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A CLOSE SHAVE
172 evidence that any harm has been done so far and do not think that legislation will help in this sphere ". However, doctors are urged to read and determine which are relevant " the recommendations about computer-held files-these include limited access to files, files to be held for a specific purpose and the information to be the minimum compatible with that purpose, machinery for telling a person what information is held about him, identities to be kept separate, a time limitation on data held, and care in coding value judgments. The British Medical Association, in its evidence, stated that " it is assumed by public and profession alike that any contact with the complex medical machinery of today implies acquiescence in some degree of extended confidence ". It is certainly assumed by the profession, but do patients realise the enormous distance that confidence could be extended in an integrated Health Service closely linked with social-service and other departments in a coterminous local authority ? It seems a sensible course not to assume too much but to make clear from the start of integration the advantages of responsible nonmedical staff having access to some clinical information. It may be necessary to define a point at which a patient’s express permission is required before disclosures can be made outside the Health Service.
no
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A CLOSE SHAVE
THE physiology of hair is a proper study for any male who wants a close shave. For instance, when should he shave ? Verel showed the advantage of waiting after getting out of bed. He weighed the hair removed by shaving at various times, and found a remarkable apparent growth in the first four hours after getting up. This was not due to a true circadian rhythm of beard growth; by measuring his ear-lobe, he showed that it steadily lost thickness when he stood up, whatever the time of day. The first part of this loss of thickness is rapid, the " half-thickness " of the lobe decreasing by about 0-2 mm. in half an hour. Since beard growth is about 0’5 mm. a day, such thinning of the skin over a mere 30 minutes should provide a considerably more lasting shave, even if all the thinning is not between base of hair and skin surface, and even if ear-lobe and beard-area skin do not behave identically. So it seems sensible to shave as after getting up, and never on any shave or be shaved while still in bed. It is obvious that hot What about technique ? water softens the hair, and standard advice is available from razor manufacturers.2 What is less obvious is that water is taken up from the skin surface by the horny layer of the skin, which steadily swells (ultimately to several times its original thickness 3) and prevents the razor from cutting as near to the base of the hair as before. The effect is most striking after a prolonged spell in a hot bath; fingertip skin becomes boggy to the touch and pale, since it is thicker; and it wrinkles, since it is not only thicker but also wider, yet it is
late
as
possible
account to
1. Verel, D. J. Physiol., Lond. 1955, 130, 72. 2. Gillette Ltd. Personal communication. 3. Scheuplein, R. J., Blank, I. H. Physiol. Rev.
1971, 51, 702.
close intervals to the deeper tissues. Possibly frequently washed with soap can take 4 less water. This uptake of water by the horny up also tends to block sweat-ducts, a consequence layer which starts within five minutes, at least in the fingertips,4 and a decline in sweat-rate is established within 15 minutes, by mechanisms not entirely simple.5 The decline can be prevented by making the water not just isotonic but quite strongly hypertonic (15% saline).s The moral is that barbers should not swathe the face for long in hot wet towels, unless they use hypertonic hot water; the subsequent shave may seem highly professional, but only till the face dries again. A similar drying out of the skin is presumably the reason for apparent hair growth after death.’7 What about the habits of the owner of the hair ? An anonymous writer8 has provided evidence that, at least in himself, the prospect of sexual relations stimulates beard growth, and he could mimic the effect by taking androgens or cortisone. Coitus itself is accompanied by higher testosterone levels in the male, as has been shown by procedures involving conjugal intracoital venepuncture.99 The effect of androgens on hair growth of course varies with the part of the body concerned and with the sex of the subject. Beard area is quite different from scalp. Early male baldness of the scalp is dependent on normal androgen secretion.1O In rats, testosterone has either no effect on hair growth or inhibits it." We usually manage to keep warm even in cold weather, and so it is hard to find out whether there are seasonal changes in beard growth in man.12Z Age makes a difference, the years between 40 and 65 being the most prolific of beard hair. There are well-known differences between races in the amount of hair growth: the yield of a Japanese beard area is only about a quarter that in a Westerner. 13 Whether shaving in itself speeds hair growth is not entirely clear. A study using non-shaving intervals of only up to 3 days 14 indicated no difference in growth-rate, but two earlier trials 15,16agreed in concluding that shaved hair grows faster, even a single shave accelerating hair growth perceptibly; Nature’s anonymous contributor 8 thought so too, but his measurements are not available and he was unaware of the effect of posture. Still, it seems hardly likely that what Delilah did to Samson was to precipitate protein deficiency by shearing his hair and speeding the growth of the replacement. 17
tethered
at
skin
4. Blank, I. H., Shappirio, E. B. J. invest. Derm. 1955, 25, 391. 5. Kerslake, D. McK. The Stress of Hot Environments. Cambridge, 1972. 6. Hertig, B. A., Riedesel, M. L., Belding, H. S. J. appl. Physiol. 1961, 16, 647. 7. Taylor’s Principles and Practice of Medical Jurisprudence; vol. I. London, 1948. 8. Nature, 1970, 226, 869. 9. Fox, C. A., Ismail, A. A. A., Love, D. N., Kirkham, K. E., Loraine,
J. A. J. Endocr. 1972, 52, 51. 10. Hamilton, J. B. Am. J. Anat. 1942, 71, 451. 11. Mohn, M. P. in The Biology of Hair Growth (edited by W. Montagna and R. A. Ellis). New York, 1958. 12. Chase, H. B. Physiol. Rev. 1954, 34, 113. 13. Hamilton, J. B. in The Biology of Hair Growth (edited by W. Montagna and R. A. Ellis). New York, 1958. 14. Trotter, M. Anat. Rec. 1927, 37, 373. 15. Seymour, R. J. Am. J. Physiol. 1926, 78, 281. 16. Berthold, A. A. Arch. Anat. Physiol. 1850, 156. 17. Judges, XVI.
