DISEASES OF THE HAIRS AND HAIR-FOLLICLES.

DISEASES OF THE HAIRS AND HAIR-FOLLICLES.

885 sycosis contagio8um. It is characterised, hespects, you may be consulted as to the best observes, by the appearance of white, grey- method of get...

473KB Sizes 1 Downloads 36 Views

885

sycosis contagio8um. It is characterised, hespects, you may be consulted as to the best observes, by the appearance of white, grey- method of getting rid of them. This can ish, and yellowish scales, with angular only be effected with any prospect ..of cerborders, slightly raised in the middle, and tainty by excision; and if the naeviis be pierced at all points by the hair. The scales small, it may be removed without risk of the are but loosely connected with the skin, but cicatrix being apparent. so closely with the hairs, that in removing a Diminished Formation of Hair. scale we at the same time pull out a hair. Diminished formation of hair gives rise to Microscopic examination discovers that the scales are composed of epidermic cells, but alopecia or baldness, and alopecia may be the shaft of the hair within its follicle is sur. either congenital, accidental, or natural, the rounded by a vegetable cryptogamic forma- latter being termed calvities. The proximate tion, which forms a sheath to the hair, but cause of baldness is defective development does not rise above the level of the follicle. of the formative pulps of the hair, or atrophy The cryptogamic plant is abundantly pro- of those organs. vided with sporules, by means of which the CONGENITAL ALOPECIA. extension of the disease is supposed to be Baldness sometimes exists from the period effected. of birth ; such cases are rare ; instances of The causes of sycosis are constitutional and local; those of the former kind are the kind have, however, been recorded. ACCIDENTAL ALOPECIA. referrible chiefly to the nervous system, andI the latter to exposure to heat or cold, the This is a much more common form of baldThe ness of the irritation caused by a blunt razor, &c. scalp than the preceding, and is disease occurs occasionally in females. that to which Willan applied the term Treatment.-There is scarcely a disease decalrans; it is also known by the in the whole catalogue of cutaneous coin-porrigo appellatives, tenia tondans ; alopecia circnnaplaints that is more obstinate than sycosis. scripta ; area; tyria; and ophiasis. In You must see that all the functions of the some instances of this affection the baldness system are duly ordered ; you must esta- is limited to one or two spots of a circular blish a course of alterative medicines ; and but in others nearly the whole of the then direct your local measures so as to form, is cleared, together with the eyebrows, scalp reduce the irritation existing in the skin in beard, and whiskers. When eyelashes, the first instance, and employ some stimulatis complete the scalp is thin, smooth, alopecia ing application afterwards. I have derived and depressed at the centre of the patch; but mere benefit from tonics than from any other when there is a disposition to the reproducclass of remedies which I have employed; tion of the hair, the follicles are apparent as and locally I have found pressure by meansI so many dusky points, and very frequently a of an air cushion of great service, paving thei minute hair may be seen issuing from the way to this application by leeches, puncture, of each. The newly formed hair aperture The vapour douche is a very useful is of a &c. light colour and thin, and is a long means in this disease. Other remedies are, time before it acquires the hue of the surthe zinc ointment, bichloride of mercury, hair. rounding sulphuret of potash, tincture of iodine, &c. NATURAL ALOPECIA OR CALVITIES.

DISEASES OF THE HAIRS AND Natural alopecia is the baldness of old HAIR-FOLLICLES. age, or, as it is technically termed, calvities. The pathological changes in the hairs andThis form of baldness appears to result from hair-follicles are referrible to six differentdiminished nutrition of the scalp, for in some I have found the integument so heads, namely, augmented formation of hair ;instances that the sutures of the skull diminished formation of hair ; atteration of transparent could be seen through it, and on holding it of the the haircolour of hair : diseases to the light it was perfectly diaphonous. The pulps ; diseases of the hair-follicles; and integument was, indeed, too thin to afford abnormal direction of the hair. the necessary depth for a hair-follicle to deAugmented Formation of Hluir. velop its hair. The exciting causes of baldness are all Augmented quantity of hair, so long as it occupies its normal situation, is a subject ofsuch as tend to reduce the excitability of the physiological rather than of pathological in- nerves distributed to the hair-bearing skin, terest ; but when hair is developed of consi- hence I have observed it in association with derable length and in circumscribed patches neuralgia of the supra-orbital nerves, and on parts of the body where hair is not usually following very accurately their distribution. apparent, we have that state produced which Constitutional disorder from mental anxiety is termed pilous ntvvi, moles and mother’s is a common cause of this affection, and to marks. Many curious cases of pilous nasvi these may be added long-continued disorder are recorded, but individual instances must of whatever kind, and acute febrile diseases. be known to every one. When pilous navi Excesses nervous exhaustion producing are unsightly or inconvenient in other ie- comes under the same category. Among the ,

