Speaker 1: My opportunities for observing scabies were extensive. In the Confederate Army.
Speaker 1: Our soldiers were badly fed, badly clothed, soap was scarce,
Speaker 1: and army itch, as it was denominated, was painfully plenty.
Speaker 1: Army itch is nothing more than scabies with exzema or impetago,
Speaker 1: or ecthema or some other dermatosis superadded. In eighteen sixty two,
Speaker 1: in the Confederate Service, I became the subject of Sarcopti's hominus.
Speaker 1: At the same time, several generals and some very elegant
Speaker 1: ladies of my acquaintance were my fellow sufferers. At first,
Speaker 1: the itching was not only not unpleasant, but was positively delightful.
Speaker 1: Very soon, however, the proitis became terrific. I often awoke
Speaker 1: at night, exhausted and panting from violent scratching begun in
Speaker 1: my sleep. I lacerated the skin with my nails to
Speaker 1: abate the tortured itching, for the smarting pain of the
Speaker 1: upbraded surface was far preferable to the proitis. Sulfur ointment
Speaker 1: relieved me entirely in three days.
Speaker 2: The only difference I can discover between the army itch
Speaker 2: and scabies as it is met with in civil practice
Speaker 2: is a difference in degree. Soldiers frequently neglect to apply
Speaker 2: for treatment until they are completely covered with the eruption,
Speaker 2: and in such cases it is sometimes so marked by
Speaker 2: lacerations made by the patient's nails and by secondary eruptions
Speaker 2: that it would be difficult to recognize the disease. It
Speaker 2: is not surprising that the disease should cover a larger
Speaker 2: extent of the surface and appear upon the outside of
Speaker 2: the limbs as well as in the flexures. When we
Speaker 2: consider the crowded manner in which soldiers live in their
Speaker 2: tents or barracks, and the carelessness that exists among them
Speaker 2: in regard to personal cleanliness. That was a little harsh,
Speaker 2: isn't it.
Speaker 1: It is a little harsh. So those were quotes from
Speaker 1: the American Civil War about scabies, which was apparently very endemic,
Speaker 1: very prevalent throughout both armies, throughout the towns where the
Speaker 1: armies passed through, and those quotes themselves were from a
Speaker 1: couple of places. One the first one was from the
Speaker 1: book The Itch Scabies by Errol Craig, and the second
Speaker 1: was from an article by Cropley from two thousand and
Speaker 1: six titled the army itch a dermatological mystery of the
Speaker 1: American Civil War.
Speaker 2: Mystery was it was? It was it?
Speaker 1: I think the mystery was concluded to be like it
Speaker 1: was skabyab It was definitely scaly, really bad scabies, and
Speaker 1: like probably combined with just the general grossness.
Speaker 2: That accompanied everything. I can only imagine.
Speaker 1: I mean, I feel like I remember quotes from our
Speaker 1: typhoid episode and it was just like pooping near water
Speaker 1: sources and stuff like that. Pooping and holes was our
Speaker 1: very first episode. Yeah, but probably applies. It was also, Yes,
Speaker 1: scabies was also prevalent during World War One.
Speaker 2: Blah blah words.
Speaker 1: You know that's jumping ahead of things.
Speaker 2: Hi, I'm Aaron Welsh and I'm Aaron Alman Updike.
Speaker 1: And this is this podcast will kill you.
Speaker 2: If you haven't guessed it. We're talking about scabies. It's
Speaker 2: all just skabes today.
Speaker 1: Gabies, scabies. I am really excited for this because we
Speaker 1: haven't done something like this in quite a while.
Speaker 2: It feels I mean, you know how when we were
Speaker 2: doing Neurovirus, you were like, I was so nauseous recording
Speaker 2: this episode. I have never been so itchy. Really. I
Speaker 2: actually did have lice and it really made me feel
Speaker 2: like I was like, do I do I have Lisay,
Speaker 2: I'm like I I was so so so, like I'm
Speaker 2: surprised that I don't have wounds from how much I
Speaker 2: was scratching. My last reading about Scutty's, I did not
Speaker 2: feel that itchy.
Speaker 1: And I don't know why.
Speaker 2: I don't know. Maybe because the.
Speaker 1: History, I mean, but there were like a lot of
Speaker 1: excerpts about the itchiness. I guess maybe I didn't read
Speaker 1: as much about like the these widespread outbreaks, but people
Speaker 1: certainly talked a lot about the the itch and also
Speaker 1: like how enjoyable. Like that's something that I found really strange,
Speaker 1: is that, like that's not the first firsthand when I
Speaker 1: was talking about how enjoyable it was to itch or
Speaker 1: to scratch the itch. Yeah, that's not the only time
Speaker 1: I encountered that sentiment.
Speaker 2: How interesting.
Speaker 1: And then somebody else was like anyone who actually had
Speaker 1: scabies probably does not agree with this, and.
Speaker 2: Like so that's like just what doctors would say about
Speaker 2: it back then. But like, yeah, I don't know, I mean,
Speaker 2: maybe I do.
Speaker 1: I will say that when I had really bad poison ivy,
Speaker 1: that first hit of the hot water from the shower
Speaker 1: head and it would just it, It would scratch it
Speaker 1: in such a delightful way, but then it would lead
Speaker 1: to uncontrollable itching. Yeah. Yeah, so maybe I can relate anyway,
Speaker 1: Speaking of itching and scratching, it's quarantiny time, It's quarantin
Speaker 1: any time. What are we drinking this week?
Speaker 2: We're drinking the itch Itch.
Speaker 1: The itch is. You know this episode is coming out
Speaker 1: early Decement. I feel like it's nice cozy times, so
Speaker 1: we're doing a cozy drink to hopefully soothe any sort
Speaker 1: of itchy feeling or to have it is. Essentially, it's
Speaker 1: like gingerbread vibes, is what we're going for us. We've
Speaker 1: got rye whiskey, We've got a little bit of orange juice,
Speaker 1: a little bit of ginger ale, and then like a
Speaker 1: spiced syrup with molasses and spices.
Speaker 2: It's going to be so yummy and cozy so that
Speaker 2: you can cuddle up by the fire and scratch your itches.
Speaker 2: You can find the full recipe for that quarantine as
Speaker 2: well as our non alcoholic plusy Burta on our website,
Speaker 2: this podcast witha dot com, and on all of our socials.
Speaker 2: Are you following us there? Because you should be following
Speaker 2: us on social media.
Speaker 1: You should on our website, you can find all sorts
Speaker 1: of things, from transcripts to the sources for each and
Speaker 1: every one of our episodes. You can find links to bloodmobile,
Speaker 1: to bookshop dot org, affiliate account, to our Goodreads list,
Speaker 1: to merch to Patreon, to promo code. So if you
Speaker 1: ever hear about something on the podcast where you're like, oh,
Speaker 1: what was that thing that you just advertised for, go
Speaker 1: to our website try to check it out and other
Speaker 1: things that exist there. I'm sure it's.
Speaker 2: Great, And if you haven't already, please rate, review, and
Speaker 2: subscribe on your podcaster to this podcast because it helps
Speaker 2: other people find it and we love it and appreciate it.
Speaker 2: So thank you so much, thank you, thank you, thank you.
Speaker 2: On to a topic of today, great love it. We'll
Speaker 2: take a quick break and then talk about the biology
Speaker 2: of scabies. I have to just start this way because
Speaker 2: it was one of those moments of you know, when
Speaker 2: you see something in one place and then you can't
Speaker 2: stop seeing it everywhere. Yeah, we just recorded our episode
Speaker 2: on strep pyogenies and scarlet fever. So ready for this,
Speaker 2: I'm ready. The first paper I read about scabies. It
Speaker 2: was a review in The Lancet from two thousand and six.
Speaker 2: It was a great paper. They start off, literally start
Speaker 2: off the paper saying, I'm going to quote here quote.
Speaker 2: Scabies is a neglected parasitic disease that is a major
Speaker 2: public health problem in many resource poor regions. It causes
Speaker 2: substantial morbidity from secondary infections and post infective complications such
Speaker 2: as acute post streptococcle glomeriolonephritis. Oh g, I know, and
Speaker 2: now everyone knows that is. It's when your kidneys get
Speaker 2: attacked by your own self after a strep infection, which
Speaker 2: is a major complication of scabies infection. So let's get
Speaker 2: into it, shall we. Yeah, okay, but like.
Speaker 1: Why is it just because strap is one of is
Speaker 1: on many people all the time.
