into a warm bath and let him soak for fifteen or twenty minutes. Then let him be rubbed thoroughly all over with soft soap, assisted with a fleshbrush. Every part of the body from the neck down should receive a thorough application of the soft-soap and water and brush, in order to break over the burrows of the insects. The soap is then washed off and the surface rubbed dry. Then rub the entire surface with alkaline sulphur ointment to each ounce of which a drachm of iodide of potassium has been added. After a thorough inunction the patient should go to bed and stay there until the following morning. When morning comes a warm bath should be given to remove the ointment, and the patient should put on new under- clothes. The under-clothes and bedding that have been in use should be thoroughly disinfected by boiling or baking, in order to destroy any wandering acari. This treatment is effective but harsh, and for a day or two the patient’s skin will be far from comfortable, and the eczematous and other secondary lesions will be greatly aggravated. Emollient treatment, therefore, will in almost every instance be needed for a few days longer, and the use of the oxide of zinc ointment is as good as any.
One of the following Rx’s is, I think, far preferable, and less annoying to the patient:
Rx Beta naphtholi,
Balsam Peru, aa gm. x
Sapon, kalini viridis,
Cretae albae pulveris, aa gm. xx
Vasogen. Sulph (3 per cent.) spiss. gm. x L. M. f. unguentum.
Twenty-four hours’ covering of the affected parts is sufficient in most cases.
Or, Rx Sapon. med., 100.
Ol. petrae., Alcohol, aa 50.
Cerium alb., 40.
M. sig.: soap the whole body with this three or four times daily and the itch-mite will be destroyed.
Another, which has proved very efficacious in destroying the acarus scabiei, is: Rx Naphthol, 15.
Green soap, 50.
Prepared chalk, 10.
M. ft. Unguent.
For obstinate cases the following is excellent: Rx Petroleum, 50 parts.
White wax, 40 parts.
Alcohol, 50 parts.
Soap, 100 parts. M. Sig.: apply locally.
Arsen. alb.- Inveterate cases; eruption in the bends of the knee; pustular eruption, burning and itching; better from external warmth.
Carbo veg.- Eruption dry and fine, almost over the whole body, worst on extremities; itching worse after undressing; dyspeptic symptoms, belching of wind and passing flatus; after abuse of mercurial salves.
Causticum.- After abuse of sulphur or mercury; yellowish color of face; warts on the face; involuntary urination when coughing, sneezing, or walking; sensitive to cold air.
Croton tig.- Itching and painful burning, with redness of skin; formation of vesicles and pustules; desiccation, desquamation, and falling off of the pustules.
Hepar.- Fat, pustular, and crusty itch; also after previous use of mercury.
Lobelia.- Pricking itching of the skin all over the body.
Lycopodium.- Humid suppurating eruption, full of deep fissures; itching violently, when becoming warm through the day.
Mercurius.- Fat itch, especially in the bends of the elbows, if some of the vesicles become pustular; itching all over, worse at night when warm in bed; sleepless at night from the itching; diarrhoea.
Psorinum.- Inveterate cases, with symptoms of tuberculosis; also, in recent cases, with eruptions in the bend of the elbows and around the wrists; repeated outbreak of single pustules after the main eruption seems all gone.
Sepia.- After previous abuse of sulphur; itching worse evenings, especially in females.
Sulphur.- Main remedy; voluptuous tingling, itching with burning and soreness after scratching; worse in warm bed; disposition to excoriation; glandular swellings.
Acid Sulphuricum- When itchiness of skin and single pustules appear every spring; after imperfectly cured itch.
VEGETABLE PARASITIC DISEASES.
Favus is a parasitic disease of the skin caused by a minute vegetable fungus.
