CREEPING ERUPTION (Cutaneous larva migrans)

This disorder is analogous to swimmer's itch, in that both are due to a parasite that penetrates human skin but is then unable to adapt. Creeping eruption is caused by hookworms, whose natural hosts are usually dogs or cats. After penetrating the skin, the hookworm is unable to find its way into the bloodstream and wanders aimlessly beneath the surface of the skin until it dies.

Creeping eruption is seen most often from New Jersey to Texas. The infective larvae hatch in sandy soil, such as beaches, sandpiles, or under cottages and houses, and enter the skin at an exposed site. The incubation period varies from a few days to several months, but the hallmark of creeping eruption is an irregular, raised, red-to-purple thread-like line about 2 to 4 millimeters in diameter indicating the path of the larva. This lesion is extremely itchy and is often scratched vigorously by the host. The tip of the line advances a few millimeters each day. If several parasites are present, these lines may be less apparent. Eventually the larvae die, sometimes after persisting for several months, but secondary bacterial infection is common.

CREEPING ERUPTION (Cutaneous larva migrans) –Treatment

Thiabendazole (Mintezol), available by prescription only, if taken by mouth or applied to the skin will eliminate the parasite. This medication often causes nausea when taken orally. Liquid nitrogen, dry ice, ethyl chloride, or Freon spray have been used to freeze the worm. One must see a physician for any of these treatments. Secondary infections are treated with antibiotics.

CREEPING ERUPTION - Prevention

Individuals should wear shoes when walking in sandy soil that is known to house these worms, or soil that is used by dogs and cats as a latrine. One should avoid sitting or lying on damp soil or sand. Sandpiles can be treated to destroy the worms, or the sand can be replaced; protective clothing and gloves should be worn if it is necessary to crawl under houses or cottages or to clean out dog or cat pens.

SEABATHER'S ERUPTION

Some authors feel that this is a variant of swimmer's itch and is also caused by schistosome larvae. There is some evidence supporting this claim, but several differences between the two are often noted. Seabather's eruption usually occurs in salt water, primarily along the coast of Florida and the Gulf states. A rash appears on areas that are covered by the bathing suit, while swimmer's itch affects exposed skin. Seabather's eruption begins a few hours after bathing with itchy red bumps or wheals that closely resemble insect bites. Small blisters do not appear on the bumps, as are sometimes seen in swimmer's itch. There may be chills and a low-grade fever for a day or so.

SEABATHER'S ERUPTION - Treatment and Prevention
Treatment is palliative (calamine, antihistamines, etc.) and symptomatic since protective creams are of unproven value. Waters known to cause this problem should be avoided.

Swimmer's Itch - Treatment and Prevention

Schistosomes are parasites, also known as flukes or flatworms, whose primary hosts are ducks. Schistosomal dermatitis, or "swimmer's itch" or "clam digger's itch" is a rash which results when the larval stage, or cercariae, of these parasites penetrates the skin of a human, perhaps in the course of seeking a freshwater snail as its host.

This problem is not always limited to freshwater lakes and rivers. In the United States, the states surrounding the Great Lakes have the highest occurrence, but the far south, Pacific northwest, and plains states also have had outbreaks. The snails that harbor the larvae inhabit the same type of lake waters that bathers prefer, and are not abundant in rough waters. The larvae are normally released in warm water, with July the peak month.

The development of the rash depends on previous exposure and individual allergy to the larvae. After the first exposure, bumps may appear five to thirteen days later. Re-exposure produces reactions that are increasingly more rapid and intense because of the heightened allergic response. After sensitization develops, the rash typically begins one or two days after exposure with small, itchy bumps. There may be a prickling sensation as the victim leaves the water, due to the cercariae penetrating the skin. This sensation can be felt for an hour or so, as the water evapor­ates from the skin. The bumps may appear as soon as ten hours later. They are surrounded by a red area and sometimes develop small blisters on top of each bump. In severe reactions, the bumps coalesce to form large, red swollen areas. The rash resolves in a few days, but secondary infection is common.

Swimmer's Itch - Treatment
Rubbing alcohol, calamine, or soothing creams or lotions can be applied to the rash for symptomatic treatment. Antihistamines help relieve itching. Aspirin may be helpful. The most practical preventive is rough toweling and showering.

Swimmer's Itch - Prevention
Duck hunters and fishermen may be involved as well as swim­mers and bathers. A layer of thick grease applied to the skin or the wearing of tightly woven clothing may deny the larvae access to the skin, but this is impractical for bathers. Swimmer's itch can best be prevented by destroying the snails, through chemical treatment, that serve as hosts for the larvae.

JELLYFISH Stings

There are two groups of stinging jellyfish found in coastal waters of North America. The Portuguese man-a/-war of the genus Physalia, is found worldwide in tropical and subtropical waters. This creature is purple or violet in color and pos~esses a gas-filled float. In fact not a true jellyfish, its tentacles may be as long as 12 meters (40 feet). The sea nettle, of the genus Chrysaora, is found in tropical and northern temperate waters. Common along the Atlantic coast, the sea nettle's tentacles may be 1.2 meters (4 feet) long, and its color varies from white to red.

The venom apparatus of these creatures is contained in nemato­cysts or stinging cells. (Nematocysts are also characteristic of all species of corals and sea anemones.) The nematocyst consists of a long, thready tube coiled within a capsule and is filled with venom. On the outer surface of the capsule is a trigger-like fiber. Stimulation of this fiber causes the capsule to pop open and the thread tube to spring forth-sort of a nightmare version of a jack­in-the-box. The tip penetrates the victim's skin and injects its venom.

Jellyfish stings produce immediate, burning pain. Small bumps or wheals develop rapidly, either in lines or scattered over the skin. Usually, the skin around the bumps is bright red. Pain is localized but may be severe. The bumps normally disappear in a few hours but sometimes proceed to swelling, blistering and necrosis. Severe or widespread stings can result in nausea, vomiting, weakness, headache, muscle spasms, and difficult breathing. Vic­tims who are allergic to jellyfish venom may. suffer anaphylactic reactions and death.

This injury produced intense pain and profuse tearing. Vision was impaired temporarily, but the symptoms cleared up within a half hour.

Treatment for JELLYFISH Stings

Jellyfish stings should be treated as follows:
1. Do not apply fresh water or rub the skin with sand. Rinse the area gently with-sea water.

2. Any tentacles remaining on the skin should be gently lifted off, preferably with gloves. If this cannot be done, alcohol, as in step 3, may be applied to the tentacles. If none is available, dry sand, salt, or sugar can be sprinkled liberally on the tentacles and scraped off after fifteen to twenty minutes. These substances inactivate the nematocysts.

3. Apply alcohol of any type to the sting site. Rubbing alcohol, liquor, cologne, or toilet water will do. This will inactivate any loose nematocysts remaining on the skin.

4. After the alcohol has been applied, a basic or alkaline sub­stance such as a mixture of baking soda and sea water, diluted ammonia, flour, or shaving cream is used. Dry sand may be used if powders are not available.

5. The mixture is scraped off with a knife and the area is washed again. Soothing creams, containing cortisone or its derivatives, may be applied.

6. Antihistamines may be helpful for severe stings, itching, or allergic reactions. Anaphylactic reactions are treated in the usual manner (see the discussion on insect sting reactions). The victim should be transported to a physician or medical facility, if necessary.

SEA URCHINS Stings

Sea urchins are immobile creatures that attach to the bottom, underwater pilings, rocks, and other objects. Covered with brittle, hard, calcareous spines, sea urchins can produce several injuries.

A few species of urchins have long, hollow spines that contain venom. These can easily break off in the skin. Wounds from these spines produce immediate, burning pain, followed by redness, swelling, and aching. The pain is not greatly out of proportion to that which might be expected from a similar mechanical injury.

Some tropical urchins have delicate pincer-like, seizing organs called pedicellariae. These are scattered among the spines and some are venomous. Pedicellariae wounds produce immediate, severe, radiating pain, which may be followed by numbness, weakness, fainting, and paralysis. Deaths have occurred.

Treatment for SEA URCHINS Stings

Particles of the urchin's spine that are imbedded in the skin but can be easily removed should be. Heat may be applied. Over­zealous attempts to remove imbedded spines may cause the spines to disintegrate further, thus aggravating the wound and perhaps increasing the possibility of infection. Pain relieving medications may be necessary, but antibiotics are usually not given unless frank infection develops. Vinegar soaks may help dissolve im­bedded spines.

Pedicellariae can break off and remain attached to the skin; they should be removed promptly. Medical care should be sought immediately if systemic symptoms develop after pedicellariae envenomation by pedicellariae.

SEA URCHINS Stings Prevention

Protective gloves, shoes, or flippers should be worn when diving or working in areas inhabited by urchins; the pedicellariae stings of tropical urchins result from handling it carelessly or allowing it to crawl on the skin.

CORAL Wounds

Corals are not a major problem except in the waters around the Florida Keys and in the Caribbean. Some corals produce mild stings, similar to those of jellyfish, but the most important injuries produced by corals are cuts and abrasions. The calcareous external skeleton of these colonies of animals is often very sharp.

The initial reaction to a coral cut is the development of itchy, red wheals around the wound. This is sometimes referred to as "coral poisoning." Relatively minor wounds may be quite slow to heal, but if neglected, such wounds can become painful, festering sores within a few days. These sores may reappear periodically for years, due to bits of calcareous matter and animal protein that remain in the skin.

