A Hairy Predicament
Our centuries-old relationship with lice is more complicated that you'd think.
Lowly, unlovely lice, that is. Despite their unwavering lineage, I was shocked to find them crawling on my own children. I knew that lice still existed, of course, but I had always assumed that they belonged in someone else’s house. So despite receiving a letter from school alerting parents of an infestation, it took three days of watching my son furiously scratching his neck before I realized that he might not have mosquito bites.
The moment I checked, there they were: little wingless, bloodsucking insects skittering over his thick-haired scalp. I wondered how long had they been hiding there, and how I could not have noticed. They were there on his little brother, too, who had also fostered them unnoticed despite having thin, fine, blond hair. Then a quick check in the mirror at my own hair confirmed the inevitable: A single louse perched assertively on my hairline, looking like it had popped out to say, “See, I’ve been here all along.”
After a confirmatory visit to the school nurse, the realization of what lay ahead set in. Eradicating head lice takes a lot of work. In addition to hair treatments with pesticide shampoo, a visit to the barbershop, and painstaking combing for nits daily for two weeks, everything in the house that can be washed must be washed (that’s piles and piles of laundry), everything that cannot be washed must be put in a hot dryer or bagged and quarantined, and all furniture must be thoroughly vacuumed. As a precautionary measure, I washed the bed sheets everyday for a week. I could not let the bugs come back.
Meanwhile, a paranoia set in that has not yet completely abated. On a follow-up visit to the school nurse, she comforted me that lice are a common problem, but she looked worried, recommending that I cut the kids’ hair even shorter, promising to keep our names confidential, and banning us from school until the bugs were definitely gone. I refused any visitors to the house for three weeks. I warned our friends to check their hair, cringing all the while about going public with our buggy problem. There was something overwhelmingly, unavoidably humiliating about it all.
Not to mention something creepy. Even now, more than a month later, my scalp feels itchy as I write this, and I have checked twice in the mirror to reassure myself that the bugs are really gone. The medical literature reveals that recurrent lice infestation is common in some families, and now I have nightmares that we might be one of them.
Treatment-resistant lice are on the rise, making lice harder to obliterate. At least 50 percent of the bugs in some geographical areas have inherited protective mutations to survive exposure to the most common commercial anti-lice shampoos containing pyrethroid insecticides, according to research by University of Massachusetts Amherst toxicologist and lice expert John Clark. Since this is the treatment I used, it is no surprise that hours after the first treatment, I still found live lice in my sons’ hair.
There are treatment options for persistent head lice infestations, including lindane, malathion, and ivermectin, but all of these options have their own drawbacks, according to Clark. Various new treatments are in the pipeline but still await FDA approval. Meanwhile alternative options featuring essential oils and herbal extracts remain unproven. I tried one of these, too, since it didn’t carry the toxicity of an insecticide. I figured doubling up treatment this way couldn’t hurt.
Some pharmacists, although not mine (he just pointed me to the shampoo aisle), are now encouraging people to eschew the available treatments and battle against lice the old fashioned way — with their fingernails and a comb. French poet Arthur Rimbaud eulogized this approach in his intimate, enchanting, and certainly disturbing, poem “The Seekers of Lice” (1891). The poem tells of two sisters removing lice from a young boy’s head, “The crackle of small lice dying, beneath/The imperious nails of their soft, electric fingers."
A famous 1935 book called Rats, Lice and History, by bacteriologist Hans Zinsser, expounds on the “intimate role” that lice played in the social life of the human race until well into the 19th century. “It was not so long ago, indeed, that its prevalence extended to the highest orders of society, and was accepted as an inevitable part of existence like baptism, or the smallpox,” he writes.
Some cultures even incorporated the parasite into their traditions, according to Zinsser. The Aztec people collected lice from their bodies in small bags and laid them at the feet of their king. Native people of Northern Siberia threw lice on a visitor in a traditional declaration of love. Zinsser explains this as “a sort of ‘My louse is thy louse’ ceremony.” A Swedish town in the Middle Ages elected a mayor by placing a louse in the middle of a table of eligible candidates, and “The one into whose beard the louse first adventured was the mayor for the ensuing year.”
Later, some Europeans took to shaving their heads and wearing a wig in an effort to deter lice, but the wigs themselves were often full of nits. Nitpicking was a way of life; educated children, however, were taught that it was “improper to take lice or fleas or other vermin by the neck to kill them in company, except in the most intimate circles,” according to Zinsser.
As I try to imagine nitpicking away at my hair with my “most intimate circle” of friends, I wonder whether I could have survived the full-time, parasitic infestations of old without going mad. As it is, I’m just about crazy with fear that the bugs will come back. This time, however, I remain vigilant to invasion. I refuse to let lice sneak attack again. • 14 November 2008
“The Seekers of Lice," by Arthur Rimbaud (translated by Jeremy Harding)
When the boy's head, full of raw torment,
Longs for hazy dreams to swarm in white,
Two charming older sisters come to his bed
With slender fingers and silvery nails.
They sit him at a casement window, thrown
Open on a mass of flowers basking in blue air,
And run the fine, intimidating witchcraft
Of their fingers through his dew-dank hair.
He listens to their diffident, sing-song breath,
Smelling of elongated honey off the rose,
Broken now and then by a hiss: saliva sucked
Back from the lip, or a longing to be kissed.
He hears their dark eyelashes start in the sweet-
Smelling silence and, through his grey listlessness,
The crackle of small lice dying, beneath
The imperious nails of their soft, electric fingers.
The wine of Torpor wells up in him then
— Near on trance, a harmonica-sigh —
And in their slow caress he feels
The endless ebb and flow of a desire to cry.
SOURCES: Rats, Lice and History: A Chronicle of Disease, Plagues, and Pestilence by Hans Zinsser (Little, Brown & Company; January 1935); Takano-Lee M, Edman JD, Mullens BA, Clark JM. “Home remedies to control head lice: assessment of home remedies to control the human head louse, Pediculus humanus capitis (Anoplura: Pediculidae).” J Pediatr Nurs. 2004;19:393-8; Strycharz JP, Yoon KS, Clark JM. “A new ivermectin formulation topically kills permethrin-resistant human head lice (Anoplura: Pediculidae).” J Med Entomol. 2008;45:75-81.
Jennifer Fisher Wilson is the science reporter for Annals of Internal Medicine. Her stories are available at www.annals.org.
Image from istockphoto.com.