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Incurables, All at Edinburgh. the Ulster Eye and Ear Ence

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Incurables, All at Edinburgh. the Ulster Eye and Ear Ence 803 not in with these should Kindness, severity, dealing patients THE IN THE be the watchword. Their affections are easily gained, and ON ATROPHIC CHANGES HAIR should be so cultivated that the deprivation of the love of KNOWN AS TRICHOREXIS NODOSA. those who come in contact with them should be felt to be a great punishment. BY THOMAS C. FOX, B.A. CANTAB., M.B., Care must be taken that plenty of amusement is pro- PHYSICIAN TO THE ST. GEORGE’S AND ST. JAMES’S DISPENSARY, LONDON. vided, so that work and play may bear the proper proportion the one to the other. I SHOULD be loth to occupy valuable space in the columns In order that these be to the advantages may gained of THE LANCET with remarks on such a comparatively fullest it is that imbeciles should be edu- extent, necessary trivial were it not that the affection is at cated Unfortunately, however, the few institu- subject present together. some and in of the want tions which exist are nearly full, and so not many cases can attracting notice, that, consequence be admitted. We may hope that the time will not be far of knowledge respecting it, repeated redescriptions are con- distant when every county, or combination of counties, in tinually being made as independent observations. It seems England shall have its school for the training and treatment therefore expedient to gather together into a collected form of imbeciles. what has been written about the disease from scattered sources, and so place the subject in a more satisfactory light ON SAYRE’S APPARATUS. for subsequent observers. I wish, further, to compare such information with what I have myself observed. BY SAMPSON GAMGEE, F.R.S.E., Mr. Erasmus Wilson1 states he has been acquainted for a SURGEON TO THE QUEEN’S HOSPITAL, BIRMINGHAM. period of thirty years with an affection of the hairs of the " beard, moustache, and whiskers, in which the outer fibres IN an illustrated paper on Surgical Swings and Pulleys of the shaft are broken at short intervals all as Aids to Rest and Motion," which was honoured with through along puhlicity through the columns of THE LANCET (July 13th, the hair, causing an appearance of white specks to the naked as with an he 1878), I sought to demonstrate the advantages to be derived, eye. Provided, usual, apt illustration, the condition be " imitated a in out Professor treatment for says may by breaking tough carrying Sayre’s suspension stick the bark and outer fibres spinal curvature, from the employment of a self-stopping partially through, bursting block. Experience, in private and of the wood, and leaving the central fibres comparatively pulley hospital practice, Mr. claims the for his has justified the most anticipations of the advan- uninjured." Wilson priority descrip- sanguine tion of what he crinium " in his work tages resulting from that contrivance. It acts smoothly and called " fragilitas Skin."2 He, however, in to safely, entirely obviating the dangers which more than once entitled "Healthy objecting have threatened suspension in the tripod with the ordinary the name "trichorexis nodosa,’’ subsequently applied by denies that there is any swelling precursory to the pulleys. and he has never seen a nodal A still further be effected bursting,Kaposi, says definitely improvement may by adopting swelling on such hairs. In the year 1855 Dr. Hermann Mr. worsted head with a run- Golding-Bird’s webbing gear, Beigel described a similar affection3 under the title " On cord as he has to at ning arranged, suggested, vary pleasure Swelling and Bursting of the Hair." An engraving after a the drag on the arms and head. Messrs. Salt and Son have drawing by Beigel is in the Dermatological Collection of the just constructed for me an apparatus embodying these im- of and it is to note that Mr. with the and the result College Surgeons, important provements self-acting pulley block, Wilson recognises the disease as identical with his fragilitas is in every way most satisfactory. crinium. In the catalogue (1870) it is called " trichoclasia," It is true of this as of other methods of treatment, that in and subsequently Mr. Wilson suggested the alternative clumsy hands no perfection of appliances will ensure success; name " clastothrix." It that Dr. Wilks also with skill and of appears (THE whereas, exceptional nicety manipulation, with made in was the rudest contrivance be made subservient to excellent LANCET, Sept. 7th, 1878, drawing 1852) may acquainted with the condition about the same time; for he to ensure the utmost to results; nevertheless, advantages in his " Lectures on " in the combination of mechanical with sci- published, Pathological Anatomy patients, precision 1857, the account he had been in the habit of at entific is of It is no less delivering knowledge paramount importance. was true that all methods of however sound in Guy’s Hospital. Engel,4 quoted by Kaposi, acquainted treatment, prin- with it too, but he described a kind of exudation from and however are liable to ciple, skilfully planned, abuse, the cut-ends of the hairs, which then grew on, the and even under the most favourable leaving cannot, circumstances, attached exudation as on the hair. In 1867 Mr. be infallible. But their merit is not detracted from swellings just by Wilson exhibited some (at in the College of the that discrimination on the of drawings present assumption judicious part Surgeons) to the Royal Medical and Chirurgical Society’ of an the practitioner is indispensable, and that invariable success which he called of the beard and is affection, tricho-syphilis manifestly impossible. whiskers. He considers this condition quite a distinct one Without entering into the question of priority, which is fromfragilitas crinium, and the drawings certainly do not show often irritating and rarely profitable, it must be admitted the characteristic fracture of the latter ; but in the red haiis that Professor has his treatment of disease Sayre by spinal there are long fusiform blackish swellings, composed almost a new field to the not a terra opened up operating surgeon; entirely of an expanded, much pigmented medulla in which it is for we all knew too well the i2tcognita, true, only pro- are air-globules and the cuticle. The hairs were very brittle, gress of countless patients through life-long suffering to broken off here and and death. What the American has there, split longitudinally, especially premature distinguished at the swellings. The condition occurred, not as part of the us that with and I taught is, by applying, simple painless ordinary alopecia syphilitica, but when the patient was in tt contrivances, to spinal affections the well-established prin- cachectic state in the late of of the immovable it is to very secondary period syphilis. ciples apparatus, possible promote Mr. Wilson considered that there was an arrest of develop- the of lesions which otherwise would cause an incon- repair ment of the hair at the cell stage, and that no fibres were ceivable amount of pain, and in a large number of cases formed. in the Journal of Cutaneous lead to fatal consequently Again, disorganisation. Medicine (1869, p. 309) the same observer details a similar Birmingham. case-indeed, as far as I can judge, it is actually the same case. I think that this tricho-syphilis, though presenting BEQUESTS ETC. TO MEDICAL CHARITIES.-Mr. some peculiarities, is undoubtedly only a phase of tricho- W. R. of sole executor of a rexis nodosa. In the same journal (vol. iii., p. 133), Dr. Clapperton, Edinburgh, gentle- of described still another of the man whose name is not to be published, has, out of the Paxton, Chichester, phase " residue of the estate placed at his disposal, paid 91000 disease, occurring in the hairs of the axilla, as a fairly to the .6200 to the Convalescent Royal Infirmary, Hospital, 1 Lect. on Derm., 1876-7-8. £150 to 2 the Royal Hospital for Sick Children, 9150 to the Third Edition, 1849, p. 231. Mr. Wilson says perhaps it was even in Royal Maternity Hospital, and £100 to the Hospital for the second edition, but I have been unable to obtain a copy for refer- Incurables, all at Edinburgh. The Ulster Eye and Ear ence. s Sitzb. d. k. Akad. d. W., Bd. xvii., p. 612. Hospital has received £1000 from Mr. George Benn, of 4 Wiener. Akad. Sitzungst, 1856. Belfast. 5 I have been unable to find this paper in the Transactions..
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