[Reprinted from The MEDICAL October 29, 1892.] 
TRICH 0 REXIS NODOSA A PRELIMINARY 
NOTE. 
MAZYCK P. RAVENEL, M.D., 
OF CHARLESTON, S. C. 
The generally accepted etiology of this rare and 
interesting disease of the hair-shaft has caused it to 
be described in most text-books as an atrophy of the 
hair, and some form of malnutrition is put down as 
the first cause. 
I have recently made an observation that tends to 
overthrow this belief, and points almost conclusively 
to a parasitic origin. For five years past I have 
had the opportunity of watching the clinical fea- 
tures of the disease in myself, and I have therefore 
naturally been more than usually interested in it, 
and during that time all of the commonly-advised 
remedies have been tried without benefit or effect. 
About a month ago I discovered that many of the 
hairs in my shaving-brush—probably one fourth of 
them—were affected with the disease. So soon as 
possible the brush was submitted to my teacher, Dr. 
Henry W. Stelwagon, the well-known authority on 
diseases of the skin, who, after careful examination, 
has pronounced the condition of the hairs in my 
brush identical with that seen in my beard and 
moustache. Dr. John Guiteras, Professor of Pathology at the 
University of Pennsylvania, kindly interested him- 
self in the matter, and sent at once to Cuba for the 
shaving-brush and tooth-brush of a gentleman who, 
for some years, has been troubled with trichorexis 
nodosa. In both brushes the disease is typically 
illustrated. At the suggestion of Dr. Guiteras, my 
own tooth-brush has been examined by Dr. Stel- 
wagon and myself, and in it also the same condition 
is well marked. 
It is of interest to note that the shaving-brushes 
are made of entirely different hair, one being what 
is called in the shops “Badger” hair, the other 
some coarser hair, resembling hog bristles, while the 
tooth-brushes represent still another kind of hair, all 
probably infected from the users, as will be shown 
more fully in a subsequent paper. 
Dr. Guiteras has begun an investigation of the 
subject, which will be reported in time, and which 
I trust will result in the clearing up of our knowl- 
edge of the etiology of the disease. 
In the meantime, may I ask that any physicians 
having the disease themselves, or in the case of 
patients under their care, will examine the shaving 
and tooth-brushes, and report the results to me, of 
which suitable acknowledgment will be made. 
Should the brushes be found affected, I will be glad 
to have some of the hairs sent to me, with a brief 
history of the case. 
Please address, in care of Dr. H. W. Stelwagon, 
223 South Seventeenth Street, Philadelphia.