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Itch - Scabies.Until the nature of the disease was discovered, the itch was one of the most troublesome and dreaded of all the affections to which flesh is heir. In former times the patient was an object of loathing to others, and of torment to himself, for months and even years at a time ; and although the disease does not affect the vital organs directly, yet the dreadful scratching caused indirectly serious impairment of the health. After the parasitic nature of the disease was discovered, and a certain means for its cure came into use, the spread of the disease was much restricted. At the present day the itch is comparatively rare in the United States, though still very common in many of the European countries. In the skin departments of the large hospitals in London, Paris and Vienna, for instance, about one patient in five is afflicted with this disease. The itch parasite, or itch mite, is a microscopic insect called the acarus or sarcoptes scabiei. It is a round, somewhat turtle-shaped animal, provided with eight legs and with horny jaws ; with these they burrow into the upper layers of the skin and crawl gradually along just under the surface. The female lays her eggs closely together in the burrow as she proceeds ; the track of the insect and the row of eggs can usually be perceived as a black line, from a sixteenth to an eighth of an inch long, near the surface of the skin. The black color is due not to the insects themselves, but to the dust and dirt with which the little groove in the skin becomes filled. After a time the adult insect dies, but not until she has made ample provision for the propagation of her species in the shape of numerous young; these attain maturity and repeat the process of burrowing and of laying eggs. The life of the insect seems to vary from three to eight weeks ; each female pro duces from ten to fifteen young. The parasites are readily conveyed from one individual to another, and even from man to several of the lower animals, especially dogs and horses ; and it seems quite certain that the disease can be communicated again from these animals to man. It is probable that the disease is rarely communicated from hand to hand. In most cases some more intimate contact of the person is necessary. In the majority of instances the disease is acquired by sleeping in the same bed with a person already suffering from it. Certain parts of the skin are more frequently visited by the itch mite than others. This results partly from the fact that they find the best nourishment in the thinner and more juicy parts of the skin, and partly because they are transferred by the fingers to certain parts of the body with especial frequency. Among the first localities usually visited are the spaces between the fingers ; they are then found upon the sides of the fingers, on the front of the wrist, on the inside of the elbow and around the armpit. In fact all those parts of the skin which an individual is especially apt to touch or rub soon become affected. Any part of the body which is chafed or irritated by the clothing is sure to be plentifully inhabited by the itch parasites. Thus in women they are found on the breast and around the waist. In men they can often be ob served to mark out the course of the suspenders over the shoulders. Those individuals who support their nether garments by means of a strap or belt around the waist are sure to present a girdle of irritated and inflamed skin under this belt. Symptoms.- The first intimation that the patient has is an intolerable itching, which is usually felt only over a limited part of the body, especially in the hands and wrists. This itching is, of course, followed by violent scratching, as a result of which the skin becomes roughened and sore. Indeed it is rare that one sees the changes caused in the skin by the itch mite without the complications due to the use of the finger nails. The rash caused by the insect itself consists of pimples which resemble somewhat those of acne ; but as we see the patient, we rarely find any of these pimples in a good state of preservation, for the top is usually scratched off and replaced by a black crust of blood. Thus the entire surface of the skin may be speckled over with these little black patches, the intervening space diversified by welts raised by the finger nails. Unless soon relieved, the patient presents patches of eczema, or salt rheum,, in different parts of the body, a condition due entirely to the irritation caused by the scratches. In advanced cases, indeed, the physician himself may overlook the true cause of the disease, since the appearance will be that of eczema simply. Various other irritations may cause the appearance of a rash similar to that of the itch, and may induce persistent and violent scratching ; among these are body lice, which may sometimes afflict individuals who have no suspicion of their existence. There are two points, however, which enable one to recognize the itch and to distinguish it from all other affections ; first, the location of the rash. For the itch parasites are distributed around the individual's body by his own hand and are hence most numerous in