Speaker 2: Yeah, it's because impetigo, which is the main superficial skin
Speaker 2: infection caused by strep, is the main risk factor for
Speaker 2: post strip glomery leonephritis, and scabies is a major risk
Speaker 2: factor for a whole bunch of like secondary skin infections.
Speaker 2: But skin infections are mostly caused by either staff or strap.
Speaker 2: And so if it's strip, then you get this. Oh
Speaker 2: my goodness, it's terrible, let's get into it. Yeah, so
Speaker 2: scabies is an infection of your skin, but it's an
Speaker 2: infection of your skin not with a bacteria, not with
Speaker 2: a virus, but with a mite called Sarcopdi's SCABYI variant hominus.
Speaker 2: And I feel like people might not know what the
Speaker 2: heck a mite is. So a mite is an arachnid,
Speaker 2: which means it's more closely related to spiders and ticks
Speaker 2: than like mosquitoes or other insects. But I feel like
Speaker 2: when you look at pictures of especially these particular mites,
Speaker 2: they look more like tartar grades like water bears ampletely do. Yeah,
Speaker 2: they're kind of cute.
Speaker 1: Yeah, maybe not as cute as like a lause, but
Speaker 1: pretty cute.
Speaker 2: Yeah, I don't know. I kind of feel like they're
Speaker 2: cuter than a laus but your around, judge. So they
Speaker 2: have this like little head. You can barely even see
Speaker 2: that they have a head. They kind of just have
Speaker 2: these little chompy mouth parts, and then this really big, fat,
Speaker 2: chunky body with these little rolls of like toddler legs
Speaker 2: that don't look like they should be able to touch
Speaker 2: the ground. And then they have little hairs coming off
Speaker 2: of them. Yeah, and I don't know. They're kind of cute.
Speaker 1: But when I say that, they're right now, right, especially.
Speaker 2: All of the like generated images that aren't like real
Speaker 2: pictures of them under a microscope.
Speaker 1: They're really like the face app what's it called.
Speaker 2: Yeah, one of the Instagram face filters put it.
Speaker 1: Yeah, they've got Once you put filter on the mite,
Speaker 1: it is it is much cuter than the laus. I
Speaker 1: take back my earlier claim. They do have a lot
Speaker 1: of spikes on them.
Speaker 2: They have a lot of little hairs. Yeah, but this.
Speaker 1: One, oh, that must be computer generated. Yeah, it's like
Speaker 1: on the skin. It's very cute.
Speaker 2: And I'm like, oh, right, it looks like a little
Speaker 2: teddy bear, like a toddler. They're very cute. Anyways, they're
Speaker 2: also incredibly tiny and aarin you asked before we recorded,
Speaker 2: can you see these mites? And that paper that two
Speaker 2: thousand and six review paper in The Lancet described them
Speaker 2: as quote at the limit of human visibility. And of
Speaker 2: course every paper sites how big they are. But I
Speaker 2: have a real hard time conceptualizing how tiny something is
Speaker 2: when you give me a number. So here is your concept,
Speaker 2: Aaron of how small they are? Ready?
Speaker 1: Okay, great.
Speaker 2: Size twelve font. We all know that size, right did
Speaker 2: you know that that size? Like font sizes are based
Speaker 2: on measurement, and size twelve font is a unit of
Speaker 2: measure called a pika. I learned a lot on Wikipedia.
Speaker 2: It's just over four millimeters. That's how big size twelve
Speaker 2: font is. These mites are size one font.
Speaker 1: I'm not sure what you mean by twelve, Like, what
Speaker 1: do you mean.
Speaker 2: If you typed on a piece of paper and printed
Speaker 2: out size twelve font, Yeah, it would be four millimeters
Speaker 2: each letter.
Speaker 1: Oh, each letter would be four millimeters.
Speaker 2: Got yeah, okay, yeah, so mites are if you type
Speaker 2: into your computer and change it to size one font,
Speaker 2: that's how big a mite is.
Speaker 1: So okay, But like like an H or like a C,
Speaker 1: or like a period or a specific of questions? Yeah,
Speaker 1: like I mean, because an H is very different than
Speaker 1: a period, So like what so.
Speaker 2: Not a period? Like a letter? Like a letter, like
Speaker 2: a like a typical letter in a in size one font.
Speaker 2: Type it into your computer. You can see it if
Speaker 2: point four millimeters and there's a range, so maybe like
Speaker 2: an M or a H. I don't know, there's a
Speaker 2: range and the males are half that size. So the
Speaker 2: males are even tinier.
Speaker 1: Okay, I'm doing it with a t because that was
Speaker 1: the first one that came up. There, you go one.
Speaker 1: I can't see it, Yeah, I do, man, I can
Speaker 1: see it exactly.
Speaker 2: I wrote the word scabies in size twelve and then
Speaker 2: I wrote it in size one next to each other,
Speaker 2: just to keep that in my mind for this whole episode.
Speaker 2: So they are very very very very small. Point four
Speaker 2: millimeters is the average size for a female mite, and
Speaker 2: the female mites are the ones who actually cause disease.
Speaker 2: So these mites, Sarkopdi's scabyi variant hominus, is a human
Speaker 2: specific mite. There are a lot of different mites in
Speaker 2: the same genus sarcop Di's that cause disease in other animals,
Speaker 2: and much like our friends the lice, they tend to
Speaker 2: be very species specific, so every species of animal has
Speaker 2: our own species of mites. We also have lots of
Speaker 2: other mites that live on us, called Dermodex mites, and
Speaker 2: these tend to not cause disease, but Sarcopti's sure does,
Speaker 2: and their life cycle goes a little something like this.
Speaker 2: Adult males and females find each other on our skin,
Speaker 2: They mate and then the male dies and the female
Speaker 2: then burrows herself into our skin. And conveniently, we've talked
Speaker 2: about our skin layers relatively recently on our Retinoid's episode.
Speaker 2: So these mites are staying incredibly superficial only in that
Speaker 2: epidermal layer, so that very first layer of our skin,
Speaker 2: and even within those layers of the epidermis, they only
Speaker 2: go to like about the middle part of our epidermis,
Speaker 2: So they're really superficial. But in order for something so
Speaker 2: tiny to burrow underneath our skin, they spit out an
Speaker 2: enzyme that essentially dissolves our skin cells, and then that's
Speaker 2: what they eat, So they feed on our dissolved skin goop.
Speaker 1: Yeah, it's kind of like maggots in that way.
Speaker 2: Sort of. Yeah, exactly, just really small and they're really efficient.
Speaker 2: They burrow pretty quickly. It takes them about thirty minutes
Speaker 2: to make their little nest. And in their little nest,
Speaker 2: in their burrow in our epidermis, they lay a whole
Speaker 2: bunch of eggs.
Speaker 1: How much is a whole bunch?
Speaker 2: I knew you were going to ask, so we'll do
Speaker 2: some air and math to tell you exactly they lay.
Speaker 2: Some sources say like one to three or two to four,
Speaker 2: so we'll call it an average of two eggs every day.
Speaker 2: And those eggs take like three or four days to hatch,
Speaker 2: and they live underneath our skin for about four to
Speaker 2: six weeks.
Speaker 1: And after the eggs hatch.
Speaker 2: They lay two eggs a day every day for four
Speaker 2: to six weeks. Oh I see yeah, yekay, So that's
Speaker 2: about if you call it an average of two eggs
Speaker 2: a day for an average of five weeks, it's about
Speaker 2: seventy or so eggs that eat each female might is depositing.
Speaker 1: And then at the end of that four to six
Speaker 1: weeks they're just like peace out. Okay, yep, they die
Speaker 1: they okay. A few questions here, give it to me.
Speaker 1: When they hatch, where do they hang out there? Do
Speaker 1: they have to find their own burrow? Do they just
Speaker 1: go down the skin a bit?
Speaker 3: Like?
Speaker 1: What what's going on?
Speaker 2: Great question? So when they hatch there, of course like
Speaker 2: larvae or they call them like protonymphs. So they have
Speaker 2: to eat our skin goop and then molt and grow
Speaker 2: two more times before they become adults. And then they
Speaker 2: will go out onto the surface of our skin and
Speaker 2: find a mate of their own. And that process takes
Speaker 2: a couple of weeks, so like ten to fourteen days
Speaker 2: to go from hatched egg to adult, and in theory,
Speaker 2: they could do this on your body or on another
Speaker 2: human body if they're transferred to another host.
Speaker 1: Because the female is laying eggs continuously for that chunk
Speaker 1: of time. This can be like a growing infection. It's
Speaker 1: not self limited, it can be.
