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A CONTRIBUTION TOWARDS THE ETIOLOGY OF ALOPECIA AREATA.
651 "confusion" of vision. Mr. Collier Green’s careful examination of the eyes revealed no trace of muscular asthenopia. Added to the easily recognisable auditory vertigo (vertigo ab aure læsa) of Ménière’s disease was therefore super.imposed an ocular vertigo of what one is obliged to call of "idiopathic"origin, which not only appeared to accelerate the onset of an attack of vertigo but definitely aggravated the ocular symptoms themselves at each successive vertiginous attack. 2. The distinct alleviation by the insertion of a seton in the nape of the neck of the most distressing and-to the patient, I may say-appalling symptoms of ,these sudden and violent attacks of vertigo after the drugs above mentioned had entirely failed to produce any adequate It seems to me that surgeons at about the alutary effects. of must have sometimes had recourse last century beginning ,to this method of treatment in obstinate cases of M6ni6re’s disease, although I have no doubt but that "bleeding" would have been the first treatment to be adopted, and even this, it seems.to me, by unloading the intracranial sinuses would tend to relieve any by perse mia there might be in the labyrinth and possibly procure excellent temporary results. The very fact of this disease not having received a name till after 1861, when Meniere’s classical case was published, is ’quite sufficient a reason for there being obscurity as to both diagnosis and treatment of this disease in times gone by. Curiously enough, I have been through the titles of every published case of importance on this subject in the Index Catalogue of the Surgeon-General’s Library, U.S.A." which brings one up in the literature of the subject to 1894 and, again, I have looked over a number of the later volumes of the "Bibliographia Medica"" and 11 Index Medicus," but can find not a single case whose title justifies the conclusion that the seton has been tried as a remedy in the treatment of Meniere’s disease. At any rate, whether it has been employed before or not, I feel that as the results above enumerated have taken place in the present recorded case, which was, it will be admitted, of an exceptionally severe and persistent type, one has reasons for thinking that a slighter case would naturally yield much more beneficial results and, in any case, the treatment by seton in Meniere’s disease is well worthy of a trial. Hornsey-lane, N.
neaaacne ana localised neuralgias in sucn cases ana cms iea cause of me to turn my attention to the as a as irritation. The result was in some cases very
sight
possible striking,
the following will show. CASE 1 -A woman consulted me for a large patch of alopecia areata on the vertex which had persisted for over a year in spite of careful local treatment. On reading her prescriptions I found that she had used almost all the forms of local stimulants and antiseptics which are usually recommended for such cases. Her health was not of the best and her occupation necessitated much close application near a lamp in a somewhat vitiated atmosphere. Headache was a marked symptom and on inquiry I found that she had an error of refraction which had been corrected by a well-known ophthalmic surgeon some five years before. As her age was about 35 years I thought " it possible that her glasses were no longer suitable and advised her to consult the ophthalmic surgeon again. This she did and the glasses were altered, with the result that in six weeks’ time the whole patch was thickly covered with new hair. This patient suffered from marked seborrhcea oleosa and the micro-bacillus was found by examination of the scales and by cultivation. CASE 2.-Another woman came to me for a patch of alopecia areata over the left ear. She had a great deal of work in selecting materials necessitating very close examination of the texture. Headache again was a marked symptom but no seborrhcea oleosa was found. Her age was 38 years. I had already treated her very unsuccessfully for some time when the possibility of eyestrain occurred to me and I got a friend of mine to examine her refraction. His report was that she had well-marked hypermetropia which had been latent and was becoming effective and that he had ordered her glasses. Again the hair grew rapidly but this case was not quite so satisfactory as she came to me a year later with another patch and more headache. Her health is still poor, as she has violent migraine, though she has lost the persistent headache from which she suffered before her vision was corrected. CASE 3.