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HAIR AND SCALP
DISORDERS
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HAIR AND SCALP
DISORDERS
Medical, Surgical, and Cosmetic Treatments
Edited by
Amy J. McMichael, MD
Chair and Professor, Dermatology, Wake Forest University School of Medicine
Winston-Salem, North Carolina
Maria K. Hordinsky, MD
Chair and Professor, Dermatology, University of Minnesota
Minneapolis, Minnesota
CRC Press
Taylor & Francis Group
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© 2018 by Taylor & Francis Group, LLC

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This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information,
neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that
any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions of the
publishers. The information or guidance contained in this book is intended for use by medical, scientific or health-care professionals and is provided strictly as a supplement
to the medical or other professional’s own judgment, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best
practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified. The
reader is strongly urged to consult the relevant national drug formulary and the drug companies’ and device or material manufacturers’ printed instructions, and their
websites, before administering or utilizing any of the drugs, devices or materials mentioned in this book. This book does not indicate whether a particular treatment is
appropriate or suitable for a particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her own professional judgments, so as to
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Our thanks to our dedicated contributing authors, without whom this new edition would have been impossible, and to Ralph, Jessica,
and Jacob Thomas and Bob, Irene, Catherine, Alexander, and Kristina Kramarczuk for their help and support. Their
understanding about the late nights at the computer, the many conference calls, and the missed family time
was the key that allowed us to finish this endeavor. We could not have done it without you!
Amy J. McMichael
Maria K. Hordinsky
Contents
Preface .................................................................................................................................................................................................... ix
Editors .................................................................................................................................................................................................... xi
Contributors.......................................................................................................................................................................................... xiii
1. Human Hair................................................................................................................................................................................................1
John Gray
2. Evaluation..................................................................................................................................................................................................23
Jennifer M. Marsh
3. Dermoscopy of Hair and Scalp Disorders (Trichoscopy)................................................................................................................31

Fernanda Torres and Antonella Tosti
4. Photographic Imaging of Hair Loss.....................................................................................................................................................43

Douglas Canfield and Jim Larkey
5. Hair Follicle Anatomy in Human Scalp Biopsies..............................................................................................................................49

David A. Whiting and Lady C. Dy
6. Nonmedicated Grooming Products and Beauty Treatments..........................................................................................................61

Zoe Diana Draelos
7. Practical Case Scenarios: How to Utilize Products..........................................................................................................................73

Ariana Eginli and Maria Fernanda Reis Gavazzoni Dias
8. Dandruff and Seborrheic Dermatitis: Use of Medicated Shampoos.............................................................................................83

Janet G. Hickman
9. Alopecia Areata........................................................................................................................................................................................99
Maria K. Hordinsky and Ana Lucia Junqueira
10. Androgenetic Alopecia..........................................................................................................................................................................111

Navid Ezra, Andrew G. Messenger, and Ken Washenik
11. Telogen Effluvium..................................................................................................................................................................................123

Cheryl Bayart and Wilma F. Bergfeld
12. Cicatricial Alopecia...............................................................................................................................................................................139

Paradi Mirmirani
13. Structural Hair Abnormalities............................................................................................................................................................153

Vijaya Chitreddy, Leslie N. Jones, and Rodney D. Sinclair
14. Scalp Prostheses: Wigs, Hairpieces, Extensions, and Scalp-Covering Cosmetics....................................................................173

Ingrid E. Roseborough
15. Hair Transplantation for the Dermatologist....................................................................................................................................179

Ronald Shapiro, Valerie D. Callender, and David S. Josephitis
vii
viii Contents
16. Alternative Treatments for Hair Loss...............................................................................................................................................195

Andreas M. Finner and Christine Jaworsky
17. Hirsutism and Hypertrichosis.............................................................................................................................................................207

Jacqueline DeLuca and Amy J. McMichael
18. Light-Assisted Hair Removal and Hair Growth.............................................................................................................................219

Ronda S. Farah, Lydia Y. Sahara, and Brian Zelickson
19. Allergic Contact Dermatitis.................................................................................................................................................................229

Sara A. Hylwa, Sharone K. Askari, and Erin M. Warshaw
20. Psychodermatoses Involving Hair......................................................................................................................................................245

Lucinda S. Buescher
21. Scalp Infections and Infestations........................................................................................................................................................251

Irene K. Mannering and Sheila Fallon Friedlander
22. Sources of Alopecia Information for Physicians and Patients.....................................................................................................269

Amy J. McMichael and Abby C. Ellison
23. Approach to the Alopecia Patient......................................................................................................................................................273

Kimberly S. Salkey and Lynne J. Goldberg
24. Hair Aging and Anti-Aging Strategies..............................................................................................................................................281

Ralph M. Trüeb
Index ................................................................................................................................................................................................... 301

Preface
Welcome to the second edition of Hair and Scalp Disorders: chapter is a practical case scenario guide to challenging cases seen
Medical, Surgical, and Cosmetic Treatments. In this edition, we by dermatologists every day.
wanted to capture the myriad updates in the field of hair and In this new edition, chapters have been updated to include
scalp disorders while still keeping our comprehensive review of exciting breakthroughs in conditions and diseases that have new
treatment approaches. We have maintained our commitment to treatments, often with mechanisms that were not known at time of
creating the quintessential text on the treatment of hair disorders as publication of our first edition. Our authors continue to include
well as our commitment to a balanced discussion of ethnicity and mechanism of action, absorption characteristics, and general
cultural practices as they relate to disease mechanism and treat- pharmacology of the agent or agents discussed. This book serves
ment. Our goal is to impart widely the information that has been as a primer for those seeking an approach to hair and scalp con-
accumulated by specialists in the field of hair and scalp disorders ditions, from the patient with irritant and allergic contact der-
and to do so in a way that is easy to follow, practical, and complete. matitis reactions of the scalp to the latest technology in lasers for
Finally, we strove to enumerate treatments that may go beyond hair growth or reduction. We understand that diverse populations
accepted US and international guidelines and incorporate off-label are the norm for so many of our readers, so we specifically tasked
use of the medications when data indicate this may be necessary. our contributors with incorporating diverse hair types and hair
In this second edition, we charged our contributors with the care practices into each of their chapters. It is our hope that this
challenge of approaching each hair disorder with a therapeutic integration will allow the appreciation of diversity in patients as
ladder. The treatment of each disorder begins in the simplest form well as treatment methods.
and becomes more complex, depending upon patient response, The audience for this work is wide. Practicing dermatologists
cultural practices, and concomitant disease. We again asked each and dermatologists in training will find the therapeutic regimens
author to create treatment plans that look beyond the best- presented here to be practical and helpful. Researchers and
described treatments to those that incorporate creative, thoughtful product managers in pharmaceutical and cosmetic industries will
approaches to the management of the multitude of hair and scalp benefit from understanding the dermatologist’s approach to the
disorders that challenge dermatologists. In order to add more diagnosis and management of the disorders discussed. We firmly
value to the text, we added several new chapters to capture current believe that anyone interested in hair and scalp disorders will
ideas about hair and scalp health. We have added a chapter on benefit from using this book as a resource. Please enjoy this
aging hair to highlight our specialty approach to anti-aging. exciting updated edition of our book.
Another exciting addition is the chapter that explains the latest
trends in the cosmetic chemistry approach to the healthy hair shaft Amy J. McMichael
and how to effect benefit to the unhealthy hair fiber. Our final new Maria K. Hordinsky
ix
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Editors
Amy J. McMichael, MD, received her medical degree from the Maria K. Hordinsky, MD, received her medical degree from the
University of Pennsylvania School of Medicine. She completed University of North Dakota School of Medicine. She completed
her dermatology residency training at the University of Michigan her dermatology residency training at the University of Minnesota
School of Medicine. followed by research fellowships supported by the Dermatology
Dr. McMichael is currently a professor and chair of the Foundation and a National Research Service Award from the
Department of Dermatology at Wake Forest University School of National Institute of Health.
Medicine in Winston–Salem. Her clinical and research interests Dr. Hordinsky is currently a professor and the chair of the
include hair and scalp disorders and skin of color. She is the Department of Dermatology at the University of Minnesota in
immediate past president of the Skin of Color Society, a fellow of Minneapolis. Her clinical and research interests include hair and
the American Academy of Dermatology, and a past chair of the scalp diseases and neurodermatology. She is the current president
National Medical Association Dermatology Section. She has of the North American Hair Research Society, immediate past
served as the vice president of the Women's Dermatologic Society chair of the Clinical Research Advisory Council of the National
and secretary/treasurer of the North American Alopecia Research Alopecia Areata Foundation, and a past president of the Associ-
Society. She serves on the editorial boards of JAMA Derm, ation of Professors of Dermatology. She is also a member of the
Cosmetic Dermatology, and The Dermatologist, and is the author Board of Directors of the Cicatricial Alopecia Research Foun-
of numerous journal articles and chapters. dation and is the section editor on Hair Diseases for UpToDate, an
evidence-based clinical decision support system. She is the author
of numerous journal articles and chapters and regularly lectures
and teaches on hair diseases.
xi
Contributors
Sharone K. Askari, MD Abby C. Ellison, BA

Department of Dermatology and Cosmetic Dermatology, National Alopecia Areata Foundation
Kaiser Permanente San Rafael, California
Department of Dermatology, Harbor-UCLA
Gardena, California Navid Ezra, MD
Department of Dermatology
Cheryl Bayart, MD, MPH Indiana University School of Medicine
Department of Dermatology Indianapolis, Indiana
Cleveland Clinic Foundation
Cleveland, Ohio Ronda S. Farah, MD
Wilma F. Bergfeld, MD, FACP University of Minnesota
Departments of Dermatology and Pathology Minneapolis, Minnesota
Cleveland Clinic Foundation
Cleveland, Ohio Andreas M. Finner, MD, FISHRS
Trichomed Hair Clinic and Hair Transplant Center
Lucinda S. Buescher, MD Berlin, Germany
Division of Dermatology
Southern Illinois University School of Medicine Sheila Fallon Friedlander, MD
Springfield, Illinois Division of Dermatology
University of California
Valerie D. Callender, MD San Diego School of Medicine
Department of Dermatology and
Howard University College of Medicine Rady Children’s Hospital
Washington, District of Columbia San Diego, California
Douglas Canfield Maria Fernanda Reis Gavazzoni Dias, MD, PhD