Speaker 2: But the average might burden is surprisingly only about five
Speaker 2: to fifteen mites per person, which is a lot lower
Speaker 2: than something like the LUs burden can be, and it's
Speaker 2: honestly a lot lower than I expected. A lot of
Speaker 2: this probably has to do with our immune response to
Speaker 2: the mites, and we'll get into that in a little
Speaker 2: bit more detail. However, there is also a condition called
Speaker 2: crusted scabies, and in that situation, a person can be
Speaker 2: infected unfortunately with hundreds, if not thousands, of mites because
Speaker 2: they essentially can just grow and continue to grow unchecked
Speaker 2: by our immune system.
Speaker 1: Okay ooh yeah, how does that. We'll get it to
Speaker 1: play into this, Okay, okay, yeah.
Speaker 2: If there's any good news aside from the fact that
Speaker 2: most of the time the mite burden is relatively low,
Speaker 2: transmission also tends to require body contact and is not
Speaker 2: as much reliant on foemtes, so like bedding or clothing
Speaker 2: or things like that, which you might think of with
Speaker 2: things like body lice, it's a little bit easier to
Speaker 2: transmit that way. Yeah, they only live for a couple
Speaker 2: of days max. Off of the body, but most of
Speaker 2: the time, because the mite burden is relatively low, there's
Speaker 2: not a lot of transmission that happens from things like
Speaker 2: bedding or clothing. It usually takes fifteen to twenty minutes
Speaker 2: of skin to skin contact for mite transmission to happen.
Speaker 2: Got it.
Speaker 1: Yeah, and it has to be the female mite.
Speaker 2: Yeah, it's the female mites that are causing the disease.
Speaker 2: That are the ones actually burrowing into our skin and
Speaker 2: causing disease.
Speaker 1: What proportion of eggs are male and female?
Speaker 2: I have no idea, What a fun question.
Speaker 1: No clue. Can scabies? Sorry?
Speaker 2: I love it. I love I can see on your
Speaker 2: face that you're just like I have so many questions
Speaker 2: I do.
Speaker 1: Can scabies mites? Are they known to transmit any pathogens?
Speaker 2: Excellent questions. No, not any pathogens to humans that we
Speaker 2: know of, thank you. Okay, So, as this might burrows
Speaker 2: into our skin. As I kind of alluded to, it
Speaker 2: really does kind of set off our immune system in
Speaker 2: a way that's really important. We heard in our first
Speaker 2: time to count just how itchy scabies can be, but
Speaker 2: I just said that the mite burden itself is usually
Speaker 2: relatively low. And it turns out that the itchiness and
Speaker 2: the main symptoms that people get from a scaby's infection
Speaker 2: are actually caused by a hypersensitivity reaction to the mites,
Speaker 2: to the mites themselves, and to the feces, to the
Speaker 2: poop that the mites are leaving in their burrow, just
Speaker 2: like fleas, right, fleas can do that poison ivy. Arin,
Speaker 2: you mentioned the itch from poison ivy and how you
Speaker 2: like very specifically have like reactions to hot water and
Speaker 2: things like that. This is the same type of hypersensitivity reaction,
Speaker 2: which also means that this itch is no not limited
Speaker 2: to the places where the mites are. The itch is everywhere.
Speaker 2: It's a generalized, incredibly itchiness because it's hypersensitivity reaction everywhere.
Speaker 2: The mites themselves most often infect places like your wrists,
Speaker 2: the like interwebs between your fingers or toes, the areas
Speaker 2: underneath your waistband, armpits, groin places like that, places that
Speaker 2: are kind of like little areas that are easy for
Speaker 2: them to like nestle their way in. And sometimes you
Speaker 2: can see the areas where scabies actually infest. And when
Speaker 2: you can see them, they're described as like this one
Speaker 2: little kind of nodule or vesicle, this one area where
Speaker 2: where the mite has actually made its burrow, and then
Speaker 2: a little curvy, very short, little curvy burrow that just
Speaker 2: looks like either a red or a dark or a
Speaker 2: gray or a purple kind of line. And then maybe
Speaker 2: a little vesicle in the place that the mite is
Speaker 2: now living, like at the end of her barot. Okay,
Speaker 2: but most of the time you can't see that at all,
Speaker 2: and what you see instead are scratch marks all over
Speaker 2: a person's body from itching. You can see other like
Speaker 2: nodules that appear are other bumps that are all a
Speaker 2: part of your immune response to these mites and to
Speaker 2: all of the antigens that these mites are producing. And
Speaker 2: the itch tends to happen weeks after the initial infection.
Speaker 2: It's not like right away unless you've been infected with
Speaker 2: mites before, in which case immediately will you feel itchy.
Speaker 2: As soon as that might makes her home.
Speaker 1: Yeah that I mean, it makes sense, Yeah, it makes sense.
Speaker 1: It does because I had no idea weeks to mount
Speaker 1: an immune responses.
Speaker 3: Yes, wild yeah yeah yeah.
Speaker 2: Now there is another phenomenon I mentioned crusted scabies, and
Speaker 2: this is what happens when there are very large numbers
Speaker 2: of mites that can establish an infection. But in this case,
Speaker 2: there's very often an association with some kind of immunodeficiency,
Speaker 2: whether that's HIV, whether it's topical or systemic steroid use,
Speaker 2: whether it's people who are on immunosuppressive medication because of
Speaker 2: an organ transplant, or maybe they are malnourished, lots of
Speaker 2: different potential reasons that you could end up with crusted scabies.
Speaker 2: But these situations are very very severe because what happens
Speaker 2: is that there are so many mites that you end
Speaker 2: up with these severe plaques where the skin is growing,
Speaker 2: it becomes hyperkeratotic, which is that very thick, very scaly
Speaker 2: like flax and scales, and these can flake off and
Speaker 2: they harbor a lot of mites, which is why it's
Speaker 2: more easy for things like bedding or clothing to serve
Speaker 2: as a source of infection in these cases, got it, okay.
Speaker 2: In all cases of scabies, there's a very high risk
Speaker 2: of secondary infection, which means everywhere that you're scratching and
Speaker 2: there's a break in the skin, it's really easy for
Speaker 2: bacteria like streptococcus and staphylococcus to get into those wounds
Speaker 2: and then cause either skin infections or especially in the
Speaker 2: cases of crusted scabies, more severe infections like bloodstream infections
Speaker 2: and sepsis and even death. So scabies is kind of
Speaker 2: a big deal, especially because, as we'll talk about later,
Speaker 2: it's still really really prevalent.
Speaker 1: There seems like there are many different options for treatment.
Speaker 1: There are what are those options and is there any
Speaker 1: are there like treatment resistant mites or scabies?
Speaker 2: Yeah, there are so most of the treatment options, and
Speaker 2: there are a lot of different kinds. Most of them
Speaker 2: are topical, which means that there are lotions creams that
Speaker 2: you're putting on all over your body because again, you're
Speaker 2: not sure exactly where the mites are most of the time,
Speaker 2: so the treatment really has to go kind of everywhere.
Speaker 2: And there are things like permethrin that's what we use
Speaker 2: most commonly here in the States. Benzyl benzoate is another
Speaker 2: one or sulfur compounds, and these are all generally very effective,
Speaker 2: but there are a number of different things that can
Speaker 2: contribute to either of them being difficult to implement, Like
Speaker 2: some of these require multiple applications multiple times a day
Speaker 2: for multiple days in a row, which can be sometimes
Speaker 2: difficult to do, and some of them can cause a
Speaker 2: lot of other skin reactions, like they can be itchy,
Speaker 2: they can cause stinging and burning and be really uncomfortable
Speaker 2: to put on. Then there is also insecticide resistance, especially
Speaker 2: to things like permethrin. So yes, we do see some resistance,
Speaker 2: and this is something that can also be induced, like
Speaker 2: if you are repeatedly applying it, especially maybe not to
Speaker 2: all surfaces of your body things like that, then you
Speaker 2: can have resistance start to appear. But most of the
Speaker 2: time we still rely on topical treatments. There is an
Speaker 2: oral treatment as well. Everyone's heard of it now, it's ivvermactin.
Speaker 1: I knew you were.
