At Large January 2003

The Louse is in the House

A malady that does not speak its name
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America gives every appearance of being a nation besotted with trashiness—divorce, illegitimacy, casual Fridays. The murder rate in the cities is rising again. Anna Nicole Smith is back for a second season on cable TV. But recent experience argues that this love for the dirty and the vulgar is only skin deep, so to speak. Social critics shouldn't nitpick—at least not figuratively.

Our country has an enormous stockpile of bourgeois propriety, highly refined bourgeois propriety. In fact, it is weapons-grade, as verified by the detonation of me at our house when our five-year-old daughter was sent home from pre-K because she had head lice.

"How could my daughter get lice?" I shouted (out of daughter's earshot, of course, for propriety's sake). "It's a private school!"

"They let us in," my wife said. And possibly our head lice, too. On inspection our two-year-old daughter—who does not go to school—proved to be even more populated than her older sister.

"Where would my baby get lice?" I shouted.

"At the country club?" my wife said.

"It's a private club!"

"They let us in," my wife said.

I felt a blush of shame creep across my face, not to mention what I felt creep across my scalp. None of the six motor vehicles in our yard is actually up on blocks. We have a huge satellite dish, but that's from a couple of marriages ago. I defy anyone to call the O'Rourkes trashy, now that my nephew is out of prison. And my wife's family was on the Mayflower (Van Lines). The piano was always moved in a well-bred fashion.

"Oh, hush—and quit clawing at yourself," said my wife, who was consulting The AMA Home Medical Encyclopedia. "'Children,'" she read aloud, "'are most affected, women occasionally, and ...' —it figures—'men rarely.'"

The head louse, Pediculus humanus capitis, is a cousin of the body and pubic lice that truly are indicative of trash. The former live in filthy clothing, and the latter are the result of reading Kahlil Gibran by lava lamp and cavorting on a waterbed. But the head louse is different. The American Academy of Pediatrics, The Merck Manual of Diagnosis and Therapy, the New England Journal of Medicine, and the Harvard School of Public Health say, respectively, "All socioeconomic groups are affected"; "It is common among school children, without regard to social status"; "[It] affects persons of all ... socio-economic backgrounds"; and "Head lice ... do not respect socio-economic class distinctions." One need not scratch one's head about the repeated mentions of status. The New England Journal of Medicine notes, "Most children get them at some point, including doctors' children."

The adult head louse is usually described as being the size of a sesame seed. But a sesame seed stuck between teeth is visible at ten yards, whereas to my bifocaled eyes lice are ...

"I think I have lice all over my shoes."

"Those are the holes in your wing-tips," my wife said.

The female louse lays one to six nits a day, according to the NEJM. She lays ten nits a day, according to the American Academy of Pediatrics. The nits hatch in three to fourteen days, claims The Merck Manual; in ten to fourteen days, maintains the Academy of Pediatrics; in about a week, declares the Centers for Disease Control. The CDC states that the louse nymphs (a Nabokovian, and not very proper, image) mature in about another week. The Harvard School of Public Health avers maturation in nine to twelve days. A louse that's been separated from its host dies in a day or so, says Harvard; within forty-eight hours, asserts the CDC; in fifty-five hours, opines the NEJM. That journal postulates head-lice-infestation rates of one to three percent in industrialized countries. This would give the United States 2.8 to 8.4 million cases a year. The CDC estimates only 6 to 12 million cases worldwide. The AAP thinks there are that many cases among three-to-twelve-year-olds in the United States alone.

Medical researchers don't know much about head lice because they don't much care. The reason that they don't much care is, paradoxically, that they know a lot. That is, they know one important thing: there is no evidence that head lice transmit disease. Body lice can carry deadly typhus, and pubic lice breed fatal excuses. All that head lice cause is a vibrant pizzicato on the skull and an occasional secondary infection from fingernail raking. The Merck Manual, however, does say, "Moderate discrete posterior cervical adenopathy is frequent." I was halfway through calling an ambulance for the girls when my wife slammed my hand with the Merriam-Webster. That means "swollen glands."