Treatment for CORAL Wounds

Coral wounds should be cleansed carefully and promptly by brushing with soap and water. Particles of foreign matter or dead tissue should be removed. Alcohol, peroxide, or other antiseptics are then applied, followed by topical antibiotics.

CORAL Wounds Prevention

Corals may appear beautiful and innocuous, but even minimal contact can produce significant wounds. Anyone working in or around coral reefs should protect the hands, feet, and body with appropriate garments, such as a wet suit.

SCORPION FISH (Scorpaena)

Scorpionfish vary considerably in size, shape and color, but all have some seventeen or eighteen venomous spines among their fins; most are dorsal in location.

Scorpionfish dwell at the bottom of shallow waters, in crevices or seaweed, or beneath debris. They are scattered geographically: one species, the California Sculpin (Scorpaena guttata), is found along the coast from central California to the gulf of California. Similar species are found on the east coast from New England southward.

There are several hundred stings per year due to the California sculpin or related species. Most victims are fishermen who are stung while trying to remove fish from their hooks. Stings usually occur when the fish is handled or stepped on, but some fish may be more active and lunge or butt if approached. There is imme­diate shooting or throbbing .pain following the injury which may involve the entire hand within ten minutes and sometimes the arm and armpit as well. The affected area rapidly becomes pale, then dark blue, then swollen, red and firm. Severe pain lasts three to eight hours, while swelling and tenderness may persist for days. The effects of the sting are generally mild, though vomiting, weakness, headache, fainting and shock can occur. Pain may be excruciating with severe stings.

Treatment and Prevention
As with stingray injuries, hot soaks are preferred treatment. Some authors recommend incision and suction. Since the vast majority of scorpion fish stings result from careless handling of the fish, one should exercise great care and always wear gloves.

Injuries from Sting Rays

A sting ray is a flat fish that is circular to rhomboidal in shape. These fish prefer the shallows and are found in tropical and warm temperate waters around the globe. The weapon of the sting ray is a barbed, bony spine located on top of the tail. Different species of sting rays have tails and spines of varying lengths, and the location of the spine along the tail also varies from species to species. The sting has sharp, recurved teeth on either side and is enveloped in a layer of skin known as the integumentary sheath; this sheath contains venom.

An estimated 750 sting ray injuries occur yearly along the coasts of North America. Death from sting ray injuries is rare and is usually due to penetration of the heart or abdomen by the stinger, or to secondary infection such as tetanus.

Rays lie partially buried on the bottom in the surf, on mud flats, bays, or sloughs. They sting only in self-defense; virtually all stings result from either stepping on the fish or handling them carelessly. When stepped on, the ray whips its tail up and around to reach its victim. Stings in the chest or abdomen may occur in those who are swimming very close to the bottom.

Sting ray injuries are either puncture wounds or lacerations. The actual wound is often much larger than the sting, and may be as long as 6 to 8 inches. Portions of the integumentary sheath are often found in the wound as grey or pink fragments of tissue.

Initially, the wound bleeds freely, and is soon surrounded by an area of blue to white discoloration. Shooting or throbbing pain is the predominant symptom, may be severe, and reaches its greatest intensity within ninety minutes. Discomfort may persist for six to forty-eight hours, though usually diminishing in severity. Pain in the groin or armpit, vomiting, diarrhea, falling blood pres­sure, cramps, muscle twitching, difficulty breathing, convulsions, and paralysis may occur. The symptoms and signs of poisoning are usually confirmed to the area of the wound, however. Fainting, weakness and nausea are the most common generalized symptoms.

Treatment for Sting Rays Injuries

Immediate treatment of sting ray wounds consists of thorough cleansing of the site with the salt water at hand. Any portions of the integumentary sheath found in the wound should be re­moved. Writers disagree 'on the advisability of using tourniquets in sting ray injuries.

The injured limb should be immersed in water that is as hot as the victim can tolerate for thirty to ninety minutes. After the hot soaks it may be necessary to cleanse the wound further. When all debris or foreign matter present has been removed, the wound can be stitched up. Some physicians prescribe prophylactic antibiotics, but infections are rare with proper treatment. Anti-tetanus mea­sures should be employed.

Prevention Tips for Sting Rays Injuries

Bathers and waders can avoid stepping on these fish by sliding their feet along the bottom rather than stepping. Careless handling of captured specimens may result in injuries.

Tips for Snake Bites Prevention

The following suggestions have been adapted from Poisonous Snakes of the World.

DO:

1. Remember that snakes are more afraid of you than you are of them, and rightly so. Most snakes will retreat if given the opportunity.

2. Learn to recognize and identify the poisonous snakes in your area. 3. Remember that snakes can't take direct sunlight for long, and are most active at moderate temperatures, especially at night.

4. Remember that snakes are very good climbers and swimmers and may be found at altitudes of up to 10,000 feet.

5. Wear protective clothing and boots but don't consider this complete protection against large snakes. Wear trousers over boots, not tucked in. When a snake's teeth penetrate an object, there is reflex closing of the mouth for venom injection. Therefore, the fangs are much less likely to penetrate the boots.

6. Carry a walking stick. Probe bushes, logs, and clumps of vegetation before stepping over or around them.

7. Hike with a companion in snake-infested areas.

8. Carry a snakebite kit.

DON'T

1. Put your hands or feet into places into which you cannot or have not first looked!

2. Walk around after dark without a light.

3. Handle or disturb snakes, whether they are "dead" or alive. A "dead" snake is like an "unloaded" gun.

4. Walk through tall grass, underbrush, or thick ground cover if possi­ ble. Use a walking stick to clear the way or rout lurking serpents from their lairs if you must pass through such terrain.

5. Swim in areas where snakes are plentiful.

6. Sit down without first looking around carefully.

7. Sleep on the ground if it is avoidable.

8. Venture into or poke around caves, rocky ledges or crevices, espe­cially in the spring. Large numbers of snakes may be hibernating in such locations.


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Treatment for SNAKE BITES

Writers and medical researchers have debated the first aid treatment of snakebite for a long time. Major areas of controversy have been over the use of tourniquets, incision and suction to re­move the venom, and the use of ice. It is clear that very significant amounts of venom can be removed by incision and suction, more than fifty percent and sometimes as much as ninety percent of the total injected.6 This procedure is much less valuable if begun thir­ty minutes or more after the bite and should not be used if more than sixty minutes have elapsed since the bite.

Tourniquets, incision, and suction are not used for coral snake bites. The wound should be washed immediately and the victim taken to a hospital.

One of the prime goals in handling a snakebite victim is for everyone involved to keep calm. Physical activity on the part of the victim may result in faster spread of the venom throughout his system. -Efforts should be made to kill or at least identify the offending serpent, though not at the risk of further bites. Physi­cians often see near-hysterical persons who have been bitten by snakes that were not poisonous. It is much easier to reassure these individuals if the snake is available for identification.

If tourniquets are to be used, they should be applied above the next joint or two to four inches above the bite. The tourniquet should fit snugly, but remain loose enough to allow a finger to be slipped beneath it. It must not cut off the pulse beyond it. The tourniquet should be released for about ninety seconds every ten to fifteen minutes and moved towards the body to keep it just ahead of the swelling. Tourniquets should probably not be used if they cannot be applied within thirty minutes of the bite and should not be continued for more than two hours.

Incisions are made with a sharp blade, such as a razor or sharp knife that has been sterilized with heat or alcohol. The incisions should be 1/8 to 1/4 inch long and about 1/8 inch deep through each fang mark. The incisions are made no more than skin deep. When making the incision, it is very helpful to pinch the skin between 'the thumb and forefinger and pull this fold of skin upward and away from the surface of the extremity. This allows careful control of the depth of the incision and helps avoid cutting too deeply into underlying tendons or blood vessels. Suction is then begun and continued for one hour or until antivenin is administered. Commercially available suction cups are much better than oral suction because the latter contaminates the wound with germs from the mouth. Oral suction should not be attempted if there are cuts or sores in the mouth.

If the bite is on an arm or leg (almost all are), the limb should be gently immobilized with a splint and kept at a level below the heart but not hanging downward. Ice bags have been suggested, mainly to control pain, but should be avoided; excessive cooling will increase damage to the tissues and blood vessels and can cause loss of the limb.

Obviously, the victim should be transported to the nearest medical facility immediately. In severe bites antivenin may be lifesaving, but allergic reaction to it is common. The quantity given depends on the severity and circumstances of the bite, size and species of the snake, and size and, health of the victim. Possible complications, other than direct results of the venom, include a secondary infection of the wound, tetanus, reactions to the antivenin, and amputations necessitated by the over­zealous use of ice.

In summary, the following measures should be taken in the case of snakebite:

1. Don't Panic.

2. Kill or identify the snake, but not if it will be risky or time consuming.

3. Apply a tourniquet.

4. Begin incision and suction of the wound.

5. Immobilize the extremity.

6. Evacuate the victim to the nearest qu~1ified medical facility.

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SNAKE BITES

There are several indicators that can help determine whether a bite is from a poisonous or nonpoisonous snake. The importance of identifying the species, if possible, has been stressed. In a pit viper bite (99 percent of poisonous snakebites known in America are attributable to this family), there is immediate pain, sharp and burning, at the site. Swelling begins at the site within five minutes and usually progresses gradually, continuing for several hours or up to a day and a half. Sometimes however, an entire limb be­comes swollen very rapidly.

