ACA1UJS SCABIEI. 41 



The diagnosis is possible in all cases with a lens/ and the 

 microscope, but without them completely impossible in many 

 cases, or a mere piece of luck, which a conscientious surgeon 

 should never allow to have any dominion over him in cases where 

 he has the means of a diagnosis. Suspicion is excited in dirty 

 cases, by nocturnal itching, increased by warmth, with eruption 

 of vesicles and papillae. The diagnosis is founded upon the de- 

 tection of the gallery of the mite with the balls of excrement, eggs, 

 or remains of the mites, by the aid of the microscope. By the latter, 

 and by this alone, even those cases are recognised in which 

 it does not come to reaction, or in which the formation of galleries 

 retrogrades, as is sometimes the case in the so-called Norwegian 

 itch. 



Therapeutics. The only indication is that of killing the mites, 

 as there can hardly be cases of spontaneous cure. The attempt 

 at attaining this object by internal remedies is mere folly. Such a 

 process is only introduced now-a-days by quacks, ignoramuses, or 

 pick-pockets, and should be punished by the authorities on account 

 of the infection to which others are exposed by such a treatment 

 of the disorder. The destruction of the mites is the first and 

 principal object of the treatment, and that remedy is the most 

 deserving of recommendation which causes their death with the 

 greatest rapidity, and with the least inconvenience to the patient. 

 We need never despair of this destruction and the cure pro- 

 duced thereby. Even very old cases rapidly yield to treatment. 

 But if in a particular case we should be in dread because the 

 long existence of the disease has led to habitual secretions, of the 

 sudden suppression of which by the rapid cure we are frightened, 

 it is only necessary to maintain a fontanelle or an artificial sore 

 for some time, and allow this to heal up slowly. Usually, how- 

 ever, this is quite unnecessary. (See Langenbeck, ' Bericht der 

 24 Versammlung der Naturforscher zu Kiel/ p. 161.) 



The remedies fall into three series : 



1 . Those which remove the mites mechanically, to which I have 

 given the name of Itch-mite-combs (Kratzmilbenkamme], a series 

 of remedies, with regard to which I have been so misunderstood 

 by Gudden, that I cannot but think that he has not read my 

 essay, referred to by him, upon the testing of the rapidity of the 

 remedies as regards the destruction of the mites; 



2. The remedies which have a chemico -physiological action 

 upon the mites and kill them (Antisarcoptica); 



