Scalp (trophy)

“ On account of the free arterial anastomosis in the deeper layers of the integument, large flaps of scalp will survive when replaced, even if badly bruised and torn, and it is never advisable to cut away any un-infected portion of the scalp, however badly it may be lacerated or however narrow may be the pedicle which unites it to the head. ”

“ A short time after painting the hairs of the head black, a fashion now more common in France than at the period in which they powdered them, there is often experienced pains in the head and a swelling of the hairy scalp, though the skin has been in no way concerned, has not been pulled, and the hair only has been affected. ”

“ Scald Head is totally unlike the preceding disease: brown-colored scabs appear on the crown of the head, which discharge a glutinous matter, and unite the hairs, so as to prevent their being separated with a comb: these scabs continue to spread until they occupy the whole of the scalp. ”

“ In many unpromising cases of lacerated scalp, when a great part of the cranium has been exposed, and partially deprived of its periosteum, a rapid cure has taken place without the formation of much matter. The detached scalp, though much torn and bruised, ought not at first to be removed, it being more prudent to leave nature to determine how much must be destroyed. After the sloughs, if any, have separated, and granulation has commenced, the loss of substance is rapidly repaired in this region, more especially when the patient is young and healthy. ”

“ When an American Indian slays an enemy, he removes the scalp as a proof of his victory. The scalp is a piece of skin, with the hair attached to it, taken from the very crown of the head, so as to exhibit that portion of the skin where the hair radiates from a centre. ”

“ When a portion of bone is as it were sliced off with the scalp and adheres to it firmly, the scalp and bone should be reapplied; and the cure will often be effected without difficulty. When the portion of bone cut off and hanging to the scalp, which is turned down, has but little adherence, it should be removed. ”

“ The scalp is well supplied with blood, but it is not given much exercise. The tendency is for the blood stream to become sluggish, deposits gradually forming in the walls of the blood-vessels, which make them less elastic and decrease the size of the lumen. The result is less food for the hair roots and food of inferior quality. ”

“ The scalp you are to make is without a patent 168parting, but with a crown either of silk or skin. If any parting is to be made on this scalp, it should not be clearly defined, but whether it be formed with weft or “knotted,” the hair ought to be set closer than it is elsewhere. This, however, will be alluded to later on. Should a rather narrow scalp be all that is required, and the wearer’s hair thick enough, a parting could well be made upon the head, some of the natural hair being trained to comb over and allowed to mingle with the hair of the scalp. ”

“ The skin of your scalp is shedding tiny thin scales all day and all night, just as the rest of your skin is doing. Fortunately, 19your hair is growing from roots under the skin much in the same way as blades of grass grow from their roots; and, as it grows, it pushes up these scales from the surface of the scalp to where you can readily reach them with a good bristle brush. If they are not well brushed out, the dust and smoke from the air will mix with them, and the germs in the dust and smoke will breed in the mixture, and you will soon have “scurf” or dandruff on your head. ”

“ The erroneous idea prevails, that the skin which holds the hair follicles and the delicate secretory organs of the scalp must be kept as 'clean,' so to speak, as the face or hands; consequently young men patronize barbers or hairdressers, and once or twice a week they have what is called a 'shampoo' operation performed. This consists in a thorough scouring of the hair and scalp with dilute ammonia, water, and soap, so that a heavy 'lather' is produced, and the glandular secretions, which are the natural protection of the hair, and promotive of its growth, are saponified and removed. ”

“ However, most men do object to baldness, which can be prevented in nearly every case. To produce hair on a polished pate is a different proposition. It is indeed difficult. If you will look at a picture of the circulation of the blood in the scalp, you will notice that the arteries supplying it come from above the eye sockets in front, from before and behind the ears on the sides, and from the nape of the neck in the rear. They spread out and become smaller and smaller as they travel toward the top of the head, and especially toward the back. ”

“ The scalping is an operation not calculated of itself to take life, as it only removes the skin, without injuring the bone of the head; and necessarily, to be a genuine scalp, must contain and show the crown or centre of the head; that part of the skin which lies directly over what the phrenologists call “self-esteem,” where the hair divides and radiates from the centre ”

“ When of the ivory type and growing from the flat bones of the skull, but so situated that no marked deformity or pressure symptoms are likely to ensue, they may be left alone, but when definitely progressive and situated in accessible regions, they should be removed. Their exposure is carried out by the formation of a suitable scalp-flap—designed as far as possible so as to be subsequently hidden by the hairy scalp—and the exostosis removed by the application to its base of a Gigli saw. ”

“ In some, an appearance takes place which has not hitherto been noticed by authors. This is a relaxation of the integuments of the [Pg 83] cranium, by which they may be wrinkled, or rather gathered up by the hand to a considerable degree. It is generally most remarkable on the posterior part of the scalp; as far as my enquiries have reached, it does not take place in the beginning of the disease, but after a raving paroxysm of some continuance. ”

“ Under the more favourable conditions an attempt may be made at the extirpation of the growth. The operation should be rendered as bloodless as possible, for which purpose it is essential that the scalp-tourniquet should be applied as a preliminary measure. A scalp-flap is then framed, suited to requirements, and allowing of free exposure of the tumour and surrounding healthy tissues. The skull is then trephined to one side of the growth, and the disk removed. ”

“ Diagnosis.—When the instrument impinges on the head obliquely, after piercing the scalp it may pass for some distance under it before perforating the skull, so that on its withdrawal a valvular wound is left, and at first sight it appears that only the scalp is involved. Sometimes a foreign body left in the gap so fills it up that it is difficult to detect the fracture with a probe or even with the finger. In all doubtful cases the scalp wound should be sufficiently enlarged to exclude such errors. ”

