[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 ofWashington, D. C.

READ BEFORE THE MEDICAL SOCIETY OF THE DISTRICT OF COLUMBIA, JANUARY 13, 1898,

On July 25, 1897, 1 was consulted by ayoung married man, who had been re-ferred to me by one of our best physi-cians. On the upper part of the patient’schin, just below the mucous membraneof the lip, there was as perfect an exam-ple of the chancre known as Hunterianas I have ever seen. It was about thesize of a ten-cent piece, oval in shape, ofa bright red color, and was surroundedby well-marked induration. Oozing fromit was an ichorous semi-fluid substance,which had a tendency to scab over atnight.

Situated on the mucous lining of theleft 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 twoopaline mucous patches, one on eitherside of the pillars of the fauces, werebrought into view. There was also an-other mucous patch on the inner surfaceof the lower lip, over the frenum. Thesubmaxillary glands were indurated, andso were the epitrochlear. Upon disrob-ing him, I beheld extending all over hisbody the erythematous blush, which isthe first manifestation of constitutionalsyphilis. There was no lesion on the or-gans of generation or adenitis in the in-guinal regions.

He first noticed the pimple-like soresabout six weeks before consulting me.He had seen a most prominent Philadel-phia physician, who emphatically statedthat he would risk his professional repu-tation on the lesions being simply ring-worms. The patient was in the habit ofbeing shaved in what are supposed to befirst-class barber establishments. I have

no doubt at all but that he acquired syphi-lis in one of them, either from the razoror more probably from the fingers of thebarber.

Treatment was commenced by the in-unction method. One drachm of mercu-rial ointment was rubbed daily for halfan hour over the patient’s back, either bymyself or my associate, Dr. James T. Ar-wine. On the 10th of August I left thecity for my summer vacation of sixweeks’ duration. Before my departure Itaught 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 wasaway from home traveling his wife hadcarried out the treatment. I found notrace of the initial lesion in the nostril.On the site of the location of the chancreof the chin there was simply a pin-pointhyperemic spot. It is hardly necessaryto state that the inunctions were appliedby hands that were protected with rubbergloves.

The accompanying photograph waskindly taken for us by a young medicalstudent, son of Dr. Francis B. Bishop.

In acknowledgment of an article whichI wrote for the Journal of Cutaneous andGenito-Urinary Diseases, May, 1897(“Non-Venereal Chancre of the UpperLip”), my friend, Dr. William Judkins ofCincinnati, sent me a reprint of an ar-ticle written by himself for the same jour-nal December, 1893, entitled “OddMethods of Syphilitic Inoculation.” Hereported the case of a patient who had asuspicious sore on his scalp. I take theliberty of quoting the following from Dr.

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Judkins’s paper: “Inquiry brought outthe fact that the patient the day after theNovember election (he having celebratedthat event quite extensively) spent themajor part of the time in a Turkish bath.Later in the day he visited, as he sup-posed, a first-class barber, where he hadhis hair cut with what is known as‘clippers.’ He stated that he rememberedthe barber ‘jabbing him at about thepoint of soreness, but, from his condi-tion, gave it no special attention.

“From the general appearance of thesore at this visit, and as I was loathe tobelieve it was syphilitic, but subsequentevents have proven such to be the case,a guarded prognosis was given. At thispoint mention might be made of anothercase that came under my care, late in theattack, some nine years ago, which wasinoculated through the hands of a barberwith papular eruption of the palms. Thelesion in this case was located on the eye-brow. The case was under treatmentsome three years, and as twice that lengthof time has elapsed since his discharge,and no symptoms calling for treatmenthave been seen, or any indication of con-stitutional trouble in two children bornin 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 casescould be expected. For a week or twohe is quite regular in the attention hegives himself, until he feels better, when,becoming negligent regarding his wel-fare, he indulges his appetite, and conse-quently relapses. I report this case notso much from its novelty as to the modeof the introduction of the poison, but toadd another case to the few on recordgoing to prove the scalp is not proofagainst infection, as Ricord at one timeheld, but who acknowledged his error be-fore his death. We, as sanitarians, shouldwarn our patients against the use of thisvillainous instrument that is daily in thehands of the barber.”

In this connection it is interesting tonote “that the government of the Repub-lic of Colombia has, in view of the pos-sibility of contagious diseases, such asringworm, favus and syphilis, being trans-mitted by combs, brushes, etc., passed

an enactment making it compulsory forall barbers and hairdressers to keep theinstruments of their art clean, and to dis-infect them every time they have beenused. A notice to this effect is to beposted up in all tonsorial establishments.”

Professor Fleischer, in the Lancet, re-ported a case occurring in his practice ofa man who contracted syphilis from aninfected razor in one of the best hair-dressing establishments in Kief. Thelocal medical society thereupon decidedto call the attention of the sanitary au-thority to the subject in the hope that itwould make regulations to obviate a rep-etition of such an occurrence. Anothercase of the same kind has also been pub-lished lately. It was of a soldier who hadbeen infected with a primary sore of thechin from being shaved in a public shav-ing establishment in Tiflis. This casewas shown to the Caucassian Society byDr. 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 mucouspatches. Despite treatment the improve-ment was slow. In July, 1895, the fatherof this young man, while using his son’srazor, cut himself on the chin. Thisslight wound became an ulcer, with in-durated border, accompanied by a pain-ful submaxillary adenitis. Well-markedsecondary symptoms developed. He wasgiven large doses of the protoiodide,which developed obstinate stomatitis. InMarch, 1896, there was a double iritis,which yielded to mixed treatment. Theauthor insists that this case teaches phy-sicians not to regard too lightly the pos-sibility of contagion in the second stageof syphilis.

