[Reprinted from Maryland Medical Journal, January 29, 1898.] DANGERS OF THE BARBER SHOP. Henry Alfred Robbins, M.D., Washington, D. C. President of the South Washington Free Dispensary. President of the Medical Journal Club of Washington, D. C. READ BEFORE THE MEDICAL SOCIETY OF THE DISTRICT OF COLUMBIA, JANUARY 13, 1898, On July 25, 1897,1 was consulted by a young married man, who had been re- ferred to me by one of our best physi- cians. On the upper part of the patient’s chin, just below the mucous membrane of the lip, there was as perfect an exam- ple of the chancre known as Hunterian as I have ever seen. It was about the size of a ten-cent piece, oval in shape, of a bright red color, and was surrounded by well-marked induration. Oozing from it was an ichorous semi-fluid substance, which had a tendency to scab over at night. no doubt at all but that he acquired syphi- lis in one of them, either from the razor or more probably from the fingers of the barber. Treatment was commenced by the in- unction method. One drachm of mercu- rial ointment was rubbed daily for half an hour over the patient’s back, either by myself or my associate, Dr. James T. Ar- wine. On the 10th of August I left the city for my summer vacation of six weeks’ duration. Before my departure I taught the wife of the patient how to ap- ply the inunction. I did not hear any- thing of him until the loth day of No- vember. He told me that with the excep- tion of two or three nights when he was away from home traveling his wife had carried out the treatment. I found no trace of the initial lesion in the nostril. On the site of the location of the chancre of the chin there was simply a pin-point hyperemic spot. It is hardly necessary to state that the inunctions were applied by hands that were protected with rubber gloves. The accompanying photograph was kindly taken for us by a young medical student, son of Dr. Francis B. Bishop. In acknowledgment of an article which I wrote for the Journal of Cutaneous and Genito-U rinary Diseases, May, 1897 (“Non-Venereal Chancre of the Upper Lip”), my friend, Dr. William Judkins of Cincinnati, sent me a reprint of an ar- ticle written by himself for the same jour- nal December, 1893, entitled “Odd Methods of Syphilitic Inoculation.” He reported the case of a patient who had a suspicious sore on his scalp. I take the liberty of quoting the following from Dr. Situated on the mucous lining of the left nostril, over the lower lateral carti- lage, there was another indurated sore, in fact another initial lesion of syphilis; upon opening the patient’s mouth two opaline mucous patches, one on either side of the pillars of the fauces, were brought into view. There was also an- other mucous patch on the inner surface of the lower lip, over the frenum. The submaxillary glands were indurated, and so were the epitrochlear. Upon disrob- ing him, I beheld extending all over his body the erythematous blush, which is the first manifestation of constitutional syphilis. There was no lesion on the or- gans of generation or adenitis in the in- guinal regions. He first noticed the pimple-like sores about six weeks before consulting me. He had seen a most prominent Philadel- phia physician, who emphatically stated that he would risk his professional repu- tation on the lesions being simply ring- worms. The patient was in the habit of being shaved in what are supposed to be first-class barber establishments. I have 2 Judkins’s paper: “Inquiry brought out the fact that the patient the day after the November election (he having celebrated that event quite extensively) spent the major part of the time in a Turkish bath. Later in the day he visited, as he sup- posed, a first-class barber, where he had his hair cut with what is known as ‘clippers.’ He stated that he remembered the barber ‘jabbing him at about the point of soreness, but, from his condi- tion, gave it no special attention. “From the general appearance of the sore at this visit, and as I was loathe to believe it was syphilitic, but subsequent events have proven such to be the case, a guarded prognosis was given. At this point mention might be made of another case that came under my care, late in the attack, some nine years ago, which was inoculated through the hands of a barber with papular eruption of the palms. The lesion in this case was located on the eye- brow. The case was under treatment some three years, and as twice that length of time has elapsed since his discharge, and no symptoms calling for treatment have been seen, or any indication of con- stitutional