Canfield Scientific, Inc. Department of Dermatology
Parsippany, New Jersey Fluminense Federal University
Antonio Pedro Federal Hospital
Vijaya Chitreddy, MBBS, FACD Rio de Janeiro, Brazil
Department of Dermatolgy
Sinclair Dermatology Lynne J. Goldberg, MD
Melbourne, Australia Departments of Dermatology and Pathology
Boston University School of Medicine
Jacqueline DeLuca, MD and
Department of Dermatology Hair Clinic
Kaiser Permanente Boston Medical Center
Downey, California Boston, Massachusetts
Zoe Diana Draelos, MD John Gray, MD

Dermatology Consulting Services, PLLC Winston Park
High Point, North Carolina Gillitts, South Africa
Lady C. Dy, MD, FAAD Janet G. Hickman, MD, FAAD

Dy Dermatology Center The Education & Research Foundation, Inc.
Glenview, Illinois Lynchburg, Virginia
Ariana Eginli, MD Maria K. Hordinsky, MD

Department of Dermatology Department of Dermatology
Wake Forest Baptist Health University of Minnesota
Winston-Salem, North Carolina Minneapolis, Minnesota
xiii
xiv Contributors
Sara A. Hylwa, MD Paradi Mirmirani, MD

Park Nicollet Contact Dermatitis Clinic Department of Dermatology
and The Permanente Medical Group
Hennepin County Medical Center Vallejo, California
and and
University of Minnesota Department of Dermatology
Minneapolis, Minnesota University of California
San Francisco, California
Christine Jaworsky, MD and
Department of Dermatology Department of Dermatology
Case Western Reserve University Case Western Reserve University
Cleveland, Ohio Cleveland, Ohio
and
Department Dermatology Ingrid E. Roseborough, MD
University of Pennsylvania Department of Dermatology
Philadelphia, Pennsylvania University of California San–Francisco
San Franscico, California
Leslie N. Jones, PhD
Sinclair Dermatology Lydia Y. Sahara, MD
and Dermatology of Department
Epworth Hospital Healthpartners
and Bloomington, Minnesota
University of Melbourne
East Melbourne, Australia Kimberly S. Salkey, MD
David S. Josephitis, DO Virginia Commonwealth University Health
Shapiro Medical Group Richmond, Virginia
Ronald Shapiro, MD, FISHRS
Jim Larkey Shapiro Medical Group
Canfield Scientific, Inc. and
Parsippany, New Jersey University of Minnesota
Ana Lucia Junqueira, MD
Complexo Hospitalar Heliopolis Rodney D. Sinclair, MBBS, MD, FACD
São Paulo, Brazil Sinclair Dermatology
and
Irene K. Mannering, MD, MHA, MBA, MS, FAAD University of Melbourne
Skin Cancer and Dermatology Institute Melbourne, Australia
Reno, Nevada
Ralph M. Trüeb, MD
Jennifer M. Marsh, PhD Center for Dermatology and Hair Diseases
The Procter & Gamble Company Wallisellen, Switzerland
Beauty Technology Division
Mason, Ohio Fernanda Torres, MD
Hair and Scalp Disorders
Amy J. McMichael, MD Rio de Janeiro, Brazil
Wake Forest University School of Medicine Antonella Tosti, MD
Winston-Salem, North Carolina Department of Dermatology and Cutaneous Surgery
University of Miami Miller School of Medicine
Andrew G. Messenger, MD Miami, Florida
Royal Hallamshire Hospital
Sheffield, United Kingdom
Contributors xv
Erin M. Warshaw, MD, MS David A. Whiting, MD, FRCP

University of Minnesota, Dermatology The Hair and Skin Research & Treatment Center
and Dallas, Texas
Park Nicollet Contact Dermatitis Clinic
and Brian Zelickson, MD
Minneapolis VA Medical Center Department of Dermatology
Minneapolis, Minnesota University of Minnesota
Ken Washenik, MD, PhD
Ronald O. Perelman Department of Dermatology
New York University School of Medicine
New York City, New York
and
Bosley Medical Group
Beverly Hills, California
1
Human Hair
John Gray
Introduction Structure of Hair

Hair first arrived on the evolutionary scene some 310 million Many other publications describe in detail the human hair follicle,
years ago on reptilian-like animals, preceded and survived the rise its unparalleled metabolic activities, and its failings. It is the end
and extinction of the dinosaurs, and emerged as the dominant skin product of this activity-the human hair shaft-which we discuss
appendage of the class of mammals. As members of this class, in this chapter.
modern humans have "inherited" skin which, although bearing There are three essential_»::pes of hair in humans, which are
several million hair follicles covering 95% of the body, have dependent to some extent on the size of the follicle.
largely confined growing hair to the scalp.
Lanugo Hair
Human Scalp Hair Lanugo hair is fine and non-medullated hair which appears on the
fetus, and with Fare e ceptions is shed prior to or immediately
Unlike our primate cousins, we, the fifth and "naked" ape, do not after birt�gur .1).
possess an all-encompassing, thick, and pigmented pelage. Once
the body-wide intrauterine lanugo hairs are shed, visible follicular
activity is confined to the scalp, with secondary sexual sites a poor
second even after puberty.
air is fine, short, and non- or lightly pigmented (less than
Since the human head bears some 100,000-150,000 hair fol
icrons in diameter), and is the most numerous of human
licles, an individual adult with 30 months continuous, unsty ed
hairs. It can be seen from the neonatal period onward covering all
growth at 0.9 cm per month will carry some 30 kilometers of
surfaces other than the palms of the hands and soles of the feet. At
hair. This is a significant investment in protein and energy
puberty, some vellus hairs enlarge to become terminal hairs, and
consumption.
develop sebaceous glands. Vellus hairs occur on the scalp but are
far less numerous than terminal hairs.
In male and female pattern hair loss, terminal hairs miniaturize
Function of Human Hair and return to the size of vellus hairs. This can be reversed with
treatment.
The function of human hair is, curiously, unresolved. Hypotheses
vary: Is it a relic of an aquatic phase of human development where
a pelage would be an impairment, or an integral adaptation for Terminal Hair
thermoregulation and ultraviolet protection? Is it a mere adorn
ment, or the result of Fisherian runaway sexual selection? All of Terminal hair is thick, long, and pigmented. It is some 50 to
these theories can be disproved, not least by the tendency for 150 microns thick. Terminal hairs are the dominant hairs on the
humans of both sexes to bald. Sociological research has suggested scalp, eyebrows, lashes, axillae, and genital areas. In men, terminal
that hair is often interpreted as a marker of age, health, nutrition, hairs are variably found on the trunk and legs. There is great
and fecundity. In its styled form, it is employed in all societies to regional difference in terminal body hairs.
express social status or cultural affiliation. Hair in most cultures is Cross-section of the terminal hair shaft reveals three major
at its zenith on the wedding day. By contrast, sociological studies components:
have revealed the full impact of so-called "bad hair days," where
subjective and objective negative assessment of hair may reduce • Cuticle-the outer protective layer
self-esteem. • Cortex-the core of the hair
Modern hair care involving the use of many products is an • Medulla-a central soft protein core which is more
(almost) ubiquitous human habit in the twenty-first century. These common in thicker hair, and particularly so in white hairs
products are increasingly designed to repair and protect hair from
environmental and self-inflicted damage while preparing it for The main constituents of these structures are sulfur-rich pro
styling. teins, lipids, water, melanin, and trace elements.
1
2 Hair and Scalp Disorders: Medical, Surgical, and Cosmetic Treatments
i
A
EX
En
FIGURE 1.1 Lanugo hair seen on the face of a newborn. (From Gray J, The
World of Hair, Macmillan, 1977, with permission.)
0.4 µm
Cuticle
The cuticle is composed of specialized keratins and consists of six
to eight layers of flattened overlapping cells with their free edges
directed upward to the tip of the hair shaft. There are several
FIGURE 1.2 Overlapping scales of the cuticle. (From Gray J, The World of
layers to each cell. The innermost endocuticle is covered by the
Hair, Macmillan, 1977, with permission.)
exocuticle, which lies closer to the external surface and is com-
prised of three parts: the b-layer, the a-layer, and the epicuticle.
The b-layer and the a-layer are largely proteinaceous, while the
epicuticle is a hydrophobic lipid layer of 18-methyleicosanoic
acid (a main component of the outer layer of the epicuticle of
human hair that endows hydrophobicity to the outer hair surface)
attached via a covalent chemical bond to the surface of the fiber.
This is commonly known as the f-layer.
The f-layer is of critical importance to hair health. The cuticle’s
complex structure (Figure 1.2) allows it to slide as the hair swells,
and the f-layer imbues a considerable degree of hydrophobicity. It
is critical in protecting the hair and rendering it resistant to the
influx and outflow of moisture.
The undamaged cuticle has a smooth appearance and feel. It
is primarily responsible for the luster and texture of the hair
(Figure 1.3).
The cuticle may be damaged by any of four major “insults”—
environmental, mechanical, chemical, and heat.
Chemical removal of the f-layer, particularly by oxidation FIGURE 1.3 Reflection from the intact cuticles of well-aligned hair is
during bleaching or perming, eliminates the first hydrophobic largely responsible for hair shine. (From Gray J, The World of Hair, Mac-
defense of the shaft and leaves the hair more porous and vul- millan, 1977, with permission.)
nerable (Figure 1.4). If the cuticle is damaged, there is little
change in the tensile properties of hair; however, its protective comprising 400 to 500 amino acid residues in heptad sequence
function is diminished. repeats, form hard keratin polypeptide chains that pair together to
form protofilaments, which make up a keratin chain. The keratin
chains have a large number of sulfur-containing cysteine residues.
Cortex
Cysteine residues in adjacent keratin filaments form covalent
The cortex consists of closely packed spindle-shaped cortical cells disulfide bonds, which create a strong crosslink between adjacent
rich in keratin filaments that are oriented parallel to the longitu- keratin chains. The disulfide bonds confer shape, stability, and
dinal axis of the hair shaft, and an amorphous matrix of high sulfur resilience to the hair shaft. Other weaker bonds link the keratin
proteins. The intermediate filament hair keratins (40–60 kDa), polypeptide chains together, such as Van der Waal interactions,
Human Hair 3
Hair texture is a less precise term but is usually classified as

