706 THE ANIMAL PARASITES OF MAN 



disintegrated tracts over the penis (prepuce and glans), will allow of 

 the diagnosis being made. Certain occupational eczemas (grocers, 

 lime- workers, maltsters, bakers and others), also prurigo, must be 

 borne in mind when diagnosing this disease. 



The prognosis is always a favourable one. Even after such a 

 long duration and after such severe symptoms the disease may 

 completely clear up. There are, however, frequently left behind post- 

 scabious inflammatous and pruriginous conditions which only yield 

 after protracted treatment. Scabiophilia, which persists in certain 

 patients for a long time after the scabies has been cured, must here 

 be mentioned. 



In the treatment of scabies four points must be kept in view, 

 (i) The mites and the ova must be killed by the treatment ; (2) the 

 treatment must have regard to the intensity of the inflammatory 

 symptoms ; (3) the clothes (body-linen) of the patients must be 

 disinfected ; the bed-linen, the beds and the bedsteads must be 

 cleansed ; (4) when a person suffers from scabies his entourage 

 must be examined, and all diseased conditions treated in the same 

 way as under (3). 



The treatment (i) should be preceded by a bath with thorough 



soap ablution, and when the inflammatory symptoms are not too 



severe, with green soap. After the bath the skin is dried and the 



scabies remedy proper applied in warmth. Sulphur preparations 



receive first consideration ; among such Vlemingkz's mixture occupies 



a prominent position ; this is rubbed in for half an hour by means of 



a strong camel-hair brush, to be followed by another bath and 



powder applications after drying. Repeat this method for three days 



one after the other, or for two days, and a third time eight days later. 



The latter method is worthy of recommendation as the ova, which 



perhaps resist the parasiticide action, have by this time developed into 



larvae, and the latter can then be destroyed with certainty. The 



remaining sulphur preparations, which are specially employed in the 



form of ointments, are more complex, as the ointment should remain 



on the skin. Helmerisch's and Wilkinson's ointments are the kinds 



specially employed. Nagelschmidt 1 recommends thiopinol as a very 



suitable sulphur preparation in the form of baths or as a 10 or 



5 per cent, ointment in the following way : Upon his reception the 



patient is given a thiopinol bath, in which he remains for thirty 



minutes. Immediately afterwards 30 to 40 grm. 10 per cent, thiopinol 



vaseline is carefully rubbed in. The rubbing is repeated daily, and 



the treatment is concluded on the second to fourth day with a second 



thiopinol bath. Thiopinol produces no more irritation than the 



ordinary sulphur ointments ; it is, however, much more penetrative 



and more capable of absorption. 



1 Nagelschmidt, Med. Klin., 1907, xxxv. 