Speaker 2: Ivremectin is a phenomenal option. We've talked about it on
Speaker 2: this podcast before because we use it for a lot
Speaker 2: of other parasitic diseases, especially worms, that's what it's mainly
Speaker 2: used for. This tends to be used for things like
Speaker 2: crusted scabies, which requires both oral and topical treatment because
Speaker 2: it's so severe. It also can be used as a
Speaker 2: second line if you treat someone with a topical and
Speaker 2: it doesn't seem to go away, or in areas where
Speaker 2: you have really, really high prevalence of scabies, then sometimes
Speaker 2: oral i'veremectin is used as what's called mass drug administration,
Speaker 2: so giving it to an entire community to try and
Speaker 2: really wipe out scabies. There's a couple of things that
Speaker 2: are important to know about scabies and the treatment for scabies.
Speaker 2: First is that again sometimes people don't have symptoms of
Speaker 2: scabies for weeks because it takes weeks for that itch
Speaker 2: to first appear. But even after someone is treated, it
Speaker 2: can take weeks for their symptoms to get better. And
Speaker 2: that's again in part because so many of these symptoms
Speaker 2: are due to our immune response to the mite antigen.
Speaker 2: So these treatments are wiping out the mites, but they're
Speaker 2: not necessarily treating the symptoms of the itch themselves. Okay,
Speaker 2: reinfection can also happen because, especially when we use topical treatments,
Speaker 2: mites can hide in some places like under the fingernails,
Speaker 2: and so That's why sometimes it's hard to know are
Speaker 2: the symptoms still there because the mites are still there
Speaker 2: or just because the symptoms haven't gotten better in a
Speaker 2: couple of weeks. But usually if it's not better in
Speaker 2: a couple weeks, then you have to think is there
Speaker 2: a reinfection or was it not scabies to begin with?
Speaker 1: Gotcha? So Aaron, Yeah, why why do we scratch? Why
Speaker 1: do we itch? Why do we scratch? Why do scratching
Speaker 1: relieve an itch?
Speaker 2: Oh? I have no idea. I actually can't believe that's
Speaker 2: the first time that you've asked me that question. I know,
Speaker 2: like we've talked about itching before. I don't know what
Speaker 2: does it? What does it do? I mean, it's got
Speaker 2: to be releasing some like neurotransmitters, right, that are that
Speaker 2: are interacting with whatever the receptors are that are causing
Speaker 2: us to feel that itch. H Then scratching somehow does
Speaker 2: something to help relieve that. But I don't know. Yeah,
Speaker 2: and like what think interesting episode?
Speaker 1: Yeah? Just itching?
Speaker 2: Yeah?
Speaker 1: I yeah, because like if if it's something that's immune mediated,
Speaker 1: something that's like driven by you know, like we we
Speaker 1: control that, our bodies control that? Is it adaptive?
Speaker 2: Is right? Evolutionarily, and now I'm thinking, like what is
Speaker 2: the what.
Speaker 1: Is the benefit out of an itch? I mean there's
Speaker 1: probably many different things, like if there's maybe if you
Speaker 1: feel a mosquito or something on your body.
Speaker 2: I don't know, right, Oh, that's such an interesting question.
Speaker 2: I don't know, and I need to look into it.
Speaker 2: I didn't research itching, Aaron, which I had.
Speaker 1: Well, just like it's you know, like how it is
Speaker 1: described as pleasurable at first, or like to scratch its
Speaker 1: preasurable at first, and like why does it feel good
Speaker 1: to have your back scratched, your arms scratch?
Speaker 2: You know, like what Yeah, those head scratchers and head scratchers,
Speaker 2: those are Yeah, I don't know. What an interesting question, Aaron.
Speaker 2: We're gonna have to look into it.
Speaker 1: Yeah, we will.
Speaker 2: Okay, Well, but I would like to know, Yeah, where
Speaker 2: did these gabies come from? I mean, like, are you
Speaker 2: gonna answer that? I don't know. They're just with us.
Speaker 1: I'm gonna answer something. Okay, let's take a quick break
Speaker 1: and we'll see what I talk about today. You can't
Speaker 1: define the word scabies without mentioning the might that causes
Speaker 1: the itch, and in that same vein, you can't describe
Speaker 1: that might sarcopti's scaby i hominus without including that it
Speaker 1: causes skin infestations in humans. The might and the itch
Speaker 1: are indivisible, entwined, inseparable, but that hasn't always been the case.
Speaker 2: I love that. Aaron I was like, yeah, I'm feeling
Speaker 2: that that's not how it always was. You know.
Speaker 1: I love a leading statement.
Speaker 2: I love it.
Speaker 1: For centuries, the itch and the might stood separately in
Speaker 1: the eyes of medicine, with no clear causal relationship between
Speaker 1: the two. And I call out medicine specifically because that's
Speaker 1: where the confusion remained about the cause of scabies until
Speaker 1: shockingly late in the history of medicine. Among the lay people,
Speaker 1: the peasants, the commoners. Stavies was well known for thousands
Speaker 1: of years to be caused by a creature, and that
Speaker 1: it was the creature moving from person to person that
Speaker 1: spread the itch.
Speaker 2: I'm I love this story already. I am bought in.
Speaker 1: When the night was finally widely recognized by medicine to
Speaker 1: cause the itch with a capital eye as it was
Speaker 1: kind of known. It was like scabies was known as the.
Speaker 2: The itch, right. It was all the things that itch you,
Speaker 2: this was the one.
Speaker 1: The one yep, capital I, and this recognition marked a
Speaker 1: huge turning point in the history of science and medicine.
Speaker 1: It called into question concepts like the humoral theory of
Speaker 1: disease or spontaneous generation where life just comes spontaneously out
Speaker 1: of the maggots on the meat in organic material exactly.
Speaker 2: Yeah, yeah, which.
Speaker 1: Both of which had been accepted as truth or at
Speaker 1: least had been leading causes of you know, explaining the
Speaker 1: world around us for hundreds, if not thousands of years.
Speaker 1: The recognition of the might causing scabies led to contentious
Speaker 1: rivalries with public humiliation, prize money, and medical demonstrations. It
Speaker 1: could even be argued that the might itch connection primed
Speaker 1: the scientific world to accept Louis Pester's germ theory of
Speaker 1: disease in the following decades. Stop it eron, I know,
Speaker 1: would you have believed that this little might had this
Speaker 1: much up its little mighty sleeve. I certainly had no idea.
Speaker 2: I love it.
Speaker 1: But before we get into this might revolution as I
Speaker 1: am calling it, let's travel back to where it all began.
Speaker 1: But where and when that is we don't fully know.
Speaker 1: It's course surprise. One hypothesis suggests that humans and early
Speaker 1: human ancestors have been infected for millennia with this might,
Speaker 1: and that other Sarcopti's scabyie varieties evolved from our human might. So,
Speaker 1: for instance, the might that causes one type of mange
Speaker 1: in dogs and other canids was thought to jump from
Speaker 1: humans to dogs after domestication, but another hypothesis suggests the
Speaker 1: opposite happened, that when we welcome dogs into our lives,
Speaker 1: we also welcomed a hitchhiking MTE that adapted to live
Speaker 1: on us and cause us to itch.
Speaker 2: Okay, I don't know.
Speaker 1: As far as I could tell, how humans and mights
Speaker 1: got acquainted with one another has yet to be fully resolved,
Speaker 1: and maybe it will be by the time we do
Speaker 1: our mange episode, which we will be doing at some
Speaker 1: point in the future. Don't worry, we did not. This
Speaker 1: is not mange erasure, this is not wombat might erasure.
Speaker 1: We're going to cover all of the wildlife animal mange
Speaker 1: scabies situations. Yeah, And as to the question of when
Speaker 1: people first described scabies the itch, it's also less than
Speaker 1: fully resolved. So some people point towards a line in
Speaker 1: Leviticus in the Old Testament suggesting that the Hebrew term zarath,
Speaker 1: which meant some sort of skin malady, actually meant the
Speaker 1: itch or scapies, or was referring to that. Others say
Speaker 1: that it was the ancient Romans who distinguished scabies from
Speaker 1: other skin conditions, and in fact the term scabies comes
Speaker 1: from the Latin scaberry scabbery, meaning to scrape or to scratch.
Speaker 1: Much later, the mite genus name Sarcopti's comes from the
Speaker 1: Greek word sarks for flesh and Coptian for to smite
Speaker 1: or cut. The ancient Romans also proposed what would have
Speaker 1: been and actually remains, as you mentioned, aaron an effective
Speaker 1: treatment for scabies, sulfur with liquid pitch. Others still say, nah,
Speaker 1: the Romans got it wrong. It was actually an ancient
Speaker 1: China that the first true scabies description was made, And
Speaker 1: not only that, but unlike the Old Testament and ancient
Speaker 1: rom which just made note of the skin condition itself,
Speaker 1: the itch itself, this early medical text from China in
Speaker 1: the five hundred CE included mention of the parasite quote
Speaker 1: the itchy scaby sores always contain a tiny worm. We
Speaker 1: can extract it with a needle and see its worm
Speaker 1: like shape when it.
