Head Lice / Public Health
1870 In both the US and UK, public funding of schools began in ~1870. At that time, “… 90% of all children in England could be infested with head lice at any given moment.” [Maunder et al., 2001] At first, Health Officers (Doctors) were assigned to UK school systems to prevent infectious disease epidemics among the children. This eventually led to the public funding of ‘Nit Nurses’, who visited each school twice a year to inspect the children’s heads for nits.
1902 The New York City school system hired its first public school nurse in 1902. [Anon., 2008]
1902 Professor Edward Shaw recommended that students with head lice be excluded from school and not readmitted until the infestation had been eliminated. In order to eliminate head lice, he suggested the overnight application of cloths saturated with either tincture of larkspur or kerosene on two successive nights. [Shaw, 1902]
1904 “The Brighton (U.K.) municipal authorities … have taken the matter (of children infected with head lice) in hand by appointing a trained nurse in the place of an attendance officer. … The nurse is to act directly under the medical officer, and will assist also in visiting houses when infectious disease has broken out, so that her functions will be manifold.” [Anon., 1904]
1905 “The nit nurse they called her… Some kids or mothers would not believe they had nits. The nurse would comb a child’s hair onto a paper, then put the paper and moving contents into an envelope, seal it, then write: ‘For the attention of Mrs… The child would then take the note home to Mum”. [Anon., 2009]
1907 In the U.K., the Education Act of 1907 introduced periodic medical inspections to address government concerns over the poor health of school children and of recruits for the Boer war. [Hall, 2006]
1910 The eleventh school report for New York City noted that: “… there were 145,066 cases of pediculosis, that 688,980 treatments were given, and that 3,000 were excluded from school.” [Junius, 1910]
1914-18 There was a head lice pandemic during WW1 [Maunder et al., 2001]
1921 “Derbac soap,” unlike soap made from fat, was made primarily by the action of caustic soda upon the starch, proteins, etc. contained in cereals, and in addition contained a large amount of birch tar. (Birch tar is obtained by the destructive distillation of the white epidermis of the bark of the silver birch tree [Betula alba, L.] and contains a high percentage of methylsalicylate, and also creosol and guaiacol. [Grieve, 1931]) This mixture resulted in a black soap with a strong odor. In 1921, G.A. Auden conducted tests which showed that “Derbac soap”, when lathered on the head and allowed to remain for 10 minutes, immobilized the head lice but did not immediately kill them. However, over the next 24 hours all the lice died. [Auden, 1921] He suggested a weekly head wash using “Derbac soap.” This routine was widely recommended by ‘nit nurses’ and was followed in many British homes until DDT became available. [Manifold E., 2004] [McKinley, 2006] However, Derbac soap was still being used to kill head lice by at least one UK ‘nit nurse’ in the 1950’s. [Faulkner, 2006]
1939-45 There was a head lice pandemic during WW2 [Maunder et al., 2001]
1945 DDT insecticide was released in 1945 for farm and other uses and became widely used over the next ~27 years. In that period 1.34 billion pounds was used in the US alone, until it was banned by the US EPA in 1972.
1945-72 Between 1945 and 1972, head lice infestations in both the UK and US
were rare. [Maunder et al., 2001; Greene, 2004]
1946 Mary Weiss, a family health service nurse in New York City, noted that in 1946 many people still believed a variety of misconceptions about head lice: the presence of lice signifies health or production; lice generate spontaneously from dirt; nothing will cure some individuals who are breeders; swallowing sulphur will effect a cure; lice bring luck; and, eaten, will cure jaundice. [Weiss, 1946]
1951 USP Lindane was introduced as a head lice remedy in the US.
1973 “An epidemic due to Pediculus humanus capitis occurred in the public schools of Buffalo, New York in the winter of 1973. A survey at one elementary school showed that 20% of whites and no blacks were infested, and city-wide prevalence survey during the academic year September 1972 to May 1973 showed that 7.2% of all pupils were infested.” [Slonka et al., 1977]
1974 The UK National Health Service was reorganized in 1974 and the ‘Nit-Nurse’ was eliminated.
1977 NIX (permethrin) was approved as a head lice treatment in the US.
1983 National Pediculosis Association (NPA) was founded in 1983 to advocate the mechanical removal of lice and nits by combing, rather than the use of pediculicides. It also promotes ‘no nit’ policies for schools.
1984 OVIDE (0.5% USP malathion) was approved as a head lice treatment in the US.
1985-97 The World Health Organization (WHO) reported that infestation rates are “… high almost everywhere, both in developed and developing countries and in tropical and temperate countries. In many of the studies…infestations were found among 90 percent or more of the children.” [Gratz, 1997]
1996 There was “an upsurge in head lice infestations in the United Kingdom, peaking at a high of four to five percent in 1996 and now (2001) holding steady at two to three percent of the school age population. Maunder speculates the upsurge and continuing problem are caused both by insecticide resistance, and the reorganization of the country’s (UK) National Health Service.” [Maunder et al., 2001]
1998 NPA introduced the ‘LiceMeister’, a metal fine tooth comb in 1998.
2000 “Evidence now shows that ‘no-nit’ policies in schools are ineffective and banning children with nits from school is frowned upon since about 50% of children sent home for head lice don’t have them.” [Pollack et al., 2000]
2001 In Atlanta, Georgia 7th grade classes, 1729 children were screened for head lice. 28 children (1.6%) had lice, whereas 63 children (3.6%) had nits without lice. Fifty of the 63 children completed the follow-up, and only nine of these 50 children became infested with lice within 14 days; i.e. less than a fifth of the children who had nits went on to have a real head lice infection after 14 days. The authors concluded that: “Policies requiring exclusion from school and treatment of all children with nits alone are likely excessive. Instead, these children may benefit from repeated examination to exclude the presence of crawling lice.” [Williams et al., 2001]
2002 The American Academy of Pediatrics (AAP) recommends that the nation’s school districts back off from their ‘no nit’ policies. “Head lice screening programs have not been proven to have a significant effect on the incidence of head lice in a school setting over time and are not cost effective.” [Frankowski and Weiner, 2002]
2010 In Douglas County, Oregon, “… The Health Department will no longer see people on a walk-in basis or by appointment for head lice … . People should seek medical care through health care providers, local or regional health clinics, or talk with pharmacists about effective over-the-counter medications.” [Anon., 2010]
©2010 by Harry A. Morewitz, PhD. All rights reserved.