PEDICULOSIS CAPITIS

Synonyms.—Phthiriasis capitis; Pediculosis capillitii; Head-lice; Head-lousiness;
Fr., Phtiriase de la tête.

Pediculosis capitis, or head-lousiness, due to the presence of the pe-
diculus capitis, occurs much more frequently in children than in adults,
although it is quite common in grown girls and women, the occipital
region being that predominantly infested. Men, owing doubtless to the
shorter hair and fewer opportunities for a successful lodgment of the para­
site, are rarely its subjects. In some instances beyond slight itchiness
there are no other symptoms, except, of course, the presence of the para­
sites, and their ova attached to the hairs. In many subjects, however, the
affection is characterized not only by marked itching, but also by the for­
mation of various inflammatory lesions, such as papules, pustules, ex­
coriations, and small crusted areas—resulting from the irritation produced
by the parasites and from the scratching to which the intense pruritus
often gives rise. In fact, commonly an eczematous eruption of an oozing
and pustular type soon develops, attended with more or less crust forma­
tion, and such is often practically limited to or most pronounced pos­
teriorly just at the region of the occiput. Impetiginous lesions over the
scalp, and sometimes a few on face or neck, together occasionally with a
few excoriations on these parts, may be seen in some cases. In extreme
instances, as a result of the exudation and negligence and the collection
of extraneous dirt, the hair becomes glued together, forming irregular,
tangled, more or less felted masses, and emitting an exceedingly offensive
odor. Most of the cases of the so-called plica, or plica polonica, so com­
mon in former times among the poorer classes, especially in certain

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PARASITIC AFFECTIONS

countries, as in Poland, were unrecognized instances of this kind; some
were examples of tangled felting and massing, doubtless resulting from
uncomplicated oozing, crusted eczemas.

In addition to the various other symptoms, few or many pediculi
can commonly be discovered scattered around in the hair, and ova, or
nits, generally in great numbers, are to be seen attached to the hair-
shafts. Several or a profusion of them may be found on a single shaft.
They are minute, pin-head-sized, pear-shaped, whitish or grayish-white
bodies, firmly glued to the hair with the projecting butt end pointing
toward the distal extremity of the shaft.

The diagnosis of pediculosis capitis is a matter of no difficulty.
The pediculi are usually to be found, sometimes requiring some hunting;
but even if they exist in small numbers and are not readily discovered,
the presence of ova, or nits, on the hair-shafts, always to be seen upon
careful inspection, will indicate the nature of the affection. They
should not, however, be confused with the minute seborrheic scaly
particles quite frequently to be observed scattered through the hair,
and occasionally slightly encircling the shaft; nits are firmly attached,
while seborrheic scales can be dislodged by light brushing or shaking.
In women and girls, pustular eruptions upon the scalp, especially pos­
teriorly, should always arouse a suspicion of pediculosis. There is, of
course, the possibility in some cases of the pediculosis being secondary
to eczema instead of being the primary exciting factor of the eczematous
irritation.

Treatment.—The applications upon which reliance is usually
placed consist of crude petroleum, tincture of cocculus indicus, mercuric
chlorid lotion; and ointments of white precipitate, sulphur, and B-
naphthol, from 20 to 60 grains (1.3-4.) to the ounce (32.) of petrolatum.
In slight cases I have found a daily shampooing with a sulphur-naphthol
soap a satisfactory method; the lather is always to remain on five to ten
minutes. In the use of crude petroleum the scalp is to be soaked with it,
and a head-bandage applied or a suitable cap worn; care should be taken
that the oil does not run down over the forehead or down the neck, as it
is likely to be irritating to these parts. To lessen its inflammability it
may be mixed with half its quantity or even an equal part of olive oil
or liquid petrolatum. This dressing is to be worn for twelve hours, and
the scalp then thoroughly washed with soap and water. As a rule, this
will suffice to destroy all the pediculi and the attached ova. If there is
any doubt in regard to this, the dressing is to be renewed for another
twelve hours. Owing to its inflammability it is not a good plan for
practice among the ignorant or careless. Tincture of cocculus indicus
is commonly employed diluted with one, two, or three parts of alcohol,
and sponged on the scalp twice daily for a few days, and associated and
supplemented with soap-and-water washings. Mercuric chlorid lotion,
in the strength of ½ or 2 grains (0.033-0.13) to the ounce (32.) of water,
or equal parts of alcohol and water, is to be applied for two or three days
twice daily; it should not be employed if there is much irritation or a raw
surface. If the parts are decidedly eczematous, one of the several oint­
ments named may be used instead of the lotions, making the application

PEDICULOSIS

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freely and thickly and enveloping the head in a bandage, and renewing
the dressing twice a day for from two to four days. Subsequently to the
active treatment, or in association with it, the scalp should be washed
once daily with soap and water or with alkaline lotions or dilute acetic
acid (1 part to 10 or 20 of water) in order to free the hair-shafts from the
ova or shells that may be attached; frequent combings with a fine-toothed
comb will be of service both for this purpose and also for the removal of
the pediculi. In the management of pediculosis capitis close cutting
of the hair will facilitate the treatment, but it is not essential.

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