no
we "
A CLOSE SHAVE
THE physiology of hair is a proper study for any male who wants a close shave. For instance, when should he shave ? Verel showed the advantage of waiting after getting out of bed. He weighed the hair removed by shaving at various times, and found a remarkable apparent growth in the first four hours after getting up. This was not due to a true circadian rhythm of beard growth; by measuring his ear-lobe, he showed that it steadily lost thickness when he stood up, whatever the time of day. The first part of this loss of thickness is rapid, the " half-thickness " of the lobe decreasing by about 0-2 mm. in half an hour. Since beard growth is about 0’5 mm. a day, such thinning of the skin over a mere 30 minutes should provide a considerably more lasting shave, even if all the thinning is not between base of hair and skin surface, and even if ear-lobe and beard-area skin do not behave identically. So it seems sensible to shave as after getting up, and never on any shave or be shaved while still in bed. It is obvious that hot What about technique ? water softens the hair, and standard advice is available from razor manufacturers.2 What is less obvious is that water is taken up from the skin surface by the horny layer of the skin, which steadily swells (ultimately to several times its original thickness 3) and prevents the razor from cutting as near to the base of the hair as before. The effect is most striking after a prolonged spell in a hot bath; fingertip skin becomes boggy to the touch and pale, since it is thicker; and it wrinkles, since it is not only thicker but also wider, yet it is
late
as
possible
account to
1. Verel, D. J. Physiol., Lond. 1955, 130, 72. 2. Gillette Ltd. Personal communication. 3. Scheuplein, R. J., Blank, I. H. Physiol. Rev.
1971, 51, 702.
close intervals to the deeper tissues. Possibly frequently washed with soap can take 4 less water. This uptake of water by the horny up also tends to block sweat-ducts, a consequence layer which starts within five minutes, at least in the fingertips,4 and a decline in sweat-rate is established within 15 minutes, by mechanisms not entirely simple.5 The decline can be prevented by making the water not just isotonic but quite strongly hypertonic (15% saline).s The moral is that barbers should not swathe the face for long in hot wet towels, unless they use hypertonic hot water; the subsequent shave may seem highly professional, but only till the face dries again. A similar drying out of the skin is presumably the reason for apparent hair growth after death.’7 What about the habits of the owner of the hair ? An anonymous writer8 has provided evidence that, at least in himself, the prospect of sexual relations stimulates beard growth, and he could mimic the effect by taking androgens or cortisone. Coitus itself is accompanied by higher testosterone levels in the male, as has been shown by procedures involving conjugal intracoital venepuncture.99 The effect of androgens on hair growth of course varies with the part of the body concerned and with the sex of the subject. Beard area is quite different from scalp. Early male baldness of the scalp is dependent on normal androgen secretion.1O In rats, testosterone has either no effect on hair growth or inhibits it." We usually manage to keep warm even in cold weather, and so it is hard to find out whether there are seasonal changes in beard growth in man.12Z Age makes a difference, the years between 40 and 65 being the most prolific of beard hair. There are well-known differences between races in the amount of hair growth: the yield of a Japanese beard area is only about a quarter that in a Westerner. 13 Whether shaving in itself speeds hair growth is not entirely clear. A study using non-shaving intervals of only up to 3 days 14 indicated no difference in growth-rate, but two earlier trials 15,16agreed in concluding that shaved hair grows faster, even a single shave accelerating hair growth perceptibly; Nature’s anonymous contributor 8 thought so too, but his measurements are not available and he was unaware of the effect of posture. Still, it seems hardly likely that what Delilah did to Samson was to precipitate protein deficiency by shearing his hair and speeding the growth of the replacement. 17
tethered
at
skin
4. Blank, I. H., Shappirio, E. B. J. invest. Derm. 1955, 25, 391. 5. Kerslake, D. McK. The Stress of Hot Environments. Cambridge, 1972. 6. Hertig, B. A., Riedesel, M. L., Belding, H. S. J. appl. Physiol. 1961, 16, 647. 7. Taylor’s Principles and Practice of Medical Jurisprudence; vol. I. London, 1948. 8. Nature, 1970, 226, 869. 9. Fox, C. A., Ismail, A. A. A., Love, D. N., Kirkham, K. E., Loraine,
J. A. J. Endocr. 1972, 52, 51. 10. Hamilton, J. B. Am. J. Anat. 1942, 71, 451. 11. Mohn, M. P. in The Biology of Hair Growth (edited by W. Montagna and R. A. Ellis). New York, 1958. 12. Chase, H. B. Physiol. Rev. 1954, 34, 113. 13. Hamilton, J. B. in The Biology of Hair Growth (edited by W. Montagna and R. A. Ellis). New York, 1958. 14. Trotter, M. Anat. Rec. 1927, 37, 373. 15. Seymour, R. J. Am. J. Physiol. 1926, 78, 281. 16. Berthold, A. A. Arch. Anat. Physiol. 1850, 156. 17. Judges, XVI.