SCABIES: 
ITS SYMPTOMS, DIAGNOSIS, AND 
TREATMENT. 
BY 
J. ABBOTT CANTRELL, M.D., 
Instructor in Dermatology in Jefferson Medical College; Dermatologist to 
the Philadelphia Hospital and to the St. Agnes Hospital, 
Philadelphia. 
REPRINTED FROM THE THERAPEUTIC GAZETTE, JULY 15, /Sgj. 
DETROIT, MICH. : 
GEORGE S. DAVIS, PUBLISHER, 
i S9 3. Scabies: Its Symptoms, Diagnosis, and 
Treatment. 
SINCE the influx of certain elements of civ- 
ilization to American soil we certainly 
have had a decidedly large increase in the 
number of cases of scabies, and as there will 
be no abatement until the huddling together of 
these people is done away with, or until they be 
placed under better hygienic conditions, it is 
likely they will still further increase; and as we 
all should be on guard, that we may be able to 
cure all cases as soon as possible, I will give you 
this morning the symptoms, diagnosis, and treat- 
ment of this affection. 
Scabies affects certain portions of the body, 
and attacks the body in such a way that all 
those affected with it suffer innumerable tor- 
tures from the diverse points of itching, and, 
as the disease is contagious, it is well that we 
know something of the appearance of the dis- 
ease upon the skin, the localities affected, and 
the cause of it. 
The disease being one of parasitic origin, is 
caused by a small animal,—the Sarcoptus or 
Acarus hominis,—the female parasite being 
larger by double than the male. It is a whitish, 
opaque body, measuring from one-seventh to 
one-fifth of a line in length and one-eighth to 2 
one-sixth of a line in breadth, and as the female 
is the cause of the lesions of the skin, the male 
dying shortly after impregnating her, it is to 
her destruction that we must look. 
Shortly after impregnation the female enters 
the skin by burrowing beneath the surface, in 
like manner to a mole entering the ground, 
and, as she progresses, enlarges the burrow and 
at the same time deposits eggs, and after lay- 
ing a certain number—about six or eight—she 
dies. The young parasite, after being hatched, 
reaches the surface of the skin by means of the 
free extremity,—that through which the mother 
entered,—and as she reaches the surface meets 
the male, becomes impregnated, and then im- 
mediately burrows and goes through the same 
course as her mother before her; and as these 
conditions are likely to go on indefinitely with- 
out they are soon checked, you can see what 
they will be in a short time. 
The appearance of the burrow upon the skin 
is that of a darkish streak, which is made by 
the faeces of the parasite; it may be either 
straight, curved, or tortuous in character, and 
ranges from one-eighth to an inch or more in 
length. One end, being free, is sometimes 
marked by a small vesicle or pustule; the other 
is blind, and here the mother parasite lies as a 
foreign body. In fact, the patient will not 
come to you until the condition has reached 
the maximum,—about one month after con- 
tagion,—complaining of the itching and a skin 
eruption, and as the burrow is now very well 
marked, you may find it upon those portions 
of th,e body where it is the warmest. 
On inspecting the patient, examine all por- 
tions of the body, as you have often seen me 3 
do. Do not be satisfied with a peep. Have 
the patient strip positively as far as the waist. 
Look first at the hands ; examine the sulci be- 
tween the fingers, the wrists, but do not con- 
clude that the case is not scabies if you do not 
find anything upon them, because in Ameri- 
cans, who are, as a general rule, cleanly, we 
often find that the hands are unaffected. Next 
inspect the bend of the elbow, the axillae, and 
parts around the front of the shoulders, the 
lower part of the abdomen, the lumbar region, 
and the nipples and breasts of the female, the 
buttocks and inner parts of the thighs and gen- 
itals of the male. If the patient be an infant 
in arms, look at the face, as this is the portion 
that comes in contact with the breasts of an 
affected mother. The feet of infants must also 
be examined. 