886

causes I may specify preg- and nerves. Dr. Bidder, who has lately rheumatism and gout, phthisis, and made some communications on this disease in Muller’s Archiv, states that he has seen syphilis. Treatment.—The indications for treatment the morbid action display itself in the hair in baldness are two-fold ; firstly, to regulate independently of the scalp, the latter being the functions of the system and use such sound, and he observed a spontaneous separemedies as are calculated to benefit the ration of the diseased mass take place, by a constitutional disorder; and, secondly, to process which he likens to the disseverment stimulate the cutaneous nerves and capillary !, of a mortified limb. Several authors agree circulation locally. By this means I have in the statement that the scalp is unaffected. Plica is, in an extreme degree, loathsome, succeeded repeatedly in causing the reproduction of hair after it had fallen, and also disgusting odours are given forth from the in preventing its loss. For the plan which diseased mass, and pediculi are engendered

occasional nancy,

I consider most efficient I must refer you to in great numbers. Some varieties in the apmy work on Cutaneous Diseases. pearance of plica have been observed, having reference to the mode of distribution of the Alteration of Colour of the Hair. hair; thus, in males, who wear the hair Alteration of colour of the hair arises short, numerous locks are matted separately, from disorder in the chromatogenous func- constituting the plica multiformis; while at tion of the hair-pulp, and is very commonly other times the matted hair forms a single associated with alteration in tint of the rete coil, plicacaudiforinis; or, again, it is agglomucosum of the skin. It is not uncommon merated into a single irregular mass. to find one lock of hair different in colour Plica polonica is accompanied by severe from that which surrounds it, and numerous febrile lethargy and other sympinstances are recorded in which a change in toms ofsymptoms, cerebral disturbance, and pruritus; the colour of the hair took place duringlittle is known with regard to its treatment. illness or recovery from some serious disDiseases of the Hair-follicles. order. Sometimes alterations of colour have been observed to take place suddenly, while: The principal disorder included under blanching of the hair, the natural conse- this title is that remarkable affection quence of the torpor of age, is produced FAVUS OR RINGWORM.

gradually.

I

CANITIES, OR BLANCHING OF THE HAIR. Canities is by no means confined to old age, it may occur also in the adult or in in’ fancy, as in the instance of the albino, where the whiteness is general; or partially in the ’, midst of darker coloured hair. Canities, therefore, admits of classification into three forms according as its occurrence may be congenital, accidental, or senile. Under the head of accidentat canities must be collected all those remarkable instances in which the hair in the adult has become suddenly white from the influence of mental agony and despair. While senile canities tells significantly its own tale.

Favus is

a

chronic inflammation of the

hair-follicles, associated with the production of a peculiar yellowish substance which surrounds the cylinder of the hair, and is seen through the epidermis as a minute circular spot not raised above the level of the skin. The yellow substance, after a short from the follicles upon the surface of the epidermis, and desiccates into yellowish friable crusts, forming a distinct cup with an inverted border around the base of each hair. When a number of these

period, escapes

crusts

are

aggregated together, they give

rise to an appearance somewhat resembling the cells of a honeycomb; hence the generic designation of the disease—favus. The hair included within the diseased follicle is altered DISEASES OF THE PULPS OF THE HAIR. in its appearance and growth; it becomes Plica Polonica. thin, discoloured, and twisted, and is evenLittle is known with regard to this re- tually thrown off, the formative structure markable disease, and authors are much being destroyed by the extension of the disdivided in opinion with regard to its patho- ease to the deep textures of the skin. When logy. The hairs are swollen and imperfectly the disorder declines the affected skin is left formed, they are tinged with a viscous, red- bald and smooth, but if it continue unchecked dish-coloured fluid, and an abundance ofit gives rise to morbid alteration of all the this fluid is secreted by the follicles, causing textures down to the bones of the cranium, agglutination, and subsequently solidification and is prolonged to an indefinite period. The of the hair in mass. The scalp is red, in- ordinary seat of favus is the scalp, but it may flamed, and excessively tender, so that the extend thence to the face and neck, and, inbare movement of the hair in the attemptdeed, to the entire body. The disease is made to divide it is attended with pain. Ithighly contagious, and is communicable by is this circumstance, with the oozing of a red contact to any part of the skin. The varieties of favus are two in number, serous fluid from the extremity of a cut hair, that has given rise to the idea of the hairfavus dispersus, the porrigo lupinosa of being sarconed and furnished with vessels Willan, in which individual, follicles dis,

