Human scabies has played a modest but not insignificant role in history. Severe infestations have lowered the morale of armies in the field, contributing to major military defeats. The world incidence shows an interesting cyclical pattern which is not completely understood. Scabies is usually transmitted by close personal contact, usually in the warmth of a bed. Indirect spread is relatively rare. The mite cannot survive for more than a few days away from the skin. The connection between promiscuity and scabies is indicated by the very similar age end seasons} incidence of scabies and venereal disease (that is, both occur most commonly in young people in the 16-25 age-group, particularly in the summer months) and the fact that those with scabies are not infrequently found to have venereal disease as well.

The lesions of scabies are mostly a manifestation of allergy to the mite or its products. With a primary infestation symptoms do not appear for weeks after contracting the disease. If, however, a person has been previously affected, he or she will develop spots and itching within hours of contracting the disease. The commonest and most disabling symptom of scabies is an intractable, generalized, unrelenting itch. It is markedly worse at night. Examination of the webs between the fingers, of the wrists, the breast or penis, may reveal the classical burrows where the mite has gained entry. Secondary lesions, however, account for most of what is seen. These consist of various lumps, bumps, pustules, crusts, and scratch marks. Only rarely is the face or neck involved. The areas most commonly involved are the hands, the breasts, the buttocks, and the genitals. Confirmation of infection is by microscopic identification of the mite, its eggs or its droppings. They are usually found in one of the burrows.

Treatment involves the whole family and all intimate contacts. The whole skin below the chin must be treated, not just the areas which appear involved. After a hot bath and scrub, 25 per cent benzyl benzoate emulsion, or 1 per cent gammabenzene hexachloride cream should be applied. Twenty-four hours later, this should be repeated without bathing between times. The clothing and bed linen must then be changed. Normal laundering or hanging up of the clothes for a week will destroy the remaining parasites and larvae. The treatment may if necessary be repeated once after two weeks. Extra applications should be avoided because of the irritant effect of the applications.

Scabies is by no means rare these days. It can be very difficult to diagnose, however, in the well-groomed and well-washed individual who is often. In fact, the sufferer of this complaint.

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