If you have persisted in this examination, 
you will find evidences of the disease. From 
within the burrow you can remove the parasite 
upon the head of a gold needle; but, unfortu- 
nately, this cannot always be done, and at such 
times a knowledge of the situation of the dis- 
ease will, as a rule, suffice. In this condition 
you will also find the evidences of decided itch- 
ing in the accompanying dermatitis. 
After examining the patient and being fairly 
satisfied that the diagnosis is correct, the next 
thing would be the treatment. But suppose 
for an instant that you are doubtful what are 
the diseases that may resemble it, and vice 
versa. 
Eczema is not likely to be so diffuse; not 
found in the usual scattered sites of scabies; 
will not be the diverse points of itching; 
lesions are not likely to be multiform, but there will be a moisture, with some infiltration. 
The itching in eczema is marked at all times, 
while that of scabies is more so after disrobing 
for the night. 
Pediculosus Vestimenti.—Parasite, as a rule, 
easily found in the seams of the clothing; the 
upper part of the chest and back are affected, 
while these are unusual sites for a scabies; 
hands are never affected; no burrows; the 
outer sides of the thighs rather than the inner. 
Urticaria. — Lesions disseminated, while 
scabies may be found in the usual sites; but 
if urticaria be present in the case, as I have 
seen in a number of instances, you must cer- 
tainly find the burrow, and then your diagnosis 
is undoubted. 
Being perfectly satisfied that the diagnosis is 
correct, we want to know something of the 
treatment. . Naturally the first thing is to pro- 
cure extreme cleanliness. This is best done 
by using some common soap, placing the pa- 
tient in a bath-tub, and directing him to lather 
himself well, rubbing all parts, and then rinsing 
all over the body. If by this process you irri- 
tate the skin a little, it will the sooner be 
cured. 
Immediately after the bath you must rub 
into the affected parts the chosen parasiticide, 
placing on the patient a clean suit of under- 
clothes, rubbing the ointment on every even- 
ing, and allowing this underwear to remain on 
the patient for at least three or four days. By 
this means you have the ointment in constant 
contact with the affected parts, and thus, I be- 
lieve, more rapidly cure the disease. 
In the treatment of this affection sulphur 
seems to have held, and to still hold, the first 
4 5 
place, in whatever form it may be prescribed. 
The other remedies that may also be applied 
are naphthol, styrax, and balsam of Peru. 
I will speak of each of these remedies as I 
show you the cases. 
The first cases are a mother and her child. 
Examining first the child, which is about four 
months of age, you notice the eruption is scat- 
tered over the hands and wrists in large pus- 
tules. You will also note the same condition 
on the feet and ankles; and as the child is 
nursing, you see that the face is well covered 
with the pustules also, and here on the left 
side of the neck I show you a burrow; the 
buttocks, thighs, abdomen, and back share the 
same condition. 
The mother, you note, has no lesions upon 
the hands. This I have seen in a number of 
instances when the patient has been an Ameri- 
can. So, as I have often told you, do not say 
that scabies is not present because the hands 
are free. 
For the mother I prescribe the following: 
R Sulphuris sublimatum, gi; 
Adeps, gi. M. 
And for the child : 
R Sulphuris sublimatum, gr. xv; 
Adeps, M. 
Directions will be given that each patient 
take a bath this evening before retiring, and 
will cleanse all portions well, then will be ap- 
plied the ointment to every point of disease, 
after which they will put on a clean suit of un- 
derwear, and every evening for three or four days they will continue the use of the oint- 
ment, at the end of which time they will take 
another bath, and go through the same per- 
formance. At this time it will be well ta ex- 
amine them, and, as a rule, they will be well 
of the scabies. 
The next case is that of a young man (Pole 
by birth), and his condition has existed for 
some time. This you find in this class of 
people always as well marked as here. Having 
the patient strip, you find that the eruption is 
on the usual sites, and here I show you several 
upon the penis. Here upon the under surface 
I show you a burrow ; it is about a quarter of 
an inch in length. The young man states that 
the condition has existed for four months, and 
that he has not had any treatment. Therefore, 
from his being rather timid about taking a bath, 
and not receiving any advice of a physician, 
you can readily understand why the affection 
has gone on to this proportion. 