Many snakebites are dry runs, that is-the snake fails to inject any venom into the tissue. Many more result in minimal envenom­ation and mild to moderate bites. Envenomation is significant in only about 15 percent of the bites. If there is little or no swelling and no symptoms after a half hour, significant envenomation is very unlikely.

Numbness and tingling of the scalp, face, mouth or lips is fre­quent and twitching of the muscles around the eyes and mouth is sometimes observed. The victim may be sweating and complaining of faintness and nausea. In severe cases there may be bleeding from the lungs, stomach, intestines, or kidneys, difficulty breath­ing, and shock.

As a rule, the more rapidly symptoms develop, the more severe the bite is likely to be. Parrish has classified pit viper into four clinical grades, depending on the quantity of venenation, degree of pain, amount of surrounding swelling and redness, and the degree of systemic involvement. Such grading of bites is valuable in determining the proper dosage of antivenin.

Lawrence Klauber has listed the major factors which influence the severity of the bite and the likelihood of a fatal outcome:

1. Age, size, sex, vigor and health of the victim.

2. Allergy complex; susceptibility to protein poisoning. (Allergic reactions to snake venom are possible, particularly in those unfortunate enough to have been bitten before.)

3. Emotional condition and nature of victim. Panic or hys­teria on the part of the victim or his comrades could be quite harmful. (Stress can double the toxicity of Rattle­snake venom.)

4. Site of the bite. Ninety-eight percent of bites are on the hands or feet, fortunately.

5. Nature of the bite. Was it a full, direct stroke, as opposed to a glancing blow or scratch?

6. Protection afforded by clothing.

7. Number of bites. Occasionally more than one is involved.

8. Length of time the snake holds on. Most pit vipers strike and release immediately.

9. Extent of the anger or fear of the snake. If the snake is injured or fighting for its life, it may well release more venom.

10. Species and size of the snake. ­

11. Age of the snake. Very old and very young snakes may be less virulent in proportion to size.

12. Condition of the venom glands. Are they full or partially depleted?

13. Condition of the fangs.

14. Presence of various germs in the snake's mouth.

15. Nature and rapidity of first aid and eventual treatment given.

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SCABIES (Itch Mite) Treatment

Physicians around the globe are seeing cases of scabies in quantities which suggest that we are experiencing an epidemic of this disease. Such levels of scabies have recurred about every thirty years, and can b~ more frequent in crowded or unsanitary living conditions. The itch mite is a human parasite and, like lice, cannot survive if detached from a host body for more than a few days. Symptoms normally don't appear for several weeks after the onset of infestation, during which time the host gradually becomes sensitive to the mite.

The female mite burrows under the most superficial layer of the skin. Within this tunnel, she lays numerous eggs, from which are hatched larvae which scurry across the skin looking for other mites or places to burrow. The life cycle of the mite is about 30 days.

The first evidence of scabies is itching, which may be severe and is characteristically worse at night. The rash of scabies, which appears on the hands in over 95 percent of cases, has itchy bumps of various sizes and sparse blisters between the fingers. Annoying bumps may also appear on the arms or trunk of highly sensitive individuals.

The burrow is a sure sign of scabies. Burrows appear as fine, dirty, wavy lines that are short and very superficial. Produced by the female mite as she tunnels under the superficial layer of the skin, they can sometimes be seen ending in a blister. The sides of the fingers and the webs between the fingers are often the areas first involved, and the undersides of the wrists and edge of the hands are also commonly affected. In men, the genitalia are often involved, typically with large, swollen bumps. Other favored sites are the elbows, waist, and lower portion of the buttocks. The head, face, and neck are not involved, except occasionally in infants. The palms and soles are rarely affected except in infants or elderly people with very thin skin.

Scabies mites are easily eliminated with proper treatment, but because of the lingering allergy to the mites, itching may persist for days or weeks after treatment. Though the mites are dead, their eggs, feces and body parts may remain in the skin for a few days until complete healing occurs. The individual reasons that since he continues to itch, he must still be infected, and thus re-treats himself furiously and repeatedly. This may lead to irri­tation of the skin and even worse itching. Neglected or long­standing cases of scabies can lead to eczema and secondary infec­tions.

Scabies is moderately contagious. In young adults, it is often spread by sexual contact, since transmission of the mites is a­chieved primarily by close skin-to-skin contact. The mites are very unlikely to be caught from the clothing of others. Sleeping in a bed recently or currently used by someone with scabies may suffice to produce infestation. After the initial infestation there is a period of several weeks before itching begins. Family members or other close contacts who are destined to later develop the eruption are usually asymptomatic when the first person in the family begins to itch.

Treatment for SCABIES (Itch Mite)
GBH is the preferred scabicide although it is not recommended for children because of possible toxicity from absorption into the system. Eurax (crotamiton), and 10 per'cent Sulfur are also effec­tive, and may be used on children. All of these treatments require a prescription. The following regimen is recommended:

1. Bathe prior to the application of the scabicide.

2. The scabicide is applied to the entire body-from the neck down. Failure to do this is the most common error in treat­ment. Remember, if a single female mite is missed, she can produce a whole new generation. The genitals, buttocks, and feet should be covered with utmost care.

3. GBH is left on for twenty-four hours, then washed off. A second application one week later can be done but is usually unnecessary. Crotamiton and sulfur should be reapplied.

4. People with whom the individual has close contacts should be treated in the same fashion whether they are itching or not.

5. Clothing, underwear, and bed linens should be laundered at the conclusion of treatment. This is done for contacts as well.

6. Itching often persists for a few days or even weeks depending on the individual and the severity of the infestation. People who continue to itch after two weeks should be re-examined.
When the scabicide is applied correct1y, treatment failures are unusual. The itching is treated with soothing baths, lotions, cortisone creams and antihistamines taken orally.

SCABIES (Itch Mite) Prevention
Individuals who practice good personal hygiene are less likely to develop severe scabies. (They can still get it.)

Every Thing about LICE

There are three types of human lice: the head Lice, body lice, and the pubic, or crab lice. All are bloodsuckers, and the head and body louse are identical in appearance. The crab louse differs from the others in that its width is greater than its length. Its front legs are powerful and curved forward for grasping, giving it an appearance similar to its namesake, the crab.

HEAD LICE
Head lice primarily infest children. The major symptom of their presence is itching, and secondary infection is common, and the lymph nodes of the back of the head and neck may be enlarged and tender. An itchy rash may be seen around the neck and on the trunk. Nits, or louse eggs, appear as small, oval whitish objects that are firmly attached to hair shafts. While flakes of dandruff are easily brushed off the hairs, nits are not. The lice themselves are agile and can be very elusive.

Treatment for HEAD LICE
Gamma benzene hexachloride (GBH, lindane or Kwell) sham­poo is prescribed by most pnysicians. Approximately I tablespoon is used to clean the scalp thoroughly for four minutes. The hair is rinsed and dried, and a second shampooing may be necessary in a week.
Several over-the-counter preparations are of value, especially those containing mixtures of pyrethrins and piperonyl butoxide. These are applied for ten minutes and then washed out with soap or shampoo. Such preparations should be kept away from the eyes, mouth, and nose. Dead nits and lice may be combed out afterwards with a fine-tooth comb.

After treatment, washable clothing and personal articles that may be contaminated should be machine washed or dry cleaned, as appropriate. Nits can be destroyed by drying for twenty min­utes at high heat.

BODY LICE
These lice can live in the seams of clothing, and generally thrive in unsanitary conditions. Their bite produces small red bumps that are quickly scratched away. Linear scratch marks usually appear on the shoulders, trunk, or buttocks after infestation, and secondary infection is possible.

Treatment for BODY LICE
Laundering, dry cleaning, boiling or ironing infested clothing will destroy nits and eggs as well as the lice. The lice die in about ten days if they cannot feed. If clothing is stored for thirty days, adult lice as well as nits that hatch in the interim will not survive.

PUBIC LICE (Crab Lice)
Pubic lice infestations normally occur in the pubic hair, but they are sometimes found in body hair, the armpits, eyebrows, or eyelashes in severe cases. These lice are sandy colored, partially transparent, and flat. Often seen attached to the base of a hair, the lice vary in size, but are usually about the size of a pinhead. Nits attached to hair shafts are conclusive evidence of infestation with pubic lice. The rash may be no more than a few scratched bumps except in severe cases, but itching can be severe.

Treatment for PUBIC LICE (Crab Lice)
GBH is most often used for pubic lice. A warm bath is followed by the application of a thin layer of GBH to the infested area as well as to adjacent, hairy areas. The medication is washed off after twenty-four hours. If nits persist, a second application in one week may be necessary. Clothing or bed articles that have been in contact should be washed, laundered, ironed or boiled.

The over-the-counter agents mentioned in the section on head lice may be used.

CHIGGER Bites

The chigger, also know as the red bug or harvest mite, is the larva of a Trombiculid mite. These mites are widely distributed in the United States and are most common in the southern and central states. Large numbers are found in grass, bushes, pine needles and underbrush where they await a suitable vertebrate host. Chiggers are most numerous in the late summer and fall.

The mite larva itself is tiny and pale red in color. After reaching its host, the larva runs rapidly over the skin until it finds either a satisfactory place to attack or an obstacle, often the edge of an area constricted by clothing. At this point it attaches to the skin and secretes a digestive fluid which causes the bite reaction. Itching begins within a few hours and swollen, extremely itchy bumps appear. Often the chigger can be seen in the center of the bump with the naked eye or a hand lens. The bumps may appear around the ankles, in the groin, including the male genitalia, around the belt line, in the armpits, and other areas. The chiggers are removed by scratching or fall off after they are engorged, usually departing within two or three days. Nodules may develop and scratching can cause secondary in­fection. Some individuals acquire a sensitivity to chiggers and then lose it, as with several other types of insect bites.

