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prematura idiopathica, the other comprising those accompanied by some disease of the scalp, or symptomatic Alope. cia ; and in my own experience, the former class comprises mostly men, the latter class more women. Idiopathic baldness is most often hereditary, descending from father to son, although not all the sons of one father may be afflicted. These patients come, as a rule, when the baldness is already more or less advanced, and for them but little if anything can be done; the hair papillæ, on which the nutrition of the hair depends, is atrophied or entirely gone, and nothing can renew their integrity.
Those saddest words of Tennyson, “It might have been,” are not inapplicable here, for many of these unfortunates might have been spared this misfortune had the danger been recognized and guarded against. Something can be done either to prevent or procrastinate this affliction by treatment, but the treatment should be begun the hour after birth and continued through childhood.
The vernix caseosa which covers the scalp at birth should not be scrubbed off within an hour or two with soap and water, but the head should be oiled with olive or sweet. almond oil and gently wiped with a soft cloth; if all the secretion is not thus removed it should be again anointed and left for twenty-four hours, when the same process should be repeated. After four days the head may be gently washed, dried, and immediately oiled, and in general it may be said that the scalp should not be washed oftener than every fourth or fifth day, and after each bath should be thoroughly dried and anointed.
During childhood the hair should be kept moderately short (in girls until about the eighth year, after which it may be allowed to grow long), and the scalp should be washed only as often as the necessity for cleanliness should require. Daily sousing of the head in water should be absolutely prohibited, and the presence of excessive dryness of the scalp or the beginning of dandruff shows a diseased condition, which should be treated at once. There is no more fatal mistake than the constant shampooing of the scalp for the
removal of dandruff. It does remove it for the time being, but it soon returns, worse than before. If the children of parents prematurely bald were treated as to their scalps along the lines indicated above, I am sure the development of their inherited tendency would be much delayed, if not prevented.
The second class, Alopecia symptomatica, is made up of those patients who present as a concomitant some disease of the scalp, the most frequent being dandruff. Here the prognosis is more favorable, as the cure of the disease is generally followed by a cessation in the falling of the hair ; and if the scalp has not been permanently damaged, a return of growth may be reasonably looked for. Besides dandruff, anæmia either localized in the scalp or a general anæmia ; prolonged indigestion with consequent malnutrition ; mental worry and anxiety ; overwork of any kind; and, in short, any cause which tends to lower general vitality, may act to produce this affliction, and the treatment will be successful so far as we may be able to remove the cause and cure the local or systemic disease present. The prevention of these cases consists in the observance of the same hygienic principles for the care of the scalp as in the first class, and in addition, the early recognition and cure of dandruff.
BY FRANK C. RICHARDSON, M.D. By this term is meant the lethal and non-lethal effects of electric currents of high potential.
The very general and constantly increasing use of electricity in modern times has brought to the notice of the physician, and more especially the neurologist, a new and interesting class of cases the result of accidental shocks from powerful currents. The literature upon this subject is so meagre and so indefinite that further discussion seems desirable, and it is with this object in view that I present this brief paper, merely suggestive in character, to the society.
This subject is the more important inasmuch as these cases are rapidly finding their way into the courts as a basis of liti. gation, and it is necessary that we as physicians should be prepared to express at least an intelligent opinion in regard to the probable and actual effects of such injuries.
The passage of a high potential current through the human body is followed by exceedingly uncertain results, varying from immediate death to no effect whatever. Fifteen hun dred volts is commonly supposed to be sufficient to produce death, and in the cases reported where very much more was received without lethal effect, it is probable that the entire current did not enter the body. The varying influences of electro-motive force, resistance, conditions of moisture or dryness, contact with metals, or the interposition of non-conducting substances, conspire to form a complex problem, and we are obliged to admit that the question of the necessary voltage to produce death involves so many variable factors that a definite answer is impossible. The alternating current has proved more fatal than the direct, and the danger increases with the rapidity of the alternations.