follows:
Fine less than 60 microns

Medium 60 to 80 microns
Thick 80 to 150 microns
f-layer
Many women, on questioning, believe their hair to be finer than

accurate measuring would confirm. This misunderstanding may
affect their sometimes less-than-ideal choice of hair care products.
=o =o =o = o =o = o = o = o
s s s s s s s s
Epicuticle
Terminal Hair Phenotypes
Not all terminal hairs have the same cross-sectional appearance
FIGURE 1.4 Preservation of the f-layer is of critical importance in main-
taining homeostasis. Removal renders the hair shaft potentially vulnerable to (phenotype). The phenotype of the first modern humans is
further damage. unknown, but recent genomic work is identifying when major
mutations occurred resulting in current regional hair forms.
Terminal hairs have traditionally been described as round, oval,
hydrogen bonds, and coulombic interactions known as salt links. or flat. In reality there is a broad spectrum of hair shapes, and
These weaker bonds can be overcome with water. although individuals tend to bear essentially one type on their
The disulfide bonds are critical in conferring shape, stability, scalps, it has been observed that all three can be present. The
and resilience to the hair shaft, and can only be broken by external phenotype is determined by genetic inheritance, and more than
oxidative chemical agents such as occurs with perming or relaxing. one form can be seen on a single head more commonly with
Weak hydrogen bonds link the keratin polypeptide chains. increasing genetic diversity due to the easing of social and ethnic
These weaker bonds are easily overcome by water, rendering barriers in societies.
curly hair temporarily straight. While peoples from subequatorial Africa and their dispersed
The cortex (Figure 1.5) contains melanin granules, which color descendants have hair follicles which are curved, the final shape
the fiber based on the number, distribution, and types of melanin of the hair emerging from the follicle is determined more by the
granules (Figure 1.6). activity of the matrix cells deep in the follicle and the manner in
which the keratin proteins are laid down in the cortex.
The hypothesis that hair shaft shape is principally due to the
Medulla
shape of the follicle is further confounded by the ability of ter-
The medulla is a soft, proteinaceous core present in thicker and minal hair follicles to produce different phenotypes under altered
white hair. It has no known function in humans. circumstances. After chemotherapy, patients routinely report
dramatic changes in hair shaft phenotypes, presumably due to
a change in arrangements of keratins in the cortex from a
“re-programmed” matrix.
Hair Color
Hair color is determined by the melanocytes found only in the
matrix area of the follicle at the base of the cortex directly above
the follicular papilla. Melanocytes transfer packages of melanin
Classification of Hair Phenotypes
(melanosomes) to the cortical cells during the active growth phase Classically, hair shaft shape (phenotype) was described as cauca-
(anagen). Eumelanin is the dominant global pigment and confers soid, negroid, or mongoloid, supposedly but erroneously alluding
black/brown hair. Pheomelanin, a mutation of eumelanin, is the to inhabitants or descendants of people from Europe, Africa, or
predominant pigment found in red hair. Blond hair is a complex Eastern Asia. This classification presupposes that these groups
mixture of the two melanins, but in principle is relatively devoid of related peoples are regionally static or evolved in parallel
of pigment compared to black or brown hair. Greying of hair is a isolation. In reality, from a genetic standpoint, Africans living
normal manifestation of aging and illustrates progressive reduc- north of the equator have considerable affinity with European
tion in melanocyte function, probably influenced by the accu- and Middle East phenotypes. In addition, this classification ignores
mulation of reactive oxygen species. the millions of peoples from the northern part of the Indian sub-
continent who have a greater genetic and phenotypic association
with modern Europeans than with those in eastern parts of the
Asian continent.
Hair Diameter
This author contends that this classification is now archaic and
The diameter of human hair varies from 17 to 180 micrometers was based on a number of racial stereotypes which are no longer
(0.00067−0.0071 in). Hair less than 40 microns is regarded as acceptable and have no genetic basis. A more phenotypic sub-
vellus hair. group approach might be proposed by examining world locations.
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Hair’s Microfibril (three Called keratin

cuticle chains called polypeptide
into one strand) chain
Keratin
One hair cell macrofibril
4
FIGURE 1.5 Composition of the cortex (not to scale). The cortex is the thickest portion of the hair, the area between the cuticle and the medulla. (1) medulla;
(2) cortex; (3) cuticle; (4) hair; (5) hair cell; (6) keratin macrofibril; (7) microfibril (three chains coiled into one strand); (8) coiled keratin polypeptide chain.
Subequatorial African Hair types, African hair suffers most from grooming issues due to its
dense curl, and from breakage due to its shape. Many African
Subequatorial African hair shafts are flattened and prone to tight
women and women of African descent use heat or chemicals
curling. Many people classified by the US Census Department as
to straighten their hair for both practical and aesthetic reasons
African American have this type of hair; however, many such cit-
(Figure 1.7). This may result in damage.
izens by now have antecedents from continents other than directly
from Africa, again a reflection of the easing of social barriers.
The distribution of the African and African-like phenotype is
Asian or Eastern Asian Hair
strongly oriented toward the equator. Research indicates that
although Sub-Saharan Africans are the most genetically diverse Asian or Eastern Asian hair is circular and of wide diameter, with
group on Earth, there is a strong selective pressure to produce this a tendency to straightness and rigidity. This phenotype has a large
curly hair phenotype. This does not seem to support sexual diameter (up to 150 microns), and is essentially straight and black
selection as the sole or principal cause of the distribution. Further, (Figure 1.8).
peoples with no recent African lineage also express this pheno- However, not all Asian peoples have the classical straight or
type at the equator, possibly supporting a thermoregulatory thick hair associated with the extreme northeast Asia continent
function. Individuals with African hair were forcibly transported and Inuit peoples of Alaska (Figure 1.9). The range of hair
to both the Americas in the 1800s and immigrated into Europe diameters stretches from 80 to 150, with a South-to-North bias of
from post-colonial Africa in the twentieth century. Of all the hair increasing diameter.
Human Hair 5
Co
Ex
(a)
1 μm
FIGURE 1.6 Melanin granules in the cortex with overlapping scales of the
cuticle. Co, cortex; Ex, exocuticle. (From Gray J, The World of Hair, Mac-
millan, 1977, with permission.)
Volume control is an issue, and chemical permanent procedures

are still widely utilized as a method of control. From research,
celebrity trends ARE the key driver for women/and some men
bleaching to achieve a change of hair color.
Indo-European Hair
This type of hair is more ovoid and has variable characteristics—
thin/straight to thicker and/or wavy/curly. This is more typical of
those primarily of Dutch origin mixed with Portuguese, British,
French, Belgian, German, and other countries of origin.
The broad group of Indo-Europeans shows an East-to-West
bias of darkly pigmented, straight hair to thinner, lighter hair
(Figure 1.10). Those from the Indian subcontinent have hair that
is classically straight. In Europe a range of straight, wavy, and
curly hair occurs. The presence of pheomelanin pigment increases
in the northwest of the Indo-European area.
As human beings spread out around the world, arrival in
Europe only occurred in the last 35,000 years. Low sunlight levels (b)
are regarded as the cause of the emergence of lightened skins, but
the explanation for light hair is uncertain. Only 1.8% of humans FIGURE 1.7 Strategies managing tightly curled hair. (a) Classical subequa-
torial African hair plus hair dye; (b) braids, relaxing, extensions. (Continued )
have naturally light/blond hair, with the highest preponderance in
Estonia.
(c)
FIGURE 1.7 (CONTINUED) Strategies managing tightly curled hair. (c) A

“No. 1” haircut. (From Gray J, The World of Hair, Macmillan, 1977; Gray J, FIGURE 1.9 Not all Eastern Asian people have straight hair or the thick hair
Healthy Hair, Springer, 2015, with permission.) associated with the extreme northeast and Inuit peoples. (From Gray J, The
World of Hair, Macmillan, 1977, with permission.)
Indo-European hair diameter tends to be in the lower range, and

Asian hair in the upper. The combination of hair diameter
and shape contributes significantly to the general behavior of hair
and consequently its cosmetic management.
Australasian Hair
Genetic evidence shows the Aboriginal peoples, whose ancestors
arrived in Australia some 50,000 years ago and remained isolated
until Captain Cook discovered their land, are direct descendants of
the first modern humans to leave Africa, without any genetic
mixture from other subgroups. Their highly pigmented skin
reflects an African origin and a migration and residence in latitudes
near the equator, unlike Europeans and Asians whose ancestors
gained the paler skin necessary for living in northern latitudes.
Based on the rate of mutation in DNA, geneticists estimate that the
Aboriginal peoples split from the ancestors of all Eurasians some
70,000 years ago, and that the ancestors of Europeans and East
Asians split from each other about 30,000 years ago. Their hair is
interesting in having features of subequatorial Africa but with a
distinct loosening of the tight curl (Figure 1.11). Interestingly,
some Aborigine children are born with blond hair.
Hair Phenotypes in the Americas