-I was asked to see a student for a single patch His age was about of alopecia areata on the vertex. 20 years and he already wore glasses for myopia, but the prescription for them had been given him a long time ago. I sent him to the ophthalmic surgeon who found his glasses A CONTRIBUTION TOWARDS THE ETIO-unsuitable and some curious changes in the fundus ; so other glasses were prescribed. The hair grew rapidly and LOGY OF ALOPECIA AREATA. remained healthy. BY ARTHUR WHITFIELD, M.D., M.R.C.P. LOND., CASE 4.-While discussing this with another student ASSISTANT PHYSICIAN IN CHARGE OF THE SKIN DEPARTMENT, KING’S he informed me that while reading hard for one recently COLLEGE HOSPITAL ; PHYSICIAN TO THE SKIN DEPARTMENT, of the examinations of the University of London ha suffered GREAT NORTHERN CENTRAL HOSPITAL. severely from headache and developed alopecia areata. After a couple of months his headache led him to have his ALOPECIA areata, though merely a ’disfiguring disease eyes tested and his vision corrected, and the alopecia, which .rather than one causing pain or ill-health, is sufficiently had so far resisted treatment, disappeared in a very short annoying to make sufferers from it extremely anxious to find : time. He did not connect the two and consequently his history is not very full of detail. an efficacious treatment. At the same time, I think it will be Acting on the results of my earlier cases I had the vision admitted that the results of treatment directed against it tested in a large number of cases of children with alopecia are very often extremely unsatisfactory and any additional areata. The disease is very common in the earlier school knowledge of its cause, though only applicable to a few years and I thought it quite possible that the strain of cases, is of unquestionable value. As is well known, the reading might determine it. In one or two cases marked two main theories as to the causation of alopecia areata are ’, error was found, but in by far the greater majority the eyes the parasitic and the trophoneurotic, a great impulse having were evidently not the cause of the trouble and I wish it to been given to the former by the publication of Sabouraud’s be understood clearly that I do not claim to have discovered careful work on seborrhoea oleosa and its bacteriology. the cause of alopecia areata. At the same time in this While admitting the presence of the organisms described troublesome disease it appears that there is a certain perof cases in which the nervous irritation consequent by Sabouraud in every case where there is excessive centage an undue effort to focus fine objects determines the onset on formation of grease I have failed to find sufficient evidence that the bacilli are the cause of the symptoms. Moreover, of the symptoms in people whose health is not the most Sabouraud found himself forced to give up his contention robust. At all events, an inquiry into the correctness of the that seborrhcea was the cause in all cases and to differen- vision can do no harm. Bentinck-street, W. tiate a special variety in children, which he called ophiasis, and stated to be due to some cause other than invasion by the micro-bacillus of seborrhcea. More recently Jacquet has called attention to the frequency of disturbances of a decree of ConUNIVERSITY OF dentition-either abnormal eruption of the teeth or caries vocation it has been determined that the statute institutof existing teeth-in such cases and has credited the icg a separate examination in forensic medicine and nerve irritation thus produced in patients whose general public health as part of the final examination fcr the health is not quite up to the normal with the production B.M., B.Ch. degrees shall come into operation in 1905 of the bald areas. It is too soon to criticise this theory (see THE LANCET of Feb. 27th, p. 631).—Scholarships in since, as far as my knowledge goes, his results and obser- natural science have been offered for competition on the vations have not yet been carefully controlled by others, following dates : March 15th, Keble College ; March 22nd, but if it be correct it is probable that other causes of nerve Magdalen College ; April 19th, Merton College, New College, irritation may determine the disease. Some time ago I was and Corpus Christi College; and June 28th, Brasenose struck, as I suppose many have been, by the frequency of College.