CHIGGER Bites Treatment

A very effective treatment is a thorough, soapy bath as soon as possible. If lathering and rinsing are repeated several times, most of the chiggers will be killed. If a bite reaction develops, the bumps will persist for periods of several days to two weeks. Chigger bites are treated with cleansing and measures to control itching. Incidentally, household remedies such as nail polish, furniture polish, kerosene, Clorox, butter and salt, and pastes made of meat tenderizer are of unestablished value.

CHIGGER Bites Prevention
Uncut areas, pine needles, and underbrush should be avoided or eliminated; infested areas can be treated with insecticides. Clothing should fit snugly at the ankles and wrists. Repellents are useful, especially diethyl toluamide (deet), ethyl hexanediol, and dimethyl phthalate, and should be generously applied to cuffs and sleeves, legs, ankles, wrists, and the area around the waist. The application of dusting sulfur to skin and clothing is an old but effective preventive.

TICK Bites

Ticks are members of the order Acarina, as are mites. Distin­guished by their fused thorax and abdomen, ticks have an oval body that is flat and sac-like, with a leathery consistency. While larval ticks have six legs, adult ticks have eight, with the front legs curved forward as in crabs. Adult females may be up to ½ inch in length.

Ticks lie in ambush for their warm-blooded hosts on the tips of tall grass and shrubs. Heat and carbon dioxide may stimulate adult ticks to drop off their perch, and special sensory organs enable them to spot potential hosts at long distances. Ticks attach to the skin with recurved teeth and produce a glue-like secretion which tightens their grip. After feasting on. the victim for a few days, the tick may become grotesquely bloated and distended, with legs barely protruding. Ticks are well-known for their ability to survive without food for prolonged periods, up to sixteen years for some species.

There are two families of ticks, the soft Argasid and the more important hard Ixodid ticks. Among hard ticks, the American dog tick (Dermacentor variabilis) is found both on the Pacific Coast and east of the Rockies; in the east, it is the species most often found on man. This tick can transmit tularemia and tick paralysis. It is the principal, if not only, carrier of Rocky Mountain spotted fever in the eastern and central United States.

The Rocky Mountain. wood tick (Dermacentor andersoni) is found in the Rocky Mountains and neighboring regions to the west and in the Southwest. In these areas it is the major vector of Rocky Mountain spotted fever and of Colorado tick fever. It is almost always the species responsible for tick bite paralysis in the Pacific Northwest where this disease is most common.30

The lone star tick (Amblyomma americanum) is named for the silver spot on its back. This tick is found in the southeast and in Missouri and Texas. Especially common in the Ozark region, the lone star inflicts severe bites and spreads several serious diseases, particularly tularemia. Unlike the Dermacentor species, it attacks man in the larval and nymphal as well as the adult stages. 31 The lone star tick is also difficult to control with pesticides.
A few soft ticks are of importance. Some carry relapsing fever in the western states, while the pajaroello, a large tick of the mountainous coastal counties of California and Mexico is feared because of its bite, which can result in considerable swelling, dis­coloration, and ulceration at the site.

Tick bites are seldom painful. Often the attached tick will not be noticed for several days. There may be some itching, and the tick may be first discovered as a lump that has been scratched.

Complications of tick bites can develop, however. Tick bite granuloma, or "tick nodule," is a lump which appears at the site days to weeks later. Usually red and firm, this lump may be itchy or tender and can be as large as I inch in diameter. Sometimes they are soft, and periodically drain fluid or purulent material. These granulomas may persist for months, and usually require medical attention.

A more serious disorder is the infamous tick bite paralysis.This occurs chiefly in the Pacific northwest, but has become more common in the eastern states. Most often seen in the summer, tick bite paralysis seems to be due to a toxin present in the saliva of some female ticks. The closer the tick is attached to the brain or spinal cord, the more rapidly the paralysis will develop and the worse it will be. The tick is often attached at the nape of the neck but may be in the groin or other areas. Children under two years of age are most frequently involved. Thankfully, this is not a common problem, accounting for about 1 death per year, with a death rate of about 12 percent.

In cases of tick paralysis, there is a latent period of about 5 days after the tick becomes attached to the skin. The victim may become tired and irritable, and complain of pain or tingling sensations in the legs. This is quickly followed by staggering and a loss of coordination, and paralysis within twenty-four hours of the onset of symptoms. The paralysis begins in the lower extremi­ties and moves rapidly upward, but there is no pain or fever in the early stages. This helps differentiate the disease from polio, with which it may be confused. Unless the paralysis is severe the victim will recover dramatically after removal of the tick. Thus, paralysis and death are preventable, if the disease is suspected and the tick searched for and removed in time.

Treatment for TICK Bites

When removing attached ticks, it is important to be sure that none of the mouthparts are left behind. A drop of kerosene, benzene or gasoline can be applied to encourage the tick to release its grip. The tick's posterior can be burned with a hot cigarette tip or match (obviously not while flammable solvents are still present). Clear fingernail polish, mineral oil, or vaseline can be used to smother the tick. After any of these remedies one should wait at least ten minutes 'to allow the tick time to release its grip.

If this fails, the tick can be gently pulled off. It should be remembered that ticks are very firmly attached and may be unable or unwilling to release their grip. They should be pulled off gently with sustained pressure. The tick should not be crushed or squeezed, because this could force its body's contents into the wound, along with any undesirable germs it may harbor. After removal of the tick, the site should be treated with an antiseptic.

TICK Bites Prevention

When venturing into tick-infested areas, the individual should wear protective clothing as well as high-topped shoes, boots, or leggings. Sleeves and cuffs should fit tightly and the trousers should be tucked into the boot tops. After such field trips, your clothes should be hung up for several days, because ticks present on the garments will eventually walk away in search of more fertile fields. The body should be inspected carefully once or twice daily and at the end of the day while on trips into infested areas. The scalp and hairy areas, such as the armpits, groin, and between the fingers and toes should be especially scrutinized. It may help to do this in pairs, and remember to check the children very thoroughly.

The insect repellents discussed in the chapter on biting insects are useful against ticks. Particular care should be taken to apply them around cuffs and at locations that allow the tick access to the skin. Dogs should be treated regularly since they can bring ticks into contact with man.

If an individual becomes ill with fever, headache, a rash or other suspicious symptoms, he must see a physician immediately. Serious infectious diseases such as Rocky Mountain spotted fever, tularemia, relapsing fever, Q fever, and tick paralysis can result from tick bites.

What to Do for Scorpions Eat - Bytes?

The menacing appearance of the well-armed scorpion should provide ample warning to anyone unfamiliar with this creature. The scorpion looks like a crab with a segmented tail, and has two pincers. At the tip of the tail is a swollen segment with a stinger which the scorpion holds poised over its back. Scorpions vary from about ½ to 8 inches in length, depending on the species. About thirty species inhabit the southern three-fourths of the United States, predominantly the southwest; scorpions are rarely found north of an imaginary line connecting Baltimore, St. Louis, Salt Lake City and San Francisco.

. The only dangerous species found in the United States is the sculptured scorpion (Centruroides sculpturatus), which lives exclusively in Arizona and limited adjoining regions of New Mexico and California. This scorpion is about 2 1/2 inches long, and a solid straw yellow in color.

Scorpions are nocturnal, hiding under anything available or in crevices during the day, and sallying forth at night to search for food. Scorpions kill their prey by grasping it with their pincers and stinging repeatedly.

The venom of most scorpions is rather mild, with reactions not spreading beyond the sting site. Initially there is a burning sensa­tion followed by swelling and discoloration. Local reactions vary from slight swelling to pronounced painful swelling with discolor­ation and severe burning, but allergic reactions occur rarely. In contrast, stings of the deadly sculptured scorpion produce minimal local reactions, but systemic effects may be severe and fatal.

The venom of the sculptured scorpion is at least as potent as that of the rattlesnake. This venom attacks the nervous system primarily. The sting produces an immediate, sharp pain followed by a prickling, pins-and-needles sensation in the area, which spreads and is followed first by a period of increased sensation, then decreased sensation, then numbness and drowsiness. The site is likely to be very sensitive and increased salivation and sweating are strongly suggestive of sculptured scorpion stings. The victim may exhibit garbled speech, restlessness, and uncontrollable twitching followed by muscle spasms, convulsions, and respiratory arrest. Symptoms may last for one or two days, though death often comes quickly.

Unlike a snake bite, a scorpion sting produces a single puncture with little, if any, bleeding. Scorpion stings of all types produce more severe immediate pain than spider bites.

Treatment for Scorpions Eat

Most scorpion stings are mild and require no more than the local application of an ice cube and symptomatic treatment.

Immediate first aid treatment may determine whether a sting is mild or becomes serious. A tourniquet should be placed as close to the sting site as possible, and must be loosened briefly every ten to fifteen minutes. Incision and suction are of no value, but the entire limb should be immersed in ice water. If this is not possible, ice packs can be applied. The tourniquet can be removed after five minutes of immersion in the ice water, but the limb should be kept in the ice water continually for at least two hours.

Antivenin is available and may be necessary if the sting is that of a sculptured scorpion. Opiates must not be used since they may increase the effects of the venom.

