[Reprint from The Alienist and Neurologist, St. Louis, October, 1887.] 
Hypertrichosis, due to General Disease 
of the Nervous System.* 
W1 TH AN ILL USTRA TIVE CA SE. 
By A. H. Ohmann-Dumesnil, A. M., M. D., of St. Louis. 
TT is now a well-established fact that a large number 
of cases of skin disease is seen whose cause can be 
traced to some organic or functional disorder of the nerv- 
ous system. In fact, they seem to be rather the local 
manifestations of some neurotic disorder than diseases per 
se, and constitute symptoms whose underlying causes are 
sometimes far removed from the integument itself. This 
fact is so well known that it would be a work of super- 
erogation to attempt to enumerate the dermal affections of 
nervous origin. 
It is also well known that certain diseases affecting or 
changes occurring in the hair are frequently due to neu- 
rotic influence, such as cases of alopecia areata. That 
the hair will suddenly blanch, under intense nervous 
excitement, the authenticated cases on record prove be- 
yond the possibility of all doubt. It is a matter of 
observation, moreover, that, in certain cases of chronic 
insanity in women, there is developed a well-marked tend- 
ency on the part of the hair of the face and forehead to 
grow, and to grow profusely, so much so that the patients 
become bearded. What the reason can be, which underlies 
this strange perversion of growth, has not yet been satis- 
factorily determined. 
A careful consideration of the above is what led the 
writer to formulate an opinion, which subsequent results 
proved to be correct, in the case about to be related. 
The case is one to which no precedent has been found 
* Read before the Mississippi Valley Medical Association, July 15th, 1887. 
1 2 
A. H. Ohmann-Dumesnil, 
after a careful search of dermatological literature, of a rather 
limited extent it is true, although not incomplete to any 
marked degree. 
Case.-About a year and a half ago, Dr. I. N. Love, 
of St. Louis, consulted me in regard to the condition of 
the face of one of his patients, he having accompanied 
the lady to my office. Upon inquiry, I learned that Mrs. 
X , aged twenty-eight, had possessed a remarkably 
clear complexion and fine skin. She has brown hair, dark 
brown eyes, and stated that previously her skin was un- 
usually fair and that she was markedly free from any 
excessive hair growth, Dr. Love corroborating this state- 
ment. At the time of examination, the skin was dark, 
yellowish and somewhat roughened, although to a slight 
degree only. The sides of the forehead, the sides of the 
face and the upper lip, principally, were the seat of a per- 
ceptible growth of hair, whilst the lanugo hair of the whole 
face appeared to be somewhat more marked than normal. 
This growth had developed in a comparatively short time. 
The hairs were dark brown in color, fine and silky in tex- 
ture, and varied in length from one-quarter to one-half 
of an inch. Although the growth could not be called thick, 
the hairs were situated quite close to each other, and the 
margin of the hairy portion of the skin was pretty sharply 
defined against the other. This growth proved to be quite 
a source of distress to the patient, who had formerly ex- 
hibited a certain amount of pardonable pride in the purity 
of her complexion. She desired to be relieved of her 
trouble by some local means, having learned of some of 
the methods employed by dermatologists for the extir- 
pation of hairs. 
As is my general custom, I proceeded to interrogate 
my patient as to the details of her general condition, 
habits, etc., before giving an opinion. My interrogatories 
elicited the fact that there existed considerable nervous 
trouble. It had been pronounced spinal irritation by 
some, and neurasthenia by others. It appeared to be a 
malnutrition of the entire nervous system. The food that Hypertrichosis. 
3 
should have been appropriated by the nervous tissue 
seemed to be diverted and converted into adipose tissue. 
Whilst the patient gained in weight, she lost strength and 
nerve force, and, in short, her nervous system was being 
subjected to a slow process of general starvation. 
Having satisfactorily settled this point, the opinion I 
gave was that local treatment of the hypertrichosis would 
be worse than useless, that all that was necessary was to 
administer assimilable nerve food, and, in all probability, as 
the nervous system approached more nearly to a normal 
standard, the offending hairs would diminish in number 
and eventually completely disappear at about the same 
time that her nervous affection did. 
Under the management of Dr. Love, the normal func- 
tions of the nervous system were gradually restored, and 
in January, 1887, I was gratified to learn that the patient 
was restored to a state of complete health. In addition 
to this the abnormal growth of hair had gradually disap- 
peared. Upon examination, not long since, her complex- 
ion was found to be as good as it had ever been, no 
vestiges of the hypertrichosis remaining, thus confirming 
the prognosis that had been made. She also looked and 
felt better, having lost a considerable amount of the adi- 
pose which had accumulated so rapidly during her nervous 
trouble. 
Some interesting questions naturally suggest them- 
selves in connection with this case. Whilst it is certainly 
not sound logic to deduce general conclusions from iso- 
lated cases or from a single observed fact, it still seems 
reasonable to utilize such a fact for this purpose, when 
the relations of cause and effect appear as plainly defined 
as they do in the instance given above. One question 
which suggests itself is: Why was the face the particular 
seat of this growth of hair in preference to other portions 
of the body ? It is a difficult matter to answer this ques- 
tion, and although it may be suggested that this is prob- 
bly due to the fact that the face being so much exposed 
is subject to greater stimulation, and that stimulation or 4 
A. H. Ohmann-Duinesnit. 
irritation will, in some cases, produce a perceptible growth 
of hair where only lanugo existed previously, as has been 
observed, for instance, at a site where a blistering plaster 
had been previously applied, we must not forget that in 
this case the hands, at least, were as much exposed to 
this stimulation as the face, and still did not exhibit any 
sign of hypertrichosis. 
We are also taught that hypertrichosis follows injuries 
to nerves, but remains only to disappear as soon as the 
nerves are restored ad integrant. There might exist a lo- 
cal perversion of nutrition, causing an increased growth in 
quantity without any perceptible decrease in the quality 
of the hair. 
Another interesting question is: Why was there an in- 
creased growth in the hair of the face and not a dimin- 
ished growth in the hair of the head? In other words, 
would it not appear more probable that & starvation of 
the nerve tissues should entail alopecia rather than hyper- 
trichosis? Although this might be expected the facts in 
the case point to the contrary condition. There seems to 
be but one explanation possible in this case. It is known 
that the hairs are low in the scale of vitality, and very 
little pabulum is necessary to supply all their needs. A 
greater quantity than necessity actually demands will often 
be taken up and utilized. This is what, in all probability, 
took place. By some means or other, there was diverted 
to the face a certain quantity of food refused by the 
nerve tissues, and this was made use of by the epidermal 
tissues, thus increasing the growth of hair, the quantity 
of pigment and the thickness of the epidermis. 
The object of this short paper has been to direct atten- 
tion to a condition which may not be an uncommon one. It 
is of some little importance, insomuch that in cases where 
the condition described exists, it will obviate the necessity 
of resorting to painful local measures, whose value can 
be nothing but doubtful when the fons et origo of the 
trouble is left untreated. It relegates the treatment of 
such cases to the domain of the neurologist, and by Hypertrichosis. 
5 
being promptly and thoroughly managed, so as to place 
the nervous system at par once more, may save many 
disappointments and an unnecessary expenditure of time 
and patience. It is even preferable to wait until the nerv- 
ous system is once more normal, with the certainty that 
the hypertrichosis will persist. Fer, in such a case, the 
influence of the nerve disturbance in the production of 
the hairy growth can be estimated, a less number of hairs 
may have to be removed, and, without doubt, the patient 
will be in a much better condition to submit to the neces- 
sary manipulations to ensure a radical destruction of the 
hair papillae.