SCABIES.
Definition.—An inflammatory conta gious disease of the skin, due to the pres ence of the Acorns scabiei and attended by severe pruritus.
Symptoms. — The eruption produced by the Acarus scabiei consists of scat tered vesicles and papules, which are usually located between the fingers and on the flexor side of the wrists and el bows. The axilke, mons veneris, ab domen and buttocks, the penis, the mamma?, and in children the legs and feet are the points of predilection next in order. The burrows of the parasite resemble scratches, which, upon close examination, may be seen to be beaded. The ;Icarus may readily be extracted from its burrow with the tip of a nee dle for microscopical examination. The eruption is attended with severe itching, which is especially marked at night. The scratching to which the patient subjects the parts greatly increases the local irritation. The eruption may be come pustular or complicated by other dermatoses (eczema, urticaria, etc.), and present various characteristics due to the accumulation of epidermic detritus, dead acari, etc., or accumulated crusts. The hairs of the limbs affected are often shed, and the nails may become trophied. The incubation-period extends from two days to a week. Occasionally the itching is absent: apruriginous sca bies. During a general illness scabies is apt to disappear or improve; but the dis ease reappears as soon as convalescence is established.
Acarus does not inhabit the prickly layer, but the undermost part of the middle layer of the epidermis. The ec zema of scabies is not caused by scratch ing, but by irritating substances given off by the Acorns. Tiirok (Monats. f. Prakt. Derm., vol. viii, No. S, 'S9).
Etiology.—The Acarus scabiei is about one-quarter millimetre long, and resem bles an eight-footed turtle in general outline; the males live under the skin or epidermic scales, the females under the epidermis in the burrows, where they deposit their eggs. The disease is very contagious, through contact with affected individuals and any wearing apparel or bedclothing that they may have used.
Treatment. — Scabies may be rapidly cured by adopting Hardy's method: scrubbing with soap and water, using a brush, twenty minutes; the same pro cedure, thirty minutes, but with the part immersed in the soap-water; rub bing of the part with the Helmerich Hardy 4 Carbon. of potass., 25 grains. Sulphur, 50 grains.
Lard, 5 drachms.—MI.
This is left on two hours and the parts are bathed as before, but not brushed. Pruritus may usually be relieved by means of a menthol ointment. Vaselin or cosmolin is sometimes suffi cient.
The simple sulphur ointment thor oughly, though gently, applied at night before retiring, followed the next morn ing by a warm bath, is often sufficient to cure scabies when persisted in two or three weeks, but the underwear should be very frequently changed. In many
cases the ordinary sulphur ointment is too strong; it is always best to reduce its strength by mixing it with an equal quantity of benzoated lard. Sulphur baths are also valuable, but ointments can be kept in contact longer with dis eased parts, and are therefore more de structive to the parasite.
Large number of cases treated by painting the entire body with the bal sam of Peru, which exercises a toxic action on the 'learns. No soap and water should be used before its applica tion. With a brush a thin layer of the balsam is laid on at night, followed by gentle rubbing. A bath is taken on the following morning. The remedy causes no irritation and is always well borne. Julien (Province Med., Nov. 21, '96).
Tincture of benzoin used with excel lent effect in two cases. The itching ceased after the first application of the tincture, and the eruption began to de cline. Effects ascribed partly to the alcohol and partly to the benzoin. V. Holstein (Rev. Gen. de Pharm. et d'Hyg. Prat., vol. i, p. 5, 98).
Endermol (nicotine salicylate) used in 63 cases of scabies, six applications of a 1-per-cent. ointment being used. In stronger proportions toxic effects are pro duced. It is free from odor and does not stain linen. It proved curative in all cases. Wolters (Then. Monats., Aug., '93).
Thirty-two cases of scabies have been successfully treated with nicotine soap. It is of a dark-brown color, and may be scented with oil of bergamot. It con sists of tobacco extract, 5 per cent.; pre cipitated sulphur, 5 per cent.; and over fatty soap, 90 per cent. The patient is washed with warm water night and morning, and is then anointed from head to foot with this soap, which is allowed to dry on. This process is repeated for three or four successive days, when the cure is complete, and then he is given a hot plunge-bath. This ointment is free from unpleasant odor, and does not dis color the bed- or body- linen of the pa tient. Marcruse (Then Monats., Dec., '99).
After thorough bathing, the body and limbs should be rubbed lightly with washed sulphur, less than '/:„ teaspoonful for each person; this to be followed by clean underclothes and clean sheets with '/, drachm of sulphur dusted between them. If this is repeated every second or third day the cure, in ordinary cases, is complete in a week. No resultant der matitis noticed. S. Sherwell (Med. News, Oct. 13, 1900).