I’ve said, on many occasions, that good sanitation and hygiene will do more to keep you healthy than anything that I can do as a medical doctor.  As survival medic, you will have some control over the likelihood that your family or group will be exposed to unsanitary conditions.  Indeed, your diligence in this matter is one of the major factors that will determine your success as a caregiver.

Lice and Hygiene

A common health problem pertaining to poor hygiene is the presence of lice, also known as “Pediculosis”.  Lice (singular: louse) are wingless insects that are found on many species. On humans, there are three types:  Head, Body and Pubic.  Some diseases use lice as vectors, causing major implications for entire survival groups.  Sometimes, itching caused by lice causes breaks in the skin which allows other infections to develop.

Although it is thought that human lice evolved from organisms on gorillas and chimpanzees, they are, generally speaking, species-specific.  That means that you cannot get lice from your dog, like you could get fleas. You get them only from other humans.  It is interesting to note that human lice and chimpanzee lice diverged from each other, evolutionarily, about 6 million years ago; this is almost exactly when their hosts went their separate ways.

How Do Lice Spread?

Lice spread rapidly in crowded, unsanitary conditions where close personal contact is unavoidable. These conditions occur, for example, in many schools where children come into contact with each other during the course of the day (head lice, mostly).  The sharing of personal items can also lead to louse infestations; combs, articles of clothing, pillows, and towels that are used by multiple individuals are common ways that lice are spread.

Adult head lice (Pediculus humanus capitis) are greyish-white and can reach the size of a small sesame seed. Infestation with head lice can cause itching and, sometimes, a rash. However, this type of lice is not a carrier of any other disease.  Even in developed countries, head lice are relatively common, with 6-12 million cases a year in the United States, mostly among young children.  With their less developed immune systems, kids sometimes don’t even know they have them; adults are usually kept scratching and irritated unless treated.  An interesting fact is that African-Americans are somewhat resistant to head lice, probably due to the shape and width of the hair shaft.

The diagnosis is made by identifying the presence of the louse or “nits” (their eggs). Nits look like small bits of dandruff that are stuck to hairs. They are more easily seen when examined using a “black light”.   This causes them to fluoresce as light blue “dots” attached to the hair shafts near the scalp. As “black lights” will be rare in a collapse, a fine-tooth comb run through the hair will also demonstrate adult lice and nits. Special combs are used to remove as many lice as possible before treatment and to check for them afterwards.  Many prefer the metal nit combs sold at pet stores to plastic ones sold at pharmacies.

You will find that the nits are firmly attached to the hair shaft about ¼ inch from the scalp.  Nits will generally appear as yellow or white and oval-shaped.  Olive oil may be applied to the comb; this may make the nits easier to remove.

Body lice (Pediculus humanus corporis) are latecomers compared to head lice, probably appearing with the advent of humans wearing clothes 110,000-170,000 years ago.  As the concept of cleaning clothes occurred quite later, the constant contact with dirty garb caused frequent infestations.

This may be a common issue with the homeless today, but will likely be an epidemic in a collapse situation when regular bathing and clothes washing becomes problematic. Body lice are slightly larger than head lice; they also differ in that they live on dirty clothes (especially the seams), not on the body.  They go to the human body only to feed.   They are, also, sturdier than their cousins, and can live without human contact for 30 days or so.

Removal and, preferably, destruction of the infested clothing is the appropriate strategy here.   Sometimes, using medication is unnecessary as the lice have left with the clothes (don’t bet on it, however).  Body lice, unlike head lice, ARE associated with infectious diseases such as typhus, trench fever and epidemic relapsing fever.  Continuous exposure to body lice may lead to areas on the skin that are hardened and deeply pigmented.

Pubic infestations may be either caused by lice or mites. Pubic lice (Pthirus pubis), also known as “crabs”, usually start in the pubic region but may eventually extend anywhere there is hair, even the eyelashes.  They are most commonly passed by sexual contact.  Severe itching is the main symptom and can involve the axillary (armpit) hair or even the eyelashes.

Although they are sometimes seen in a patient that has other sexually transmitted diseases, pubic lice do not actually transmit other illnesses.  It should be noted that pubic lice is one of the few sexually transmitted diseases that is not prevented by the use of a condom.

Scabies is different from “crabs” and is caused by tiny eight-legged organisms called mites (Sarcoptes scabiei), not lice. The mites burrow through the skin forming small raised red bumps.  Itching is noted and is most intense at night.  Scabies can affect skin folds, even those with little hair such as the folds of the wrists, elbows, or between the fingers or toes.

These types of infestation are killed by medications called “Pediculocides”.  They include:

• Nix Lotion (1% Permethrin)
• Rid Shampoo (Pyrethrin)
• Kwell Shampoo (Lindane)
• Malathion 5% in isopropanol

Nix lotion (permethrin) will kill both the lice and their eggs.  Rid shampoo will kill the lice, but not their eggs; be certain to repeat the shampoo treatment 7 days later.  This may not be a bad strategy with the lotion, as well.  Ask your physician for a prescription for Kwell (lindane) shampoo to stockpile. It is a much stronger treatment for resistant cases.   It may cause neurological side-effects in children, so avoid using this medicine on them.  To use these products:

• Start with dry hair.  If you use hair conditioners, stop for a few days before using the medicine. This will allow the medicine to have the most effect on the hair shaft.
• Apply the medicine to the hair and scalp.
• Rinse off after 10 minutes or so.
• Check for lice and nits in 8 to 12 hours.
• Repeat the process in 7 days

Wash all linens that you don’t throw away in hot water (at least 120 degrees). Unwashable items, such as stuffed animals, that you cannot bring yourself to throw out should be placed in plastic bags for 2 weeks (for head lice) to 5 weeks (for body lice), then opened to air outside.  Combs and brushes should be placed in alcohol or very hot water. Your patients should change clothes daily, although this may be difficult in a survival situation.

Natural remedies for lice have existed for thousands of years. Even commercial medications like Rid Shampoo use pyrethrin, which is extracted from the chrysanthemum flower.

For external use only, mix a blend of salt, vinegar, Tea Tree oil and Neem oil and apply daily for 21 days.  Alternatively, Witch Hazel and tea tree oil applied daily after showering for 21 days has been reported as effective against hair lice.

A triple blend of tea tree, lavender, and Neem oil applied to the public region for 21 days may be effective in eliminating Scabies. Witch Hazel and tea tree oil, again, may be helpful for lice in this region as well.  Some have advocated bathing with ½ cup of Borax and ½ cup of hydrogen peroxide daily for 21 days.

Although I have seen recommendations to “suffocate” lice with margarine, lard, butter, or coconut/olive oil, there isn’t enough evidence to be certain that this method will work.

Another parasite that is related to lice is the bedbug.  There appears to be an epidemic of this insect that has occurred over the last few years and is worth mentioning in a future article.

Part of your duties as survival medic is that of Chief Sanitation Officer.  Pay attention to this aspect of community health, and your people will have a head start to staying healthy in times of trouble.

Dr. Bones