Prevention Tips for Scorpions Eat

One should remember the nocturnal habits of the scorpion and its preference for secluded hiding places. Piles of boards, rocks, and other debris should be eliminated, and the number of insects, spiders, and rodents on which scorpions feed should also be controlled. Insecticides are effective and can be used against scorpion habitats for lasting control. A favorite scorpion hideout is sandboxes. Where scorpions are numerous, shoes and clothes should be carefully shaken out before dressing, especially if one is sleeping outdoors.

BROWN RECLUSE SPIDER Bite

The brown recluse spider is oval, with a body about 3/8 inches long and a leg span of 1 to 1 ½ inches. Its color ranges from yellowish-tan to dark brown. There is a characteristic, dark, violin-shaped marking on the spider's back. This marking is situated with the base of the violin just behind the eyes on tops of the head and the stem of the violin extending along the back to the abdomen. Thus the spider is often referred to as the "fiddle-back" spider. Another distinctive trait of the brown recluse is its arrange­ment of six eyes in a semicircular pattern-most other spiders have eight eyes.

Like the black widow, the brown recluse prefers a dark, dry, secluded habitat, often indoors, though related species of the southwest are usually found outside. The brown recluse camps in or around houses, in spots that have not been disturbed for some time. Its web is small, haphazard, and woven in cracks, crevices, or corners.

The initial bite of a brown recluse may be almost painless, but often there is a sensation similar to the sting of a bee. Most bites are mild and cause no more than a minimal local reaction. More serious bites are accompanied by pain; within a few hours', an area of redness one to two inches in diameter develops around the bite, with blistering in the center. In the developing stages of the bite, it may be surrounded by a pale, blanched ring. A large area of swelling may surround the bite, with this region becoming blue to blue-black and very sensitive. Within three or four days, the site is covered by a dark, dry scab or eschar, made of nothing more than dead skin. The depth of dead tissue may extend as far as the muscle. This scab can vary in both shape and size, becoming nearly star-shaped in some cases.

Within two weeks, the dead tissue is lost and the bite site is replaced by an open sore. Healing may take months.

The victim usually is moderately ill during the acute stages of the reaction. Severe reactions are possible and deaths have occurred, primarily in children. The victims often experience fever, chills, nausea, vomiting, weakness, joint and muscle pains and hives or measle-like rashes within one or two days. Table I gives a classification of brown recluse bites according to severity. This classification has been suggested as an aid to establishing the proper treatment for individual cases.

Treatment for BROWN RECLUSE SPIDER Bite

There has been controversy among writers concerning the treatment of these bites. First aid is not effective, but early excision of the entire bite is generally felt to be of value, especially if the bite is greater than 1 cm (4/ 1 0 inch) in diameter. Large doses of cortisone have been advocated by some authors, and antibiotics are sometimes used. A major problem in treating these bites is in diagnosis, since the victim is often unaware of having been bitten. Identification of the spider is very important. A number of peculiar skin wounds have very likely been blamed on this spider for lack of any other culprit since other spiders, ticks, and bugs can produce similar wounds, though not as severe.

Prevention Tips for BROWN RECLUSE SPIDER Bite

Almost all spider bites are inflicted when the spider is forced to defend itself. Since the brown recluse often hides in old garments, putting on shoes or clothes that have not been worn for a while may trap the spider against the victim's body, resulting in a bite. Bites may also take place when the victim rolls on top of the spider when in bed. For this reason, shoes, clothing, bed linens and blankets should be stored with mothballs and thoroughly shaken out before use.

A crucial step in the control of black widow and mown recluse spiders is the elimination of their current and potential habitats. Old lumber and rubble of any sort should be cleared away, or at least treated with an insecticide. Since paint, light and cleanliness discourage these creatures, secluded places behind furniture, appliances, or in closets should be kept clean. Because black widows may defend both their webs and egg sacks, these should be destroyed with care. As mentioned above, outdoor privies should receive careful attention since these spiders often meet their victims there.

BLACK WIDOW SPIDER Bite

The black widow spider has a shiny, black, globular body about ¼ inch long. On the underside of the abdomen is a distinctive, bright red marking which is shaped like an hourglass. This marking is replaced in some individuals with several triangles, spots or an irregular blotch. The spider is often called the "hourglass spider" or "shoe button spider" because of the marking and its overall appearance. Its legs are long and when stretched they extend to a diameter of about 1 ½ inches. The feminine gender and mating status suggested by its name is appropriate. The male is a much smaller spider and is not dangerous.

Black widow spiders live in dry, sheltered spots. They weave a rather sparse web of strong, coarse but randomly arranged threads. Favored homesites of black widows include cracks and crevices in old buildings, trash, old lumber piles, and beneath rocks and debris. Backsides encountered in outhouses are a favored target of the black widow.

The seriousness of a black widow spider bite is determined by the same factors that are important in snakebite: the size and aggressiveness of the spider, the number and location of bites, the amount of venom injected, the time of year, and the health and size of the victim. The fangs of the black widow are only about 1/50 of an inch in length and may not penetrate tough skin. Drop for drop, the venom is equal in potency to pit viper venom.

Initially the bite produces a sharp prickling sensation, followed by a dull, numbing pain. The reaction at the point of the bite is usually minimal; no more than slight swelling and perhaps a set of tiny, red fang marks appear. The pain increases in severity for one to three hours, until it becomes severe due to agonizing cramps of the abdomen, shoulders, back, and chest. The stomach muscles become rigid, and spasms of other muscle groups follow. Dizziness, headache, sweating, nausea, vomiting, rashes and burn­ing and tingling sensations often occur. Convulsions, paralysis and shock may finally develop; but the picture is usually dominated by muscle spasms and the resulting pain.

Most deaths from black widow spider bites have occurred in children, the elderly, and persons with high blood pressure.

Treatment for BLACK WIDOW SPIDER Bite
Local first aid such as that recommended for snake bites is of little value, but ice packs may reduce pain and delay the spread of venom. The poison does not attack the tissues around the bite as does snake venom, and the use of ice is therefore not hazardous. Muscle relaxants for the spasms are helpful, and antivenin is available.

Spiders and Your Skin

All spiders possess fangs and practically all are venomous. Fortunately, the fangs of most spiders are not capable of pene­trating human skin. Spiders are not aggressive and bite only in self-defense, though the black widow may attack those trespassing onto her web.

The most dangerous spiders in America are the black widow and the brown recluse. Both spiders are occasionally responsible for fatal bites. The black widow is found in every state except Alaska and is especially numerous in the rural South. Closely related spiders, found in various parts of the South and West, are known as the brown widow and red widow.

The brown recluse is most plentiful in the South-Central states ranging from Nebraska to Ohio in the north, to Georgia and Texas in the south. Especially common in Missouri, Arkansas, and Oklahoma, this spider is being found living in a growing number of places, in part due. to its habit of hiding in furniture and dark closets; it frequently travels via a moving van along with household goods. Again, similar species are found in the Southwest.

Some fifty other species of spiders in the United States have been known to bite humans. The bite of the orb-weaver or garden spider, the trap door, running, or wolf spider, and the so-called banana spider can produce pain, swelling, redness, itching, and occasional blisters or sores. Systemic effects are rare.

The tarantula's reputation as a dangerous spider is probably based on its appearance, since the common tarantulas of the Southwest are docile and their bites are no worse than a bee sting.

Flea Bites and Your Skin Health

Fleas are rather cosmopolitan insects. They are found anywhere man or animals are available as hosts. They live on many species of animals, both domestic and wild. Some prefer a specific host, but generally they will bite whomever is available for a blood meal. Fleas are found throughout America, and are especially common in California because of its mild climate.

Fleas are small, reddish-brown, hard-bodied insects. Adult fleas are 1 to 4 mm long (about 1/16 inch) and are wingless. The legs are long and slender and the posterior pair (hind legs) are elongated for jumping. Fleas can jump about 2 feet. They are rather elusive and when caught are difficult to crush. Their life­span may be as long as two years. They can survive for months without food, sometimes well over a year.

Flea bites tend to be seasonal, except in the warmest climates of the south and west, where they can occur year round. Flea bites are usually grouped, because the flea wanders around a particular area biting at random. Bites are usually on the legs, arms, and face. A tiny red dot (punctum) can sometimes be seen in the center of the bite. Small blisters occasionally appear on the bumps and sometimes large blisters form. Flea bite reactions most often affect children between the ages of two and seven. Typical flea bites are small, firm bumps. These bumps may be bright red and wheal-like, or dull red to brown.

Like mosquitoes, fleas may be more attracted to some indivi­duals than to others. Body odor, age, and sex hormones may contribute to these differences. The major determinant in flea bite reactions, however, is individual sensitivity. This situation is analogous to that seen with mosquito bites. Those who have not been bitten will not be sensitive and persons who have been bitten many times may well lose their sensitivity.

Allergic sensitization to flea bites follows a definite and char­acteristic sequence. Initially, there is no reaction. Sensitivity develops suddenly, usually several days later. Original bite sites, heretofore quiescent, may erupt into firm bumps (delayed re­action). Then comes a period when the firm bumps develop about twenty-four hours after new bites. Immediate reactions (wheals within thirty minutes of the bites) begin to appear and the delayed reaction gradually fades away. The wheals of the immediate reaction resolve within a few hours, while the bumps of the delayed reaction last several days. A period of immediate reactions alone follows. Finally, a state of immunity is reached in which there are no reactions at all. This chain of events is remini­scent of the sequence seen with mosquito bites.