In prescribing for a case as bad as this, you 
may use remedies that are somewhat stronger 
than in the preceding cases, remembering that 
we have a decided eczema here, and, if possi- 
ble, do not make this any worse; but as we 
have also a tough skin, we will not be likely to 
make the eczema more prominent. 
6 
R Sulphuris sublimatum, 
Olei cadini, of each, gii; 
Cretse prasparata, giiss; 
Saponis viridis, 
Adipis, of each, M. 
This is the Hebra modification of Wilkinson’s 
ointment, and in such cases as these there is 
nothing better; but in the majority you will be obliged to dilute it one-half. This is ap- 
plied after the preliminary bath, and used as 
in the preceding cases. 
If this ointment appears to disagree with the 
patient it may be changed to the following: 
7 
R Sulphuris sublimatum, gi; 
Balsam Peruviana, sjss; 
Adipis, M. 
And the same instructions given as for the 
former ointment. 
Sometimes I have prescribed the following, 
which I prefer in most cases : 
Ijt Sulphuris sublimatum, 
Naphtholis beta, of each, gi; 
Adipis, gi. M. 
With this preparation I have seen better re- 
sults than with the others, and have in only one 
instance observed the bad effects spoken of from 
the use of the naphthol. This is applied with 
the same preliminary measures as with the 
other preparations. 
This young man presents himself for the first 
time, and we will study his case together. He 
states that the eruption has existed for one 
month ; that at the time of contracting it he was 
a travelling salesman; that one night he was 
obliged to sleep with a fellow-traveller, and a few 
days after noticed an itching on his arms and 
legs. He examined himself, and finding nothing, 
he used some carbolic acid, as this seemed to give 
him relief; but after two weeks he noticed that 
small vesicles or pustules presented themselves, 
and being frightened, he comes to us. Look- 
ing in the usual sites of a scabies, we find that 
the eruption is mostly on the arms and legs, 
over the hands and wrists, and on each axilla, 8 
over the genitals and buttocks. I here mark a 
burrow, and to demonstrate that the diagnosis 
of scabies is the correct one, I take a gold 
needle and pass it along the burrow, and now 
upon the point you can see a small whitish 
opaque body, which I will place under a micro- 
scope and pass among you, cautioning you all 
to look at it well, because some day you may 
be obliged to make your diagnosis this way, 
and now is your time to study it. 
I will prescribe for this case as follows: 
fit Styrax pulvis, gi; 
Adipis, gi. M. 
And as he will be instructed to use the oint- 
ment as in the other cases, we will hope for a 
speedy cure. 
If at any time you should wish to prescribe 
the remedies in some other way, one of the fol- 
lowing will be beneficial. 
The plan adopted by Sherwell, of New York, 
is to rub the whole body with dry sulphuris 
loti, after the application of a bath. This has 
at times given good results in my hands. 
The sulphur vapor is recommended by some, 
and is easily made by having a heated surface, 
either iron or brick, the patient being wrapped 
in a sheet, and the dry sulphuris loti placed 
thereon (about two ounces of the drug). This 
may be repeated every day, and the patient can 
go about his business soon after the bath with- 
out fear of catching cold. 
Of all the methods spoken of, I myself prefer 
that of sulphur and naphthol, as I have got 
far better results with it than with any of the 
others, and can safely recommend it as a speedy 
cure; more speedy than those above spoken of. JANUARY ,16, 1*93. 
WHOLE SERIES, VOL. XVII. No. 1. THIRD SERIES. VOL. IX. 
TH E 
Therapeutic Gazette 
A MONTHLY JOURNAL 
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GENERA!. THERAPEUTICS, 
H. A. HARE, M.D., 
Professor of Therapeutic* ir the Jefferson Medical CoUege. 
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0 E. DE SCHWEINITZ, M.D., EDWARD MARTIN. M.D., 
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Jefferson Medical College. Pennsylvania. 
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