those parts of the body which are most accessible to the fingers. The rash is, therefore, distributed chiefly between the collar bones and the knees on the front of the body, and it may often be observed that while the skin in this locality is covered with blotches and scratches, the skin between the shoulders of the same individuals is quite free from them. This results from the fact that the itch insects do not leave the skin for the clothing, and hence do not travel around the body independently. Lice, on the other hand, live altogether in the clothing, and hence are apt to affect all parts of the body indifferently. But the most characteristic feature in the recognition of the itch, is the occurrence of minute black grooves in the skin. These look as if short pieces of fine black silk have been drawn under the surface of the skin ; it is often possible to detect by close scrutiny a minute whitish point, looking somewhat like a small blister located at the end of the black line ; this is the itch insect itself, and by dextrous use of the needle the animal can be lifted out of the groove. The extent of the rash and the consequent irritation of the skin vary much in different individuals, chiefly according to the cleanliness which the person observes. In individuals of filthy habits the body is often a mass of eruption, and presents a most disgusting and loathsome appearance. If, however, a person who is accustomed to strict personal cleanliness be infected with the itch, the manifestations of the disease are not so numerous nor so aggravated ; indeed it is quite possible for such a person to suffer for some time from scabies without suspecting the true nature of the disease. Even upon examination of the skin there will be detected only a few black furrows here and there upon the hands and wrist or in the vicinity of the genitals. Sometimes there will be also a few pale red pimples scattered here and there over the body. Such patients are often treated for weeks for some other disease of the skin. In every case in which a person of cleanly habits complains of intense itching, especially at night y suspicion as to the existence of the itch should be entertained, and a close search made to detect the black furrows characteristic of the disease. In some cases the rash appears only in the vicinity of the genital organs, the rest of the body being free from it; and instances have been known in which inflammation of the glands in the groins, resulting even in the formation of matter, has resulted merely from the irritation of the parasites in this locality. This point should be borne in mind by the physician as well as by the non-professional, since the occurrence of suppurating glands in this region is usually a sign of venereal disease. Treatment.-The object of treatment is simply to destroy the itch mites, after which the rash subsides of itself. While this is true of the itch in an early stage, or in an individual of cleanly habits, it sometimes becomes necessary to adopt additional treatment in those who have long suffered from the disease, or whose habits are such that the rash has rapidly become extensive and aggravated. The disease is confined entirely to the skin ; there is no " impurity of the blood, ''and, therefore, no necessity for sulphur and molasses, or other medicines internally. In ordinary cases the plan to be pursued should be as follows: The individual should take a hot bath, lying in the water sufficiently long to soak the skin thoroughly, and using plenty of soap ; after leaving the bath the skin may be energetically rubbed with a coarse towel. Then all parts of the body which show any indications of the rash should be annointed with one of the following ointments: Sulphur, - - - - - Three ounces. Tar, ------ Three ounces. Soft soap, ----- Eight ounces. Lard, - Eight ounces. Chalk, ----- Two ounces. Mix and make into an ointment. Flowers of sulphur, - One drachm. Ammoniated mercury, - - Fifteen grains. Olive oil, ----- Half an ounce. Lard, ----- Two ounces and a half. This will be found blander and less irritating than the former, though it does not always act with the same rapidity. The simple sulphur ointment as obtained at the drug store is usually efficient in destroying the parasites. If the skin be very delicate, as is often the case in young children, ointments containing sulphur are apt to irritate extremely ; in such cases the balsam of Peru will be found serviceable. The ointment selected should be applied morning and night for three days ; at the end of this time the patient should again take a warm bath, and he will usually find on the fourth day that there is no further itching. It is highly important in applying these ointments that they be thoroughly rubbed into all parts of the skin, especially into the folds and creases between the joints, since it is just here that the itch insects are abundant. There are various affections of the skin, called bakers' itch, grocers' itch, and the like, which are not due to parasites but are really forms of salt rheum or eczema, caused by contact of the hands with irritating substances which these persons are compelled to handle. 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