Treatment for Flea Bites
Itching may be controlled' by topical medications and anti­histamines by mouth. If scratching results in breaks in the skin, measures to prevent infection, such as cleansing the sites and applying topical antibiotics or antiseptics, should be employed. Scratch marks may be deep. Keeping the nails clipped as short as feasible may be helpful to minimize trauma from scratching.

Prevention for Flea Bites
Fleas in and around the house must be controlled. Family pets are usually the source. Dogs and cats should be treated periodically and prophylactically, since they will become rein­fested after contact with other animals. Lindane dust or shampoos can be used on dogs. Several powders are available for puppies and cats. Deet is probably the most satisfactory flea repellent.

Things to know about Insect Repellent

A number of good insect repellents are available. The best of these is deet (N,N-diethyl-m-toluamide). Deet tends to last longer on the skin than the other repellents. Other effective repellents are ethyl hexanediol, dimethyl phthal­ate, dimethyl carbate, and indalone. Combinations are sometimes used. Higher concentrations of these agents are more effective and last longer, but sometimes are rather oily. Most are available in a variety of vehicles such as sprays, sticks, oils, and saturated pads. They may damage synthetic fibers and plastics.

Repellents do not literally repel insects. Rather, they make the skin unsatisfactory as a landing area. Insects will land on untainted skin even if repellent is quite near; it follows that all skin that is accessible should be treated.

If the repellent is present on the skin, insects will hover around the surface and sometimes land, but depart hastily. When the repellent begins to wear off, insects will land and walk around. At this point, the repellent should be reapplied. Some individuals are protected for longer periods than others. In warm, humid conditions, a single application of deet protects for no more than two hours, at best. In more moderate weather, deet protects for about four hours.

The repellent should be applied to the entire area that is to be protected. Most repellents will sting cuts or mucous membranes. The face should not be sprayed directly. The repellent can be applied to the face with the fingertips. One application will usually last several hours, but wind, heat, humidity or profuse sweating may remove the repellent more rapidly. Much repellent is rubbed off by clothing and other objects. These agents should be applied to clothing in areas which are susceptible to bites such as the shoulders, upper back, and thighs.

One useful method is the impregnation of all outer clothing with a repellent. About 2 1/2 ounces (five tablespoons) of the repellent is used for each jacket, shirt or pair of trousers or socks. This is done by dissolving the repellent in dry cleaning fluid and thoroughly wetting the garments with the mixture. The garments should wet thoroughly without any excess. This process usually requires about three pints of the dry cleaning fluid for each heavy cotton garment. The fluid should ,be allowed to evaporate before wearing the clothes. An alternate method is to dissolve 2 ½ ounces of an emulsifier or 1 ounce (two tablespoons) of a laundry soap in water; then add the repellent while stirring vigorously. The clothes are saturated with the emulsion and dried before wearing. Trousers and mesh soaked in repellent are available but may be expensive. They may offer protection for several weeks.

Biting Insects – Treatments and Prevention Tips

The biting insects fall into three major orders. The order Siphonaptera encompasses fleas, the order Diptera includes mos­quitoes and flies, and the order Hemiptera contains biting bugs such as wheel bugs, assassin bugs, bedbugs, corsairs and kissing bugs. The Dipterae are most important because of their role as vectors of infectious diseases as well as the greater frequency of their bites.

BITING FLIES
A number of species of biting flies are distributed throughout North America. Actually, these flies do not bite in the literal sense; they stab their victims with a sharp stylet. The reaction produced is due to saliva injected by the fly. The stab itself may produce pain. The reaction to these bites depends on the type and degree of allergy or sensitivity to the fly's saliva.

STABLE FLY (biting house fly, beach fly, dog fly)
The stable fly is very similar to the common house fly, which cannot bite or sting. The stable fly can be distinguished by its much broader abdomen and bayonet-like mouth parts. This fly prefers the company of the domestic animals on which it feeds. I t is usually found outdoors and bites during the day. It may come indoors in the fall, or during rainy weather, and thus

SNIPE FLY
This is a biting fly of moderate size which resembles the stable fly. It can be distinguished by its long legs and tapered abdomen. The snipe fly is notable for its stealthy attack and painful bite, which has been likened. to having a needle forced into the skin. I t is found at J1igher altitudes and only attacks in the open and on sunny days. Otherwise, their habits are similar to those of the deer flies. Snipe flies are slow and easy to swat or catch.

HORSEFLY
The horsefly is large and heavy-bodied, normally ten to twenty­five mm (3/8 to I inch) in length. Horseflies feed primarily on livestock, but may attack humans. They are more readily repelled than smaller flies because they are larger and. slower. The wide­spread black horsefly of eastern North America is probably the infamous "blue-tailed fly" of the well-known ballad. The greenhead fly and striped horsefly are annoying pests of the eastern United States.

DEERFLY (yellow fly, triangular fly, three-cornered fly)
Deerflies are about half the size of horseflies. They may be yellow, green, gray or black in color and are often spotted. They are much quicker and more difficult to avoid than horseflies. Deerflies seem to prefer to bite humans on the head. They attack persistently and inflict painful bites. Deerflies are active during the day and are found around animals and in woodlands.

SAND FLY (Phlebotomus)
Sand flies are tiny gnats found in tropical or subtropical cli­mates. They are weak fliers and attack only on still nights. Because of their small size, sand flies can penetrate nets and screens. They tend to attack ankles, wrists, elbows, and knees.

BITING MIDGES (punkies, no-see-ums, gnats, sand flies)
Biting midges are very small gnats that may be mistaken for black flies, though they are smaller than the latter. Midges are usually one to three millimeters in length-not much larger than a pinhead. Their biting habits are also similar to those of the black flies. They are likewise distinct from the Phlebotomus sand flies mentioned above. Biting midges are more common than sand
flies. They are distinct from the Phlebotomus sand flies mentioned above. Biting midges are more common than sand flies in moderate climates. These insects are found around water, often in heavily populated areas, where they may be a serious nuisance. Midges may fly in swarms and usually attack at dusk.

Because of their diminutive size, biting midges often go un­noticed until their bites are felt. Pain, usually a mild prickling sensation, occurs immediately. They tend to attack the areas such as the neckline, beltline, shoe tops, and below rolled-up sleeves and upper portions of the body. Reactions to the bites may be immediate or delayed. Some persons have quite bothersome reactions with persistent swellings or sores.

Treatment for Insects Bite
The area around the bite should be thoroughly cleansed because of the frequent occurrence of secondary infections. This is all that is necessary for most fly bites. Antihistamines by mouth or various topical medications can be used for itching. Cold compresses should be applied for local swelling. Allergic reactions are treated like those that occur with the stinging insects

Prevention for Insects Bite
Familiarity with the habits and distribution of these insects is helpful. Protective clothing limits the areas they can attack. Clothing should be secured tightly at wrists, ankles, and neck. Hats, gloves, and veils may be beneficial. The liberal and repeated use of insect repellents may be necessary.

BLISTER BEETLES and Your Skin Health

There are about two hundred species of blister beetles found throughout the world. The beetle excretes a toxic substance called cantharidin from various parts of its body upon the slightest pressure or contact. Cantharidin applied to human skin, even in small amounts, will result in blister formation within a few hours. If the eyes are involved, severe reactions, even blindness, can occur. Blister beetles are active throughout the United States in the summer, but are more frequent in the west.

These beetles are from ~ to I inch in length. They are elongated creatures characterized by a "neck" that is distinctly narrower than the head or thorax. In the east the most common species is deep purple or black, while those found in the west are usually ash-colored.

Cantharidin has long been used as an aphrodisiac. The Lytta vesicatorea species, found in Europe and especially in Spain, is known as the "Spanish fly." If taken internally, cantharidin can cause severe nausea, vomiting, diarrhea, and cramps. It is sometimes used to treat warts because of its ability to blister the skin.

Most blisters result from contact with the beetles when they are drawn to artificial lighting in the evening. If the beetle is permitted to walk across the skin, cantharidin is not released. If the insect is gently brushed off, however, the fluid will probably be secreted and blistering will result. There may be a slight tingling or burning sensation within a few minutes. Mild redness follows; blisters begin to appear in two to three hours, and are fully formed in eight to ten hours. They are large and often linear.

Treatment for BLISTER BEETLES
These blisters may be treated as bum blisters. Simple protection suffices for most. Cool soaks are cleansing and soothing. Large blisters may be drained and protected with dressings and an antibiotic ointment.

Prevention Tips for BLISTER BEETLES
Blister beetles should be gently blown off the skin, never crushed. Yellow bulbs for outdoor lighting are less attractive to them.

What to Do CATERPILLARS Eat?

Caterpillars are the larvae of butterflies or moths. They are generally innocuous creatures who pass their time eating contin­ually and waiting to turn into butterflies or moths. Some fifty
species of caterpillars possess short, hollow hairs or spines which. can irritate the skin. These spines are arranged in clusters among the longer hairs; some contain a toxin while others seem to irritate the skin by mechanical means. Reactions to these spines may occur from direct contact but also from airborne matter. Particles that contact the eyes or that are inhaled or swallowed can cause severe problems. Rashes or eye irritation from caterpillars occur primarily in the summer and fall.

Treatment for CATERPILLARS
For puss caterpillar stings, the immediate, gentle application of adhesive or Scotch tape will help remove remaining spines. The sting site should than be cleansed. Calamine lotion may be helpful, and antihistamines sometimes bring relief if used immediately. Puss caterpillar stings often produce severe pain which may require medical treatment with calcium injections or potent analgesics.

