The greatest predisposing cause in premature loss of hair is heredity. In 1200 private cases a family history of baldness was found in 571. Of these cases 28 were brokers, 81 clerks, 38 lawyers, 35 merchants, 74 physicians, 68 students, 57 teachers and 34 of other professions and trades, all indoor occupations. The exciting cause is frequently some form of inflammation of the scalp characterized by excessive oily secretion which collects on the skin in the form of an oily coating, crusts or scales. Of the 1200 cases 730 were due to this cause; either the dry and flaky form (dandruff) or the crusted form, either with or without inflammatory symptoms. In women dandruff, both dry and oily variety, were more often seen than in men. While men often become more bald than women, the latter more often suffer from moderate loss of hair. There were 410 males and 790 females in the above total. In men when the hair begins to fall it is usually progressive, while in women the hair falls for a time and grows in again. The disease is contagious and very prevalent. The wonder is not that so many people lose their hair but that more do not’.
The prognosis (forecast) is good if taken in time be-fore there has been actual thinning of the hair and there is no family history of baldness. Even where there has been decided loss of hair there is a fair prospect of staying the course of the disease and increasing the diameter and amount of the hair if treatment is persisted in. Hair is of slow growth and six months will be needed to show progress. In women the prognosis is much bet-ter. When the scalp is atrophied (shrunken) and bound down to the skull the prognosis is bad.
Where there is no local disease to combat, the first step is to increase the circulation by massage of the scalp, to loosen it up, followed by a stiff brush used carefully. This should be done frequently. Before commencing, for a man, hot cloths are sometimes advantageously applied; and there should be some emollient (a substance to soften and soothe the skin), and there is nothing better than sulphur cream, which our author has used for many years. Its formula is:
Cerro albae (white wax) 7 drams 01. petrolati (liquefied vaseline) …. 5 ounces Aqua rosin (rose water) 2 1/2 ounces Sodm biborat (borax) 36 grams Precipitated sulphur 7 drams
The patient is to rub a little of this into the scalp (not the hair) for three nights in succession. It is better if the application is made by another person. On the fourth day the scalp is to be washed with tar soap and water. After drying the ointment is to be reapplied. For the next seven to ten days it is to be used every other day and the scalp again washed with good tar soap. Then the application is to be made three times a week, the washing to come at the end of two weeks. The number of applications is thus to be reduced until the ointment is used twice a week and the washings made every two or three weeks. Now in the intervals the pilocarpine lotion is used morning and night.
R. Sabourand, quoted by Jackson, endorses the use of pilocarpine (from the leaves of the pilocarpus), especially in the loss of hair in women. His formula is:
Grain alcohol 8 ounces Spirit of lavender 6 1/2 drams Spirit of ether . 6 1/2 drams Pilocarpine muriat (alkaloid from leaves of pilocarpus) 6 grains Water sufficient to dissolve Liquor ammonia: (ammonia water). 1 dram
Jackson has used this formula with satisfaction, especially when the hair is oily.
The four medicinal agents that are of most use in this disorder are sulphur, resorcin, tar and mercury, and the greatest of these is sulphur. The chief objection to its use is that nothing dissolves it excepting in a very small percentage, so it must be used in ointments. The addition of 2 or 3 per cent of salicylic acid to the ounce in certain cases makes it more active. Sulphur need never be used stronger than a dram to the ounce (1 part to 8) . When it cannot be used because it sets up inflammation resorcin may be substituted, 1 dram to 4 ounces of absolute alcohol (alcohol deprived of its water), with 20 drops of castor oil. It is usual to add a small percentage of bichloride of mercury (corrosive sublimate) to the resorcin for its antiseptic effect (the destruction of germs) and the chloral hydrate is sometimes added for its stimulating effect. Thus we have a substitute for the preferable sulphur prescription:
Alcohol 4 ounces Hydrarg. biehlorid (mercury)… 1 to 2 grains Resorcin 1 dram Chloral hydrat 1 dram Oil ricini (castor oil) 20 to 30 drops
The alcohol insures rapid drying.
In the use of sulphur cream care should be taken not to daub the hair. It can best be applied to the scalp by the use of a collapsible tube which forces out a thin stream through an extended conical opening at the exact point to be treated and in the small quantity de-sired. Using the stiff brush as a treatment supplementary to massage not only effects the reddening of the scalp without injury, if care is used, but it removes dead hairs so that live ones can come in. Our author also recommends light headgear, and frequent exposure to the air and sun.
The loss of human hair is a natural process. As soon as the old hair falls out there is a growth of new hair, if the scalp is kept in a condition of health. According to Unna (a distinguished German dermatologist), the cause of the loosening and shedding of the hair is to be sought in the character of the blood supply. Any lessening of the nutritive supply to the papilla (bottom of the hair follicle or sac from which the hair springs) causes the hair to be shoved higher up so long as it remains in the middle third of the follicle, but when it reaches the unproductive upper part of the follicle, that is, just below the mouth of the sebaceous gland, the circulation fails, the hair ceases to grow and falls out.
