My hair is grey, but not with years,
Nor grew it white
In a single night,
As men’s have grown from sudden fears.
Lord Byron, The Prisoner of Chillon
ON A JOURNEY THE LENGTH of the New York subway I once attempted a survey of the hairstyles of everyone who entered my carriage. There were spray-backs of radiant gold; ringlets of bouncing delight; dreadlocks and crew cuts; fore-locks and permanent waves. A multiplicity of braids, plaits, ponytails, pigtails, tresses, tufts and knots. I counted Afros, mullets and tonsures. There were quiffs, coiffures, streaks of white and rainbow-dyes of colour. There were also fungal patches of ringworm and balding patches of alopecia.
Even the bald scalps showed a wealth of diversity: some were pockmarked like asteroids, others looked worn down and freckled – sandstone sculptures under acid rain. Some had swatches of bruises, others were glossy as polished mahogany. Some were wrinkled, others suave, some scratched like glacial erratics. I saw scalps that were crusted with psoriasis, others with sun damage and dermatitis. I didn’t see anyone with horns.
THE SCALP HAS one of the best blood supplies in the body: wide arterial trunks ascend into it from each side of the face, and when it gets wounded, blood can spurt a couple of centimetres into the air. Scalp skin is tough, and its wounds satisfying to stitch – in the emergency department I often start with a few tight silk sutures to halt the bleeding, and then finish the job with staples or glue. ‘Superglue’ was invented during the Vietnam War for the express purpose of repairing briskly bleeding wounds like those of the scalp. Only the tongue and cheek heal quicker, thanks to their more generous blood supply. The scalp is among the thickest skin on the body, at around 1 mm (skin thickness varies from 0.05 mm in the eyelids and behind the ears, to 1.5 mm on the palms and soles of our feet). Women have thicker skin on their scalps than men, and bald, elderly men the thinnest scalps of all. All this variety across the acreage of the body’s surface makes skin our largest and heaviest organ, oddly and unjustifiably overlooked by most medical training.
Training in every speciality involved being summoned to ‘interesting cases’ and then adding them to an inner register of experience, but being a medical student in Dermatology felt peculiarly voyeuristic: every day we were asked to crowd around scantily clothed patients and scrutinise their skin. I remember being ushered in to view verrucas that had metastasised across someone’s heel; to dress necrotising blisters of bullous pemphigoid (an auto-immune condition, the name of which derives from the Greek for ‘pustule’); and to witness a scabies hunt that ended with the skewering of mites from tunnels in the skin of an aghast student.
One morning I was marshalled with five other students into a consulting room where a middle-aged woman in a rainbow-coloured cardigan and gypsy skirt was sitting on the side of an examination couch. Her face was haloed with blonde frizz, and she had brushed it forwards over her forehead. ‘I’d like you all to see this,’ said the consultant, and asked her if she’d lift up her fringe. At least two of us took a sharp intake of breath: in the centre of her forehead, just at the hairline, she was growing a horn. It was about two inches long, brown, and curling to a point like the stalk on a Halloween pumpkin.
‘We’re making arrangements to remove this,’ said the consultant. ‘These cutaneous horns are made of keratin, just like your hair, nails and … rhinocerous horns.’ Various skin conditions can generate a horn: sun-damaged skin, which may start overproducing a horny layer of skin that lengthens; some skin cancers; verrucas; and even some disorders of the sweat glands. About one in five horns turn out to be cancerous. Though of different origins, the horns are all composed of the same substance – keratin. ‘They’re fairly straightforward to remove,’ the consultant went on, ‘though this one will require a skin graft to close the defect.’
We all stood in a half-moon around her, trying not to look horrified, though the patient herself seemed unconcerned. ‘Don’t take it off today,’ she said, and gave an impish laugh. ‘I’ve a costume party next week – I was thinking of going as a unicorn.’
IN ROME THERE’S a statue of Moses by Michelangelo, in which he is portrayed with twinned horns, gathered brows and an intense gaze. It was commissioned for the tomb of the Renaissance pope Julius II, but sits in a small church called San Pietro in Vincoli. The horns commemorate the moment in the Bible when Moses, after receiving the ten commandments, descends Mount Sinai to his people with his face noticeably changed. St Jerome, in translating the Hebrew into Latin, described the transformation of his face as ‘horned’, and ever since, in the iconography of the West, that’s how Moses has been represented. The Moses of Michelangelo is an enthralling, masterful piece of sculpture – Sigmund Freud devoted a lengthy and breathless essay to it (‘How often have I mounted the steep steps … and have essayed to support the angry scorn of the hero’s glance!’)
Transformations in the classical as well as the Biblical tradition tend to imply an element of divine justice: in the Metamorphoses of Apuleius someone behaving like an ass becomes a donkey, in the Metamorphoses of Ovid a blood-thirsty murderer changes into a wolf. The Bible has a couple of horned transformations: in Deuteronomy 33 there’s a prophet whose horns convey strength and grandeur, while the book of Revelation is stuffed with horned messengers from hell. What meaning or justice was served by putting horns onto Moses’s head?
Three and a half centuries ago the physician and poly-math Thomas Browne puzzled over this inconsistency, and so went back to the Bible’s original Hebrew and Greek. He realised that in Hebrew the word ‘kaeran’ means ‘glorified’ or ‘shining’ and that the almost identical ‘karan’ means ‘horned’, and concluded that the western iconography of Moses, for more than a millennium, is all down to a mistranslation. Horns, Browne concedes, are the ‘hieroglyphic of authority, power and dignity’ and so of all the transformations that could have been effected on the face of Moses these were perhaps not inappropriate.* In Ovid, the future king of Rome accepts his destiny only when horns start growing from his skull. The confusion between ‘horned’ and ‘shining’ too is an ancient one – Browne quotes the Roman philosopher Macrobius: ‘The Libyans reckon their god Hammon to be the setting sun, and they portray him with ram’s horns, since these are the source of that animal’s strength, as sunbeams are of the sun’s.’