This disease may affect any portion of the body where there are hairs; but it prefers the scalp, especially the scalps if scalps of children. The fungus on which the disease depends is called Achorion Schonleinii, and falling on a congenial soil, gains access to the hair follicles, where it spreads and multiplies. In a short time it is perceived on the surface as a whitish speck, and later forms a very light-yellow umbilicated crust, the centre of which is perforated by a hair. A number of contiguous cups may coalesce, forming a crusty patch. The fungus, by its development and increase, presses on the follicular contents, and interferes with the nutrition of the hairs, and in time insures their destruction and permanent disappearance. Favus of the scalp usually makes its first appearance in childhood. Spontaneous cure rarely, if ever, occurs; and the affection lasts indefinitely-that is, as long as there is a hair follicle left for the achorion to lodge in. In this way the affection may be prolonged for twenty years or more. The most striking features of a long-standing case are the sparseness of the hairs over the affected area, the appearance presented being entirely different form that of any of the commoner forms of alopecia. The peculiar crusts may be present to aid the diagnosis, but not infrequently they are entirely absent from the surface, as various ointments, or even plenty of soap and water, are sufficient to prevent their development on the surface to an extent to prevent them to be visible to the naked eye.
The progress of the affection is extremely slow, and, when not checked by efficient treatment, may last for twenty years or more.
Favus on the body – that is, on the trunk or extremities first exhibits its presence by a small erythematous patch like a commencing ringworm; this spreads until it has a diameter of an inch or more, when the characteristic crusts appear.
Etiology.- The disease is due to a vegetable parasite, and is communicable from on to another. This disease is not infrequent in the common domestic mouse, from which animal it is sometimes conveyed to the household cat, who in turn transmits it to the children of the family.
Diagnosis.-In most cases the diagnosis is easy. If the affection is in full efflorescence, it can hardly be mistaken for anything else, as there is no other disease that presents the characteristic umbilicated, light yellow, and dry crusts. In an advanced case the peculiar alopecia, marked by the presence of a few, scattered, lustreless hairs, distinguishes it from every other form of baldness. In doubtful cases the microscope will reveal the parasite, which consists of minute spores and mycelium.
Treatment.- The treatment of favus of the general surface is exceedingly simple. All that is necessary is to pick off the crusts and make a few applications of tincture of iodine, or other efficient parasiticide, to the affected patches.
When, however, the affection is located on the scalp, it is very difficult to cure. The primary indication is to destroy the parasite. As this fungus flourishes in the lowest depths of the hair follicles, ordinary applications made to the surface are not sufficient. It is necessary to attack the parasite in its stronghold, and this can only be done by first extracting the hairs. These should be removed by properly constructed epilation forceps. After epilation a solution of corrosive sublimate, two grains to the ounce, should be rubbed in. This should be repeated daily until a considerable degree of irritation is produced. The artificial irritation should be sufficient to produce exfoliation of the epithelial lining of the follicle. If the affected surface is at all extensive, it is hardly practicable to epilate and mercurialize the whole of it at a single sitting: it should be done in sections. This treatment should be continued with as much regularity and thoroughness as circumstances will permit. In a few weeks the disease will appear to be cured; but in general this appearance is delusive, and treatment should not be relaxed simply because the disease is no longer visible on the surface. In all cases the patients should be kept under observation for several months after active treatment has been suspended.
Of internal remedies the following may be mentioned:
Agaricus.-Favus with biting itching in the scalp; crusts sometimes spread to other parts of the body; sensation as if ice- old needles were piercing the skin.
Arsenicum alb.- The scalp is found perfectly dry and rough, covered with dry scales and scabs, extending sometimes even over the forehead, face, and ears.
Arsenicum iod.-Scalp dry and rough, and covered with dry scales and scabs; extend to forehead, face and ears; intense itching and burning.
Bromine.-Malignant scald head, oozing profusely; discharge dirty looking, offensive smelling; when the skin is dry, extreme tenderness of the scalp; crawling beneath the skin of the occiput.
Calcarea carb.- Scabs are thick and cover a quantity of thick, pus; the scabs are large, even one-half of the entire scalp being covered with a single scab; eruption spreading to the face; burning itching; glandular swellings on the neck.