OXFORD.-By
neaaacne ana localised neuralgias in sucn cases ana cms iea cause of me to turn my attention to the as a as irritation. The result was in some cases very
sight
possible striking,
the following will show. CASE 1 -A woman consulted me for a large patch of alopecia areata on the vertex which had persisted for over a year in spite of careful local treatment. On reading her prescriptions I found that she had used almost all the forms of local stimulants and antiseptics which are usually recommended for such cases. Her health was not of the best and her occupation necessitated much close application near a lamp in a somewhat vitiated atmosphere. Headache was a marked symptom and on inquiry I found that she had an error of refraction which had been corrected by a well-known ophthalmic surgeon some five years before. As her age was about 35 years I thought " it possible that her glasses were no longer suitable and advised her to consult the ophthalmic surgeon again. This she did and the glasses were altered, with the result that in six weeks’ time the whole patch was thickly covered with new hair. This patient suffered from marked seborrhcea oleosa and the micro-bacillus was found by examination of the scales and by cultivation. CASE 2.-Another woman came to me for a patch of alopecia areata over the left ear. She had a great deal of work in selecting materials necessitating very close examination of the texture. Headache again was a marked symptom but no seborrhcea oleosa was found. Her age was 38 years. I had already treated her very unsuccessfully for some time when the possibility of eyestrain occurred to me and I got a friend of mine to examine her refraction. His report was that she had well-marked hypermetropia which had been latent and was becoming effective and that he had ordered her glasses. Again the hair grew rapidly but this case was not quite so satisfactory as she came to me a year later with another patch and more headache. Her health is still poor, as she has violent migraine, though she has lost the persistent headache from which she suffered before her vision was corrected. CASE 3.-I was asked to see a student for a single patch His age was about of alopecia areata on the vertex. 20 years and he already wore glasses for myopia, but the prescription for them had been given him a long time ago. I sent him to the ophthalmic surgeon who found his glasses A CONTRIBUTION TOWARDS THE ETIO-unsuitable and some curious changes in the fundus ; so other glasses were prescribed. The hair grew rapidly and LOGY OF ALOPECIA AREATA. remained healthy. BY ARTHUR WHITFIELD, M.D., M.R.C.P. LOND., CASE 4.-While discussing this with another student ASSISTANT PHYSICIAN IN CHARGE OF THE SKIN DEPARTMENT, KING’S he informed me that while reading hard for one recently COLLEGE HOSPITAL ; PHYSICIAN TO THE SKIN DEPARTMENT, of the examinations of the University of London ha suffered GREAT NORTHERN CENTRAL HOSPITAL. severely from headache and developed alopecia areata. After a couple of months his headache led him to have his ALOPECIA areata, though merely a ’disfiguring disease eyes tested and his vision corrected, and the alopecia, which .rather than one causing pain or ill-health, is sufficiently had so far resisted treatment, disappeared in a very short annoying to make sufferers from it extremely anxious to find : time. He did not connect the two and consequently his history is not very full of detail. an efficacious treatment. At the same time, I think it will be Acting on the results of my earlier cases I had the vision admitted that the results of treatment directed against it tested in a large number of cases of children with alopecia are very often extremely unsatisfactory and any additional areata. The disease is very common in the earlier school knowledge of its cause, though only applicable to a few years and I thought it quite possible that the strain of cases, is of unquestionable value. As is well known, the reading might determine it. In one or two cases marked two main theories as to the causation of alopecia areata are ’, error was found, but in by far the greater majority the eyes the parasitic and the trophoneurotic, a great impulse having were evidently not the cause of the trouble and I wish it to been given to the former by the publication of Sabouraud’s be understood clearly that I do not claim to have discovered careful work on seborrhoea oleosa and its bacteriology. the cause of alopecia areata. At the same time in this While admitting the presence of the organisms described troublesome disease it appears that there is a certain perof cases in which the nervous irritation consequent by Sabouraud in every case where there is excessive centage an undue effort to focus fine objects determines the onset on formation of grease I have failed to find sufficient evidence that the bacilli are the cause of the symptoms. Moreover, of the symptoms in people whose health is not the most Sabouraud found himself forced to give up his contention robust. At all events, an inquiry into the correctness of the that seborrhcea was the cause in all cases and to differen- vision can do no harm. Bentinck-street, W. tiate a special variety in children, which he called ophiasis, and stated to be due to some cause other than invasion by the micro-bacillus of seborrhcea. More recently Jacquet has called attention to the frequency of disturbances of a decree of ConUNIVERSITY OF dentition-either abnormal eruption of the teeth or caries vocation it has been determined that the statute institutof existing teeth-in such cases and has credited the icg a separate examination in forensic medicine and nerve irritation thus produced in patients whose general public health as part of the final examination fcr the health is not quite up to the normal with the production B.M., B.Ch. degrees shall come into operation in 1905 of the bald areas. It is too soon to criticise this theory (see THE LANCET of Feb. 27th, p. 631).—Scholarships in since, as far as my knowledge goes, his results and obser- natural science have been offered for competition on the vations have not yet been carefully controlled by others, following dates : March 15th, Keble College ; March 22nd, but if it be correct it is probable that other causes of nerve Magdalen College ; April 19th, Merton College, New College, irritation may determine the disease. Some time ago I was and Corpus Christi College; and June 28th, Brasenose struck, as I suppose many have been, by the frequency of College.
OXFORD.-By