9 
Itching is the most prevalent and first symptom to attract the 
attention of the patient. It is most persistent and intense during 
the after part of the night. At about the time the itching was most 
intense there appeared an urticarial eruption, accompanied, in severe 
cases, with general systemic symptoms, such as rise of temperature 
from 99 to 102; in one case the temperature rose to 103.8; the pulse 
rate is accelerated to 100, or as high as 110—in one case to 130. 
Other symptoms were intense headache, anorexia, nausea, in some 
cases vomiting, and a mild form of diarrhea. In severe cases some 
complained of general joint pains and backache; in these cases the urine 
was examined and albumin in small amount was found, but no casts or 
blood. When the acute symptoms disappeared, so did the albumin. 
Many patients who suffered from mild cases complained of nothing 
aside from the intense itching. If all straw was removed from the 
beds and house, the symptoms would subside in one or two days and 
completely disappear in a few days more. 
The lesion, which is typical of the disease, is the urticaria vesiculosa. 
The urticarial lesion varies in size from that of a split pea to that of a 
penny; it is surrounded by a pinkish halo, varying in intensity of 
color from a pale pink to a most bright pink. The “‘hive’’-like 
lesion is at first blanched, but later becomes a rose-red color. It is 
elevated about 1 or 2 millimeters above the skin surface, and is sur- 
mounted by a small vesicle containing a whitish fluid marking the 
place of inoculation. The vesicle is about 1 or 2 millimeters in diame- 
ter and elevated about 3 millimeters above the surface of the urti- 
carial lesion. As the lesion grows old it goes through the process of 
evolution: (1) It is blanched and has a central vesicle; (2) it is rose- 
red and the vesicle may become a pustule; (3) it generally recedes to 
the skin level with scab formation, due to the scratching; (4) it leaves 
‘a brownish or greenish-yellow or purple spot on the skin surface. In 
debilitated patients the markings look not unlike faded indelible- 
pencil marks. (This was noted in a patient suffering from pulmonary 
tuberculosis.) These discolorations may last for several weeks. 
The anatomical location of the lesions is generally the back, sides, 
and abdomen, and less frequently the arms and legs. The neck has 
very few lesions; the face, hands, and feet have very few or none. 
The number of lesions depends upon the number of mites, ranging 
from very few to thousands; in some cases the back and abdomen 
have been almost a solid mass of lesions—new lesions on the tops of 
old lesions, so having lesions in all stages of development. 
Later investigations carried out by Mr. Wildermuth, at Lafayette, 
Ind., during December, 1909, and January and February, 1910, show 
that where straw is kept in masses, as in stacks and barns, the mites 
literally swarm through the straw, and as soon as an Isosoma or its 
parasites attempt to gnaw their way out through the cells in the 
[Cir. 118] 
