Popular Science Monthly/Volume 31/May 1887/Hats as a Cause of Baldness
THE suggestive article in your October number, under the heading "A Bald and Toothless Future," should arouse more than a temporary interest. Of late, frequent reference to baldness has been made in medical and other journals, but none of the articles I have read have given the cause, it seems to me, nor suggested the proper means of prevention. The reasons given are mainly: Wearing a close, warm head-covering, thus rendering the natural one superfluous; the custom of cutting the hair close, living and working indoors, ill-ventilated hats, uncleanliness, and heredity. So many explanations indicate an uncertainty as to the real origin. Is it probable that such a uniform result can be due to so many and diverse causes, some of which must operate in one case and not at all in another?
The habit of wearing warm coverings on the head is not of recent date; the armies of Europe, for instance, no inconsiderable number of men, with heads close cropped, have worn for a long period warmer and heavier head-gear than the modern dwellers in cities, without the same tendency to baldness. Nor are the heavy fur coverings of northern races incompatible with luxuriant hair. It is also difficult to understand what injury can result from close cutting, per se. The growth is in the hair-follicle, and in it alone; there is no vital connection between the hair outside the scalp and within; it is usually cut closest at the back of the head and neck, where baldness never occurs. Would not close cutting rather stimulate the growth by exposure of the scalp? Such at least is the popular belief. So, too, with indoor life: women, who ought to show it most, whether in the home or in the factory, are never bald as men are; on the contrary, it is most common with men in good circumstances, as Mr. Eaton's statistics show, men who spend a larger proportion of their daytime in the open air than the indoor worker.
I believe the common form of baldness is due entirely to the kind of hat that is worn, principally to the high hat and the hard felt hat, but also to any other head-covering that constricts the blood-vessels which nourish the hair-bulbs. To have a clearer understanding of this, we must remember that the scalp is supplied with blood by arteries at the back, sides, and front of, and lying close to, the skull, which diminish in size by frequent branching as they converge toward the top of the head. They are in a most favorable position to be compressed, lying on unyielding bone and covered by thin tissue. Consider what effect must be produced by a close-fitting, heavy, and rigid hat: its pressure must lessen to a certain extent the flow of arterial blood, and obstruct to a greater extent the return of the venous; the result being a sluggish circulation in the capillaries around the hair follicles and bulbs, a consequent impairment of nutrition, and final atrophy. This pressure is not trivial or imaginary, as any one will admit who has noticed the red band of congestion on the forehead when a hard hat is removed after moderate exercise. If the man is bald, the red pressure-mark can be seen all around the head.
It may be asked, Can the wearing of a tight band around the head for a few hours a day have any perceptible effect on the growth of the hair? That the hair-bulbs are susceptible to disturbances of nutrition is evident from the effect of a continued fever, or any wasting disease, where nutrition is seriously impaired. They (the hair-bulbs) suffer with the general system; the hair has been starved to death, so to speak, and comes out in large quantities, sometimes amounting to temporary alopecia. If the hair-crop can be thus destroyed by three or four weeks of constant lessened nutrition, it is reasonable to suppose that the same cause, though slight and intermittent, will in time produce the same result.
The course of an ordinary case of baldness corresponds with this view. We observe usually a thinning out of the hair at the poll of the head, or part corresponding to the posterior fontanelle of infancy; a patch appears two or three inches in diameter like the tonsure of a priest. Or, instead, the thinness may begin above the forehead, but in every case, the hair disappears first where the circulation is weakest—that is, along the top of the head, the region most remote from arterial force. The sparseness, at first slight, becomes year by year more apparent, and, finally, a bare and polished surface is presented which gradually descends to the hat-band and there stops. Mark this point, it never goes below the rim of the hat. I admit that the line of denudation does not in some cases correspond exactly with the hat-band; it will be noticed that the coincidence is accurate enough at the back of the head from a point opposite the top of the ear on one side to the corresponding point on the other, but in front of this on either side is often a tuft above the horizontal line that still maintains its growth. The explanation is, that the temporal muscle, occupying the hollow space in the temporal bone, acts as a cushion, thus relieving the pressure on the blood-vessels. In men with rounded heads, full in this region, a continuous line will be observed.
Before leaving this part of the subject I would direct attention to the complete change effected in the scalp after the disappearance of the hair. Unlike the thick, stiff, glandular structure it formerly was, it is now soft, thin, and flexible, like that of the forehead or other portions of smooth integument. It has lost a distinct anatomical structure; the hair-bulbs and accessories have withered away. Baldness from disease has no choice of location; it occurs irregularly on any part of the head, or affects the whole surface, quite distinct in this respect from the perfectly regular course of hat-baldness. The latter should not be regarded as a disease at all, but rather as an accident of habit.
It does not follow that all persons wearing these objectionable hats must lose their hair. The outline of the head may be irregular, or the blood-vessels may be protected by a thick growth of hair. Close cutting, from this point of view, is injurious, as it allows close contact with the skin. But, few will escape the evil effects of twenty or thirty years of rigid tight-fitting hats, the destructive process being delayed only by the length and frequency of respites from this tourniquet of fashion. I have never seen a person whose habitual head-covering was soft and yielding suffer from baldness. The agriculturist, whose habit it is to wear the loosest head-coverings during the greater part of his life, has usually more hair than is conducive to comfort; but his son who has taken to city life may be bald at thirty. I think it will be noticed that the most rapid cases are among city men with close-cut hair who wear the high hat. It must fit closer, as from its height it is more liable to displacement.
The accuracy with which the hatter plies his trade is skill and energy in the wrong direction. The little instrument, the "conformator," that marks on paper the outline of one's head by which the band is molded to press more uniformly all around, is more destructive of the natural head-covering than ever were the scalping-knives of the North American Indians. It is nothing uncommon to see an old negro, who has taken to high hats, with a bald and shiny pate above and an abundant crop of hair below the hat-rim. I have long been convinced, although history is silent on this point, that old Uncle Ned
"Who had no hair on the top of his head,
was the favored recipient of his master's old silk hats.
Baldness is not confined to race or occupation, but it is to sex. While forty or fifty per cent of middle-aged and elderly city men show some stage of it, women are entirely exempt. They are subject to the same laws of heredity, have the same habits and occupations as men, and yet have as much hair to-day as at any previous time in the world's history. This can only be explained by the essential difference in the head-coverings of the two sexes; and yet the head-gear of women has been condemned and ridiculed in various styles of literature, principally by the high-hat sex. It may not often commend itself to one's sense of utility; it may be at one time a mere nucleus for brilliant and varied decoration, and at another an expansive and imposing structure, but it has usually the charm of novelty, sometimes of beauty, and it never destroys the growth of hair.
Man's high hat for many generations has varied within very narrow limits, and has always been ugly and unnatural. Why it should so long have held its sway it is hard to understand. An artist can not make it interesting in his work. It will not compare with the Oriental turban, the Scotch bonnet, or even the slouch hat, for comfort or graceful capabilities; but the average man will wear it long after his faith in hair tonics and restorers with seductive promises has been shattered. Still, let him remember, as be takes his after-dinner repose, that his favorite hat will certainly and inevitably extend the pasture-lands of the domestic fly.