There has been considerable discussion in regard to the cause of death by lethal doses of electricity. It has been held by some observers that the electric shock paralyzes the heart, but experiments upon animals, post-mortem appearances, and in non-lethal cases resuscitation by artificial respiration, would tend to lead us to the support of those who claim that the respiratory function is primarily suspended and death is practically by asphyxia with secondary stoppage of the heart's action.
Indefinite as are these facts concerning fatal electric shocks, still more vague is our information in regard to the effects of non-lethal doses, and it is these we have to consider in the great majority of cases brought to our notice.
Dana, among others, believes that electric shocks which do not cause death produce no permanent effect. While, I think, most of us are convinced to the contrary, how few of us are prepared to explain to a jury what those evil effects are and just how they are produced.
A quite thorough search of the literature bearing upon the subject has failed to find any report of pathological change in the nervous system following death by electricity, and yet it is in this sphere that we find most of our symptoms in nonfatal cases.
For this reason there has been a natural tendency to class all of these cases among the psychoses. While there can be no doubt that the majority of cases belong to this class, and that the symptoms are those of traumatic neurosis, brought about by the functional shock of the unexpected, aggravated by a traditional fear of the mysterious electrical force, nevertheless I think we have all met with cases where the conditions seemed different, the nervous disturbance more pronounced, the succeeding neurasthenia more profound, and the patient presenting symptoms indicative of a degree of nervous instability inconsistent with mere functional change.
To differentiate between these cases and the ever-increasing number of cases of traumatic neurosis following electric shock is extremely difficult. The chief data upon which I have based a diagnosis of genuine electro-traumatism are as follows :
1. The voltage received. It is my opinion that true electro-traumatism can only follow direct contact with heavy currents of electricity, say four hundred or five hundred volts, and that cases of nervous disturbance following such accidents as the blowing out of fuses, shocks from telephone receivers, alleged injury from medical apparatus, and the like, should be classed as traumatic neurosis.
2. Development of symptoms. In electro-traumatism the symptoms are immediate and persistent, while in traumatic neurosis they are frequently delayed in development.
3. Absence of hysterical stigmata. This may be regarded as negative evidence in favor of electro-traumatism, although of course the two may coexist. 4. Prominence of vaso-motor symptoms.
A very constant symptom of electro-traumatism has been, in my experience, marked vaso-motor disturbance, amounting in some cases to ecchymosis and local syncope.
5. Disturbance of equilibration, especially disturbed coördination of respiratory movements. Severe electric shocks seem almost invariably to derange the respiratory innervation, probably by combined action upon the bulbar centre and nervous paths. I have seen one case of persistent irregular respiration, and one case of modified Cheyne-Stokes respiration continuing for weeks after the accident.
It may be interesting to note in this connection the accurate observations recently made by Langendorf and Oldag on the result of stimulating the vagus by the voltaic current. They find that expiratory standstill or slowing is constantly caused by the closure of an ascending current, and during its flow. That inspiratory standstill or quickening is always caused by descending interrupted voltaic currents.
As to the method of production of the evil effects of electro-traumatism, the nervous system is undoubtedly the primary and principal sufferer, active nerve possessing peculiar electric susceptibility by reason of its properties as a conductor, with a core and a sheath. A study of the few such cases I have met with has led me to conclude that the more or less permanent damage from non-lethal electric shocks comes through nutritive changes in nervous tissue in consequence of primary severe irritation of vaso-motor and trophic centres.
These few fragmentary ideas are, I trust, but the nucleus of more precise and extended observations which further opportunity may make possible, and my excuse for presenting them at this time is the absolute dearth of literature upon the subject, and the desire to obtain further information from the experience of others.
THE IMPORTANCE OF CORRECTLY DIAGNOSING
INJURIES TO THE HEAD.
BY W. LOUIS HARTMAN, M.D. [Read before the Massachusetts Homæopathic Medical Society.] Injuries to the cranium are very frequently met by the general practitioner and ofttimes are very hard to determine