Speaker 2: Is dropped into water end quote, Well, that's weird.
Speaker 1: I think when we think of worm, we think of
Speaker 1: like earthworm, and I think that's not necessarily what because
Speaker 1: worm pops up a lot in descriptions.
Speaker 2: Of scabies over the years, but does not I mean
Speaker 2: because the burrows are sometimes described as like surpiginous, which
Speaker 2: to me, I mean that's like snakelike. But I think
Speaker 2: of that as kind of wormy. But is a worm
Speaker 2: not always kind of like long and wiggly, I.
Speaker 1: Mean, if it's so tiny, like can you even tell?
Speaker 2: It's just like, oh, that's what That's why I think
Speaker 2: is weird. I mean, I mean because our other demodex
Speaker 2: mites are longer, their bodies are like great little kind
Speaker 2: of more tubular, tabular total, but these mites are just
Speaker 2: so round. I just but I don't know, maybe worms
Speaker 2: are different.
Speaker 1: Also, this is translated so like I don't know if
Speaker 1: like worm, if that is the closest approximation too, yeah, yeah, yeah. Unfortunately,
Speaker 1: as is the case for so much of the history
Speaker 1: of medicine, information from the non Western world rarely makes
Speaker 1: it into reviews about this topic, and so it's really like,
Speaker 1: is you know, is the worm the closest approximation is
Speaker 1: that the right translation. I don't really know whether that
Speaker 1: perception in terms of the worm causing the itch remained
Speaker 1: the predominant view, right like that's but we do have
Speaker 1: that text. In any case, in European medical writings, the
Speaker 1: mite wasn't really mentioned alongside scabies, like scabies was just itch, right, bitch.
Speaker 1: The itch was thought to be caused by what other
Speaker 1: than a humoral imbalance, imbalance and thus treated with all
Speaker 1: sorts of horrid little things like purges, foul smelling salves,
Speaker 1: blood letting, and so on. Meanwhile, though in the non
Speaker 1: medical crowd, people knew what was up, like peasant women
Speaker 1: quote unquote knew that you could extract little bits from
Speaker 1: the skin to relieve the itch, a practice disregarded by
Speaker 1: medical men for being vulgar. A medical text from the
Speaker 1: eleventh century in the Middle East says, quote the little
Speaker 1: flesh worms which crawl under the skin of the hands, legs,
Speaker 1: and feet, and there raise pustules full of water, are
Speaker 1: called sirones, as, sooa, bat and asa. So small are
Speaker 1: these animals that they can hardly be seen by the keenest.
Speaker 2: Of vision and h I mean, I would agree with that,
Speaker 2: that's true, size one font.
Speaker 1: Size one. Saint Hildegarde of Bingen do you remember her
Speaker 1: from our Migraines episodes? So she wrote about her visions,
Speaker 1: and some people have said that these were migraine aura,
Speaker 1: not actually like you know, or like aura inspired these visions,
Speaker 1: right right, right, So she wrote around the twelfth century
Speaker 1: that quote, there is another mint which is large. It
Speaker 1: is hot rather than cold. This should be crushed and
Speaker 1: placed above and around the place where the seren or
Speaker 1: snevelzen are hurting the person with their nibbling, and they
Speaker 1: will die as the coldest of the same mentha major
Speaker 1: is rather bitter and therefore kills the above mentioned little worms,
Speaker 1: which are born in the human flesh end quote. So
Speaker 1: the little spontaneous generation there a little bit of worms. Yeah,
Speaker 1: worms are a thing, Yeah, I guess so, yeah, it
Speaker 1: might just be like bugs, you know, like little critters.
Speaker 2: Yeah, maybe that's what they mean by worms. Huh. Yeah. Interesting.
Speaker 1: And these passages I think are really interesting because they
Speaker 1: show two things.
Speaker 3: Right.
Speaker 1: They show that people definitely observed the mites, even if
Speaker 1: they called them worms in association with the itch, right,
Speaker 1: But they didn't necessarily make the link that they caused
Speaker 1: the itch. Hmm, Like there's not necessarily a causal relationship.
Speaker 2: Right there, then the itches there, but they're also like
Speaker 2: if you get rid of them, you'll feel better.
Speaker 1: But also in some of these it seems like they're
Speaker 1: describing the miight as arising from the itch, if that
Speaker 1: makes sense, like a product of the itch.
Speaker 2: Interesting. Yeah.
Speaker 1: Over the next few centuries, a few passages here and
Speaker 1: there allude to the possibility that the might could be
Speaker 1: the cause of this itch, but they were overshadowed by
Speaker 1: the predominant belief that the might was not related to scabies,
Speaker 1: and that scabies was caused by a humoral imbalance. As
Speaker 1: to how it could be contagious, which it was recogne
Speaker 1: to be, that was explained simply by that the bad
Speaker 1: scabies humors contained in the blood could reach the skin
Speaker 1: and transfer it to other people.
Speaker 2: That way, I got to love when you have an
Speaker 2: explanation for everything that just false.
Speaker 1: It's honestly, it's pretty wid But the tide started to
Speaker 1: turn in the seventeenth century with two major advancements. Number one,
Speaker 1: the first known depiction of an infectious organism, and number two,
Speaker 1: the quote first comprehensive description of an infectious organism causing disease.
Speaker 2: End quote scabies.
Speaker 1: Scabies is the first one comprehensive description of an infectious
Speaker 1: organism causing disease scabies skate bees, according to this book
Speaker 1: and a few other things I've I've come across in papers.
Speaker 2: Yeah, wow, yeah, I never knew that here.
Speaker 1: I me either, I never suspected scabies. It kind of
Speaker 1: makes sense.
Speaker 2: And though because they're bigger exactly, so they're easier. Like, yes,
Speaker 2: you still need a microscope to really see them. Well,
Speaker 2: but like if you have better eyes than me, maybe
Speaker 2: you can see them without or even just like a
Speaker 2: magnifying glass, which they had back then.
Speaker 1: But like what about like lice and like, yeah, that's.
Speaker 2: Fair, but I mean it sounds like scabies where it
Speaker 2: could feels like it could have been.
Speaker 1: Either yeah exactly. Yeah, well okay. So in sixteen fifty seven,
Speaker 1: using an early microscope, physician August Houptmann published a description
Speaker 1: of the scabies mite, including an illustration a little oval,
Speaker 1: six legged, tiny thing with four long hook things coming
Speaker 1: out of its rear. It's very interesting drawing.
Speaker 2: Two with only six legs. I mean, let me see
Speaker 2: if I can find a picture of this Aaron. Okay, oh,
Speaker 2: it's so cute. It's very cute. Yeah, it really doesn't
Speaker 2: look that much like a.
Speaker 1: Very detailed, but it's it's stuck, a little thing shooting
Speaker 1: out of a I don't know, I.
Speaker 2: Don't know what those are.
Speaker 1: It's cute, though not perfect, but it was the second
Speaker 1: advancement that would really get things going. In sixteen eighty seven,
Speaker 1: Italian physician Giovanni Cossimo Bonimo, who was twenty four at
Speaker 1: the time, and scientist Diacento Cestoni, who was fifty wrote
Speaker 1: a letter to Francesco Reddy, a well known naturalist, and
Speaker 1: in this letter, Bonomo described how, while working as a
Speaker 1: physician on a ship carrying enslaved individuals, he saw men
Speaker 1: removing small little bits from each other's skin to help
Speaker 1: relieve their itch. He also saw poor women picking out
Speaker 1: little pieces of material from their kid's skin using a needle.
Speaker 1: And what makes Bonomo's observations unique is not that he
Speaker 1: was the first physician to witness this practice and note it.
Speaker 1: It's that he thought there might be something more to
Speaker 1: it and actually followed it up with research. He enlisted
Speaker 1: the help of his father's colleague Sistoni, who had the
Speaker 1: good fortune of possessing a microscope. Using this microscope, they
Speaker 1: examined the material that came from their patient's itchy skin
Speaker 1: and found mite after mite, even mites laying eggs. Like
Speaker 1: they watched mites laying eggs. Whoa, And they noted that
Speaker 1: these creatures behaved like insects, and they reproduced, they laid eggs,
Speaker 1: and they lived in burrows in the skin, causing the
Speaker 1: itch not coming to life because of the itch not
Speaker 1: there randomly. These mites, they hypothesized, were the direct cause
Speaker 1: of the itch which had haunted and plagued humanity for millennia. Wow,
Speaker 1: they weren't the first to describe this though, right, Like,
Speaker 1: they literally watched people picking mites out of each other's skin.