Stings of other caterpillars usually need no more than cleansing and the application of bland topical preparations. Ice packs and pastes made of baking soda and water can be applied to all cater­pillars stings.

Prevention for CATERPILLARS
Caterpillars can be controlled with insecticides if it is not possible to avoid them.

Things to know about ANTS and ANT BITES

The adult fire ant is about 1/8 to 1/4 inch long and varies in color, depending on the geographic area. Mounds of the imported fire ant are one to three feet in diameter and up to a foot in height. The construction and shape of the mound will depend on the environment. There is no visible opening in these mounds. One characteristic of fire ant mounds is that the ants leave the grass and vegetation undisturbed up to the edge of the mound. The mounds of domestic fire ants are smaller, usually about six inches in diameter and about an inch high, and made up of finer granules.

Harvester ants are two or three times larger than fire ants, often about 1/3 of an inch in length. Their. mounds are flat or slightly raised. They are typically surrounded by a zone which the ants have cleared of grass and weeds. This area may be up to several feet in diameter.

If their mounds are disturbed, harvester ants will readily attack man and animals in large numbers and inflict vicious stings. Their mounds are easy to avoid, though-the large defoliated area surrounding them gives ample warning. Harvester ants have been known to kill small animals but are not a great problem for people.

The imported fire ant is another matter. This ant has a more toxic venom and sting of greater severity than the native species. There are larger numbers of these ants per colony, and they have a more aggressive, vicious disposition. When fire ant mounds are disturbed, the ants spill out to attack with chilling ferocity.

Fire ants have earned their name by possessing a sting which produces a severe burning sensation. This sting has been likened to that of the honey bee. The ant grasps the skin of the victim and stabs with its stinger. The stinger has no barbs, and can be withdrawn and inserted into the victim repeatedly. One ant can inflict as many as twenty separate stings. This often results in a circle of stings with two tiny red dots in the center, where the jaws were attached. The pain subsides in a few minutes and a small wheal appears. This is followed in about four hours by a blister. After eight to ten hours, the clear fluid in the blister becomes cloudy pus, so that the typical fire ant sting at this point is a small pus bump perched on a red wheal. These pustules are painless and dry up in about ten days. This circular pattern of pustules is characteristic of fire ant stings. Generalized reactions are usually not severe, unless the victim is allergic to the ant venom. In this case, shock and even death can occur.

In certain areas of the gulf states, as many as 1/3 of the popula­tion has suffered ant stings, and this proportion increases to over 1/2 in children. About 20 percent of these have had at least mini­mal allergic reactions, usually not severe enough to require medical care.

Treatment for ANT BITES

Most ant stings produce only slight pain and itching, but im­ported fire ant stings are worse, as has been discussed. First aid treatment consists of washing the sites with soap and water followed by the application of ice packs or cold compresses. A paste of baking soda and water can be used to neutralize the acidic component of the venom of some ants.

DO'S AND DON'TS TO AVOID STINGING INSECTS

DO:

1. Be familiar with the habits and haunts of these insects so that you can avoid them.

2. Wear shoes (not sandals), socks and protective clothing outside.

3. Keep your car windows closed.

4. Keep an insecticide in your car, in the kitchen, etc. Pyrethrins knock down the insects instantly.

5. Eliminate insects and their nests. You may want to hire profes­sional exterminators for this.

6. Wear clothing made from smooth finish fabrics. Colors should be light, such as white, tan, gray or khaki. White is said to be the least insect-attracting color.

7. Shield your face and retreat slowly if approached by insects. Sudden movements or slapping at insects may provoke them. If insect nests are accidentally disturbed, run with enthusiasm.

8. Be especially careful when trimming hedges or shrubs, mowing the lawn, or painting the house or garage.

9. Brush it away if an insect lands on you. Swatting it may trap it against your skin and cause a sting.

DON'T:

1. Disturb insect hangouts, such as flower beds, flowering trees or shrubs, garbage dumps, orchards, vineyards, and clover fields. Soft drinks and ripe fruits especially attract insects.

2. Go barefoot or wear sandals outside, especially in clover.

3. Wear loose-fitting garments. Hair should not be worn long and un­tied. Insects may become entangled.

4. Wear coarse, dark clothing and floral prints.

5. Wear suede or leather materials. Such items release odors that may attract and irritate the insects. Bright, shiny articles also may attract them.

6. Use scented cosmetics or toiletries (especially floral scents), if you are going outside.

7. Eat sweet fruit, liquids, jellies, jams, honey, etc. outside. Change clothing that is soiled with these or other sweets. 8. Make sudden movements or swat at approaching insects.

8. Tease insects or molest their nests.

Treatment Guide for INSECT STINGS - THE HYMENOPTERA

In the case of a normal reaction to a sting little treatment is necessary. If the sting is from a honey bee, the stinger may be protruding from the skin and should be carefully and promptly scraped away with a fingernail or blade. Pressure applied to the venom sac by grasping or squeezing it may inject more venom. The stinger itself will continue to inject venom through reflex contractions and will empty itself quickly. The sting site should be thoroughly cleansed. This can be done with soap and water, alcohol, or peroxide. A paste made of 1 ~ teaspoon of meat ten­ derizer or baking soda in one teaspoon of water has been suggested for ordinary wasp stings and some insect bites.

Ice and tourniquets will slow the spread of venom in the case of a generalized reaction, but care should be taken because of the problems that may result from the over-zealous use of ice. Elevation and rest may be helpful if the sting is on an arm or leg. Antihistamines don't help much in local reactions except to alleviate itching; these medications may be useful in allergic reactions, however.

The vast majority of stings produce only mild local reactions, in which the victim need do little more than cleanse the area. If signs of a generalized reaction develop, or if the victim has had a generalized reaction in the past, medical aid must be sought immediately. A tourniquet should be applied at a point above the sting site. There are commercially prepared insect sting kits that should be carried by persons who are sensitive or allergic to stings. These emergency sting kits must be obtained with a prescription. The individual should discuss with his physician the necessity for carrying one of these kits and when and how to use it. These should be carried in one's car as well as on his person if he ventures into the field or woods or any area where he is likely to encounter these insects. An additional kit should be kept at home. These kits contain an antihistamine, and usually a hypo­dermic of adrenalin, the most valuable drug in severe, rapid reactions. (Adrenalin aerosols for inhalation should be carried by children who may be unable to inject themselves.)

Some allergists feel that if a severe reaction is feared, adren­alin should be administered immediately after the sting. If the victim waits for symptoms of a reaction to develop, it may be too late. These drugs are generally very safe, though adrenalin may stimulate the heart, and can cause problems in people with severe high blood pressure, heart disease, or those who are taking certain medications.

Those who have suffered generalized reactions or abnormal re­actions which are worsening should see an allergist. An individual who has a relatively mild generalized reaction may suffer a severe, life-threatening reaction with the very next sting. Generally, the more rapid the onset of symptoms, the more severe the reaction is likely to be. Allergy shots, utilizing the same principle as similar treatments for pollen allergies, allergic asthma, and hay fever have been successful in controlling future sting reactions and limiting their severity.

Recently, skin tests with insect venom and blood tests for anti­bodies to venom have been used to predict whether an individual is likely to have a severe reaction. This holds great promise.

INSECT STINGS - THE HYMENOPTERA

The most important stinging insects are grouped in the order Hymenoptera. This order includes honey bees, bumble bees, hornets, yellow jackets, paper wasps and ants.

In the case of an insect sting which results in a normal reaction, the first sign is a sharp pin-prick sensation followed by moderate pain at the site of the sting. A red dot, surrounded by a pale zone, then appears; shortly thereafter a red wheal is seen. The area may itch and sting for a few hours, but this soon subsides.

Multiple stings may result in the injection of enough venom to make the victim physically ill. The symptoms include vomiting, diarrhea, faintness and loss of consciousness, swelling, headache, fever, muscle spasms, and sometimes convulsions. Death can occur, usually after several hundred stings.

Approximately 17 to 20 percent of the population is allergic to Hymenoptera venom, and their reactions to stings vary from mild to rapid and severe. About 1 million people develop extreme, systemic reactions to insect stings each year, resulting in forty fatalities.

Exaggerated local reactions consist of unusually severe, pro­longed swelling, which may begin after a variable period of time and may last for several days.

Delayed reactions occur ten to fourteen days after the sting. This reaction closely resembles the illness sometimes seen as a result of the administration of horse serum. These individuals suffer from fever, headache, joint pains, and hives.

Generalized reactions may range from slight, with hives, itching and malaise, to the rapid onset of shock. Severe reactions are often referred to as anaphylaxis or anaphylactic shock. In fatal cases, death usually occurs within one hour and sometimes in a few short minutes.

Treatment and Prevention Guide for TETANUS

Tetanus, or "lockjaw", is caused by a toxin produced by the tetanus bacillus. The bacillus, a type of bacteria, infects a wound and grows only in the absence of oxygen. Tetanus spores enter the wound, usually at the time of the initial injury, and the bacilli develop from the spores. The source of the spores is usually dirt, dust, or excretory matter. Spores are capable of surviving in their dormant state for prolonged periods of time.

Tetanus is a very serious disease with a fatal outcome in about half the cases. The incubation period ranges from seven to twenty­ one days. Symptoms usually begin with painless stiffness of the neck and difficulty in opening the mouth. Rigidity of the muscles ensues, with severe spasms, especially of the jaw, neck, and some­times the trunk muscles. These spasms may be confined to the area of the wound. Convulsions, spasms of the throat, and extreme difficulty in breathing may result.