FREUD’S PSYCHOANALYSIS takes it for granted that the emanations and irritations of skin can reflect aspects of our inner life – almost as if the skin can be a barometer of our mental and emotional weather. In the early years of the twentieth century more pedestrian skin complaints like eczema and even nettle rash were assumed to be reactions to psychological or emotional conflicts. Many of my own patients notice that their psoriasis and eczema worsen during periods of anxiety or poor sleep – an observation that modern theories of immunobiology struggle to explain. Modern medicine is fairly good at knowing how to subdue skin diseases when they flare up, but our knowledge of what kindles them in the first place remains embarrassingly poor.
If skin can be a barometer to psychic weather, so too can hair – as a reaction to an emotional shock it’s well known to turn white or fall out. In medical journals, this phenomenon is called ‘Marie Antoinette syndrome’, because of the widespread belief that the French queen’s hair blanched over a single night, waiting for the gallows. Over a century ago Leonard Landois wrote,
One of the oldest problems of pathology and physiology which has escaped scientific research and is still clouded in mythical darkness is the sudden whitening of the hair. I call it a mythical darkness, because the reports, dating mostly from older times, sound more like fairy tales than scientific observations.
But it’s no fairy tale: modern dermatologists have confirmed it. Once a strand of hair leaves its follicle within the scalp it’s dead – it can’t change colour unless bleached. But the phenomenon of sudden whitening happens not through a change in the pigment, but through the preferential shedding of coloured hair after a fright or a shock, leaving only pale hairs behind. No one understands why the immune system attacks coloured hair in this way, and there is no known treatment.
The first historical example is in the Talmud, when bereavement is described as greying the hair. Inconsolable grief whitened the hair of Shah Jahan following the death of his wife Mumtaz Mahal (unassuaged by the building of her mausoleum, the Taj Mahal). The grief doesn’t have to be for loved ones – the loss of books can do it too. On hearing of the loss of his ship with numerous priceless manuscripts, the hair of the Renaissance scholar Guarino of Verona turned white. There are numerous examples in the literature of hair-whitening following imprisonment awaiting execution: Ludovico Sforza, when captured by King Ludwig of France; Sir Thomas More in the Tower of London; and a military officer called D’Alben in pre-revolutionary France (whose hair blanched only down one side, the right). The Chronique d’Arras tells of the hair-whitening of a condemned criminal at the court of Charles V, and Marie Antoinette has her Scottish counterpart in Mary Queen of Scots, whose hair may have turned white awaiting execution (or it may just have been that she had more grey hair than she was ordinarily willing to admit). Of Mary’s execution Stefan Zweig wrote:
When Bulle [the executioner] wished to lift the head by the hair and show it to those assembled, he gripped only the wig, and the head dropped onto the ground. It rolled like a ball across the scaffold and when the executioner stooped once more to seize it, the onlookers could discern that it was that of an old woman with close-cropped and grizzled hair.
HORNS DON’T JUST SIGNIFY DIGNITY, but also lust, gaiety and mischief. They are the symbols of stag parties, infidelity and inexperience (greenhorns). Pan, the Greek god of shepherds and sex, had two horns, as did Bacchus, the god of wine and of fertility. ‘There be many Unicorns’, wrote Sir Thomas Browne, ‘and consequently many Horns … Since what Horns soever they be that pass among us, they are not the Horns of one, but several animals.’ As a medical student I was warned against the temptation of jumping to obscure, dramatic diagnoses – if I heard hoof-beats, I was instructed to think of horses not zebras, and never mind the possibility of unicorns. Though he accepted that a variety of species could be unicornous, Thomas Browne doesn’t mention human unicorns and likely never met one. Since that afternoon in Dermatology clinic, neither have I.
But preserved in the anatomical collections of the University of Edinburgh is the horn of a human unicorn: Elizabeth Low. The stories behind many of the specimens in the collection have been lost over the centuries, but Low’s is preserved thanks to a silver medallion attached to the horn itself. The horn began growing in 1664, the year that Browne was elected a Fellow of the College of Physicians. It was removed in 1671, the year Browne was knighted.
‘This horn was cut by Arthur Temple’, it reads, ‘Chirurgeon, out of the head of Elizabeth Low, being three inches above the right ear, before thir witnesses Andrew Temple, Thomas Burne, George Smith, John Smyton and James Twedie, the 14 of May 1671. It was agrowing 7 years, her age 50 years.’
FOR CENTURIES, it’s been assumed that Michelangelo’s Moses depicts the moment when the prophet catches the Israelites in the act of worshipping a golden calf, and his expression is one of incandescent fury. In defence of this perspective Freud quotes two contemporaries, Henry Thode and Carl Justi, in describing Moses’s face as ‘a mixture of wrath, pain and contempt’; ‘quivering with horror and pain’. In Rome once I went to see Moses’s face, and he didn’t look angry to me – but wary, astonished, and even a bit frightened. It’s true his eyebrows are gathered, but the left one slopes downwards, and his expression seems more a backward glance than a furious stare, as if he can’t quite wrench his gaze from something terrifying or even wondrous.
There’s an alternative view: the statue might just commemorate an earlier moment in the story, when Moses has asked God to reveal himself. His face would show not anger, but heaven-struck, terrified awe. It’s one of the strangest and most powerful scenes in the Hebrew Bible – it’s hard to think of a more fitting moment for Michelangelo to immortalise. It’s just a pity that, being sculpted in marble, we can’t tell if Moses’s hair has turned white.