The new hair pushes up in the old follicle and grows sometimes alongside the old hair and sometimes pushes it out. The length of life of the hair varies with the individual. Mahly has determined the length of life of the eyelashes at 135 days. Pincus says the human hair has a life of from two to six years. Shaving and cutting the hair makes it coarser and may stimulate its growth. Wilson, an English authority, says the average number of hairs, on the scalp is 1,000 to the square inch.
If the hair is dry a strongly alkaline ordinary soap should not be used. In that event a good soap, recommended by Paschkis is compounded of good castile soap 80 parts; bicarbonate of soda (cooking soda) 20 parts; water 100 parts. A very little of this makes an abundant lather. If the scalp is very tender use borax and water (harmless in any strength).
A stiff brush should be used systematically in the morning with considerable vigor so as to produce a feeling of warmth but not soreness. Oil will thus be restored to dry hair. The brush should be kept in a clean condition by the use of soap and a strong solution of borax and laid in the sun to dry resting on the bristles. Afterwards it can be turned up
A millionaire coal operator told the writer that he had never learned how to cure baldness but that he had the satisfaction of having learned years ago how to stop his hair from coming outby vigorous massage of the scalp followed by an application of a stiff brush, the stiffest he could findwhich he used carefully but persistently. This is an excellent recipe.
It has been found by sailors in the arctic region when on a voyage of three years or longer that thin hair as a rule is greatly strengthened and frequently restored by exposure to the cold air. When nature needs the hair she provides it if there is no permanent baldness. The reverse of this is believed by numerous authorities to be also true, that people can greatly accelerate the loss of their hair by too much head covering, by living in super-heated houses or offices (above a temperature of about 68°) and by neglecting the rules of health hygiene, especially of the intestinal tract, as set out elsewhere.
The Bath and the Skin
An important organ, by which the general, health, the elimination of toxic substances and the duration of life is powerfully influenced is the skin. It is the chief regulator of the body heat; it has a great share in the excretory functions and reflects impressions on the nervous system from without. In old age the skin becomes drier and less elastic and many of the capillaries (the minute blood vessels of the skin, as here used) become obliterated. All active exercises help in keeping up the circulation of the skin and in preserving it’s functions but one of the most powerful means is the bath. Many persons with an active circulation can use cold baths from early life to very old age. Others with poor reaction (reddening of the skin after a cold bath), especially weakly rheumatic subjects, do better with a hot bath. Others do best to begin with a hot bath and then to turn on the cold tap and sluice themselves, head included, thoroughly with cold water, or finish most advantageously with a cold shower. The same effect can be attained by applying the water by hand. In this way the chill of the cold water is eliminated in a most agreeable reaction. By exposing the skin and its blood vessels to an alternation of heat and cold, the different components of the skin are nourished by increased circulation, stimulated and enabled to resist chills by sudden change of temperature. The hot bath has, in addition to its local effects an immediate influence on the distribution of blood through the body. The heat of the water attracts the blood to the skin and diminishes the amount in internal organs. It ought not therefore be taken soon after a principal meal when the stomach requires a large amount of blood. After the cold application the skin should be vigorously massaged with a rough towel, including the face and neck. Thus the bath, whether cold, or first warm and then cold, acts as a kind of gymnastic exercise not only for the skin but for the muscles, preserving the elasticity of the blood vessels of the skin, strengthening the heart, relieving the kidneys and assisting in maintaining the energy of the nervous system. With the ordinary bath we can well combine a short air bath by keeping the body uncovered for five or ten minutes or more after the drying and rubbing process is finished while the skin is in a state of glow. This increases the tonic influence of the bath and should be combined with gymnastic exercises, not neglecting those of the abdomen. The air bath alone during some minutes to a half hour and longer, if used with judgment, of which the test is a feeling of exhilaration, counteracts the liability to colds and rheumatism, exercises a beneficial influence on the nervous system and food assimilation and promotes intestinal activity.
Very commonly in the course of a fever the patient is restless, uncomfortable and sleepless and yet does not have a high temperature. Such a case may be sponged off with tepid water or with a little alcohol and water, or salt and whiskey, with great benefit in the production of sleep, and the reduction of fever. Sometimes the sponging is successful when used only over the arms and legs, but more frequently it should be extended at least to the spinal column. If tepid water does not lower the fever, then ordinary cool tap water should be used. It is well to remember that the secret of successful sponging lies in the use of a sponge not saturated with water but only sufficiently wet to leave a thin film of moisture on the skin, which cools the patient by its rapid evaporation and does not wet the clothes or the bed.