Head-lice infestation is a Protestant work ethic of a malady. It causes effort, attention, and planning instead of excusing you from these. There are arguments that head lice cannot be communicated by anything other than live lice going for a power walk during head-to-head contact. But the arguments aren't strong enough to keep my wife from soaking barrettes, pigtail ribbons, doll brushes, and Barbie coifs in alcohol; laundering everything, including the mittens on my three wood and driver; vacuuming the ceiling; and buying the local dry cleaner a summer house in the Hamptons. What couldn't be shoved into the Maytag had to be sealed in plastic garbage bags for two weeks. Fortunately, pets do not harbor head lice—a good thing, because the puppy was getting restless inside the Hefty Sak.

Is the head louse new to America's prosperous burghers? Is it part of the contemporary "cheese burgher" phenomenon—the lumpenproletariat migrating into our well-ordered lives, bringing with them their social problems? Maybe not: propriety incarnate George Washington apparently was infested; in the "Rules of Civility" he wrote out for himself at age fifteen, he avowed, "Kill no Vermin as Fleas, lice ticks &c in the Sight of Others." Or maybe so: the American Academy of Pediatrics claims that lice in an individual infestation may number a hundred or more among members of what the academy calls "cultures with different grooming practices"—which I nominate for euphemism of the year.

The NEJM says that head-lice occurrence "is probably increasing in the United States." The Harvard School of Public Health hedges: "The perception that lice are more prevalent today than in past decades may, perhaps, reflect societal changes in candor in discussing such issues." The more candid lower orders seem to have been discussing such issues for a while. A look into The American Thesaurus of Slang, compiled sixty years ago by Lester V. Berrey and Melvin Van Den Bark, reveals a trove of louse terminology: "seam squirrels," "shimmy lizards," "pants rabbits," "circus bees," "having the hootchy-cootchy," "on the cootie trail," "louse-cage" (hat), "lousewalk" (hair part), "louse ladder" (run in a stocking), and "Lousy-Anna" (the state).

Anecdotal evidence for the recent spread of lice to the better-off is overwhelming, according to my speed-dial: I called some parents. People whose children are over the age of twenty-five were baffled by my inquiry. When I told them that my kids have head lice, they made a kind of phone noise indicating that my entire family tree derives from those "cultures with different grooming practices." But everyone with a child under twenty-five seemed to have had a Go-unto-Pharaoh, Exodus 8:17 experience: "All the dust of the land became lice ..."

Theories about the suburban sprawl of head lice abound, many involving things that are or have become bourgeois proprieties. Feminism, for instance: with mothers working, children spend more time tête-à-tête in extended school hours, day care, and play groups. ("Plague groups," one male informant said.) Or cleanliness: the NEJM says head lice "like clean hair." Or comfort: schools of yore were furnished in polished linoleum and oak, and everyone was expected to stay in his or her own slick, hard seat. Now young educatees loll about on acres of cozy carpet and plush upholstery where, perhaps, nits lurk and lice nestle. Then there's the national epidemic of hugging. But bad news for liberals who think that head lice may be a by-product of meaningful progress in classroom diversity: "African-Americans rarely get head lice," the CDC says. The cultures with different grooming practices are those with unwashed Klan bed sheets.

To get rid of head lice you simply buy a bottle of over-the-counter pediculicide shampoo, apply, wait a week or ten days, and repeat. The various brands contain either pyrethrins, which are natural extracts of the chrysanthemum plant, or permethrin, an almost identical chemical synthetic. Stuff from mums can't be too bad, or prom night and Mother's Day would be even more toxic than they are. These shampoos can be used with safety on adults or children. The only problem is they don't work.

The prescription medications approved by the FDA for head-lice treatment contain either lindane or malathion. Lindane is a neurotoxin. I would as soon put lindane on my daughters as put my daughters unaccompanied on a commercial flight to Baghdad. Also, to briefly summarize research from the Department of Dermatology and Cutaneous Surgery at the University of Miami School of Medicine, lindane doesn't work. And malathion is bug spray. I wear a bandanna over my mouth, and gloves and a hat, to use it on the lace bugs in the azaleas.

The actual answer to head lice, once the chrysanthemum sap has been rinsed from the children's hair, is mechanical removal of surviving lice and nits. The Harvard School of Public Health tries to make the best of this: "A few lice on the head ... present an opportunity for parents to spend the needed time with their children." And Harvard goes on to recommend that treatment be "combined with perseverance and a bit of levity." I welcome any Crimson grads who care to come to my house and amuse my wife and daughters with Harvard-type jests. "A fellow with wingless insects on his head walks into the Fly Club ..."

