- Email: [email protected]
A TREATMENT FOR BALDNESS.
1363
CHRISTMAS AND THE R.M.B.F.
this country good results are recorded3 by Prof. complications, and they think it was at least S. LYLE CuMMiNS, and Dr. B. R. CLARKE, the partly responsible by virtue of its inherent toxicity latter having reviewed4 his cases after a prolonged for the unfavourable trend of the disease in some cases. interval. Turning to experimental evidence it may On the other side of the picture may be quoted be recalled that CumNS obtained successful a recent investigation in America 5 of 24 cases results in rabbits, as did also MADSEN and MÖRCH, chosen as exceptionally good subjects for the who however failed to repeat these good results treatment on the basis of clinical, radiological, later in a parallel series with BAUG. Dr. E. E. and laboratory findings. These cases were then ATKIN has recently supplemented6 his work and divided into two comparable groups of 12 each, shown that sanocrysin has an inhibitory reaction on the cases being as far as possible matched one with tuberculous lesions in rabbits. His work suggests another. One half was given sanocrysin and the that sanocrysin exerts an inhibitory effect on these other half used as controls, the choice being lesions quite apart from any bactericidal action it. decided by the toss of a coin. Each patient may have on the living tubercle bacillus. was studied independently by two of the workers We are by no means at the end of the chapter. and given a rest of 30 days in bed to eliminate Clinical records do not have the finality of a testvariable factors before treatment was begun. tube experiment, but the fact that sanocrysin is The sanocrysin cases were given total amounts still in daily use in many institutions after a trial varying from 3’11 to 6’1g. The controls were of five years and upwards is evidence that its given parallel injections of distilled water, and the advocates have reason for believing in it. Far patients themselves were not aware of any more careful comparison with controls is necessary distinction in treatment. The authors could in assessing the value of such treatment which discover no evidence of the beneficial effect of cannot be used blindly as a routine measure. sanocrysin on pulmonary tuberculosis or its Sanocrysin needs careful handling, for it is prone to give rise to various unpleasant and even serious accidents. 3 Tubercle, 1926, vii., 486. Ibid., 1927, viii., 465. 4
5 Amberson, J. Burns. Jr., McMahon, B. T., and Pinner, Max : Amer. Rev. Tuberculosis, 1931, xxiv., 401.
6 Brit. Jour. Exper. Path., August, 1931, p. 249.
ANNOTATIONS to the lion. treasurer of the Fund at 11, Chandosstreet, London, W.l.
CHRISTMAS AND THE R.M.B.F.
___
WE feel bound to make a final appeal before Christmas for the organisation which tries to relieve A TREATMENT FOR BALDNESS. the distress that often falls on members of our proIF the surprising results recorded by B. N. fession and their dependents. The brief case-notes Bengtsonare confirmed they may mark a notable published from time to time by the Royal Medical advance in the treatment of baldness. Of the 16 Benevolent Fund are so painful that most peoplecases dealt with in his preliminary report, 9 are avoid looking at them. They are painful for two stated definitely to have been cases of alopecia of duration varying from 6 months to 23 years. reasons : first, because it is shocking to read of the areata, The seven remaining cases included two associated straits into which our colleagues and their children with Fr6hlich’s syndrome, which first impelled have fallen, often despite the most courageous struggleBengtson to test the effect of pituitary injections ; against illness and adversity ; secondly, because the in one of the other cases the baldness followed sums which the Fund is able to spare them seem trauma ; in another it was due to luetic or assopathetically inadequate. This is not the moment ciated luetic infection, and finally there were two. perhaps to inquire how this so-called charity can be described as universal alopecia, of 16 and 23 years’ provided with a sufficient regular income. But duration respectively. Of the 16 patients, 11 were at a time when poverty is increasing and ordinary males and 5 females. While the aetiology of alopecia support is bound to decline, we venture to ask for aareata and the control of hair growth awaits elucidaspecial effort in favour of those who are unable totion, there is an increasing agreement that there is bear more hardship and whose claim on us allan important endocrine factor and a more or less is great. "There, but for the grace of God, goes intimate relation to the sex glands, as suggested by John Bradford " is a sentiment which each can echo the development of hair at puberty, and (as pointed as he hears of other medical men who have been out by Sabouraud long ago) the rareness of baldness unlucky or unwise, and whose misfortune or errorin the eunuch. Fr6hlieh’s disease includes dystrophy has descended, upon: their children. Maintenance is and loss of the hair, and its effective treatment by the first essential aiid the real problem is how to pituitary injections encourages the belief that the give that help which is needed constantly throughout pituitary gland has an important influence over the each year. At the same time in a season when growth of the hair. Bengtson’s scheme is to give mild self-indulgence is still the rule we may perhaps 1 c.cm. of anterior lobe extract hypodermically, at hope for generous response to Sir Thomas Barlow’s first once a week, then twice, and then three times. appeal that none of those in the care of his committee: Simultaneously 0’5 c.cm. of the same extract was given shall " look in vain this Christmas for the gift which on five or six days a week. Posterior lobe extract can bring a few additional necessities of life and extra was given hypodermically in six cases, and thyroid comfort to their homes." He says that cheques, postal orders, or even stamps should be addressed 1 Jour. Amer. Med. Assoc., 1931, xcvii., 1355. ,
.