The above proposed nomenclature is far from all-embracing, and
is particularly problematic for the Americas. The indigenous
peoples of both North and South America were descendants of
Inuits, who entered Alaska across the Bering Strait some 12,000
years ago and presumably had hair characteristics of Asian
FIGURE 1.8 Straight black hair is the commonest expression of hair in
modern humans. It is thick, straight, and darkly pigmented with eumelanin. peoples. Waves of immigration of peoples from particularly
Control of excess volume may be an issue. (From Gray J, The World of Hair, Europe and Africa have produced increasing complexity and
Macmillan, 1977, with permission.) homogenicity, with wider gene sharing.
Human Hair 7
(c)
(a)
(b) (d)
FIGURE 1.10 Hair types within the Indo-European range. (a) Nordic fine blond; (b) the red of pheomelanin; (c) twins with identical wave patterns: (d) tight
curls of Grecian descent. (Continued )
(a)
(e)
(b)
FIGURE 1.11 (a) Australasian hair has features of subequatorial Africa but
(b) with a distinct loosening of the tight curl. (From Gray J, The World of Hair,
Macmillan, 1977, with permission.)
The three classic hair phenotypes are illustrated in Figures 1.12

and 1.13.
Developments of Human Hair Differences

The exact hair shape (phenotype) of our early hominid prede-
cessors is unknown. It is presumed that during the gradual process
by which our immediate ancestor Homo erectus began a transition
(f )
from furry to “naked” skin, hair texture changed from straight (the
condition of most mammals, including all apes) to a more wavy
FIGURE 1.10 (CONTINUED) Hair types within the Indo-European range.
(e) Indian girl in South Africa; (f) Indian hair with probable “keratin” treat-
form, or even a curled phenotype, which arrived with modern
ment. (From Gray J, The World of Hair, Macmillan, 1977; Gray J, Healthy humans and is assumed to be the result of environmental pres-
Hair, Springer, 2015, with permission.) sures and/or sexual selection. It is not clear at what point classical
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“I wish to become a monk, and pray for your gracious sanction,”
said the Tsarevitch in a low firm voice.
He lied. Peter knew that he lied; and Alexis knew that he could not
befool his father. The wicked delight of revenge filled the soul of
Alexis. His unbounded submissiveness was nothing but unbounded
obstinacy. The son was now stronger than the father, the weak more
powerful than the strong. What good could accrue to the Tsar, if his
son became a monk? The monk’s cowl is not nailed to the head. It is
possible to take it off. Yesterday a monk, to-morrow a Tsar. His
father’s body would turn in his grave when his son should become
Tsar; Alexis would scatter everything, destroy everything, he would
bring Russia to perdition. It was not enough to seclude him in a
monastery, he would have to be killed, exterminated, wiped out from
the face of the world.
“Go away!” moaned Peter with impotent fury.
The Tsarevitch lifted his eyes and stared at his father, without
raising his head, as a young wolf would look at an old one, showing
his teeth and bristling his hair. Their eyes met like two rapiers in a
duel and the father’s gaze dropped, as it were broke, like a blade
against a hard stone.
And again he groaned like a wounded beast; he raised his fist and
with an oath was going to throw himself on his son, beat and slay
him.
Suddenly a small, delicate, strong hand was laid on Peter’s
shoulder.
The Tsaritsa Catherine had for a long time been listening at the
door, trying to see through the keyhole what was going on.
Catherine was inquisitive. As usual she appeared at the most
dangerous moment to save her husband. She had pushed the door
open noiselessly, and came up to him from behind on tiptoe.
“Peter, Peter,” she began in a humble tone, slightly good
humoured and coaxing, such as kind nurses adopt towards stubborn
children or invalids, “don’t tire yourself, Peter, don’t excite yourself,
my dear. Otherwise should you wear yourself out you will again fall
ill and be obliged to lie up. And you, Tsarevitch, go, God be with
you. You see the Tsar is unwell.”
Peter turned round, he saw the calm, almost cheerful face of his
wife, and at once he regained control of himself; his raised hands
dropped limp at his side, and his huge, heavy body sank into a chair;
fell like a full grown tree cut at the root.
Alexis continuing to look at his father from under his eyelashes,
stooped bristling up like an enraged animal and slowly receded
towards the door; only on the threshold did he turn round; then he
opened the door and hurriedly left the room.
Meanwhile Catherine sat down on the arm of the chair, took
Peter’s head and pressed it against her large soft bosom, soft as the
bosom of a foster-mother. Next to the yellow, withered, almost old
face of her husband, Catherine looked quite young. She had a high
colour and her cheeks were covered with small downy moles which
looked like beauty spots, pleasing dimples, dark arched eyebrows,
carefully curled rings of black dyed hair on her low forehead, large
protruding eyes and a continuous smile, such as ever adorns the
portraits of royalty. On the whole, however, she less resembled a
Tsaritsa than a German waitress, or else the simple wife of a soldier,
a laundress, as the Tsar himself called her, who accompanied her
husband on all his campaigns, washing and sewing for him, and
when he was ill made warm poultices for him, rubbed his stomach
with ointment, supplied by Blumentrost, and gave him medicine.
Nobody save Catherine knew how to tame these fits of fury, which
were dreaded by all around him.
Holding his head with one hand, she fondled his hair with the
other, repeating again and again the same words: “Peter, Peter, my
dear one, my heart’s treasure!” She was like a mother rocking her
sick child, or like a tamer of lions fondling her beast. Under the
influence of this gentle continuous caress the Tsar always grew calm,
as it were fell into a dose. The convulsions in his body abated, only
his motionless face, now almost quite rigid, with the eyes closed,
continued to twitch from time to time, as if grimacing.
A little monkey had followed Catherine into the room; it was a
present given to their youngest daughter Elizabeth by a Dutch
captain. The mischievous monkey, following the Tsaritsa like a page,
was trying to catch hold of the bottom of her dress. Noticing Lisette,
it grew frightened, jumped first on the table, then on a sphere which
represented the course of celestial bodies after the system of
Copernicus, the thin brass arcs bent under the weight of the little
animal, the globe of the universe gently tinkled, then higher still on
to the very top of the upright English clock which stood in a glazed
box of red mahogany. The last ray of sunlight caught the clock, and
the moving pendulum flashed like lightning. The monkey had not
seen the sun for a long while. As though trying to recall something,
it looked with wistful amazement at the foreign, pale, wintry sun and
screwed up its eyes and made grotesque faces, as if mocking the
convulsions of Peter’s face, and the resemblance between the
grimaces of the little animal and those of the great Tsar was terrible.
Alexis returned home.

He felt as one whose leg or arm had been amputated; recovering
consciousness he tries to feel for the missing limb and finds it gone.
In the same way the Tsarevitch felt in his soul, once filled with love
for his father, a void. He remembered his father’s words “I will sever
you—I will lop you off like a gangrenous limb,” and it seemed to him
that everything had gone when he lost the love of his father. He felt
a void, neither hope, nor fear, nor sorrow, nor joy, but a light terrible
void.
He was amazed how swiftly and easily his wish had been fulfilled:
for him his father was dead.
Book V
THE ABOMINATION OF DESOLATION
CHAPTER I
“It was the will of God, Your Highness, that a great fire should
visit Moscow in 1701, while the Tsar was at Voronesh building ships.
In this fire the whole of the Tsar’s residence in the Kremlin was
burnt: the wooden buildings, the inner parts of those built of stone;
churches, together with their crosses, roofs, screens and the holy
images themselves—all were ablaze. The belfry of the Great John
Tower caught fire, and the bell, weighing 8,000 poods, fell to the
ground and broke. So did that in the Cathedral of the Assumption
and sundry other bells. And in places the earth itself was burning.”
Thus spake to the Tsarevitch Alexis the sacristan of the
Annunciation Church, an old man of seventy.
Peter had gone abroad shortly after his illness on January 27,
1716; the Tsarevitch remained alone in Petersburg. Receiving no
further intimation from Peter, he dallied with the alternative left him
by his father, either to fit himself for the duties of the throne or to
become a monk, and he continued to live from day to day “till God
should order otherwise.” He had spent the winter in Petersburg;
spring and summer in Roshdestveno; in the autumn he went to
Moscow to see his relatives.
On September 10, the eve of his departure, he paid a visit to his
old friend, the sacristan, husband of his wet nurse, and together
they went to view the palace in the Kremlin, which had been
destroyed by fire.
For a long time they wandered about the seemingly endless ruins,
from hall to hall and terem to terem. What the flames had spared
time was destroying. There were halls without doors, windows or
floors, so that it was impossible to enter them; and in the walls huge
gaps appeared, while the ceilings and roofs were crumbling. It was
with difficulty Alexis could find the rooms in which he had spent his
childhood.
He divined the unexpressed belief of Father John, that the fire,
occurring in the same year in which the Tsar had begun to break
down the old ways, was a sign of God’s wrath.
They entered a dilapidated private chapel, where Ivan the Terrible
had prayed for the son he had slain.
A deep blue sky, such as only canopies ruins, peered through the
rent in the ceiling. Iridescent cobwebs bridged the gap, and through
them could be seen a cross which, snapped by the wind, was
suspended by half-broken chains, and so threatening to fall at any
moment. The wind had broken the mica windows, and crows flying
in through the holes had built their nests in the ceilings and messed
the screens. White streams of their droppings streaked the dark
faces of the saints; one half of the holy gates was torn off; in the
sanctuary at the foot of the altar stood a pool of water.
Father John told the Tsarevitch how the priest of the chapel, a
centenarian, had long petitioned the Public Offices, Departments,
and even the Tsar himself, that the structure should be repaired,
because, owing to the age of the ceiling, the leakage had increased
to a great extent, there was danger the Eucharist would be exposed
to the elements. But nobody listened to him; he died of sorrow, and
the chapel fell into ruins.
Crows, scared by their entrance, flew up with ominous cries;
through the windows the wind moaned and sobbed. A spider ran to
and fro in his web. Something started from the altar—apparently a
bat—and began to circle round the head of the Tsarevitch. He felt
terrified, and lamented the state into which the church had fallen; to
his mind came the prophet’s words about “the abomination of
desolation in the holy places.”
Passing the golden rails, along the front gallery of the grand
staircase, they descended and entered the Granovitaia Palace, which
had been less damaged than the others. But in place of the
receptions to foreign ambassadors, or levées, originally held there,
the palace was now used for the performance of new comedies and
dialogues, and also for buffoon weddings. And to prevent the old
interfering with the new, the existing writing on the walls had been
covered with whitewash, and daubed over with a gay ochre pattern
in the new “German style.”
In one of the lumber rooms on the ground floor Father John
pointed out two stuffed lions. Alexis at once recognised them as the
familiar objects of his childhood. During the reign of Tsar Alexis
Michailovitch the lions were placed near the throne in the Kolomna
Palace, where they bellowed, rolled their eyes, and opened their
jaws like live beasts. Their brass bodies had been covered with
sheepskins in lieu of lions’ skins. The mechanism, which had once
produced the “leonine roaring” and moved their jaws and eyes, was
secreted in a separate closet, where the bench with bellows and
springs had been fitted up. The lions had probably been brought to
the Kremlin for repairs, and forgotten here amid the lumber of the
storehouse; the springs were broken, the bellows torn, the skins had
fallen off; rotten bastwisp was protruding from their sides, and
pitiful, indeed, now looked these sometime terrible playthings of
former Russian autocrats—their muzzles expressing blank
sheepishness.
In some of the halls, which had fallen into disuse, although they
had escaped the rages of the flames, new departments had been
installed. Thus in those facing the quay, formerly known as the
“Obituary” and “Responsory,” the Treasury was now established.
Under the terems the Senate Department. In the Commissariat the
Salt Office, the Military Department, the Uniform and War Offices. In
the old stable was now the Cloth and Ammunition Stores.
Each department had been installed, not only with its archives,
officials, porters and petitioners, but also with its prisoners, who
remained confined for years in the rooms on the ground floor. These
newcomers swarmed and wriggled in the old palace like worms in a
dead body, causing much foulness.
“All the dung and waste litter from privies, stables and prisoners,”
explained Father John, “pollute the air, and expose to no small
danger the Royal Treasury and costly plate, stored in the palace
these many years; because from all that filth there rises a fetid air,
which might harm the gold and silver vessels by tarnishing them.
Would that the dirt were cleared away and the prisoners located
elsewhere! Much have we begged and prayed, but no one heeds,”
the old man concluded sorrowfully.
It was Sunday; the courts were empty. A heavy smell filled the air;
on the walls were the greasy marks of the petitioners’ backs, while
ink stains, ribald writings and drawings caught the eye everywhere.
And above, from the old faded gilt frescoes, the faces of prophets,
Church fathers and Russian saints remained to look down on the
scene.
Within the precincts of the Kremlin, hard by the palaces and
churches adjoining the Tainisky Gate, stood the tavern called “The
Roller.” It was so named because of the steep and smooth descent
of the Kremlin Hill at this place. The tavern, which had grown up like
a toadstool, was frequented by the clerks and copyists. For many
years it had flourished in secret, notwithstanding the orders “to
exclude from the Kremlin the aforesaid tavern without delay, and
that the income from the sale of liquor might not suffer to permit the
opening of other taverns at discretion in more convenient and fitting
places.”
The air was so close in one of the halls, the Tsarevitch hastened to
open a window. From the “Roller,” crowded with customers, rose up
a wild, almost bestial roaring, the noisy sound of dancing, music and
drunken song, and the words of a notorious song, one sung by the
princess-abbess at his father’s banquets:—
My mother bore me while she danced,
And christened me in the Tsar’s tavern,
And bathed me in the headiest wine.
To the Tsarevitch it seemed that “The Roller” was some dark