887

persed at various distances are affected ;and most delicate first, and from them extending favus confertus, in which a number of con- to the rest. The most frequent mode of tiguous follicles are simultaneously diseased, transmission is by the employment of towels, and constitute a patch of a circular form and combs, brushes, or by the use of hats or caps moderate size. This latter is the porrigo belonging to affected persons. Treatment.-The indications for the treat-

scutulata of Willan’s classification. nature of the

ment of favus are,

firstly, to destroy the vitathe lity of the parasitic growth ; secondly, to ob- remove all local causes of irritation ; thirdly, the to remove all general causes of irritation ; organic nature of the product, and in its re- and, fourthly, to excite the diseased hairsemblance to those inferior members of the follicles to healthy action. The first indication is best fulfilled by vegetable kingdom denominated mould. According to Dr. Gruby the cup-shaped crust impregnating the crusts and bathing the of favus is situated on a depression of the scalp with a moderately strong solution of dermis, and is covered by a sheath of epi- bichloride of mercury. This precaution, dermis which is thickest on its concave and moreover, prevents the extension of the disease through the medium of fragments of the thinneston its convex surface. Immediately within the epidermis is a crusts. The next care should be directed to the thin layer of amorphous substance, composed of minute molecules; this, layer is removal of all local causes of irritation, dense, of a sulphur-yellow colour, and forms among which the hair and crusts occupy the a capsule, which is in contact by its exter- first place. The removal of the hair may be nal surface with the epidermis, and by its effected either by shaving or with the scisinternal surface with a fungous growth. The sors ; but as the former is sometimes an inparasitic growth is attached by means of its convenient and a painful process, the latter roots to the yellow capsule, while its stems may generally be preferred, and the more and branches extend inwards towards the particularly as it is equally eflicacious. The centre of the capsule, and constitute the scalp should then be thoroughly washed whitish grey and porous contents of the with a plentiful supply of soap, and the crust. The roots and branches of the myco- crusts removed ; this is best effected by derm are smooth, cylindrical, transparent means of a local vapour-bath, applied tubuli, which divide dichotomously from throughthe medium of a caoutchouc cap. point to point. The interior of the tubuli is Another mode which may be put in practice filled with a granular substance, and divided when the vapour apparatus is not at hand, here and there by transverse septa. At the is to lay a piece of folded lint, wetted in a ends of the branches are situated the seeds solution of subcarbonate of soda or potash, of the plant, which are of a yellowish white upon the head, and cover it with an oiled colour, and either collected into an irregular silk or caoutchouc cap, which should include assemblage or disposed in the form of a gar- the entire scalp. When the crusts are wholly land. The diameter of the branches of the removed the scalp should be thoroughly mycodermis is 1-1000th to 1-250th of a washed, night and morning, with an abunmillimetre ; that of the molecules contained dance of soap, and then carefully combed ; within the tubuli 1-10,OOOth to 1-0O0th mm., the object of the former process being to free and that of the seeds 1-300 to 1-100th mm. the skin of any fresh favous matter that may Dr. Gruby has detected seeds in the follicles escape from the follicles, and of the latter to of the hair and impacted in the ducts of the remove the hairs which have been loosened sebaceous glands. by the disease, and which are now acting as Causes.—The cause of favus is a special excitants of increased irritation. In the contagion, consisting of the cells or germs of interim of the ablutions it is desirable to the mycodermis, conveyed either by the keep the scalp cool by means of evaporating winds or by actual contact to the hair-folli- lotions so long as any heat of surface or redcles of a sound person. The disease is most ness remain. The third indication calls for an exarninaeasily excited in a weakly and unhealthy state of the system, and particularly in chil- tion into the state of health and constitution dren of a scrofulous diathesis. When once of the patient, and the employment of remeestablished it is highly contagious ; it affects dies fitted to remove any symptoms of dis persons of all ages, of both sexes, and at all order which may be then present. In some seasons of the year, but is usually met with instances a course of laxative medicines in children and young persons. Various may be useful, and in others tonic recircumstances predispose to this affection, medies. The fourth indication is to be fulfilled as, for example, improper or deficient diet, want of ventilation, humid atmosphere, con- through the agency of stimulants, of which a fined and unhealthy localities. When any larger field for selection lies before you. I one of these causes is present in assemblies have generally given a preference to iodine, of children, as in public schools, the disease either in the form of vapour or in that of spreads with extreme rapidity, attacking the tincture, the latter being brushed upon the The

pathological

matter of favus has

yellow

recently been made subject of investigation by microscopic servers, the majority of whom agree in

888

seat of the disease several times in the course of the day, and after each ablution. Next to iodine I prefer a solution of bichloride of mercury. On the trunk and limbs the bichloride of mercury is very serviceable, as also is the nitrate of silver. Other remedies of the stimulant class, which have been recommended, are the ioduret of sulphur in the form of ointment;

ESSAYS ON THE

DISEASES OF THE EYE.