,
1364
THE CR[PP;r,BD CHILD.
in one case which did not respond to pituitary alone. The results recorded indicate that in all the 16 cases there was a gratifying response to the treatment. They are graded as follows : excellent (11), good (4), .and fair (1). Two photographs illustrate the effects in alopecia areata, and one shows striking benefit in a man of 58 labelled senility and alopecia. The number of injections required to provoke growth of hair of normal colour and texture varied between 78 and 220. Bengtson points out that the types of baldness treated fall into the category of glandular alopecias, and he does not commit himself about the common type of senile or presenile hair loss, although he has recently begun treatment of such cases on the same lines, and reports "regrowth of lanugo hair and hair in four weeks on daily injections," in a case with the typical shiny crown and forehead since 1914. Every dermatologist will agree with him in his concluding sentence that " enthusiasm at this time is not warranted, and continued observations should be made until the merit or failure of this treatment is decided." Caution should be exercised furthermore in the matter of dosage. Half a gramme of pituitary substance is a considerable dose, and on pharmacological grounds it would perhaps be wise to begin treatment with a smaller amount. In a subsequent letter to the same journal (Nov. 28th) Bengtson says that he has received several thousand letters about his method, and is unable to answer them. " The experiments," he adds, " while gratifying in certain types of baldness, do not indicate that a complete solution of this age-old problem has been realised." THE CRIPPLED CHILD. THE problem of the crippled child in
our
country
resolves itself into ascertainment of the incidence - of crippling among children, the possibility of preventing its causes and circumstances, effective treatment, after-care, and the education of the child in body and mind. The Chief Medical Officer of the Board of Education, in his report on the health of the school-child for 1930,1 groups the causes and conditions of crippling under five main heads. These are : (1) congenital defects and birth injuries ; ,(2) nutritional disorders ; (3) acute infectious diseases affecting the neuromuscular mechanism ; (4) constitutional diseases affecting the bones and joints ; and (5) accidents. He points out that prevention is a term that can be used in two senses : that of averting the crippling disease, and that of preventing deformity once the disease is established. The primary aim of an orthopaedic scheme is therefore to discover the cripple at the earliest possible moment and to follow him up by efficient and prolonged treatment at a hospital or clinic. It must also include after-care, vocational training, and an interest in securing and maintaining the employment of the subject. The .scheme involves first concentration on certain diseases, for example, tuberculosis, one of the principal single causes of crippling. Much is being done to prevent infection of children from human sources, while their protection from bovine sources depends on the production and supply of tubercle-free milk. Surgical tuberculosis is now treated conservatively by immobilisation under open-air conditions, and the outlook for these patients is altogether brighter than it was 30 years ago, when the treatment was radical operation. Prevention of crippling in the 1 H.M. Stationery Office.
1931.
Pp. 125.