yawning pit, whence, together with this song thus degrading
motherhood, and the smell of drink, there was exhaled a stifling
odour which filled the royal halls, causing sickness, dizziness and a
sinking at the heart.
He lifted his eyes to the vaulted ceiling of the hall. On its surface
were depicted “the heavenly bodies,” the lunar and solar circles,
angels ministering to the stars, and other works of God. There was
also a picture of Christ Emmanuel, enthroned on heavenly rainbows,
with many-eyed wheels; in his left hand the golden chalice, in his
right the staff; on his head a coigned crown, and on a gold field
tinted with green, ran the inscription:—
“Pre-existent Word of the Father, Thou who art in the image of
God, and through whom all things were made, grant peace to Thy
churches, and victory to the faithful Tsar!”
But from below there came again the song:—
“My mother bore me while she danced,

And christened me in the Tsar’s tavern.”
The Tsarevitch read the inscription in the solar circle, “The sun
knew the time of his setting ... and it was night.” These words
flashed on his mind with a new significance. The ancient sun of the
Muscovy kingdom knew the time of his setting in the dark Finnish
bog, in the rotten autumnal mire; and it was night, not the black,
but the terrible white Petersburg night. The ancient sun grew dim,
the ancient gold crown and “Barma of Monomachus” were tarnished
in the new but noxious air. And the abomination of desolation stood
in the holy place.
As if to escape from some invisible pursuer he rushed from the
palace, and, without looking back, fled along corridors, galleries and
down the stairs, leaving Father John far behind, never stopping until
he reached the square, where once more in the open he could
breathe freely. Here the autumn air was pure and fresh, and the old
white stones of the churches seemed pure and fresh also.
In the corner by the walls of the Annunciation Church stood a low
bench, where Father John used often to sit, sunning himself.
On this bench the Tsarevitch dropped exhausted, while the old
man went in to prepare for his night’s rest. The Tsarevitch remained
alone. He felt terribly tired, as if he had journeyed a thousand miles.
He could have wept, but no tears would come. His heart was
burning, and his tears dried up, like water dropped on a glowing
stone. The white walls were bathed in a peaceful evening light. The
golden cupolas of the churches caught by the setting sun were
ablaze, like living embers. The sky became lilac-hued, and as it
darkened it resembled the colour of a faded violet; the white towers
stood out like gigantic flowers with flaming crowns. The old clocks
rang forth the hour—the rapid ding-dong of many smaller bells
chiming in half-tones to the steady booming of the hour-bell—their
confused medley of sounds producing a solemn, if somewhat harsh,
church music. Meanwhile the modern Dutch clocks replied with
melodious jingling and modern dance music, “after the manner of
Amsterdam.”
And all these old and modern sounds brought back to the
Tsarevitch’s mind his distant childhood. He closed his eyes, and his
mind sank into drowsiness—into that dark domain where, betwixt
sleep and waking, hover the shadows of the past. Visions floated
before him, like motley shadows on a white wall when a sunbeam
enters a dark room through a chink. One awe-inspiring image
dominated them all—his father. And as a traveller, looking back at
night from a summit, beholds in a flash of lightning all the road he
has traversed, so the relentless light from that figure laid bare his
whole life.
CHAPTER II
He is six years old. They are watching the procession from an
ancient gilded coach with mica windows, which is as clumsy and
jolting as a farmer’s cart. The inside is hung with clove-coloured
velvet and brocade curtains. Here he sits on his grandmother’s knee
amidst downy cushions, with his nurses, and maids, plump as
pillows. His mother, the Tsaritsa Eudoxia, is there too, dressed in a
stomacher and a pearl-embroidered gown. Her round white
countenance, like the eager face of a child, wore a look of
continuous surprise.
Through the curtain and the open window of the coach, he
witnesses the triumphal procession of the troops on their return
from the Azov campaign. He is delighted with the regular lines of the
regiments as they march past, the brass guns flashing in the
sunshine, and the shields with their roughly drawn allegories. He
remembers two of them. One pictured a pair of Turks chained
together, bearing the inscription:—
“Calamity overtook us
When Azov was lost to us.”
The other depicted upon a sea of startling blue the god Neptune, a
red-hued man astride a monster with green scales. He is made to
brandish a harpoon and say:—
“We compliment you on the taking of Azov and tender you our
submission.”
He admires the German scholar Vinnius, attired in Roman military
dress, who is declaiming Russian verses by the aid of a tube, four
yards long. In the ranks, side by side with the common soldiers’
walks a bombardier of the Preobrazhensky Regiment. He wears a
dark green coat with red lapels and a three-cornered hat. He is taller
than the rest, and is conspicuous from a distance. Alexis knows him
to be his father, but his face is so youthful, almost child-like, that he
seems in reality only an elder brother, a dear comrade, a little boy
just like himself. It feels very stuffy in the carriage among the downy
pillows and plump nurses. He longs to get out into the sunshine, and
join that bright, curly-headed, quick-eyed boy.
The father sees his son, they smile at one another and Alexis’
heart beats with joy. The Tsar approaches the carriage doors, opens
them, and takes his son almost by force from the grandmother’s
arms, amid the exclamations of the nurses—he embraces and kisses
him tenderly, more tenderly than a mother, then lifting him high in
his hands, he shows him to the army and the people, and finally
placing him on his shoulders, he bears him aloft above the
regiments. At first quite near, then further and further away, across
the sea of heads, like a peal of thunder rolled the joyful cry from
thousands of voices:
“Vivat, vivat, vivat! Long live the Tsar and Tsarevitch!”
Alexis feels that they all look at him, that all love him. He feels
frightened and yet happy. He holds tightly to his father’s neck, and
nestles closer to him; his father carries him so carefully that there is
no fear he will drop him. And it seems to him that his father’s
movements are his, his father’s strength his too, and that he and his
father are one. He is ready to laugh and cry, so joyful are the shouts
of the people, the roar of cannon, the chiming of bells, the golden
cupolas, the blue sky, and the sun. His head goes round and round,
he is short of breath, he seems to fly straight up into the sky,
towards the sun!
He sees his grandmother’s head leaning out of the carriage
window, her kind old wrinkled face looks so droll and yet so dear to
him. She beckons with her hand and calls out, beseeching almost in
tears:
“Peter, Peter, dear, don’t tire Alexis!”
And again his nurses put him to bed, and cover him with a golden
damask quilt, lined with the softest sable; they fondle and caress
him and gently stroke his feet, to make him sleep the sweeter. They
tuck him in securely against the slightest breeze. As one guards the
apple of the eye, so they watched over him, the Tsar’s own babe. He
is secluded, like a fair maiden, behind the inevitable curtains which,
when he goes to church, surround him on all sides so that no one
should see the Tsarevitch, until he is “proclaimed,” according to an
ancient custom, and after his proclamation people will flock from
distant parts to have a look at him, as at some prodigy.
It is close in the low terem rooms; the doors, shutters, windows,
stoppers, all are carefully nailed round with felt to exclude the least
draught. The floor is also covered with felt for “warmth and quiet.”
The glazed stoves are overheated. The air is saturated with spirit of
yarrow and calamus, which is added to the fuel “for scent.” The
daylight, penetrating through the slanting mica panes, changes to a
yellow-amber. Little lamps glimmer everywhere before the images.
Alexis feels languid, but at the same time happy and snug; he seems
to be ever dozing and cannot wake. He dozes listening to the
monotonous conversations about the ordering of a godly household:
everything should be kept in its place, clean, swept, secured from all
damage lest it might rot or go mouldy; everything should be kept
locked up, and not open to theft or waste; the good should receive
honour; and severity should be the lot of the evil doers; and how to
be careful with the scraps, how to twine bast round split and dried
fish, how to preserve different sorts of soaked mushrooms in tubs,
and how to maintain an ardent faith in the undivided Trinity. He
dozes while listening to the wailing sounds of stringed instruments
played by blind bards who are chanting old legends, and to the
narratives of old men whose tales had once amused his grandfather,
Tsar Alexis Michailovitch. He slumbers—and the tales of pilgrims and
mendicants bring him vivid visions, of Mount Athos, pointed like a
fir-cone, on its summit above the clouds, stand the Holy Virgin
spreading her cloak about it; of Simeon Stylites who allowed his
body to rot till it was alive with worms; of the place where the
earthly Paradise stood, which Moïsláv of Novgorod had seen afar off
from his ship, and of many another divine wonder and diabolic
suggestion. When he feels dull, by order of his grandmother all sorts
of jesters, orphan girls, Kalmuck women, blackamoors dance before
him, fight, roll on the floor, pull at one another’s hair, and scratch
one another. Or again his grandmother would take him on her lap,
and begin to play with his fingers, touching them one after another,
starting from the thumb, repeating the little nursery rhyme, “A
magpie crow, having boiled some gruel, hopped to the door and
invited his guests. She gave to this and she gave to that and none
was left to feed the last.” And then she would tickle him, and he
would laugh and try to shield himself. She overfeeds him with rich
pancakes, onion patties, “levashnik,” sour apple fritters fried in nut
oil, gruel boiled in poppyseed milk, white gruel, pears and burrels in
syrup.
“Eat! Alexis, eat, it’s good for you, my treasure!”
And when Alexis suffered from stomach-ache a wise woman would
be summoned, whose incantations were supposed to benefit the
tender young. She knew herbs which cure internal ailments and
epileptic fits. Whenever Alexis sneezed or coughed, they at once
would give him raspberry tea, rub him with camphorated wine-spirit
or make him sweat in a bath prepared with althea.
Only on the hottest days is he taken out for a walk in the beautiful
“Upper Garden,” laid out on a wooden platform inside the Kremlin.
This imitation of the hanging gardens is a continuation of the Terem.
Here everything is artificial: hothouse flowers in boxes, tiny ponds in
tubs, and tame birds in cages. He looks down and forth on Moscow
which lies spread at his feet; he sees streets he had never been in,
roofs, towers, belfries, the distant town beyond the Moscow stream,
the bluish outlines of the Sparrow hills, and over all the airy gilded
clouds. And he feels weary; he longs to get out of the Terem, out of
the toy garden away to real forests, fields and rivers, away into the
unknown distance; he is eager to run, to fly like the swallows whose
flight he envies. It is very close and heavy. The hothouse flowers,
and medicinal herbs, marjoram, thyme, savory, hyssop, tansy, fill the
air with a spicy and sickly perfume. A cloud of leaden hue creeps
slowly up, fast thronging shadows fall around him, a fresh breeze
sweeps past and it begins to rain. He stretches out his face and
hands and greedily tries to catch the drops, while his nurses in great
agitation are already searching for him.
“Alexis, Alexis, come in, child, you’ll get your feet wet.”
But Alexis does not heed them; he hides among the sweet-briar
bushes. The air is now filled with a scent of mint, dill, and moist
earth; the foliage glistens in its fresh green, the double peonies glow
like balls of fire. A last ray of sunshine pierces the cloud, and the sun
mingling with the rain forms one tremulous net of gold. He is already
wet through. Yet he delights in watching the heavy drops break into
radiant dust, as they splash on the surface of the pools. He jumps,
skips, and sings a gay song to the patter of the rain, which resounds
in the hollow vault of the water tower—
“Cease, gentle rain,