trouble in two children born in the last five years, I feel safe in pro- nouncing him cured. “The first case, that of the scalp, is pro- gressing as well as this class of cases could be expected. For a week or two he is quite regular in the attention he gives himself, until he feels better, when, becoming negligent regarding his wel- fare, he indulges his appetite, and conse- quently relapses. I report this case not so much from its novelty as to the mode of the introduction of the poison, but to add another case to the few on record going to prove the scalp is not proof against infection, as Ricord at one time held, but who acknowledged his error be- fore his death. We, as sanitarians, should warn our patients against the use of this villainous instrument that is daily in the hands of the barber.” an enactment making it compulsory for all barbers and hairdressers to keep the instruments of their art clean, and to dis- infect them every time they have been used. A notice to this effect is to be posted up in all tonsorial establishments.” Professor Fleischer, in the Lancet, re- ported a case occurring in his practice of a man who contracted syphilis from an infected razor in one of the best hair- dressing establishments in Kief. The local medical society thereupon decided to call the attention of the sanitary au- thority to the subject in the hope that it would make regulations to obviate a rep- etition of such an occurrence. Another case of the same kind has also been pub- lished lately. It was of a soldier who had been infected with a primary sore of the chin from being shaved in a public shav- ing establishment in Tiflis. This case was shown to the Caucassian Society by Dr. Chudnooski. Catrin, in La Presse Medicale, June 20, 1896, reports the case of a young man aged twenty-seven who contracted syph- ilis in September, 1894. The initial le- sion was followed by roseola and mucous patches. Despite treatment the improve- ment was slow. In July, 1895, the father of this young man, while using his son’s razor, cut himself on the chin. This slight wound became an ulcer, with in- durated border, accompanied by a pain- ful submaxillary adenitis. Well-marked secondary symptoms developed. He was given large doses of the protoiodide, which developed obstinate stomatitis. In March, 1896, there was a double iritis, which yielded to mixed treatment. The author insists that this case teaches phy- sicians not to regard too lightly the pos- sibility of contagion in the second stage of syphilis. Dr. Douglas W. Montgomery of San Francisco reported to the California Academy of Medicine, September 18, 1897, the case of a young lady who had consulted him about a “cold sore” on the lower lip, which turned out to be an ini- tial lesion of syphilis. I quote his re- marks showing how his patient was in- oculated : In this connection it is interesting to note “that the government of the Repub- lic of Colombia has, in view of the pos- sibility of contagious diseases, such as ringworm, favus and syphilis, being trans- mitted by combs, brushes, etc., passed “She said that in some of the hair- dressing establishments the hairdresser. 3 as a final touch, drew a moistened ‘rouge stick' across the lips of her cus- tomers. This ‘rouge stick’ is a cylinder composed of a firm, red ointment. The firmness necessitates a slight moistening before being applied, and, disgusting to relate, this is frequently accomplished by the hairdresser, who first puts it into her own mouth and then deftly drawing it across the lips of her customers. Then, again, all customers are treated with the same ‘stick,’ and my patient told me that is not the only disease to be dreaded from the dirty instruments and hands of the average barber. Has any- one ever seen a bald Indian? Certainly no one has ever seen the untutored red- man in a barber shop. Who ever saw a negro, unless he was a barber, that was bald? Who ever saw a farm hand, or a cowboy, or a nihilist who was bald? Per- haps they owe their flowing locks to the aversion they have to tonsorial artists. It is the exquisitely clean man who has A CASE OF BARBEB SHOP INFECTION. in the shop where she usually went to have her hair dressed she has noticed many ‘chemical blondes and otherwise strikingly dressed women.’ ” Dr. E. Harrison Griffin of New York reports the case of an actress who ac- quired syphilis by applying the same rouge to the lips that was used by an- other actress who was a victim of the dis- ease. “They both used the same rouge and applied it by the finger.” premature baldness and who visits the barber daily, and has his own cup and razor and brush, and who parts his hair in the middle, until the time soon comes when there is no more dyeing or parting there. One of this class told me the other day that he visited his barber at an un- expected hour, and found the artist using his shaving instruments on another cus- tomer. The micrococci of alopecia form the 4 latest addition to the pathogenetic bac- teria. Malassez in 1874 was the pioneer investigator in searching after the causa- tive germ of seborrheic eczema. In 1884 Bizzozero isolated three varieties of bac- teria taken from seborrhea scales. These investigations were corroborated by Boeck and Pekelharine. one of the pilo-sebaceous follicles, pro- duces within it four constant results; a, Hypersecretion of sebum; b, hypertrophy of the sebaceous gland; c, progressive atrophy of the papilla; d, death of the hair. These phenomena result from seborrheic infection either of the so-called smooth parts of the skin or of the hairy areas. “2. In the hairy scalp this infection chooses as its favorite site the vertex, and the depilatory effect of the seborrhea produces the baldness. Ordinary bald- ness is, therefore, nothing else than se- borrhea oleosa of the vertex, which has assumed a chronic form. During the same year Dr. Schlen re- ported the following in the Centralblatt fur die Medicinischen Wissenschaften: Without any detectable cause, and with- out the accompaniment of any other symptom, a male individual was attacked by alopecia, which the patient himself at- tributed to infection contracted in a hair- dressing saloon. In the region of the right temporal bone was observed a cir- cular place five to six centimeters in diameter, perfectly bald. In its center were noticed a few white hairs on the shiny skin, while the margin contained a zone covered by epidermis scales. In this zone the hairs appeared broken and stunted in their growth. The least pull on a hair caused its falling out, the bulb always coming with it. On coloring, Dr. Schlen was enabled to prove the pres- ence of small, round cocci, which were less than a millimeter in size and found in large quantities surrounding the hair- cells of the epidermis and sprinkled be- tween the sheaths of the roots of the hair. A mild solution of corrosive sublimate (1 to 3000) destroyed the cocci and es- tablished the regrowth of the hair. Dr. Lassar of Berlin visited a barber shop and swept the floor, and gathered hair which fell from heads in which dand- ruff occurred plentifully, and rubbed up the sweepings with vaseline. The com- position thus made was applied to the fur of rabbits and white mice. Soon bald- ness made rapid progress on the parts so treated. Vaseline alone produced no effect. “Seborrheic infection is not only indis- pensable to the production of baldness, but this infection continues as an intense, pure and permanent condition even when baldness exists; therefore it is a perfectly well characterized disease due to a spe- cific micro-organism.” The microbacil- lus is the constant microbian expression of the affection. Tinea sycosis is generally known as the barber’s itch, for the reason that it is so often a token of remembrance from the hands of a barber. It is a ringworm of the beard. The fungus is the same as that occurring in tinea tonsurans and tinea circinata; the tricophytosis barbae. “HI blows the wind that profits no- body” said Shakespeare in “King Henry VI” (Part HI, Act 2, Scene 5). Baldness creates a demand for false hair, and the peruke and wigmaker and esthetic hair- dressers flourish in the land. Their pa- trons would not feel so self-satisfied if they only knew where their hirsute adorn- ments sometimes come from. The Eng- lish consul at Canton says that 80,000 pounds of human hair were exported from that city in 1891, and that it came mainly from those who died of con- tagious diseases, mendicants and crimi- nals. In 1891 Unna found the spores of Ma- lassez in swarms in pityriasis. In the Annales de Dermatologic et de Syphilologie, March, 1897, M. Sabouraud published the results of his bacteriologi- cal researches as to the cause of baldness. It has been reported that a disease called plica polonica has made its appear- ance in London, brought over by the traders in false hair from Poland. The hair conglomerates into thick masses. The odor from these matted plicas is ex- tremely disgusting and the itching ter- rific. The fungus is the same as that found in ringworm. I will quote his conclusions; “1. The specific microbacillus of se- borrhea oleosa, when it gains access to