2s.
third group is a diincult problem. No certain means are known at present of directly averting poliomyelitis, but treatment by convalescent serum has given encouraging results. Prompt diagnosis is of the utmost importance, both for serum treatment and for the prevention of deformity. Improved midwifery should do much to prevent birth injuries, and early treatment can prevent a great deal of congenital
deformity. Alongside diagnosis and treatment there is the need for education, and modified elementary school training is provided in all orthopaedic institutions. For the younger children there are story-telling, descriptions of pictures and talks on nature study; simple manual education such as paper-folding, clay-work, drawing and colouring; singing, breathing The older children follow the but usually need individual school curriculum, public attention, as they are backward from loss of school time, and also because they will probably have to earn their living later by some special occupation for which training can begin early. Beyond the school age there must also be training centres to teach special suitable trades under orthopaedic supervision. Finally, there is the need for re-education of the crippled body and the restoration of the inherent powers of repairto be achieved by skilled passive movement, massage, and exercise. The organisation provided by the Board of Education is, in the opinion of its chief medical officer, fulfilling its objects. The net of ascertainment is becoming both wider and finer. The report gives tables showing the gradual increase in the numbers of ascertained cases and in the number of orthopaedic schemes made by local authorities. The number of crippled persons attending vocational courses has steadily increased, from 56 in 1920-21 to 241 in 1929-30. During the past six years 131 new schemes have been approved, bringing the total in England and Wales to 216 schemes. It is becoming less and less common to find serious deformity; where schemes have been in progress for some time the cripples are dealt with earlier, and gross deformities are overcome or prevented. The orthopaedic organisation is definitely mending cripples and returning them to the ranks of normal school-children or normal employment. In Leeds 75 per cent. of the cripples have been returned to school, and other centres show similar figures. Moreover, the work being done for cripples is reducing such diseases as tuberculosis and rickets. Tuberculosis is a diminishing disease, but the death-rate for non-pulmonary tuberculosis has declined more rapidly than that from phthisis ; for children of school age it has been practically halved in 20 years. A factor in this remarkable saving of life has undoubtedly been the wide extension of schemes for cripples. The chief medical officer boldly claims that English enterprise on behalf of the medical and surgical healing of the cripple is one of the best examples of the application of the principles of preventive medicine that can be found. " It is truly economical and truly constructive," he says. " It is saving time, money, and life ; it is the building-up of capable men and women from the gravest of disabilities and impairments ; it is the reconstruction and restoration of that which has been so nearly destroyed ; it is putting into practice the real principles of preventive medicine. Secondly, it is the design of those principles in their true sequence-ascertainment, healing, prevention. And lastly, it illustrates almost perfectly the close cooperation of municipal and voluntary service."
exercises, and music.
CHRISTMAS AND THE R.M.B.F.
this country good results are recorded3 by Prof. complications, and they think it was at least S. LYLE CuMMiNS, and Dr. B. R. CLARKE, the partly responsible by virtue of its inherent toxicity latter having reviewed4 his cases after a prolonged for the unfavourable trend of the disease in some cases. interval. Turning to experimental evidence it may On the other side of the picture may be quoted be recalled that CumNS obtained successful a recent investigation in America 5 of 24 cases results in rabbits, as did also MADSEN and MÖRCH, chosen as exceptionally good subjects for the who however failed to repeat these good results treatment on the basis of clinical, radiological, later in a parallel series with BAUG. Dr. E. E. and laboratory findings. These cases were then ATKIN has recently supplemented6 his work and divided into two comparable groups of 12 each, shown that sanocrysin has an inhibitory reaction on the cases being as far as possible matched one with tuberculous lesions in rabbits. His work suggests another. One half was given sanocrysin and the that sanocrysin exerts an inhibitory effect on these other half used as controls, the choice being lesions quite apart from any bactericidal action it. decided by the toss of a coin. Each patient may have on the living tubercle bacillus. was studied independently by two of the workers We are by no means at the end of the chapter. and given a rest of 30 days in bed to eliminate Clinical records do not have the finality of a testvariable factors before treatment was begun. tube experiment, but the fact that sanocrysin is The sanocrysin cases were given total amounts still in daily use in many institutions after a trial varying from 3’11 to 6’1g. The controls were of five years and upwards is evidence that its given parallel injections of distilled water, and the advocates have reason for believing in it. Far patients themselves were not aware of any more careful comparison with controls is necessary distinction in treatment. The authors could in assessing the value of such treatment which discover no evidence of the beneficial effect of cannot be used blindly as a routine measure. sanocrysin on pulmonary tuberculosis or its Sanocrysin needs careful handling, for it is prone to give rise to various unpleasant and even serious accidents. 3 Tubercle, 1926, vii., 486. Ibid., 1927, viii., 465. 4
5 Amberson, J. Burns. Jr., McMahon, B. T., and Pinner, Max : Amer. Rev. Tuberculosis, 1931, xxiv., 401.
6 Brit. Jour. Exper. Path., August, 1931, p. 249.
ANNOTATIONS to the lion. treasurer of the Fund at 11, Chandosstreet, London, W.l.