Treatment for TETANUS
Treatment is supportive. Hospitalization and various medica­tions are required. Tracheotomy and mechanical support of breathing may be necessary.

Prevention for TETANUS
Tetanus has been very successfully controlled by widespread immunization during childhood. The disease is relatively uncom­mon in the United States now, with about 100 cases occurring each year.

While deep, penetrating wounds with much debris or dead tissue are most commonly associated with tetanus, about one ­third of the cases seen today are in individuals with either no obvious wound or with a wound that was thought to be insigni­ficant.

All wounds should be cleaned immediately and carefully. Any dirt or dead tissue present should be thoroughly removed by a physician. Antibiotics are used if needed, but are never a substi­tute for immunization.

Immunity to tetanus is achieved when antibodies are marshalled against the highly potent tetanus toxin. Tetanus toxin antibodies may be obtained in two ways. Tetanus toxoid is toxin that has been made harmless but can still stimulate the production of anti­bodies. Antitoxin consists of antibodies that have been produced in horses or humans. Immunity is reliable and longlasting, and is considered complete after four doses of toxoid have been given. Boosters are recommended every ten years thereafter. Antitoxin is used when there is not sufficient time for the individual to generate his or her own antibodies, i.e., in people who have re­ceived fewer than two doses of the toxoid.

Prevention Tips for RABIES

There are two categories of exposure to rabies-bites and non­bites. A nonbite is any scratch, abrasion, open wound, or mucous membrane that is contaminated with saliva from a rabid animal. An unprovoked bite is more likely to involve a rabid animal than is a provoked bite. One should be particularly wary of wild animals that are behaving abnormally during the day. Examples of abnormal behavior are attacks on humans or livestock, or the loss of fear of humans. If a bite occurs when the victim is feeding or handling an apparently healthy animal, the bite should be considered provoked. Again, local health authorities should be aware of the occurrence of rabies in the area and in the species of animal involved.

A bite or contaminated wound should be flushed and cleansed quickly, thoroughly, and repeatedly with soap and water. This should be followed by the application of alcohol or a 1 percent benzalkonium chloride solution to the sites. These measures alone may considerably decrease the likelihood of developing rabies. Rabies virus is communicable in animals for three to five days before signs of the disease develop, as well as during the course of the disease. Bats are the exception to this rule; they seem to survive the infection and can spread the virus for months. Thus, if the animal involved in an injury is a healthy dog or cat, it should be confined and observed by a veterinarian for a period of ten days. If the animal is a stray or unwanted dog or cat, or if it develops signs that could indicate rabies, it should be killed immediately and its head sent for examination. If the animal escapes, it may be necessary to assume that it was rabid. Health Department authorities should be consulted immediately. It is quite unlikely that an animal that has been immunized against rabies can contract the virus and spread it to other animals or humans.

Antirabies immunizations are rather prolonged, requiring daily injections for two to three weeks with additional boosters. The unpleasantness of these treatments is well known. Local reactions occur frequently and the individual may also feel gener­ally ill. This is a small price to pay, however, if this terrible and lethal disease can be prevented.

Things to know about Rabies Viral Infectious Disease

Rabies is a viral infection of the brain and nerves. It is one of the most dreaded diseases, and its reputation is well-earned. Death from rabies is both extremely unpleasant as well as virtually certain.

Fortunately, rabies in humans has nearly been eradicated, with only one to three cases occurring per year since 1960. Currently, about 70 percent of reported rabies occur in wildlife. Wild animals are the major source of infection for both humans and domestic animals; however, most antirabies treatments are given because of bites by dogs and cats.

Meat-eating animals, such as dogs, cats, foxes, raccoons, skunks, coyotes, and wolves are more likely to be infected with rabies. Fox rabies is predominant in Virginia and Kentucky and skunk rabies in Oklahoma, Arkansas, Texas, Missouri, and Tennessee.5 Raccoon rabies is found in Florida and Georgia and is moving northward into the Carolinas.6 Bats are notorious carriers and are the only animals that can carry the virus without suffering the disease. In the United States, human rabies has never resulted from the bites of rabbits, squirrels, mice, cats, hamsters, guinea pigs, gerbils, chipmunks, and other rodents; and antirabies treatments are almost never necessary for bites of these animals.7 The occur­rence of rabies varies significantly in different areas and the local Health Department should be consulted if any uncertainty arises.

The agent of rabies is a virus which attacks the nervous system. From the site of the bite, it spreads along the nerves until it reaches the brain. The virus is spread in the saliva of infected animals, and it can enter the nervous system through any break in the skin, or through a mucous membrane such as the eyes or mouth. Most rabies exposures are from bites. The incubation period is usually three to six weeks, but can be as brief as six days or as long as twenty-three months, depending on the number of nerves that the virus can enter in the vicinity of the bite. If the nerve supply for the area is rich, the disease will appear more rapidly. Thus bites of the face or fingers have the shortest incubation period, especially if they are severe or multiple. Rabies lasts only about two to six days and is almost invariably fatal.

The victim often has periods of delirium, mania, and convulsions, but may also be stuporous and indifferent. As a result, animal rabies is often classified as "furious" or "dumb." In funous rabies, the animal is very irritable at first and then becomes increasingly fearful and nervous. It may not recognize familiar humans and show only an insane desire to bite. Dumb rabies has a very brief excitation period. The animal then becomes indifferent and apathetic and goes off by itself. Soon it becomes stuporous and paralysis develops, followed by coma and death. Obviously, furious rabies is much more dangerous to humans.

The term hydrophobia is often used for rabies. This means "fear of water" and is caused by spasm of the muscles of swallowing, resulting in excessive drooling and "foaming at the mouth."

Treatment for FOLLICULITIS

Folliculitis is a normally mild infection of hair follicles, usually caused by the Staphylococcus. Folliculitis of the thighs and buttocks is common, especially in young adult males. These minor infections are often asymptomatic and may be ignored. Sometimes, however, the infection invades deeper tissues and forms a large, tender nodule, offer referred to as a boil or furuncle. Furuncles usually soften and rupture within a few days. These bothersome lesions most often occur in hairy areas that are subject to friction such as the buttocks, neck, face, armpits, and around the waist. A group of furuncles, in close association with connecting channels under the skin, is referred to as a carbuncle.

Infections around the nose and upper lip should be treated carefully since problems of this area can spread to the brain.

Treatment:

If tenderness is present or the bumps are bothersome, they can be treated with antibacterial soaps and topical antiseptics.

Pustules dry up more rapidly if they are opened and drained with care, under sterile conditions. The skin should be carefully cleansed with alcohol; the pustule may then be opened with a sterilized needle. Alcohol itself is effective as it kills bacteria and dries up the pustule. Larger or more widespread infections, especially furuncles and carbuncles, may require oral antibiotics. Pustules or furuncles that develop red, swollen, hot, spreading areas around them may indicate cellulitis. Furuncles and car­buncles should normally be incised and drained by a physician; they can be resistant to treatment and sometimes recur.

Treatment & Prevention Guide for IMPETIGO

Impetigo is a superficial infection caused by staph and/or strep. It is most common in children and often involves the face and areas about the lips and nose. Inflammation and tenderness may be slight or absent, but the hallmark of impetigo is the presence of sticky, yellow, honey-colored crust. Impetigo is more communicable in children than among adults.

Treatment for IMPETIGO

Crusts should be removed by means of gentle washing with soap and water. Several effective antiseptic soaps are available without a prescription. Adherent crusts may require soaks or compresses to soften and loosen them. After washing, topical antiseptics can be applied.

A number of antibiotic ointments and creams are available without a prescription (see Formulary); these do not sting or stain, and should be applied carefully three or four times daily until several days after healing has occurred.

Antibiotics by mouth may be necessary if the infection is widespread or does not respond to topical treatment. Systemic antibiotics should be used when strep infections are present, primarily to limit the spread of infection to others. A full ten day course of antibiotics is necessary to prevent recurrence of the infection. Kidney disease (nephritis) can result from strep infections of the skin. Though it hasn't been shown that anti­biotics decrease the likelihood of this complication, they do hasten healing and diminish the spread of infection to others.

Prevention Tips for IMPETIGO

Impetigo often appears spontaneously and therefore may be difficult to prevent. Continued use of soap, especially antibacterial soap, as well as of any medication' that has been prescribed, for several days after healing will decrease recurrent infections. The possibility of spread of infection, particularly in children, to others should be remembered; skin-to-skin contact should be avoided. The hands must be washed carefully after infected areas have been touched.

Tips for SECONDARY SKIN INFECTION

Any bite, cut, nick, scratch, abrasion, blister, burn, or puncture is a potential site of secondary infection. Areas of contact der­matitus, fungal infections, eczema, or any interruption in the continuity of the skin can provide a portal of entry for bacteria. Again staph or strep are the usual culprits. Local secondary infec­tion is manifested by slight to moderate tenderness, the accumula­tion of pus, and some redness around the edges of the wound site. Cellulitis and lymphangitis often complicate secondary infections and tequire treatment with antibiotics.

The treatment of secondary skin infections is similar to that for the primary skin infections. The necessity for antibiotics depends on the severity of the infection, that is, the extent of invasion of the tissues.

Prevention
Most secondary infections can be prevented by proper care of skin wounds. Generally, cleansing with a toilet soap and warm water is sufficient, but antibacterial soaks, topical antiseptics or antibiotics may be used as needed. Anti-tetanus measures should be remembered at all times.