(Pediculosis vestimenti; Phthiriasis corporis: Vagabond’s disease; Body-lice; Clothes-lice)
These, the largest of the three varieties of pediculi, dwell in the folds or seams of the clothes most constantly in contact with the skin and thus are found in the garments about the shoulders, arms, neck and waist. They forage on the skin to obtain food and because of this habit do not wander far and are often limited to the regions above mentioned. The injury inflicted, plus the possible injection of some irritating substance, produces a wheal-like lesion around a hemorrhagic wound. Intense itching leads to scratching which usually causes broad, deep, bloody and linear excoriations. Pigmentation is apt to follow and eventually white atrophic lines may remain. Itching is not confined wholly to the injured spots and there is often a more or less sympathetic eruption of miliary papules, scattered about. An extreme polymorphous array of lesions will be bound in long-standing cases and pigmentations following the broad blood stains of the surface may be so extensive that they resemble Addison’s disease; an observation that I have verified in a number of case.
Etiology and Pathology. The pediculus corporis is usually found in adults and poor food, cachexia, senility, and uncleanliness of any sort are predisposing factors to such an extent that vigorous and cleanly people are rarely afflicted. In fact habitual changing of clothing and bathing will usually result in the permanent eviction of body lice. Direct or indirect transference of the pediculi or their ova from one person to another is always the mode of infection. The color of this pediculus is a dirty white with blackish sides. The female is the larger and more active and lays her eggs in chain-like order in the seams or folds of the garments near the skin.
Diagnosis. Minutes hemorrhagic points, wheals, linear excoriations and pigmentations in the localities mentioned, and not on the hands and wrists, plus a careful search to reveal the existence of the pediculus, will afford the necessary diagnostic evidence. The offending animal is not always easy to find, so, in examining suspected cases, careful search should be made in he seams and bands of the clothing especially about the neck as the patient undresses. In other words, more attention should be paid to the clothing than to the surface of the skin. Pruritus, urticaria, scabies and eczema must be borne in mind, when the diagnosis is in doubt.
Treatment. The disinfection of the infested clothing or bed linen is usually an important detail. This may be boiled, baked, sterilized, fumigated or destroyed if expense is not object. A thorough hot bath with some antiseptic soap such as boric acid or cerolin may be followed by the application of carbolic acid or thymol lotions to relieve the itching, or a 5 to 10 per cent. ammoniated mercury ointment to cure the dermatitis. If the proper disinfection and bathing cannot be done, ointments of sulphur or betanaphthol, 30 to 60 grains to the ounce, may be employed.