CHRISTMAS AND THE R.M.B.F.
___
WE feel bound to make a final appeal before Christmas for the organisation which tries to relieve A TREATMENT FOR BALDNESS. the distress that often falls on members of our proIF the surprising results recorded by B. N. fession and their dependents. The brief case-notes Bengtsonare confirmed they may mark a notable published from time to time by the Royal Medical advance in the treatment of baldness. Of the 16 Benevolent Fund are so painful that most peoplecases dealt with in his preliminary report, 9 are avoid looking at them. They are painful for two stated definitely to have been cases of alopecia of duration varying from 6 months to 23 years. reasons : first, because it is shocking to read of the areata, The seven remaining cases included two associated straits into which our colleagues and their children with Fr6hlich’s syndrome, which first impelled have fallen, often despite the most courageous struggleBengtson to test the effect of pituitary injections ; against illness and adversity ; secondly, because the in one of the other cases the baldness followed sums which the Fund is able to spare them seem trauma ; in another it was due to luetic or assopathetically inadequate. This is not the moment ciated luetic infection, and finally there were two. perhaps to inquire how this so-called charity can be described as universal alopecia, of 16 and 23 years’ provided with a sufficient regular income. But duration respectively. Of the 16 patients, 11 were at a time when poverty is increasing and ordinary males and 5 females. While the aetiology of alopecia support is bound to decline, we venture to ask for aareata and the control of hair growth awaits elucidaspecial effort in favour of those who are unable totion, there is an increasing agreement that there is bear more hardship and whose claim on us allan important endocrine factor and a more or less is great. "There, but for the grace of God, goes intimate relation to the sex glands, as suggested by John Bradford " is a sentiment which each can echo the development of hair at puberty, and (as pointed as he hears of other medical men who have been out by Sabouraud long ago) the rareness of baldness unlucky or unwise, and whose misfortune or errorin the eunuch. Fr6hlieh’s disease includes dystrophy has descended, upon: their children. Maintenance is and loss of the hair, and its effective treatment by the first essential aiid the real problem is how to pituitary injections encourages the belief that the give that help which is needed constantly throughout pituitary gland has an important influence over the each year. At the same time in a season when growth of the hair. Bengtson’s scheme is to give mild self-indulgence is still the rule we may perhaps 1 c.cm. of anterior lobe extract hypodermically, at hope for generous response to Sir Thomas Barlow’s first once a week, then twice, and then three times. appeal that none of those in the care of his committee: Simultaneously 0’5 c.cm. of the same extract was given shall " look in vain this Christmas for the gift which on five or six days a week. Posterior lobe extract can bring a few additional necessities of life and extra was given hypodermically in six cases, and thyroid comfort to their homes." He says that cheques, postal orders, or even stamps should be addressed 1 Jour. Amer. Med. Assoc., 1931, xcvii., 1355. ,
.
,
1364
THE CR[PP;r,BD CHILD.