By

EDWARD

HOCKEN, M.D.,

London.

(Continued from p. 870.) chloride of lime ; sulphuret of potash, either MALIGNANT DISEASE OF THE CONJUNCTIVA. alone or combined with lime-water; solutions of the sulphates of zinc or copper; Genuine carcinomatous disease of the eye lotions of hydrocyanic, acetic, muriatic, and only the lids, conjunctiva, and lachrynitric acids.; vapour of sulphur ; acetum cangland, as its primary seats. On the contharidis ; tar ointment ; spirit of turpentine ; junctiva it appears as tuberculous enlargerue; belladonna ; black pepper ; staves- ments, attended by lancinating pains and the other indications of scirrhous tubercle, acre, &c. which, after a longer or shorter period, go on Abnormal Direction of the Hair. to ulceration and the production of fungus, Under this head are embraced two in- with much derangement of the health and stances of alteration in the regularity and cachexia. arrangement of the hair,, namely, trichiasis Mr. Travers remarks that there is a maand felting. Trichiusis is a disease of the eyelids, in lignant fungus of the conjunctiva, for, like which the eyelashes, instead of occupying the mucous membrane of other parts, this is their natural position, are directed inwards, sometimes the seat of carcinoma ; and, exand rub against the surface of the cornea; cepting the lachrymal glaud, he believes the irritation caused by this friction pro-I, that no other texture related to the organ of ducing inflammation and thickening of the vision is ever primarily so affected. He has conjunctiva. The remedy for this affection removed the contents of the orbit for a painis the removal of the inverted eyelashes by ful tuberculous fungus, with ulcerated de. pressions, containing an ichorous discharge. means of the ciliary forceps. Felting is a derangement of the hair The coats and humours of the eye were for arising from neglect, and has no claim to the most part absorbed, the lachrymal gland be considered as a disease. It consists scirrhous. The disease afterwards returned merely in an inextricable interlacement of upon the palpebras and destroyed the the hair, and is usually met with in women, patient. In 1821 Mr. Travers had a simiwhose long hair affords the only excuse for lar case under his observation, The fleshy such a state of disorder. It has sometimes tubercles grew from the conjunctiva, both on the cornea and sclerotic, and the inferior palbeen observed after childbed. pebra was extensively ulcerated. This was NEURALGIA FROM SYMPATHY WITH A Dis- accompanied by lancinating pains in the EASED TooTH. -A woman, twenty-seven supra-orbital region, and an unhealthy disyears of age, was accustomed to be awak- charge. (Plate 2, fig. 1.) ened at night with a sharp and lancinating Melanosis, or a black fungous mass, pos. pain-in fact, tic douloureux-in the left sessing all the ordinary external and inti. cheek, which extended to the temple, to be- mate appearance and structure of melanotic hind the ear, and along the anterior border growths, occasionally, but very rarely, origiof the trapezius muscle. An hour or two nates in the conjunctiva ; by its increase it in the morning, during which she slept, ap- covers the front of the eye, and (for a time at peared to be the sole respite she had from least) simply covers without involving the pain. All kinds of rubefacients and narco- component textures of the globe. Such dis. tics were employed without any more than ease closely simulates the more deeply momentary benefit, when it was perceived seated affection in appearance when it has that the second molar tooth was carious, and protruded through the ulcerated cornea, and after some delay it was extracted, when all might lead the unwary to propose and per. the pains immediately ceased. Only the form extirpation of the eyeball, when the enamel of the tooth had been decayed; its disease is simply superficial, and might be roots were sound.-Gazette des H6pitaux. removed with little or no injury to the globe, or to the function of vision. In all such cases, OF SAIALL-POX PREVENTED. therefore, we should carefully weigh the The " Gazette des Hopitaux" reports that history of the disease, and examine minutely Dr. Rousse, a physician in the Pyrenees, the condition of the organ, ascertaining has prevented the disfiguration left by the whether the growth can or cannot be lifted small-pox by means of covering the face up from the front of the eye. The case with gold-leaf, and applying to the pustules narrated byMr. Travers, of a " dark purple a strong solution of nitrate of silver. tumour," resembling a " bunch of currants,"

affects

mal

PITTING