Dr. Douglas W. Montgomery of SanFrancisco reported to the CaliforniaAcademy of Medicine, September 18,1897, the case of a young lady who hadconsulted him about a “cold sore” on thelower lip, which turned out to be an ini-tial lesion of syphilis. I quote his re-marks showing how his patient was in-oculated :

“She said that in some of the hair-dressing establishments the hairdresser.

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as a final touch, drew a moistened‘rouge stick' across the lips of her cus-tomers. This ‘rouge stick’ is a cylindercomposed of a firm, red ointment. Thefirmness necessitates a slight moisteningbefore being applied, and, disgusting torelate, this is frequently accomplished bythe hairdresser, who first puts it into herown mouth and then deftly drawing itacross the lips of her customers. Then,again, all customers are treated with thesame ‘stick,’ and my patient told me that

is not the only disease to bedreaded from the dirty instruments andhands of the average barber. Has any-one ever seen a bald Indian? Certainlyno one has ever seen the untutored red-man in a barber shop. Who ever saw anegro, unless he was a barber, that wasbald? Who ever saw a farm hand, or acowboy, or a nihilist who was bald? Per-haps they owe their flowing locks to theaversion 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 tohave her hair dressed she has noticedmany ‘chemical blondes and otherwisestrikingly dressed women.’ ”

Dr. E. Harrison Griffin of New Yorkreports the case of an actress who ac-quired syphilis by applying the samerouge to the lips that was used by an-other actress who was a victim of the dis-ease. “They both used the same rougeand applied it by the finger.”

premature baldness and who visits thebarber daily, and has his own cup andrazor and brush, and who parts his hairin the middle, until the time soon comeswhen there is no more dyeing or partingthere. One of this class told me the otherday that he visited his barber at an un-expected hour, and found the artist usinghis shaving instruments on another cus-tomer.

The micrococci of alopecia form the

4latest addition to the pathogenetic bac-teria. Malassez in 1874 was the pioneerinvestigator in searching after the causa-tive germ of seborrheic eczema. In 1884Bizzozero isolated three varieties of bac-teria taken from seborrhea scales. Theseinvestigations were corroborated byBoeck and Pekelharine.

During the same year Dr. Schlen re-ported the following in the Centralblattfur die Medicinischen Wissenschaften:Without any detectable cause, and with-out the accompaniment of any othersymptom, a male individual was attackedby alopecia, which the patient himself at-tributed to infection contracted in a hair-dressing saloon. In the region of theright temporal bone was observed a cir-cular place five to six centimeters indiameter, perfectly bald. In its centerwere noticed a few white hairs on theshiny skin, while the margin contained azone covered by epidermis scales. In thiszone the hairs appeared broken andstunted in their growth. The least pullon a hair caused its falling out, the bulbalways coming with it. On coloring, Dr.Schlen was enabled to prove the pres-ence of small, round cocci, which wereless than a millimeter in size and foundin 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 barbershop and swept the floor, and gatheredhair which fell from heads in which dand-ruff occurred plentifully, and rubbed upthe sweepings with vaseline. The com-position thus made was applied to the furof rabbits and white mice. Soon bald-ness made rapid progress on the parts sotreated. Vaseline alone produced noeffect.

In 1891 Unna found the spores of Ma-lassez in swarms in pityriasis.

In the Annales de Dermatologic et deSyphilologie, March, 1897, M. Sabouraudpublished the results of his bacteriologi-cal researches as to the cause of baldness.I will quote his conclusions;

“1. The specific microbacillus of se-borrhea oleosa, when it gains access to

one of the pilo-sebaceous follicles, pro-duces within it four constant results; a,Hypersecretion of sebum; b, hypertrophyof the sebaceous gland; c, progressiveatrophy of the papilla; d, death of the hair.These phenomena result from seborrheicinfection either of the so-called smoothparts of the skin or of the hairy areas.

“2. In the hairy scalp this infectionchooses as its favorite site the vertex, andthe depilatory effect of the seborrheaproduces the baldness. Ordinary bald-ness is, therefore, nothing else than se-borrhea oleosa of the vertex, which hasassumed a chronic form.

“Seborrheic infection is not only indis-pensable to the production of baldness,but this infection continues as an intense,pure and permanent condition even whenbaldness exists; therefore it is a perfectlywell characterized disease due to a spe-cific micro-organism.” The microbacil-lus is the constant microbian expressionof the affection.

Tinea sycosis is generally known as thebarber’s itch, for the reason that it is sooften a token of remembrance from thehands of a barber. It is a ringworm ofthe beard. The fungus is the same as thatoccurring in tinea tonsurans and tineacircinata; the tricophytosis barbae.

“HI blows the wind that profits no-body” said Shakespeare in “King HenryVI” (Part HI, Act 2, Scene 5). Baldnesscreates a demand for false hair, and theperuke and wigmaker and esthetic hair-dressers flourish in the land. Their pa-trons would not feel so self-satisfied ifthey only knew where their hirsute adorn-ments sometimes come from. The Eng-lish consul at Canton says that 80,000pounds of human hair were exportedfrom that city in 1891, and that it camemainly from those who died of con-tagious diseases, mendicants and crimi-nals.

It has been reported that a diseasecalled plica polonica has made its appear-ance in London, brought over by thetraders in false hair from Poland. Thehair 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 thatfound in ringworm.