Posted by Librarian on 4/2/2002, 12:17 pm

The much-thickened epidermis had sloughed off from the thre most heavily infested areas of the scalp before the end of the the period of acute symptoms, and since that time no such unusual thickening in these or other parts of the body has been noted. Itching red papules continue to occur irregularly on the scalp, the pinna of the ears, on the face, and occasionally on neck chest and back. Such areas frequently become covered with small incrustations. The mites succeeded in establishing themselves temporarily on one writst, between the third and fourth finger of one hand, just below one ear, on the ventral surface of one knee, and just below the hair line above the left temple. Applications of 2 to 5% aqueous solution of gentian to each of these affected areas except the one above the temple, repeated daily for a week or ten days, finally cleared up each of these sites of infestation, some of which were reminiscent of the behavior of scarcoptes scabiei. The network of red lines and itching swellings above the left temple seems also to have been brought under control, largely through the use of sulphur ointment and lysol. There still remain infested areas on the face, in the upper corner of the lower lip and in the right eyebrow, which have not yet been brought under control. Tunnels or burrows, presumably in the dermis, could be seen on the wrist, in the soft skin between the fingers, on the knee, below the ear, above the temple, and on the lower lip. On wrist and knee, these burrows took the form of one or more or less straight central tunnel, visible as a slightly raised reddish line, from which extended at right angles, several shorter lateral tunnels. Above the temple, as noted, a network of raised red lines with small swellings here and there, indicated the presence of the mites. In other areas mentioned, the tunnels were more or less U-shaped, somewhat wider at one end, and apparently without lateral branches. Inasmuch as it has never been possible to locate a mite in the sloughed-off epidermis or in the small incrustations which form over infested areas, it seems probable that the burrows are actually in the dermis. Further evidence for this belief is the fact that live mites have been captured from the deeper regions underlying such an incrustation when the latter had been removed. Certainly, during the period of acute symptoms, when mites could be felt running about below the thickened epidermal masses, and causing their host almost to tear off bits of the scalp in an effort to get at them, none were even inconvenienced by any substance used against them until the mercuric iodide soap was employed. One of the most annoying runways occupied by the mites, the entire length of the right eyebrow, with extensions to and from the adjacent hairline, does not show on the surface any indication of its presence save a slight swelling. Even when such a burrow does not show externally, however, its presence it readily ascertainable by reason of the activity of the mites, which habitually travel from one area to another along certain well-defined highways. If these highways were in the epidermis, it should seemingly have been possible to capture mites in them, as the mites moved from place to place. Symptoms experienced by other members of the family. It was no until some time after my acute symptoms had subsided that other members of the family began to feel the effects of the mites. Whether they were less susceptible to the mites, from whatever source these were originally obtained, or whether they were infested from my infestation, we shall never know. As I had not at any time discussed the details of my symptoms with either of them, it is evident that they did not develop symptoms 'in sympathy' with mine. Only now and then, one of them would mention her particular symptoms as of the moment. One has had more difficulty with mites invading the pinna of the ear than I have had. These mites, when driven from the ear by the use of sulphur ointment or some other substance, moved down on to the body and became embedded there, particularly on the chest, shoulders and lower back. This member has also had much trouble with mites invading the nostrils. The other member of the family had more difficulty with mites embedded on the neck and shoulders. At no time have either of them suffered acutely from the presence of the mites. The medical profession. Aid was of course sought from the medical profession, but very little help in treatment for the symptoms was forthcoming from this source. A reliable oculist who was consulted during the period of my acute symptoms reported the finding of some foreign objects embedded in the eye, but as these were apparently not in the cornea, he thought they would do no serious damage. A dermatologist, recommended by a local physician, was apparently convinced without more than a very casual examination, that the patient's symptoms were largely imaginary, those that did exist having been caused by an ill-advised attempt on the part of the patient to rid herself of something that was not there. Not until three days after my visit to his office, however, did he tell me this. Even he could not fail to note the greatly swollen eyes and the three areas of thickened epidermis on the scalp. He X-rayed the eyes and the affected scalp areas, and recommended several days' stay in the hospital, ostensibly for further treatment of the eyes. Actually, such treatment consisted solely of applications of hot boric acid compresses to the eyes, and theuse of cold boric acid as an eye wash treatment which I could have rendered myself at home fully as well. After the third day in the hospital, he turned me over to a neurologist for treatment of my 'psychoneurotic' condition. The patient, however, succeeded in convincing the neurologist that she had no need of his services. The local physician now suggested the use of sulphur ointment on the scalp, such as had been used effectively by the patient against mites embedded elsewhere on the body. She also suggested the use of sulfathiazole, which seemed to aid materially in reducing the allergic reactions and possible secondary infections. The complete amazement of this physician, when she was later shown some of the first mites to be captured, indicated full well that she, too, had accepted at face value the dermatologist's diagnosis of 'Just imagination.' Hence any real aid in the treatment of the scabitic condition, other than the suggested use of sulphur on the scalp, came from the patient herself or from parasitologists. It is doubtful if the X-raying of eyes and scalp had much effect on the mites, although it may certainly have aided materially in clearing up secondary infections.