Lest we should yearn in vain
To reach the river Jordan’s banks
And bring to God and Christ our thanks!”
Suddenly right above his head a blinding flash of lightning burst

through the cloud, the thunder rolled, a whirling wind rose and died
away. He felt again the same mingled sensation of joy and fear
which once before possessed him, when his father carried him
shoulder high during the triumph of the Azov campaign. To his mind
came the bright curly-headed, quick-eyed boy, and he felt his father
loved him just in the same way as he loved that terrible lightning.
His breath came quick and short, he was delirious with joy. He fell
on his knees and stretched both hands towards the black sky,
fearing and yet wishing for another flash more awful and more
blinding; but trembling old hands already catch hold of him, carry
him indoors, undress him and put him to bed; he is rubbed with
camphorated wine-spirit and made to drink medicated vodka and
lime-tea, until he sweats seven times, and then they wrap him up
and again he sleeps. And he dreams about that terrible slate dragon,
who lives in the “Stone Mountains,” and has a maiden’s face, a
serpent’s mouth and nose, and the feet of a basilisk, with which he
breaks the iron; he can only be caught with the sound of a trumpet,
for he is unable to bear it, and when its blast rings out, he pierces
his ears and dies shedding a blue blood on the surrounding stones.
Alexis dreams about the Siren, the bird of Paradise, singer of royal
songs, denizen of Eden, who tells of the joys which the Lord has in
store for the Righteous. Not every one in the flesh can hear its voice,
those who do, are so charmed that they follow its lead and pass
peaceably away listening to its strains. Alexis believes that he too is
following the singing Siren, and that while listening to its sweet
melodies he is dying, sinking into eternal slumber.
Then suddenly it seems as if a hurricane swept into the room,
threw open the door, curtains, hangings, tore the coverings off Alexis
and sent a chill over him. He opened his eyes and saw his father’s
face. He was not in the least frightened, not even surprised; he
seemed to have known and felt that he would come. The song of
the Siren still ringing in his ears, with a sweet half dreamy smile he
stretched out his hands and cried, “Daddy! daddy darling!” and
threw his arms round his father’s neck. His father embraces and
hugs him, kissing his face, neck, naked feet and all his little warm
sleepy body. His father had brought him from abroad a clever toy; in
a wooden box with a glass cover, lo, four waxen figures, three
dressed as foreign women and one as a child, stand before a mirror.
Underneath is fixed a bone handle, which makes the women and
child dance to a tune. Alexis is pleased with the toy, yet he hardly
looks at it: his father absorbs all his attention. He soon notices a
change in his father’s countenance. The face has become thin and
gaunt; he has grown more manly and seems taller. Yet to the child’s
gaze, tall as he is, he still remains the curly-headed quick-eyed boy
of old. A smell of wine and fresh air comes from him.
“Daddy’s moustache is showing! But how tiny the hairs are, they
can hardly be seen.”
And with curiosity he passes his little fingers over the black down
on his father’s lip.
“And you have a dimple on the chin, just like Granny!”
He kisses it.
“Why are Daddy’s hands so hard?”
“It is from the axe, Alexis. I have been building ships beyond the
seas. Wait until you grow up and I’ll take you with me! Would you
like to go across the seas?”
“Yes, I would. Where daddy goes, I would like to go too. I want to
be with daddy always.”
“And are you not sorry for granny?”
Here Alexis notices in the half-open door the frightened face of his
grandmother, and his mother with a deadly pallor on her
countenance. They both watch him from that distance, afraid to
come nearer; they bless him and themselves with the sign of the
cross.
“Yes, I am sorry for granny,” murmurs Alexis, and at the same
time he wonders why his mother is not mentioned.
“And whom do you love most, granny or me?”
Alexis does not answer immediately; it is difficult for him to
decide. Suddenly clinging closer still to his father, trembling and
shrinking in shy tenderness, he whispers in his ear:—
“I love daddy, love him more than any one!”
And suddenly all vanishes, the squat Terem, the downy bed, his
mother, grandmother, and nurses. He seems to have fallen into some
dark hole, like a bird from its nest, on to the hard frozen earth. He is
in a large cold room with bare walls and iron-barred windows. He no
longer dozes. On the contrary he is always longing for sleep; he
cannot get enough, he is roused so early. Through a fog, which
makes the eyes smart, loom long barrack buildings, earthen
ramparts with pyramids of shot, muzzles of cannon, the Sokolinki
field covered with grey thawing snow, dotted with wet crows and
ravens, under a leaden sky. He hears the roll of the drums, the drill
commands: “Eyes front!” “Shoulder arms!” “Present arms!” “Right
turn!” the dry rattle of the musketry and again the roll of the drums.
His aunt, the Tsarevna Natalia Alexeyevna, is with him; an old maid
with sallow face, bony fingers which hurt so in pinching, and cross
piercing eyes which seems to eat him: She cries:—
“O scurvy brat of thy mother!”
It was not until long after he learnt what had actually happened.
How the Tsar on his return from Holland had banished his wife, the
Tsaritsa Eudoxia, to a nunnery, forcing her to take the veil under the
name of Elena, while he removed his son from the Kremlin residence
to the new Potíeshny Palace in the village Preobrazhensky. Side by
side with this palace were the torture-chambers of the Privy
Chancery, where the trial of the Streltsy Mutiny took place. They
daily burnt more than thirty wood fires, at which the rebels were
tortured. Was his remembrance true or only a nightmare? He could
no longer tell. It was as if he were stealing along the huge pointed
piles of the wall which surrounded the prison; groans issue from
within, a streak of light reveals a chink in the log-built wall. He put
his eye to the hole and saw a veritable hell:—
Hot fires are burning,

Cauldrons are steaming,
Knives are being sharpened,
All to butcher thee!
Human bodies are actually roasting over the fires; they are slung on
a post and so stretched that their joints crack; their ribs are broken
with red-hot tongs, and their nails are scraped with red-hot needles.
The Tsar is among the torturers. His face is so terrible that Alexis
can hardly recognise him—himself and yet not himself, rather his
double, his “were-wolf.” He is examining one of the ringleaders, who
in stubborn silence endures all. His body already resembles a bloody
carcase from which the butchers had torn off the skin, yet he
remains dumb and looks defiantly straight into the Tsar’s eyes.
The boy Alexis swooned; soldiers found him in the morning lying
at the foot of the wall close to the moat. He lay unconscious for
many days.
He had hardly recovered, when by command of the Tsar he had to
be present at the dedication of the Lefort Palace to Bacchus. He
wears a new German coat with stiff wired folds, and a huge wig
which oppresses him. His aunt is in a gorgeous “robe ronde”; they
are in a separate room, adjacent to the Banqueting Hall. Damask
curtains, the last remnant of the Terem seclusion, hide them from
the guests. Yet Alexis sees all that goes on among the members of
“The Most Drunken Convocation,” whose insignia were cups of wine,
flagons of mead and beer, instead of the Holy Vessels; in place of
the Gospels, a case shaped like a Bible containing different vodkas;
for incense, tobacco smouldering in braziers. The high priest, the
Kniaz-Pope, attired in mock vestments imitating those of a patriarch,
trimmed with playing cards and dice, with a pewter mitre on his
head crowned by a naked Bacchus, and in his hand a staff decorated
with a naked Venus, blesses the guests with two pipes folded on the
cross. The orgy begins. The buffoons revile the aged boyars;
punching them, spitting in their faces, spilling wine over them,
pulling their hair, cutting their beards or plucking them out by the
roots. The revelry degenerates into an inquisition. As in some
terrible nightmare Alexis beholds all this. And again he cannot
recognise his father; rather it is his father’s double, his evil genius!
“His Serene Highness, the Tsarevitch Alexis, beginning with the
alphabet, and having in a short time mastered it, now, following the
order of instructions, is learning the breviary,” thus reported to the
Tsar the tutor Nikíta Viasemski, “his lowliest slave.”
It was according to the Domostroi that he taught Alexis how to
approach sacred things; the way to kiss wonder-working icons, and
relics, taking heed not to moisten them with lips, nor to tarnish them
with the breath, for the Lord dislikes our dirt and breath; how to eat
the holy loaf without scattering crumbs on the ground, or biting it
with the teeth like other bread, but breaking it into little pieces put
them one by one into the mouth and so eat in faith and fear.
Listening to these instructions of his tutor, Alexis could not help
recalling how this same tutor at the Lefort Palace amongst the
buffoons, in a drunken frenzy was used to dance before the foreign
courtesan Mons, whistling and singing.
The learned German, Baron Huissen, presented a “Methodus

