Bug's life: a woman tends to a shelf full of cockroaches in jars in a lab, c.1955. Photo: Getty
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The patient complained of insects crawling on her skin. Then she handed me a glass jar

The “matchbox sign” describes the tendency of a particular sort of patient to bring spurious evidence in a small container to show the doctor.

Erica was hugely frustrated. “I’ve had the council round several times, they’ve fumigated the whole place twice, and still I’m getting bitten.” I peered at her lower legs. There were scattered red lumps and lots of scratch marks. The pest control officer, having exhausted his insecticidal repertoire, had sent Erica along to me.

The commonest reason for someone being eaten alive in their own home is the death of a cat. Fleas live in carpets, hopping on to the resident pet when in need of food. As long as Tiddles remains hale and hearty, human beings are bitten only sporadically. But a few weeks after a feline departure, the now-starving fleas start to feast on the grieving owner. Erica, however, denied any previous pet ownership. And flea bites are typically clustered around the ankles and lower shins, whereas Erica said she was affected all over.

I scrutinised the skin of her wrist and the web spaces between her fingers. Infestation with scabies is surprisingly common, and those areas are favourite locations for the mites. There was nothing to see, though. And while most of her torso was scratched and bump-strewn, her mid-back was blemish-free. This pattern suggests something called prurigo. Incessant scratching of normal skin results in raised red prurigo lumps, which can easily be mistaken for insect bites. The area between the shoulder blades remains unaffected, though, because it is impossible to scratch there concertedly.

Numerous conditions can cause generalised itching, from iron deficiency to an underactive thyroid. I took blood samples and gave Erica a prescription for a bottle of Eurax – a fantastic lotion that will suppress itching, whatever the cause. A week later the blood tests were back, and normal. Erica was back, too. And this time she’d brought specimens of the offending insects to show me. “There!” she announced, handing me a little glass jar. Inside were a couple of wisps of dark fluff and some indeterminate bits of debris. Not even tapping the contents on to my palm for a sift-through could produce any evidence of life forms.

Something about the little glass jar rang a bell. The “matchbox sign” describes the tendency of a particular sort of patient to bring spurious evidence in a small container to show the doctor. I looked at Erica afresh: in her late fifties, a trifle eccentric, but absolutely no history or indication of any mental or physical illness. I wondered if she might have Ekbom syndrome, or delusional parasitosis.

Delusional parasitosis is a belief that one is infested with some sort of parasite. In all other respects the patient is functioning normally, and so presents a convincing account of his or her troubles to pest control personnel, doctors and veterinarians. A big problem with Ekbom’s is the characteristic refusal of the sufferer to accept that he or she is suffering from a mental illness. Antipsychotic drugs, more often used for treating schizophrenia, can be very effective, but most patients reject them out of hand.

“I’d like you to try these tablets,” I told Erica. “They’re usually used to treat schizophrenia, but bizarrely enough they’re also quite likely to reduce the itch and the rash you’re experiencing.” I smiled, hoping she wouldn’t probe my explanation. I wasn’t lying as such; just being careful which bits of the picture I painted.

She returned to the surgery a month later and, to my relief, had taken the tablets. “It’s amazing,” she told me, “it’s completely better.” She showed me a few areas of pristine skin, and then she fell silent for a few moments. When she spoke again her voice was lowered, embarrassed. “Doctor, was I psychotic?”

“Well, yes,” I told her, and explained about Ekbom syndrome. With recovery had come full insight, and she recounted, with something akin to awe, how she now looked at the specimens she’d collected and could see that they were nothing but fluff, but could clearly remember perceiving them as dead insects. And the persistent sensation of things crawling over her skin had been utterly real to her.

Ekbom’s is fascinating and rare; I doubt I’ll see another case. Pest control officers probably encounter it more often. I imagine they have a cut-off – perhaps two failed fumigations, or when the homeowner starts to present them with bits of debris in a matchbox – when they suggest that a doctor might be better placed to help with this particular infestation. 

This article first appeared in the 06 August 2014 issue of the New Statesman, Inside Gaza

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A glossary of football’s most hackneyed phrases – and what they mean

This is the time of the season when we all get tired. Time to break out the cliches.

This is the time of the season when we all get tired. The players, poor petals, are exhausted. The refs have had enough of being shouted at. The hot-dog sellers are running out of hot dogs. And the TV commentators, bless ’em, are running out of clichés. So, between now and the end, look out for the following tired old phrases, well-worn adjectives and hackneyed descriptions, and do feel sorry for them. They know not what they are doing.

It will go right to the wire. In the case of the Prem, this isn’t even true. Leicester are as good as there. It is only true of the Championship, where three teams – Burnley, Middlesbrough and Brighton – are on 87 points each, with the fourth team miles away. Now that will go to the wire. The phrase comes from those pre-war reporters in the US who telegraphed their copy. When it didn’t get through, or they’d never filed it, being too lazy or too drunk, they would blame the technology and say, “It’s down to the wire.”

Dead men walking. This is when the pundits decide to hold a seance in the studio, taking advantage of Alan Shearer having sent us all to sleep. It also refers to Pellegrini of Man City and Hiddink of Chelsea. They have known for ages they’re dead parrots, not long for this life, with their successors lined up even while their bodies are still warm. I think a moment of silence is called for. “Dead men walking” refers only to football. Must not be used in connection with other activities, such as media. When someone is sacked on a newspaper, they immediately get sent home on gardening leave, just in case they manage to introduce a spot of subversion into the classified ads, such as: “Five underpants carefully kept; make up; red dungarees; offers considered, Kent.” (The first letters of each word give it away, tee hee.)

World class. The number-one phrase when they can’t think of any other synonyms for what was quite good. As well as goals, you now hear of world-class throw-ins, world-class goal kicks, world-class haircuts
and world-class pies in the press room at half-time, yum yum.

He’s got a hell of a left peg. That’s because he borrowed it from his mam when she was hanging out the washing.

He’s got it in his locker. The fool. Why did he leave his left peg there? No wonder he keeps falling over.

And the sub is stripped off, ready to come on. So it’s naked football now, is it?

Old-fashioned defending. There’s a whole lexicon to describe brutal tackles in which the defender kicks someone up in the air, straight to A&E.

Doing the dirty work/putting himself about/an agricultural tackle/left his calling card. Alternative clichés that every commentator has in his locker for when yet another world-class, manic, nasty, desperate physical assault is committed by a player at Sunderland, Newcastle and Norwich, currently scared shitless about going down and losing their three Bentleys.

Opened up his body. This is when an operation takes place on the field, such as open-heart surgery, to work out whether any Aston Villa player has got one. OK – it is, in fact, one of the weary commentator’s nicer compliments. He can’t actually describe what the striker did, as it was so quick, so clever, and he totally missed it, but he must have done something with his body, surely. Which isn’t even correct, either. You shoot with your feet.

Very much so. This is a period phrase, as popularised by Sir Alf Ramsey. He got it into his head he must talk proper, sound solemn, or at least like a trade union leader of the times, so instead of saying “yes” he would say “very much so”. It’s having a comeback. Listen to Glen Hoddle – I guarantee that between now and the end of the season he’ll say it ten times, whenever someone has interrupted and he wants to get back to the aperçu he was about to share with us.

Most unpredictable Premier season ever. Or so Sky is telling us, on the hour, meaning “since last season”, which was the most unpredictable one since, er, the season before that.

Hunter Davies is a journalist, broadcaster and profilic author perhaps best known for writing about the Beatles. He is an ardent Tottenham fan and writes a regular column on football for the New Statesman.

This article first appeared in the 28 April 2016 issue of the New Statesman, The new fascism