Speaker 2: Right, Everyone was like, well, yeah, dude, we knew this.
Speaker 1: Get with the program, like welcome, welcome to the club.
Speaker 1: So I think in that it's not necessarily fair to
Speaker 1: say that they were the first to make this connection.
Speaker 1: But they were the first, in a scientific formalized setting,
Speaker 1: the first to describe this might, it's life cycle, its characteristics,
Speaker 1: and to link it to the itch that these mites caused.
Speaker 2: How interesting arin right?
Speaker 1: Yeah, And this makes it the first official description of
Speaker 1: an infectious disease and its causative agent. And again this
Speaker 1: is sixteen eighty seven, so well well before germ theory.
Speaker 2: Right, way way way before.
Speaker 1: Yeah, it's it's pretty cool. Yeah, but also, like, what
Speaker 1: the heck took so long?
Speaker 2: Right? If everyone else knew it, why did it take.
Speaker 1: So long for someone to actually note it down? Like,
Speaker 1: first for a scientist to write about this might itch
Speaker 1: causal relationship, and second for the scientific community to embrace it.
Speaker 1: Because even though Bonomo enlisted the help of a renowned
Speaker 1: naturalist in getting this observation out there, he was like, hey,
Speaker 1: can you, like, I'm going to release this pamphlet, can
Speaker 1: you you put your name on it and maybe write
Speaker 1: a few extra things, and then that'll help get a
Speaker 1: wider distribution so people think it's legit. Yeah, people were
Speaker 1: like nah, it was largely rejected for another one hundred years.
Speaker 1: There are several reasons I think contributed to this, and
Speaker 1: the first one is practical. So, like you said, erin
Speaker 1: the mites burrow is not directly where the itchy sores
Speaker 1: tend to arise, a little bit farther away, so it's
Speaker 1: not as clear that the two would be linked.
Speaker 2: Okay, fair, yeah, oh true.
Speaker 1: But the other main reason is simply the conservative nature
Speaker 1: of science. For millennia, learned men discarded the wisdom of
Speaker 1: peasants or women or non learned folks in general as
Speaker 1: not scientifically valid without giving it due consideration, and this
Speaker 1: superiority prevented them and still does in some ways today
Speaker 1: from exploring ideas outside of the box. And science in
Speaker 1: general is pretty rigid when presented with new information that
Speaker 1: conflicts with established facts, which is not necessarily a bad thing.
Speaker 1: Any new data, especially data that challenged the laws of nature,
Speaker 1: like the humoral theory of disease, should be checked and
Speaker 1: replicated and only then integrated into the body of knowledge.
Speaker 1: This is part of what makes science trustworthy, this need
Speaker 1: for a consensus. Of course, that's no excuse for closed
Speaker 1: mindedness and gatekeeping, which unfortunately are other hallmarks of science.
Speaker 1: So the concept that a tiny bug caused this dreadful
Speaker 1: itch went against everything that scientists knew and learned about
Speaker 1: how diseases worked. Bonomo and Sistoni anticipated this rejection, and
Speaker 1: so this is why they had this ready lend his
Speaker 1: name to this pamphlet. But I want to read you
Speaker 1: a quote from this because I think it is well,
Speaker 1: it's just really it's interesting, okay.
Speaker 2: Quote.
Speaker 1: Having frequently observed that the poor women, when their children
Speaker 1: are troubled with the itch, do, with the point of
Speaker 1: a pin, pull out of the scabby skin little bladders
Speaker 1: of water and crack them like fleas upon their nails,
Speaker 1: and that the scabby slaves in the bangyo at Leghorn
Speaker 1: do often practice this mutual kindness upon one another. It
Speaker 1: came into my mind to examine what these bladders might
Speaker 1: really be. I quickly found an itchy person, and asking
Speaker 1: him where he felt the greatest and most acute itching,
Speaker 1: he pointed to a great many little pustules not yet
Speaker 1: scabbed over, of which, picking out one with a very
Speaker 1: fine needle and squeezing from it a thin water, I
Speaker 1: took out a very small white globule, scarcely discernible. Observing
Speaker 1: this with a microscope, I found it to be a
Speaker 1: very minute, living creature, in shape resembling a tortoise of
Speaker 1: whitish color, a little dark upon the back, with some
Speaker 1: thin and long hairs, of nimble motion, with six feet
Speaker 1: a sharp head with two little horns at the end
Speaker 1: of the snout end.
Speaker 2: Quote, I love that a tortoise a little to I
Speaker 2: could see that.
Speaker 1: Yeah, yeah, And they go on to describe how they
Speaker 1: looked at more mites, They talk about treatment and contagiousness,
Speaker 1: and they deliver this direct conclusion quote from this discovery.
Speaker 1: It may be no difficult matter to give a more
Speaker 1: rational account of the itch than authors have hitherto delivered
Speaker 1: us like, you can't do better than this, essentially.
Speaker 2: Right, yeah.
Speaker 1: It being very probable that this contagious disease owes its
Speaker 1: origin neither to the melancholy humor of Galen, nor the
Speaker 1: corrosive acid of Sylvius, nor the particular ferment of Van Helmont,
Speaker 1: nor the irritating salts in the serum or lympha of
Speaker 1: the moderns. But it is no other than the continual
Speaker 1: biting of these animal cules in the skin, by means
Speaker 1: of which some portion of the serum oozing out through
Speaker 1: the small apertures of the cutess, little watery bladders are made,
Speaker 1: within which the insects, continuing to gnaw the infected, are
Speaker 1: forced to scratch, and by scratching, increase the mischief and
Speaker 1: thus renew the troublesome work, breaking not only the little
Speaker 1: pustules but the skin too, and some little blood vessels
Speaker 1: and to making scabs, crusty saurs and such like filthy symptoms.
Speaker 2: End quote. So I there are so many little pieces
Speaker 2: in that description that I loved, Aaron right, like, so
Speaker 2: so so many.
Speaker 1: I just the the increase, the mischief, thus the.
Speaker 2: Mischief, Like it's like they're little and they're biting there,
Speaker 2: like it just it's so many pieces of it, and
Speaker 2: it does make so much logical sense too, even though
Speaker 2: like they're technically a little bit wrong because it's like
Speaker 2: hypersensitivity reaction, but like it is such a logical It
Speaker 2: is such a logical description of what they saw and
Speaker 2: what is going on.
Speaker 1: Yeah, And I love how they're like, it's not the humors, bro,
Speaker 1: it's not it's not that humor.
Speaker 2: It's not the other humor you were thinking about. No,
Speaker 2: I already thought it, right, They're just like it's this,
Speaker 2: and like they keep going with it. They're not just like, yeah,
Speaker 2: there's a mite in the skin, clearly, They're like, no, dude,
Speaker 2: the mite is there and it's biting, and then it
Speaker 2: keeps biting and it makes a little pustul and then
Speaker 2: you itch at it and then you scratch it and
Speaker 2: then you push it in further, and then it keeps biting,
Speaker 2: and now you've broken the skin. Like they just they
Speaker 2: they keep going and going. It's so good and.
Speaker 1: It's all laid out there, so it's so straightforward that
Speaker 1: it must have been widely accepted and settled things once
Speaker 1: and for all.
Speaker 2: Right, But no, of course, never, ever, ever, ever.
Speaker 1: The resistance largely came in the form of, well, but
Speaker 1: the worms have nothing to do with the itch. They
Speaker 1: grew up out of the disease tissue, like you with
Speaker 1: maggat rotted meat.
Speaker 2: Right, what a weird Like I know that we have
Speaker 2: to like take our modern brains out of this, but like,
Speaker 2: what a weird thing to think.
Speaker 1: It's a hard it's harder to do when you're literally
Speaker 1: confronted with ample evidence of this, right exactly millennia, Yeah,
Speaker 1: I mean, but yeah, and those voices of resistance found
Speaker 1: out this well reasoned explanation for nearly one hundred years
Speaker 1: after this pamphlet was published.
Speaker 2: Wow.