instructionis” to the Tsar. “A syllabus to which he who shall be
instructed with the education of the Tsarevitch must conform.” “In
his feelings and heart, at all times implant and strengthen love for
virtue; also strive to inculcate in him disgust and repulsion for all
that is called sin before God; adequately represent the heavy
consequences that result from it, and exemplify by application from
Holy Writ and profane history.”
“Also instruct in the French language, which cannot be done better
than by daily use. Show coloured geographical maps. Gradually
accustom to the use of the compasses, and indicate the importance
and utility of geometry. Commence the preliminary military
exercises, storming, dancing, and riding. Develop a good Russian
style. Diligently read on all mail days the French newspapers and the
‘Historical Mercury,’ and present political and moral reflections
thereon. Always use ‘Fenelon’s Telemachus,’ in the instructions of his
Highness, as a mirror and guide for his future government. And to
prevent weariness by continual work and instructions, use for
diversion in a moderate measure the game ‘Truktafel.’ This scheme
can easily be completed in two years, and then his Highness without
delay may proceed to perfect himself in general knowledge, so that
he may be equipped for the thorough study of the world’s politics,
the real needs of this empire, all the useful sciences such as
fortification, artillery, civic architecture, navigation, and so on, to his
Majesty’s complete satisfaction and his Highness’s own immortal
glory.” To carry out this programme they chanced to hit upon a
certain worthy named Martin Neubauer. He taught Alexis the rules of
“European Compliments and Politeness,” from a book entitled “The
Youth’s Mirror of Honour.”
“Children must, above all, greatly honour their father. When a son
receives instructions from his father, he should always stand hat in
hand, not in the same line with his father but a little behind to one
side, like a page or servant. When a son meets his father he ought
to stop at a distance of three paces; take off his hat and greet him in
an agreeable manner. It is better to be accounted a gracious cavalier,
than a proud blockhead. Do not lean on tables or benches, like a
peasant who delights to lounge in the sun. Youths must not sniff
with their noses, nor blink with their eyes. And this also is no small
nuisance, to blow one’s nose like a trumpet or sneeze loudly, and so
startle people or frighten young children at church. Keep your nails
cut and don’t let them suggest a velvet border. Behave well at table,
sit upright; do not pick your teeth with a knife, but with a tooth-pick,
and cover the mouth with your hand during the operation. Don’t
munch over your food like a pig; don’t scratch your head, for even
so do the peasants. Youths should always converse in foreign
tongues among themselves to gain a ready fluency, and also the
better to distinguish themselves from the ignorant.”
Thus droned into his august pupil’s ear on one side the German;
while from the other the Russian repeated:—“Don’t spit to the right,
Alexis, for that is your angel’s side; always spit to the left, where
Satan is. In dressing don’t begin with your left foot, it is a sin.
Carefully keep the parings of your nails in paper, to climb Zion’s Hill
with on your way to Heaven.”
The German tutor sneered at the Russian and the Russian laughed
at the German, and Alexis knew not whom to believe. The touchy
student, a burgher’s son from Dantzic, hated Russia. “What
language is this?” he used to say. “It has neither rhetoric nor
grammar. The Russian priests are themselves incapable of explaining
what they read in the churches; only darkness and ignorance results
from the Russian language.” He was generally drunk, and in that
state his diatribes increased.
“You know nothing, you are all barbarians! Dogs! dogs! rogues!”
The Russian mockingly called the German “Martin Marmoset,” and
informed the Tsar that instead of instructing the Tsarevitch he,
Martin, set his Highness a bad example; creating in him a
repugnance for learning and a horror of all foreigners. To Alexis both
the Russian and German tutors were equally humbugs.
Sometimes Martin would weary him to such an extent during the
day that even at night in his dreams he would come to him in the
shape of a learned ape, which grimaced according to the rules of
“European Compliments and Politeness” in front of “The Youth’s
Mirror of Honour.” Around stood the figures from the Golden Hall,
Moscow’s ancient Tsars, patriarchs and saints. The ape mocked and
railed at them, “Dogs! dogs! rogues! None of you know anything,
you are all barbarians!” And Alexis seemed to discern a likeness
between this monkey face and another disfigured by convulsions,
belonging not to the Tsar, but to that awful double of his, the were-
wolf, his evil genius. And Alexis felt the shaggy paw stretched out to
grasp him and drag him away.
And again the scene changed. Now it is the very end of the world,
a flat seashore, bogs with mossy hillocks, a pale lurid sun, and a low
hanging oppressive sky. All is misty, phantom-like, and he himself
seems but a phantom, who dead long ago, has descended into the
realm of shadows.
At the age of thirteen the Tsarevitch joined the bombardier
regiment and took part in the Noteburg campaign. From Noteburg to
Ládoga, from Ládoga to Jamburg, Koporie and Narva he was
dragged everywhere with the baggage waggon and train to
familiarise him with military life. Although but a child, he shared
dangers, privations, cold, hunger and weariness with the men. He
saw the bloodshed, squalor and all the horrors and abominations of
warfare. He caught glimpses of his father from afar; and every time
he beheld him, his heart beat in wild anticipation, he might come to
him, he might call for him, he might caress him. Just one word or a
look and Alexis would have been roused to new life and have
understood what was expected from him. But his father had no time
to spare; his hand was ever occupied, now with a sword, now a
quill, now a compass, now an axe. He waged war against the
Swedes, and at the same time he was pile-driving for the first
dwellings at Petersburg.
“My gracious Lord Father,—
“I pray thee grant me a favour and let me be informed by letter
for my joy, about thy health, of which I always anxiously desire to
hear.
“Thy son Alexis invokes thy blessing and presents his homage.
“Written in Petersburg, August 25, 1703.”
He dared not add a single genuine word, whether of endearment
or complaint, to the letters dictated by his tutor. He grew up a
cowed, timid, lonely boy, like a weed in the moat round the arsenal
wall.
Narva had been stormed. The Tsar celebrated the victory by
reviewing his troops with music and salutes from the guns. In front
stood the Tsarevitch, watching the young giant with his bright awe-
inspiring face coming towards him, no longer his double, his evil
genius, but himself, his own dear father. The boy’s heart beat
quicker, and again it throbbed with eager hope; their eyes met, and
it was as if a lightning flash had blinded Alexis. His desire had been
to rush to meet his father, to throw his arms round his neck,
embrace him, kiss him in a paroxysm of joy.
But sharp and decisive, like the rattle of the drum, were the words
that greeted him, words so familiar in rescripts and articles.
“Son, the reason I took you with me on this campaign was to
show you that I shrink from neither toil nor dangers. Being only
mortal and liable to be summoned this day or to-morrow, I charge
you to remember that you shall taste little joy if you shun to follow
my example. Shun no toil for the common weal! But should you cast
my advice to the wind, and refuse to do as I bid you, then I will
deny you as my son, and will implore God to punish you in this life
and the life to come.”
The father takes hold of the boy’s chin between his two fingers
and looks intently into his eyes. A cloud passes over Peter’s face. He
seems to see his son, such as he really is, for the first time: this
weakly lad with sloping shoulders and narrow chest, with his
stubborn and morose looks—is he indeed his only son, the heir of
the throne, with whom the culmination of all his schemes and toil
will rest? Can it be? Whence came this puny starveling, this raven,
into the eagle’s nest? How could he be the father of such a son?
Alexis shrank into himself and strove to efface himself, as if he
guessed his father’s thoughts, and was guilty before him of some
crime unknown and irreparable. He felt so ashamed and terrified
that he was ready to burst out crying like a child before the
assembled army. But mastering himself with a supreme effort, he
uttered in a trembling voice the salutation he had been made to
learn.
“Most gracious Lord Father, I am very young at present and do
what I can, but your Majesty may be assured that, as a dutiful son, I
will strive with all my might to imitate your actions and example.
May God keep you for many years to come in perfect health and
thus grant that I may long continue in the enjoyment of so illustrious
a parent!”
And then, according to the instructions of Martin, uncovering his
head in an agreeable manner, like a gracious cavalier, he makes a
German bow, saying:—
“Meines gnädigsten Papas gehorsamster Diener und Sohn.” He
knew he looked like a puny, deformed, silly monkey, in front of this
giant, handsome as a young god. The father proffers his hand, the
son kisses it. Tears burst from the boy’s eyes, and it seemed to him
that his father feeling the warm tears pulls away his hand in disgust.
At the triumphal entry into Moscow on December 17, 1704, to
celebrate the Narva victory, the Tsarevitch marched with the
Preobrazhensky regiment shouldering his gun like a common soldier.
The frost was intense. The boy was nearly starved to death with the
cold. In the palace at the usual orgies he drank a glass of vodka to
warm himself, and at once became drunk. His head went round, it
grew dark, blurred red and green circles danced before his eyes;
only one thing he saw clearly, the face of his father who was looking
at him with a disdainful smile. Alexis was cut to the quick. He got up
and with unsteady steps, lurched towards his father; he looked at
him furtively like a young wolf at bay, tried to say something, but
suddenly turned pale, shrieked, staggered forward and fell at his
father’s feet.
CHAPTER III
“Already my earthly life is drawing to a close: my voice is going, I
am growing deaf and blind. I beseech you to relieve me from my
office of sacristan, grant me permission to end my days in a
monastery!”
The Tsarevitch, lost in dream-memories, scarcely noticed the
monotonous wail of Father John, who returning from his cell sat
down beside him on the bench.
“My small house, chattels and superfluous furniture, could be sold;
my two orphaned nieces placed in some nunnery, and the little
money I have scraped together, I would bring as my gift to the
monastery. Thus I would not live on the bounty of others; and my
offerings might be acceptable to God, like the two mites of the
widow. Then I might live for a little while in silence and repentance,
until God wills to take me from this into eternal life. I feel that I have
reached the end of my span, for even so did my parent die at the
same age——”
Awakening, as from a deep slumber, the Tsarevitch saw it was
night. The white church towers, tinged with palest blue, more than
ever suggested gigantic flowers, huge lilies of paradise; the golden
domes shone silvery in heaven’s dark blue vault, studded with stars.
The Milky Way glimmered but faintly. And the fresh breezes of
heaven, even as the breathing of a slumberer, seemed to bring with
them from the heavens a foreboding of eternal rest, and unbroken
quietude. The slow murmuring words of Father John mingled with
the stillness:—
“Give me but leave to go to my resting place, a holy monastery,
and let me live in silence until the time that I shall be taken hence
——”
He continued to mumble for some time, stopped, again resumed,
went away; and soon returning called the Tsarevitch to supper.
Alexis had again closed his eyes and fallen into that dark dreamy
abode, where twixt sleep and waking hover the shadows of the past.
Again memories, visions, image after image passed before him, like
a long chain, link after link; above them all towered one awe
inspiring image, his Father. And as a wanderer looking back at night
from a summit beholds in a flash of lightning all the road he has
traversed, so the relentless light from that figure laid bare his whole
life.
He is seventeen, at the age when in olden days the Tsarevitch was