in one case which did not respond to pituitary alone. The results recorded indicate that in all the 16 cases there was a gratifying response to the treatment. They are graded as follows : excellent (11), good (4), .and fair (1). Two photographs illustrate the effects in alopecia areata, and one shows striking benefit in a man of 58 labelled senility and alopecia. The number of injections required to provoke growth of hair of normal colour and texture varied between 78 and 220. Bengtson points out that the types of baldness treated fall into the category of glandular alopecias, and he does not commit himself about the common type of senile or presenile hair loss, although he has recently begun treatment of such cases on the same lines, and reports "regrowth of lanugo hair and hair in four weeks on daily injections," in a case with the typical shiny crown and forehead since 1914. Every dermatologist will agree with him in his concluding sentence that " enthusiasm at this time is not warranted, and continued observations should be made until the merit or failure of this treatment is decided." Caution should be exercised furthermore in the matter of dosage. Half a gramme of pituitary substance is a considerable dose, and on pharmacological grounds it would perhaps be wise to begin treatment with a smaller amount. In a subsequent letter to the same journal (Nov. 28th) Bengtson says that he has received several thousand letters about his method, and is unable to answer them. " The experiments," he adds, " while gratifying in certain types of baldness, do not indicate that a complete solution of this age-old problem has been realised." THE CRIPPLED CHILD. THE problem of the crippled child in
our
country
resolves itself into ascertainment of the incidence - of crippling among children, the possibility of preventing its causes and circumstances, effective treatment, after-care, and the education of the child in body and mind. The Chief Medical Officer of the Board of Education, in his report on the health of the school-child for 1930,1 groups the causes and conditions of crippling under five main heads. These are : (1) congenital defects and birth injuries ; ,(2) nutritional disorders ; (3) acute infectious diseases affecting the neuromuscular mechanism ; (4) constitutional diseases affecting the bones and joints ; and (5) accidents. He points out that prevention is a term that can be used in two senses : that of averting the crippling disease, and that of preventing deformity once the disease is established. The primary aim of an orthopaedic scheme is therefore to discover the cripple at the earliest possible moment and to follow him up by efficient and prolonged treatment at a hospital or clinic. It must also include after-care, vocational training, and an interest in securing and maintaining the employment of the subject. The .scheme involves first concentration on certain diseases, for example, tuberculosis, one of the principal single causes of crippling. Much is being done to prevent infection of children from human sources, while their protection from bovine sources depends on the production and supply of tubercle-free milk. Surgical tuberculosis is now treated conservatively by immobilisation under open-air conditions, and the outlook for these patients is altogether brighter than it was 30 years ago, when the treatment was radical operation. Prevention of crippling in the 1 H.M. Stationery Office.
1931.
Pp. 125.
2s.
third group is a diincult problem. No certain means are known at present of directly averting poliomyelitis, but treatment by convalescent serum has given encouraging results. Prompt diagnosis is of the utmost importance, both for serum treatment and for the prevention of deformity. Improved midwifery should do much to prevent birth injuries, and early treatment can prevent a great deal of congenital
deformity. Alongside diagnosis and treatment there is the need for education, and modified elementary school training is provided in all orthopaedic institutions. For the younger children there are story-telling, descriptions of pictures and talks on nature study; simple manual education such as paper-folding, clay-work, drawing and colouring; singing, breathing The older children follow the but usually need individual school curriculum, public attention, as they are backward from loss of school time, and also because they will probably have to earn their living later by some special occupation for which training can begin early. Beyond the school age there must also be training centres to teach special suitable trades under orthopaedic supervision. Finally, there is the need for re-education of the crippled body and the restoration of the inherent powers of repairto be achieved by skilled passive movement, massage, and exercise. The organisation provided by the Board of Education is, in the opinion of its chief medical officer, fulfilling its objects. The net of ascertainment is becoming both wider and finer. The report gives tables showing the gradual increase in the numbers of ascertained cases and in the number of orthopaedic schemes made by local authorities. The number of crippled persons attending vocational courses has steadily increased, from 56 in 1920-21 to 241 in 1929-30. During the past six years 131 new schemes have been approved, bringing the total in England and Wales to 216 schemes. It is becoming less and less common to find serious deformity; where schemes have been in progress for some time the cripples are dealt with earlier, and gross deformities are overcome or prevented. The orthopaedic organisation is definitely mending cripples and returning them to the ranks of normal school-children or normal employment. In Leeds 75 per cent. of the cripples have been returned to school, and other centres show similar figures. Moreover, the work being done for cripples is reducing such diseases as tuberculosis and rickets. Tuberculosis is a diminishing disease, but the death-rate for non-pulmonary tuberculosis has declined more rapidly than that from phthisis ; for children of school age it has been practically halved in 20 years. A factor in this remarkable saving of life has undoubtedly been the wide extension of schemes for cripples. The chief medical officer boldly claims that English enterprise on behalf of the medical and surgical healing of the cripple is one of the best examples of the application of the principles of preventive medicine that can be found. " It is truly economical and truly constructive," he says. " It is saving time, money, and life ; it is the building-up of capable men and women from the gravest of disabilities and impairments ; it is the reconstruction and restoration of that which has been so nearly destroyed ; it is putting into practice the real principles of preventive medicine. Secondly, it is the design of those principles in their true sequence-ascertainment, healing, prevention. And lastly, it illustrates almost perfectly the close cooperation of municipal and voluntary service."
exercises, and music.