The Removal of Superfluous Hair by Electrolysis BY FRED. J. LEVISEUR, M.D. DERMATOLOGIST TO THE RANDALL'S ISLAND HOSPITALS AND ST. BARTHOLO- MEW* S DISPENSARY Reprinted from the Medical Record, February 20. 1892 NEW YORK TROW DIRECTORY, PRINTING AND BOOKBINDING CO. 201-213 East Twelfth Street 1892 The Removal of Superfluous Hair by Electrolysis BY FRED. J. LEVISEUR, M.D. DERMATOLOGIST TO THE RANDALL'S ISLAND HOSPITALS AND ST. BARTHOLO- MEW'S DISPENSARY Reprinted, from the Medical Record, February 20, 1892 NEW YORK TROW DIRECTORY, PRINTING AND BOOKBINDING CO. 201-213 East Twelfth Street 1892 THE REMOVAL OF SUPERFLUOUS HAIR BY ELECTROLYSIS? We are called upon to perform the operation of perma- nently removing superfluous hair not always in order to satisfy mere vanity or the common desire to please, but very often in order to remedy an evil which, trifling as it may appear, is a constant source of serious inconvenience, even great mental suffering. The young girl who deeply grieves at seeing the bright prospect of her life sadly spoiled by the appearance of a disfiguring hirsute growth on her face, and the middle-aged lady who, being affected in a like manner, goes about heavily veiled, avoids all social intercourse, and becomes more and more irritable, morose, and despondent; these are types of easy recog- nition and rather frequent occurrence. These unfortu- nate persons generally fall an easy prey to quacks or the unscrupulous venders of some magic depilatory. Let me state from the outset that as yet I have not met with a single case which had not been made worse by some previous treatment or interference at the hand of the pa- tient. A pair of scissors is usually the first handy instru- ment which is used to cut off the offending hairs. Then perhaps the hairs are rubbed off with a pumice-stone-like substance which is in the market for this purpose. The depilating forceps may come next, or if the lady is of a more energetic disposition she may apply a resinous plaster in the manner of the French " calotte." After this plaster 1 Read before the Metropolitan Medical Society. 4 is made to adhere firmly to the skin it is pulled off, re- moving all the hairs, which come away with the plaster very much in the manner as did Hercules's skin with Nessus's shirt. The various caustic depilatories remain now for a trial. They generally contain one of the fol- lowing substances : sulphuret of barium, sulphide of so- dium, sulphide of lime, and tersulphuret of arsenic or orpiment. While it may be admitted that these remedies in exceptional cases reach the bottom of the hair follicles and thus effect a cure, it must be stated that in the ma jority of cases they do more harm than good. The hairs reappear, and in addition the epidermis becomes rough, red, and irritable. After all these efforts have proved in vain some of these women will resort to the razor and be- come proficient in the masculine art of shaving. Ce liest que .le premier pas qui cofite. If a lady is once accus- tomed to shave herself she will, as a rule, become recon- ciled to her fate and not apply for further treatment. The removal of superfluous hair by electrolysis is the only operation which is at all certain of success. It was first used by Michell, of St. Louis, and afterward by Hardaway, Piffard, and other American physicians. The mode of procedure, as is well known, is as follows : The patient being placed opposite a good light, with the head resting in a comfortable position (I use a barber's chair for this purpose), a fine needle or a jeweller's brooch, connected by means of a suitable holder with the negative pole of a galvanic battery, is introduced down to the bottom of the hair follicle by keeping the needle parallel with the direc- tion of the hair. The circuit is then completed by the patient grasping the positive pole tightly. The chemical action of the caustic alkali which is developed at the negative pole destroys the hair papilla. Besides this there are, I believe, certain indications which point to the fact that a peculiar retrogressive change begun under the electrolytic current is kept up for some time after the latter has been discontinued.1 All this is very simple 1 Dr. G. H. Rohe, Medical Record, September, 1888. 5 from a theoretical stand-point; but the practical success of the operation depends upon numerous little details to which it is absolutely necessary to pay close attention. In the first instance, the armamentarium should be com- plete. It consists of a galvanic battery, a milliampere- metre, a rheostat, a needle-holder, a sponge-electrode, some fine needles or jeweller's brooches, ar.d a depilating forceps. Any ordinary battery will do the work, but ex- perience "has taught me that twelve to fifteen simple Leclanch6 cells are superior to all the more complicated apparatus. Never should the operation be attempted without a milliamperemetre. In an article on electrolysis, published in Dr. Unna's Monatshefte fur praktische Dermatologic, vol. x., No. 7, I have pointed out this fact, and never since have I let pass an occasion to emphasize it again. As regards the needle- holder, the one which I devised some years ago has proven its general utility. It is constructed so that the needle can be inserted at an angle, it has no separate screw nor clasp, is light, and enables the operator to feel his way, so to speak, into the follicle. Needle-holders which have an attachment for closing and interrupting the current should not be used, since they cause sudden shocks and produce very unpleasant sensations. It is