Why was it called a RAT? Well, think of the wad of hair that accumulates in your own hairbrush. If you have long hair, it bears a rather remarkable resemblance to a small rodent. Since one’s own hair makes the most satisfactory bulking agent for a pompadour, ladies would naturally save their rats to make up these larger rolls. (They were tucked into the “hair receiver,” a decorated china bowl with a lid in which there was a round hole to tuck milady’s rats of hair.)

Although one’s own natural hair was preferred for styling, imported hair was also used — long and thickly textured Asian or Malaysian hair was prized. It could be bleached out and dyed to match the wearer’s color, but this was expensive, as dyes were very hard to match. Of course, most young women did not need hairpieces. They used them, of course, to improve upon their natural endowments (much as the Wonderbra is used today). It is possible, however, to lose one’s hair for a variety of reasons.

AN HISTORICAL MONOGRAPH

As a dermatologist, I am familiar with hair loss, but I thought it might be interesting to review some turn-of-the-last-century medical papers on the subject. Imagine my surprise when I discovered a monograph on alopecia (hair loss) by the great Victorian dermatologist, Sir James Saunders.

In his masterful review of types of hair loss, Sir James called attention to the different hair growth patterns in men and women. With the onset of puberty, the natural smooth hairline over the forehead

typically begins to develop inroads at the temples. This so-called TEMPORAL THINNINGoccurs in men and, to a lesser extent, some women. What is not as commonly known, however, is that women do experience natural hair thinning —some is due to age, but the major cause is genetic. Although a woman with a strong family history of baldness won’t go completely bald, she will often experience thinning over the entire vertex, or top of the head. This is called ANDROGENETIC ALOPECIA and it can start as young as the late twenties if there is a strong family history on either side.

Sir James also discussed ALOPECIA AREATA, or “baldness in areas.” We now believe that most cases of alopecia areata are autoimmune in nature, but this etiology was not a consideration in the 19th century. There was more concentration then on the role of stress in initiating the problem. A fascinating aspect of alopecia areata is that, in older people, the non-pigmented or gray hairs are not affected as quickly as the pigmented hairs. This is the source of stories about someone undergoing emotional shock and “turning gray overnight.” The dark hairs are lost rather suddenly, and only the gray ones are retained. New hair regrowth is often gray too (it acquires color later) although sometimes the hair never darkens again.

A CASE REPORT

Saunders’ monograph included a remarkably cogent discussion of the psychologic factors involved in hair loss, especially among women. Sir James described several case histories with a detail that was surely admired by Holmes. In fact, one case stood out so distinctively that I’d like to share it with you. A patient identified in his monograph by the initials “V.M.” had been afflicted with recurrent hair loss since the age of 14 (she was then

20). Her bald patches had episodically regrown hair, but new areas of fallout would occur after a few months, a cycle that Sir James documented with photographs in his publication. The newest and most extensive episode, however, involved loss of the hair on her frontal scalp, rendering the top of her head almost bald. This classically masculine pattern of hair loss had evidently tipped her mind into the realm of madness.

As V.M.’s alopecia progressed, Sir James wrote that she began wearing a veiled cap and removed all the mirrors from her house. She became morose and tearful, muttering constantly about a “familycurse.” She stayed indoors, even stopping her visits to Sir James’ hair loss clinic. He was puzzled by V.M.’s strange hysteria, as she had managed her previous episodes of hair loss in an  extremely calm and rational fashion.