A Doctor's Journal
Falling Hair
By MILES HOWARD A READER writes to ask—'Why not a few facts on simple things, like hair, teeth, and the like? They matter.' I entirely agree, and hasten to make good the omission.
The growth and fall of hair— enough (you might think) to fill a book or two : but—perhaps because it is a simple thing—not all that much is known. The disorder alopecia—falling of the hair in patches —is often cited as one of the stress disorders (it is on my list) and certainly no assured 'organic' cause is known. The fall begins after a shock, or sudden upheaval, and the cause-and-effect sequence appears plain : yet when one tries to make use of the knowledge to encourage hair to grow again, the results are disappointing, com- pared with other kinds of disorder, such as the migrainous headache. Why this should be, I don't know. In a more leisurely time-pattern, the same is true of alopecia totalis—a complete dis- appearance of hair : the components of a stress- reaction are there to be seen, but therapy isn't SO easy. Alopecia is one of the zones still largely uncharted on the map of medicine. Various physical remedies have been tried for it : the ultra-violet lamp is one, and it may do good— perhaps by increasing blood-flow to the scalp, perhaps by suggestion, or both. Another, popular now, is the ointment with a cortisone derivative: I find it very hard to separate the cortisone effect from the effect of the physician's belief in a new remedy, which is transmitted to the patient. An approach 'on all fronts' is probably best : relief of tension, which has great value in other kin- dred illnesses, is, of itself, not so valuable in this one.
The 'natural' falling of hair in men between thirty and sixty—what about that? A lot of specu- lation, but little hard fact. In my evening paper I read lately a quotation from (I think) a mediteVal writer—Wash the hands often, the feet seldom, the head never.' I put this proposition to my barber, who (of course) has views 'about hair, and he replied, 'Well, sir, not very often—but never?' I felt he held this adviZe to be un- hygienic. Last year, he gave me a lotion, said to' contain hormones, to rub in, and I remember to use it now and again; since reading that quota- tion, I gave up washing my hair, and it doesn't seem any less clean, in spite of the lotion, and the London air : indeed (but how subjective this is!) it seems more vigorous. Perhaps the massage needed to get the lotion in stimulates the 'scalp arterioles? I tell myself that now I've ceased to care whether my hair falls or not—but this isn't true : 1 do care, though not as intensely as some of my younger colleagues. For a few men, loss of hair means loss of virility. Last year I went to visit a friend who runs a large enterprise in Surrey, partly to pick his brains, and partly to renew an acquaintance after a lapse of some ten years. Entering his office, I uttered the phrase we all use (though with shades of meaning)— 'How are you?', to which he replied, with some pride, 'Well, kept my hair, as you see,' Later, I found that he had been quite ill, with chest trouble, and indeed was still afflicted; trade had been up and down, and was just then down—but he had kept his hair, and that was reassuring. I suppose that baldness, partial or total, has as much meaning as the individual gives it : if it doesn't matter to him, then it won't to anyone else either. In this, of course, it is like any other 'disability': if the man with a deformity of the hand, say, is much aware of it, and keeps trying to hide his hand, and is awkward, then people will notice,: his anxiety about it is infectious, like some other types of anxiety.
Falling of hair in men is commonly held to be 'natural,' in the same way as pain at the period in women. In our society, one synonym for men- struation is 'being unwell'—as if it was 'natural' to be ill every month. Other societies have other attitudes. A term in vogue these days in North America is 'cross cultural'—my old friend Eric Wittkower has taken it up, and is (I hear) making a study of some illness in Peru—so here is one comparison between cultures: those in which the hair of the natives (male) falls out early, and those in which every man has a thick mop right up to old age. Bowler hats have been suggested as a determinant of 'wastage,' and so they may be: but a minor factor (I would say) as compared • British Medical Journal, January 10, 1959. with some more general, and as yet undiscovered,
COLLINS
biological forces. Apologies to my reader, for not providing more material: this is (as far as I know) the 'state of play' in April, 1959.
I was glad to read an admirable study of the lifting of heavy weights. Dr. Peter Davis, who is Lecturer in Anatomy at a London medical school, has tried in his paper* to answer three questions: (1) How are heavy weights lifted? (2) What part does the trunk play in lifting? and (3) What damage may be produced? As examples of (3) he cites hernia (rupture) and prolapse, 'strains' of the back and slipped disc; these can be divided into an 'extrusive' group (such as hernia), and a 'spinal' group (such as disc lesions). In the act of lifting, whether the trunk be bent or kept erect, there are (the author says) two mechanisms: the movement of the spine and its associated muscles, and the 'pneumatic' mechanism—contraction of the abdominal wall, causing the familiar grunt or gasp that Dad gives out as he takes up the suit- case. The former mechanism is the source of strain and injury to muscle, ligament and disc; and the latter, of rupture and prolapse. Conclusion : when lifting weights, it is better to bend the knees than bend the back. Memo for medical officers in industry, and indeed the family doctor too: here is one simple means of reducing the incidence of 'lifting mishaps.' Addendum (from me): is slipping of the disc (a kind of washer between the verte- brae) made more likely by a state of tension in the lifter?—since there is some evidence that frustra- tion and tension can cause absorption of fluid by the disc, and consequent swelling, so that an edge of it is more easily 'extruded' when lifting-effort is made with the back bent.
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