Speaker 1: Eventually, though, with more interest in the might and the itch,
Speaker 1: the accepted knowledge began to shift, and a good number
Speaker 1: of these publications directly mentioned how they observed quote unquote
Speaker 1: like peasant and village elders extracting the might from the skin,
Speaker 1: saying that this knowledge has existed and has been passed
Speaker 1: down for a very long time, but it's only just
Speaker 1: now finding its way into the scientific literature, and it
Speaker 1: would take a final push to put the last shred
Speaker 1: of doubt to rest. In the early eighteen hundreds, wow,
Speaker 1: I know. Right at the Hotel Saint Luis and Paris,
Speaker 1: which was a scabies hospital, two factions emerged about the
Speaker 1: cause of the condition. On the pro mite side was
Speaker 1: the director Jean Louis Alibert and on the other Francois
Speaker 1: Vincent Raspaio. Things came to a boil when a challenge
Speaker 1: was issued find the might and receive your reward, which
Speaker 1: was three hundred francs, or fail and live with your
Speaker 1: shame forever. So Raspail set up a public demonstration this
Speaker 1: is the anti mite side, where he pretended to find
Speaker 1: the mite and was like, oh my gosh, it's actually here.
Speaker 1: This is incredible, and it was like, pich I planted it.
Speaker 1: It's just a cheese mite. So he had someone plant
Speaker 1: a cheese mite. Like too much time on your hands.
Speaker 2: Oh my god, I just what I know?
Speaker 1: Can you imagine it.
Speaker 2: Also, I love imagining someone in the eighteen hundreds going, so.
Speaker 1: This is like a public demonstration, Like, I want to
Speaker 1: know how well it was attended, was it advertised? Was
Speaker 1: he just like on just like randomly on the sidewalk
Speaker 1: on a Tuesday.
Speaker 2: I also now want to know more about cheese mites.
Speaker 1: So I agree, Okay, there's so many mites in the world.
Speaker 2: What if it's how many mite?
Speaker 1: And I guess. So that was the I suppose the
Speaker 1: humiliating moment for the pro mite side that was like,
Speaker 1: just kidding, it's a cheese mite.
Speaker 2: I mean, it seems humiliating for him, but I wasn't there,
Speaker 2: so I don't know.
Speaker 1: All right, no, let's see benefit of the doubt for
Speaker 1: the full scenario. But the pro miters would get the
Speaker 1: last laugh. In eighteen thirty four, when medical student Simon
Speaker 1: Francois Renucci was like, you know what, I'm I am
Speaker 1: going to find this, like I know that this that'
Speaker 1: scabies is caused by a mite, and I'm going to
Speaker 1: show everyone. And so he gathered a bunch of doctors
Speaker 1: together and was like, I'm doing this demonstration here, and
Speaker 1: he pulled a mite from a patient in front of
Speaker 1: everyone and was like, here it is. I found it.
Speaker 1: It's a little bits in the borough, a little bit away.
Speaker 1: There's a great illustration of this historic moment with Renucci
Speaker 1: holding up the mite for all all to see, which
Speaker 1: just like cracks me up because I'm like, I can't
Speaker 1: see it in size one font but it's like triumphantly
Speaker 1: with his arm in the air and this demonstration this
Speaker 1: like I found the mic here, here it is in
Speaker 1: this person. I don't know how it took so long
Speaker 1: for this to happen. Yeah, this was the start of
Speaker 1: a monumental shift away from the humoral theory of disease.
Speaker 1: And this isn't like, this isn't the thing that made
Speaker 1: people go, oh maybe we should question right, a combination
Speaker 1: of things, right. It sort of was like it was
Speaker 1: part of the transition away from that. The rest of
Speaker 1: the eighteen hundred saw Ferdinand rittervon Hebra, who I mentioned
Speaker 1: in our Loopus episode. So he was an early scientific dermatologist,
Speaker 1: because like, I come across these names and I'm like,
Speaker 1: some familiar where are you coming from? And then I
Speaker 1: just like search our transcripts. He distinguished the might cause
Speaker 1: scabies from other itchy skin conditions which had been called
Speaker 1: scabies in the past, and that was probably part of
Speaker 1: what led to this like long confusion. It was just
Speaker 1: like if you're itgy, it's called scabies.
Speaker 2: Right right right? It was the itch, but it it
Speaker 2: is the might yes, yeah.
Speaker 1: And then this also helped on the treatment front to
Speaker 1: determine which ointments were or were not effective, and the
Speaker 1: early twentieth century marked a jump forward in our understanding
Speaker 1: of scaby's epidemiology. As you can imagine, scabies mites love
Speaker 1: a war, they love chaos, and World War Two, with
Speaker 1: its crowded barracks, offered a great opportunity for these little
Speaker 1: guys to infest to their hearts content and infest they did,
Speaker 1: and they didn't just get under the soldier's skin. By
Speaker 1: the nineteen forties, between one and two million people in
Speaker 1: the British Isles had scabies. This was a problem in
Speaker 1: need of a serious solution, and Kenneth Mellanbie, who was
Speaker 1: a British entomologist, felt up to the task. So he
Speaker 1: directed a series of experiments where he exposed human quote
Speaker 1: unquote volunteers who were primarily conscientious objectors. So this was
Speaker 1: like they refused to join the war effort, and so
Speaker 1: he proposed this as like, oh, show your service to
Speaker 1: the country in another way. Yeah, And it's interesting because
Speaker 1: I think there has been, of course some criticism of this,
Speaker 1: you know, even with the ethics at the time. I
Speaker 1: do think it's relevant to note that he was morally
Speaker 1: opposed to experimentation on what he felt were not true volunteers,
Speaker 1: like people in prison or people who couldn't really say no,
Speaker 1: like children and so on. So that part is interesting
Speaker 1: to me. But I also don't know how much power
Speaker 1: conscientious objectors had to say no.
Speaker 2: Yeah, I don't know enough.
Speaker 1: I don't know the context enough for that. But in
Speaker 1: any case, he directed a series of experiments where he
Speaker 1: exposed these conscientious objectors to various items like blankets, towels, pants, shirts, socks,
Speaker 1: underwear that had been used by people infested with scabies,
Speaker 1: to see how long it would take to cause an infection.
Speaker 1: For centuries, scabies had the reputation of being super duper contagious,
Speaker 1: like all you had to do to get it was
Speaker 1: touch a blanket used by a person with scabies, look
Speaker 1: at someone who had skabies, like it was just like
Speaker 1: whoa the most contagious thing. Ever, but Melanie's experiments showed
Speaker 1: that this was not the case. He found it near
Speaker 1: impossible to get any of his volunteers infected, much to
Speaker 1: their relief, I imagine, And when they did get infected eventually,
Speaker 1: it took weeks for symptoms to show how which, as
Speaker 1: you mentioned, Aaron, yep, and it was much sooner though
Speaker 1: if you had had scabies before, so it'd be like
Speaker 1: six weeks or twenty four hours, right, that's it. Yeah,
Speaker 1: And he even tried it on himself.
Speaker 2: Quote.
Speaker 1: My own experience was typical. I allowed a mite to
Speaker 1: burrow into my own wrist and observed it almost like
Speaker 1: a pet, for two months. Each day the tunnel was enlarged,
Speaker 1: eggs were located in the burrow, but I had no
Speaker 1: skin reaction. It was only in the fifth week that
Speaker 1: a redness was observed around the might and that skin
Speaker 1: irritation became obvious quote interesting. He also found that scabies
Speaker 1: could only be transmitted by a female mite, not eggs,
Speaker 1: not immature mites, and that female mites don't live very
Speaker 1: long out like outside of the human body. And this
Speaker 1: meant that the Ministry of Health could better spend their
Speaker 1: time and money, tracking down contacts of affected individuals and
Speaker 1: treating them rather than destroying or disinfecting blankets and bedding.
Speaker 2: Oh my gosh, Yes, that's so good public.
Speaker 1: Hell right resource management. Despite his work, the misconception of
Speaker 1: scabies as a super contagious condition remains to this day,
Speaker 1: and I think it contributes to the stigma that scabies
Speaker 1: carries with it. Scabies as a medical condition is extremely
Speaker 1: uncomfortable and can be dangerous in some occasions. But that's
Speaker 1: just one part of the story. For the hundreds of
Speaker 1: millions of people around the globe that developed scabies every year. Shame,
Speaker 1: social isolation, avoidance, These are common experiences in people with scabies,
Speaker 1: and they can discourage a person from seeking treatment or
Speaker 1: informing other people about exposure. And while we have treatment
Speaker 1: that is for the most part effective, while we have
Speaker 1: control measures, we still need to really improve on actually
Speaker 1: putting those in place, which means decreasing the stigma associated
Speaker 1: with scabies. And so on that note, Aaron, can you
Speaker 1: tell me where we are with scabies today?