ad- visable to let the patient herself close and interrupt the current by tightly grasping the electrode attached to the positive pole. Before beginning to operate we connect both poles-sponge and needle-and then by aid of the rheostat (I use a carbon water rheostat) make the mill- iamperemetre register 10 milliamperes. To this is after- ward added the resistance which the body of the patient offers. This amounts, with our arrangement, to about 8 to 9 milliamperes. We consequently use a current of 1 to 2 milliamperes. During the operation all the cells of the battery are at work and the internal resistance, i.e., the resistance in the battery, about equals the external resistance, i.e., the resistance offered by the rheostat, the electrodes, the body, etc. This arrangement guarantees 6 the best results. If the needle is introduced into the hair follicle and the current closed, twenty seconds will suffice to destroy the hair, which will be found to be per- fectly loose, and which has to be removed at once by forceps. During the electrolytic action small air-bubbles and minute quantities of whitish sebum will often appear at the orifices of the hair follicles. 1 do not think that these simple effects of the chemical action of the electrical current have any special significance. The operation is uncomfortable, it is true, but there are few patients who declare it to be seriously painful or unbearable. A twenty per cent, salve of cocaine in lanolin, thoroughly rubbed into the skin, enables even very sensitive patients to un- dergo the operation with ease. I am well aware of the fact that the cataphoric action of the electrical current has been used to render the skin insensible. My experi- ence in this regard is rather limited. An accident which has lately been reported has strength- ened the prejudice which I have against making pass into the circulation of the blood a solution of cocaine without knowledge of its mode of absorption and without means of an accurate doseage. How many hairs can be removed in one sitting, and how many hairs will come back afterward ? These questions are constantly asked. I have made it a rule to remove as many hairs as possible in one prolonged sitting, often from fifty to a hundred. These sittings are repeated in intervals of a week to ten days. Provided the operation is done with care and skill no more than five to ten per cent, of the hairs will come back Immediately after the operation the pa- tient's face is washed with hot water, to which some alcohol may be added. The redness and wheals which the opera- tion is likely to produce generally subside in a few hours, but is followed by an inflammatory process in and around the hair follicles. This inflammation lasts a day or two, in some cases even longer. In one of my cases small superficial abscesses appeared the third day after the operation. In order to avoid all 7 such unpleasant complications I prescribe the following salve: IJ. Lanolini, Ungt. aquae rosarafi § ss. Hydrarg. bichlor, corros gr. j. This is to be applied at night and washed off in the morn- ing, and has proved to be an excellent antiseptic measure. It is best only to extract the coarser and more deep- seated hair and to leave the lanugo hairs alone. If these directions are followed no perceptible scars will result and an absolute cure will be effected. Some time ago there came under my observation the exceptional case of a lady on whose chin a keloid was pro- duced by the electrolytical treatment for the removal of superfluous hair. The lady told me the amusing fact that another physician had tried to remove this keloid by electrolysis. Let me touch, in conclusion, upon the very interesting question of the etiology of hirsuties. Virchow, Ecker, Bartels, Waldeyer, Unna, and others have advanced vari- ous well-known theories. Dr. Geyl, of Dordrecht, has tried to show of late, in a very clear and impartial man- ner, that universal as well as circumscript hirsuties is the result of the persistence and continued growth of a part or the whole of the foetal or primitive hair, and that this deformity, as it were, is a pure atavism in Darwin's sense. As regards facial hirsuties, in women particularly, Dr. Geyl claims that it usually makes its first appearance about the time of puberty or of the menopause, both periods when all the cells of the human organism are in a peculiar state of activity. A so-called sexual hirsuties (around the pubes and axillae) is, in the majority of cases, combined with the facial hirsuties. The beard which grows on a woman's face is equivalent to the beard of a man only in a second- ary manner; both have their origin in the hairy condi- tion of the face of our primeval ancestors. These theo- ries are in so far of practical interest, as they confirm the 8 opinion that an ordinary irritation produced, for example, by mercurial ointment, moist dressings, a blister, etc., will not cause a true hirsuties. Lanugo hairs may under these conditions grow to an extraordinary length, but will not be transformed into the coarse and deep-seated hairs with which we have to deal. On the other hand, if a person has a slight degree of general or circumscript hirsu- ties, or if there exists a hereditary tendency, any local ir- ritation is liable to stimulate the hair into vigorous growth. Electrolysis itself decidedly acts as an irritating measure, and if we remove only a small number of hairs at a sit- ting, we will make very slow progress, if at all, and our patient will be sadly disappointed. Hoffman Arms, Madison Avenue and Fiftv-ninth Street.