I cannot—bless my golf-buddy optician—see well enough to do the necessary grooming. The lice are elusive. The nits are the size of telecom-stock dividends. My wife is furious. She walks around the house muttering, "Men rarely!" Domestic relations are deteriorating, owing in part to a head-lice folk remedy that calls for smothering the creatures day and night with olive oil. The whole house smells of salad. And since—with hours spent on the cootie trail—little cooking has been done for the past month, all three women might be in danger of really getting their heads bitten, if I could find the balsamic vinegar.

More and worse folk remedies are available on the Internet—pennyroyal, tea-tree, rosemary, and eucalyptus oils mixed with the virgin cold-pressed, for a smell like a koala exploding in an Italian restaurant. Along with the folk remedies come the politics of head lice. Of course head lice have politics. The very birds of the air and beasts of the field have politics nowadays. It is a tenet of bourgeois propriety to be sensitive to such politics. That's why we're sending our girls over to play with kids whose parents belong to PETA.

Head lice have their own animal-rights group, or may as well. The National Pediculosis Association doesn't exactly advocate letting lice live with dignity, but it does oppose pediculicidal treatments. Headlice.org, the NPA's Web site, states, "There are no safe pesticides, 'natural' or otherwise, scientifically proven to be 100% effective ... Reliance on head lice treatment products that are ineffective promotes repeated use of potentially harmful chemicals ..." Nor does the association recommend Newman's Own. "Manual removal is the safe alternative ..."

The National Pediculosis Association urgently demands a no-nits policy: "the temporary dismissal of a child from a school, camp or child care setting until all head lice, lice eggs (nits) and egg cases has [sic] been removed." The NEJM says, "Nits may persist for months after successful treatment." Welcome to fourth grade, the best three years of your life.

In contrast, the American Academy of Pediatrics and the Harvard School of Public Health urgently demand a no no-nits policy. "Of more than six hundred samples of presumed lice and nits submitted to us for examination," Harvard says, "fewer than two-thirds contained evidence of any infestation." According to the AAP,

In a prospective study of 1729 school children screened for head lice, only 31% of the 91 children with nits had concomitant lice. Only 18% of those with nits alone converted to an active infestation over 14 days of observation.

The nits versus no-nits debate has turned into a major kerfuffle among parents, teachers, school nurses, and—for all I know—cafeteria workers forced to wear those ugly hairnets. The AAP is fretful: "No child should be allowed to miss valuable school time because of head lice." The NEJM is indignant: "Excluding children from school because of head lice results in anxiety, fear, social stigma, overtreatment, loss of education, and economic loss if parents miss work." And the Harvard School of Public Health puts its objections in terms so strong that one almost wonders if the Harvardians aren't former members of the National Pediculosis Association who've been deprogrammed: "These quarantine policies seem a disagreeable vestige of certain offensive and supposedly health-based anti-ethnic strategies practiced mainly in Europe earlier this century."

A concerned father, weighing the evidence in the controversy, can only conclude, "Where were those head lice when I was stuck learning long division while the weather outside was beautiful?"

Meanwhile, I still itch. The Harvard School of Public Health explains why.

A few people remain convinced that their infestation is real, even though they have been examined by one or more competent specialists [surely, by now, my wife qualifies] who can find no physical cause for their discomfort ... Such a person may, indeed, be delusional.

And this gives me an idea, delusional though it may be. Many Muslim extremists have lots of children and some more than one wife. Western-style feminism may prove enticing to these women after they've had to drag all the tents, rugs, and camel saddles 500 miles to the nearest laundromat. And wait until they discover "men rarely." Then imagine the chaos when the no-nits dispute becomes enmeshed in sharia. Furthermore, all the AK-47s, shoulder-fired anti-aircraft missiles, car bombs, and suicide explosive belts would have to be sealed in plastic garbage bags.

We may have here a form of biological warfare that bourgeois propriety can countenance. The entire infrastructure of al Qaeda could be driven, as it were, buggy. And from what I understand of head-lice epidemiology, all we have to do is fund one day-care center. Dear Osama, may all your troubles be little ones.

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