Speaker 2: I would love to right after this break. Globally, the
Speaker 2: World Health Organization estimates that at any given moment, two
Speaker 2: hundred million people worldwide are affected by scabies, with over
Speaker 2: four hundred million people affected cumulatively each year. It's like
Speaker 2: four hundred million cases each year. And it's everywhere. It is,
Speaker 2: everywhere that humans are, there is scabies. But even with
Speaker 2: all of that knowledge, our data is actually really cuddy,
Speaker 2: and there is a real need for better evaluation and
Speaker 2: better monitoring. While scabies exist everywhere, it exists differently in
Speaker 2: different places across the globe. In most high income countries,
Speaker 2: we see it in sometimes in outbreaks in places like hospitals,
Speaker 2: nursing homes, among homeless populations, though it can also occur sporadically,
Speaker 2: right like anybody can potentially get scabies. But in developing
Speaker 2: and underresourced areas of the world, both urban and rural areas,
Speaker 2: prevalence can sometimes be as high as ten percent, and
Speaker 2: in some regions, in some studies, prevalence has been as
Speaker 2: high as twenty to thirty percent and over fifty percent
Speaker 2: in children, who tend to be even more affected than adults.
Speaker 2: So this is a huge, huge problem worldwide, not only
Speaker 2: because like we've talked about a lot so far, like
Speaker 2: this is a very potentially painful, very bothersome infection, super
Speaker 2: super itchy Also, the itching is much much worse at night,
Speaker 2: and that is something that I could not find data
Speaker 2: on as to like why does the itch? Why is
Speaker 2: the itch so much worse at night? But it is.
Speaker 2: But scabies is also a massive risk factor for things
Speaker 2: like secondary bacterial infections, and I mentioned it at the
Speaker 2: very very top. But this causes also not just the
Speaker 2: infections themselves, but then morbidity and mortality from things that
Speaker 2: happen as a result of those infections. One paper estimated
Speaker 2: that up to ten percent of kids with scabies end
Speaker 2: up with renal damage, and that renal damage is not
Speaker 2: from the mites, it's from the bacterial infections that get
Speaker 2: in because of the mites. Right, Like, I had no
Speaker 2: idea that it was such a big deal me either.
Speaker 2: It's also really common to misdiagnosis in the US and
Speaker 2: across the globe. In one paper, up to forty five
Speaker 2: percent of people in the US, even at dermatology offices,
Speaker 2: were misdiagnosed the first time that they came in and
Speaker 2: saw physician. Is what is a common misdiagnosis? It could
Speaker 2: be eczema, it could be just a topic dermatitis, it
Speaker 2: could be just any kind of nonspecific itchyness, got it
Speaker 2: lots of different things and also interesting and very depressing. Fact. Again,
Speaker 2: I just scaby's felt so much bigger to me than
Speaker 2: I realized. The Global Burden of Disease study, which is
Speaker 2: this big study, I've cited it multiple times, they try
Speaker 2: and look at like overall burdens of a whole bunch
Speaker 2: of different diseases. So a report from twenty fifteen on
Speaker 2: scabies specifically estimated that scabies contributes more disability adjusted life
Speaker 2: years than something like atrial fibrillation, which is really common
Speaker 2: and most people have probably heard of it, so it
Speaker 2: has a huge amount of disability associated with it. But
Speaker 2: this paper also estimated that mortality due to scabies was zero,
Speaker 2: which if you think about it, is not entirely true
Speaker 2: because we know that especially crusted scabies can contribute to
Speaker 2: super imposed infections that can lead to sepsis that absolutely
Speaker 2: can be deadly, and things like poststrep glomerial neephritis or
Speaker 2: rheumatic heart disease can also be a consequence of infections
Speaker 2: that are a concepts of scabies. So it's just overall
Speaker 2: a much bigger deal, and the World Health Organization knows
Speaker 2: that luckily, and so as of twenty seventeen, scabies are
Speaker 2: actually considered a neglected tropical disease along with a number
Speaker 2: of other ectoparasites, and their twenty thirty targets are to
Speaker 2: do a few different things to try and really address scabies. First,
Speaker 2: they're trying to integrate mass drug administration anywhere that prevalence
Speaker 2: of scabies is higher than ten percent, which sounds, I mean,
Speaker 2: sounds both low and high. Like imagining ten percent of
Speaker 2: a population infected with scabies sounds awful, but it also
Speaker 2: in terms of like mass drug administration campaigns, seems low.
Speaker 2: But I think part of that is because people can
Speaker 2: be asymptomatic and treatment can take such a long time
Speaker 2: and things like that. So anywhere that which also means
Speaker 2: that we need better data because we don't necessarily know
Speaker 2: everywhere where prevalence might be ten percent or greater. And
Speaker 2: it seems like that is where most of the research
Speaker 2: on scabies is actually happening, and where the focus really
Speaker 2: seems to be is on epidemiological level research like where
Speaker 2: is it, what is the prevalence really and how can
Speaker 2: we then use public health measures to get control of
Speaker 2: this disease? Because we have treatments, we have options, we're
Speaker 2: just not maybe implementing them in the most effective way currently.
Speaker 2: So that's where we stand with scabies today.
Speaker 1: It's such a huge it's such a huge problem.
Speaker 2: It really is. I just I feel like I did
Speaker 2: not recognize it. I think also, Aaron, you mentioned the
Speaker 2: stigma that's associated with it. That's a huge, like it
Speaker 2: is very real, and that is real everywhere across the globe.
Speaker 2: That's real in developing countries. That is definitely real here
Speaker 2: in the US. I have seen that firsthand, where if
Speaker 2: somebody comes into a hospital with scabies, they are treated
Speaker 2: differently than somebody who doesn't have scabies. And that's a problem.
Speaker 1: Mm hmm. There's a lot of I think preconceived notions
Speaker 1: about scabs that then leads to this sort of treatment
Speaker 1: that is perpetuates stigma and shame and isolation and all
Speaker 1: these things.
Speaker 2: It's seen as like something that is dirty or something
Speaker 2: like that. Exactly.
Speaker 1: Yeah, it's like literally any person can get scabies.
Speaker 2: If you have skin, human skin, you can get scabies. Yeah, yeah,
Speaker 2: that's that's what it is.
Speaker 1: Bottom line.
Speaker 2: Well, if you'd like to learn more about scabies, we
Speaker 2: have a lot of information for you. We do.
Speaker 1: I have a handful of papers, but the place where
Speaker 1: I got most of my information was a great book
Speaker 1: which I already mentioned, called The Itch Scabies by Eryl Craig,
Speaker 1: and it's all about scabies. So there's a lot of
Speaker 1: information there. And then there's again I want to shout
Speaker 1: out that paper by Cropy from two thousand and six
Speaker 1: called the Army Itch, a dermatological mystery of the American
Speaker 1: Civil War.
Speaker 2: I have a number of papers, I said already. There
Speaker 2: was a Lancet article review from two thousand and six
Speaker 2: just called scabies. It was great, really nice overview. There
Speaker 2: was one from the Journey All of the American Academy
Speaker 2: of Dermatology from twenty twenty called Ectoparasites scabies. That was
Speaker 2: another good one. And honestly, there's a bunch of other
Speaker 2: papers that are reviews. There's that Global Burden of Disease
Speaker 2: study from twenty fifteen. And we'll post the list of
Speaker 2: sources from this episode and every single one of our
Speaker 2: episodes on our website, This podcast will Kill You dot
Speaker 2: Com under the episodes tab.
Speaker 1: Thank you to Bloodmobile for providing the music for this
Speaker 1: episode and all of our episodes.
Speaker 2: Thank you to Leona Scilacchi and Tom Brifogel for the
Speaker 2: audio mixing.
Speaker 1: Thank you to everyone at Exactly Right.
Speaker 2: And thank you to you listeners. We hope you're not
Speaker 2: too itchy after listening to this episode.
Speaker 1: H and we hope you learned something about scabies.
Speaker 2: We certainly did.
Speaker 1: And a big thank you as always to our wonderful, excellent, fantastic,
Speaker 1: lovely patrons. We appreciate your support. It means the world
Speaker 1: to us. Thank it really does. Thank you so much. Well,
Speaker 1: until next time, wash your hands.
Speaker 2: You feelthy animals.
Speaker 4: Ombud Buba, Buba, Buba bu