“ When associated with symptoms of brain-compression, exploration is almost always advisable, the scalp-tourniquet being applied and the injured region exposed by a suitable scalp-flap. Depressed bone is elevated, or the trephine applied so as to fully expose the underlying dura mater. A bulging, non-pulsatile, and plum-coloured membrane points to the existence of a subdural hæmatoma. The membrane is then incised and the clot evacuated. Whenever possible the dura mater should be sewn up and the scalp-flap replaced without drainage. ”

“ From infection of such wounds of the scalp abscess or diffuse cellulitis of the scalp may develop as well as erysipelas. The constitutional symptoms in such a case may be marked or even severe, but the prognosis is favorable. In very rare cases necrosis of the skull may result or the inflammation may even extend to the brain. These incised and lacerated wounds of the scalp are usually accidental or inflicted by another; they are rarely self-inflicted. Contusions and contused wounds are the most common forms of injury to the head. ”

“ They never examined into that, and yet it is highly probable that from the condition that body was in, from its position, with the head being down and the feet up, and from the evidence of the men who told you that when they attempted to pull the body up it slipped back, it is physically possible that those very wounds on the scalp might have been made while pulling the body out. ”

“ In the event of osseous deficiency the scalp is usually more or less adherent to underlying structures, and the gap in the skull filled with dense fibrous tissue, which is itself adherent to the membranes of the brain and perhaps to the brain itself. ”

“ The Care of the Hair.—There is never any danger of shampooing the healthy scalp too frequently. The oil in the scalp is not removed by washing, but is, on the contrary, always increased through the improvement in the circulation. Where there is much dandruff, or if the hair has begun to fall out prematurely, owing to long neglect or following an illness, it is well to begin by washing the hair two or three times a week, and then gradually increase the interval to every two or three weeks. ”

“ The granular structure of the hairy scalp is opposed to the occurrence of the slit forms of exit, hence the openings were usually irregularly rounded. Any increase of size in the exit wound in the soft parts due to the passage of bone fragments with the bullet, was equalised in that of entry by the fact that the latter, as supported by a hard substratum, was usually larger than those met with in situations where the skin covers soft parts alone. ”

“ The bristles of the brush must be stiff enough to warm, but not to scratch, the scalp. Brushing and massage remove any loose hairs that are ready to fall, but they will soon be replaced by new vigorous ones.
Combing simply disentangles the hair. The teeth of the comb must be far apart and have rounded ends. In no case should a fine-toothed comb be used. It tears out the hair, and often causes an irritation of the scalp which leads to disease. ”

“ Atrophy of the scalp, baldness, and even local paralysis, have sometimes, though rarely, been caused by them.
When the normal sulphur of the hair is absent, or deficient, the preceding substances fail to darken the hair. In this case the desired effect may often be produced by also moistening the head, say twice a week, with water, to which a little sulphuret of potassium or hydrosulphuret of ammonia has been added. ”

“ Symptoms of Seborrheic Eczema.—In the dry form of the disease, in which there is a scaling of the scalp, the hair is dry and unmanageable, the head itches, especially when the patient sits under a light or becomes overheated. There is a more or less constant falling of the scales upon the clothes. The scalp looks pale, and will be found covered with fine grayish or yellowish, readily detachable scales. Sometimes there is more or less redness of the scalp. ”

“ TREATMENT.—It is a curable disease, but in the majority of cases proves obstinate. The rapidity of the cure depends in a great measure upon the removal of the predisposing causes. In seborrhoea of the scalp, if the process be allowed to continue through a long period, more or less marked permanent alopecia, especially of the vertex, may result. Even in unfavorable cases, however, much may be done toward promoting a regrowth of hair. ”

“ Vascular changes in the scalp due to the same cause, the exaggeration of impulses during their transit of the gray matter of the hind-brain, making believe that the scalp is injured and needs more blood, react upon the nerve-endings increasing the illusion of injury. The pain is no illusion. It is impossible to decide whether vascular changes are the first effect of vagal agitation and therefore the immediate cause of pain or whether they are merely subsidiary results of the exaggeration of sensory impulses from the scalp. ”

“ For there are rather emphatic directions not to conclude because the scalp is unwounded that there can be no fracture of the skull. Where nothing can be felt care must be exercised in getting the history of the case. ”

“ The eruption in this stage shows a marked tendency to occur in elongated, spindle-shaped, or band-like patches. At the margin of these squamous patches numerous isolated, white-tipped papular lesions may frequently be seen. The scalp is generally affected when the disease has existed for some time, and the face often presents an appearance suggestive of ichthyosis. ”

“ If the disease had existed for any length of time, it is, of course, easily detected by the loss of hair and changed character of the individual hairs and the scalp, but in cases of recent origin detection is often difficult because of shrewd efforts at concealment. The immigrants are often prepared for inspection, the tell-tale yellow crusts carefully removed and the scalp cleansed. ”

“ The palms of the hands and the soles of the feet are not attacked. On the scalp becoming affected the hair turns white and thin, and ultimately falls out. When fully developed, the disease produces a very grotesque appearance. It is probable that the white patches in a proportion of cases are not epiphytic, as they neither itch nor desquamate; very likely they are ordinary leucodermia, possibly brought about through disturbance of the natural pigmentation by a parasite which had subsequently died out. ”

“ Sometimes the posterior primary division of the third cervical nerve reaches the scalp still nearer the middle line behind.
The third layer of the scalp or epicranium is formed by the two fleshy bellies of the occipito-frontal is muscle and the fattened tendon or aponeurosis between them. Of these two bellies the anterior (frontalis) is the larger, and, when it acts, throws the skin of the forehead into those transverse puckers which are characteristic of a puzzled frame of mind. ”