proclaimed to the people, who would flock from all parts to gaze at
him, as at some wonder. But on Alexis a man’s toil is imposed, too
heavy for his young strength; he is perpetually travelling from town
to town, buying provisions for the army, felling and despatching
timber for the fleet, printing books, casting cannon, writing ukases,
levying armies, searching for young deserters under penalty of death
—himself only a lad relentlessly executing the law on those of his
own age; he supervises everything to prevent defalcations of any
kind.
He hurries from German declensions to fortifications, from
garrisons to orgies; from orgies to deserters, until his brain is in a
whirl. The more he attempts the more is demanded. He has neither
leisure nor rest. He feels ready to drop like an over-ridden hack. And
at the same time he knows that his efforts are all in vain; it is
impossible for him ever to please his father.
At the same time he continues his studies, as if he were a
schoolboy. “Two weeks shall be devoted to the German language, to
master well the declensions, and then attention shall be given to
French and arithmetic. Instruction to take place each day.”
At last his strength gave way. During the severe frost in January
1709, he was bringing to his father, then at Suma in the Ukraine,
five regiments from Moscow which he had himself levied and which
were destined to take part in the battle of Poltava. On the journey
he caught cold, fell ill, and lay for weeks insensible. His life was
despaired of.
He regained consciousness one sunny morning, early in spring.
Slanting rays of sunlight flooded the room. Snow was lying outside,
wet drops hung already on the icicle tips. Brooks were murmuring on
their way, and from the sky the lark showered his song in melodious
strains. Alexis sees his father’s face bent over him, the one so dear
to him in years gone by, a face full of tenderness.
“My son, my love, do you feel better?”
Too weak to answer Alexis can but smile.
“Well, glory and thanks be to God!” exclaims his father piously.
“The Lord hath shown mercy upon me and heard my prayer. Now
you will soon be well!”
Alexis was told later that his father never left him during the whole
of his illness. Neglecting all other work, he had spent night after
night without sleep. When the patient grew worse, he ordered the
celebration of mass and made a vow to erect a church in the name
of “St. Alexis, the man of God.”
Then came the slow joyful days of convalescence. To Alexis his
father’s caresses were as health-giving as the warm bright sunshine.
In blissful lassitude, with a pleasurable weakness in his body, he
would lie the whole day long without moving. He was never tired of
looking at his father’s grand open countenance, his bright, fierce yet
tender eyes, and the charming, slightly cunning smile on those
finely-curved lips. The father could not do enough to show his love
to Alexis. Once he brought him a small snuff-box carved by himself
out of ivory, with the inscription, “A small gift, but from a loving
heart.” Many a year the Tsarevitch had kept it, and every time he
looked at it, something burning, poignant, akin to measureless pity
for his father would surge up within him.
Another time while gently caressing his son’s hair, Peter said in a
timid shy voice, as if excusing himself, “If ever I said or did anything
that hurt you, for God’s sake remember it no longer and do not
sorrow over it. Forgive me, Alexis! Petty annoyances are sufficient to
arouse anger in an arduous life, and my life is indeed hard. I have
no one to consult, not even a single helper.”
Alexis, as in the days of his childhood, threw his arm round his
father’s neck and all trembling and melting in shy tenderness
whispered in his ear:—
“Daddy darling, I love you; I love you!”
But in proportion as he returned to health, so his father once more
receded from him. There seemed to be a merciless fate upon them
both, to be companions and yet strangers; secretly loving, while
openly estranged and hating one another.
And again all things fell back into the old ruts: the collection of
provisions, detection of deserters, casting of cannon, felling of
timber, building battlements, wandering from town to town. Again
Alexis toiled like a convict and his father remained as ever
dissatisfied, even suspecting his son of laziness, “leaving off work,
running after idleness.” Sometimes Alexis would like to remind him
of what happened at Suma, but he could never bring himself to do
it.
“Son, we instruct you to depart for Dresden. During your sojourn
in that city we command you to live honestly and apply yourself
diligently to studies: especially languages, geometry and
fortification, and also partly to political science. And inform us by
letter when geometry and fortification have been successfully
acquired.”
Abroad the Tsarevitch lived like an exile, neglected by everyone.
His father again forgot his existence; he did not remember him save
when he wanted to marry him to Princess Charlotte of Wolfenbüttel.
The Tsarevitch had no liking for his bride; he had no wish whatever
to marry a foreigner. “Why did they force this devil of a wife on me?”
he used to cry out when flushed with wine.
Before the nuptials he had to conduct humiliating negotiations
about his bride’s dowry. Peter was eager to squeeze as much money
as possible out of the Germans.
Six months after his marriage Alexis left his wife for another tour:
from Stettin to Mecklenburg, from Mecklenburg to Abo, from Abo to
Novgorod, from Novgorod to Ládoga—again interminable fatigue,
interminable fears.
The dread he felt before each interview with his father developed
into a nervous terror. Approaching the door of his father’s room he
would mutely repeat a prayer: “Remember, O God, King David and
all his humility!” He would jerk out disconnected fragments of
lessons on navigation, it being beyond his power to remember the
barbarous terminology of such words as: “krup-kamer, balk-vegerse,
haigen-blok (anchor-stock),” and he would fumble for his amulet, the
gift of his nurse, a blade of grass embedded in wax, with a paper
bearing an ancient charm to soften the anger of a father:—
“On a momentous day was I born. I fenced myself with iron, and
went unto my father. My parent became wrathful, began to break my
bones, to pinch my body, to trample on me with his feet, and drink
my blood. Bright sun, clear stars, still sea, ripe fields! Ye all stand
peaceful and still. May my father throughout all his hours and days,
his nights and midnights, be as quiet and still as ye!”
“Well, my son, I must say this is a first-rate fortress,” said his
father with a shrug of his shoulders, looking at his son’s plan. “You
have apparently learnt a great deal abroad.”
Alexis grew only more confused, and winced like a guilty
schoolboy before the rod.
To escape such torture at times he used to take medicine and
“feign illness.”
Terror was merging into hatred.
Just before the Pruth campaign, Peter fell seriously ill, “he did not
expect to live.” When the news reached Alexis he experienced for
the first time a feeling of pleasure at the possible death of his father.
This joy frightened him; he banished it but could not destroy it; it
hid itself at the bottom of his heart, ready to spring forth like a
lurking beast.
One day at a feast when Peter, as was his wont, made his drunken
guests quarrel with one another so that he might learn from their
recriminations the thoughts of those around him, Alexis, also drunk,
began to talk about the state of the empire, and the oppression of
the people. All grew silent, even the buffoons stopped their
shouting. The Tsar listened attentively. Alexis’ heart was beating with
hope, what if he were heard? understood?
“Enough of this nonsense!” the Tsar stopped him suddenly with
that mocking smile, so familiar and hateful to Alexis. “I perceive, my

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Download the full version of the textbook now at textbookfull.

Hair and Scalp Disorders: Medical, Surgical,

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Hair and Scalp Disorders: Medical, Surgical, and Cosmetic

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Eating Disorders in Special Populations: Medical,

Opportunistic Networks: Concepts and Systems 2024th

Treatment Adherence in Dermatology Steven R. Feldman

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3. Dermoscopy of Hair and Scalp Disorders (Trichoscopy)................................................................................................................31

4. Photographic Imaging of Hair Loss.....................................................................................................................................................43

5. Hair Follicle Anatomy in Human Scalp Biopsies..............................................................................................................................49

6. Nonmedicated Grooming Products and Beauty Treatments..........................................................................................................61

7. Practical Case Scenarios: How to Utilize Products..........................................................................................................................73

8. Dandruff and Seborrheic Dermatitis: Use of Medicated Shampoos.............................................................................................83

10. Androgenetic Alopecia..........................................................................................................................................................................111

11. Telogen Efﬂuvium..................................................................................................................................................................................123

12. Cicatricial Alopecia...............................................................................................................................................................................139

13. Structural Hair Abnormalities............................................................................................................................................................153

14. Scalp Prostheses: Wigs, Hairpieces, Extensions, and Scalp-Covering Cosmetics....................................................................173

15. Hair Transplantation for the Dermatologist....................................................................................................................................179

16. Alternative Treatments for Hair Loss...............................................................................................................................................195

17. Hirsutism and Hypertrichosis.............................................................................................................................................................207

18. Light-Assisted Hair Removal and Hair Growth.............................................................................................................................219

19. Allergic Contact Dermatitis.................................................................................................................................................................229

20. Psychodermatoses Involving Hair......................................................................................................................................................245

21. Scalp Infections and Infestations........................................................................................................................................................251

22. Sources of Alopecia Information for Physicians and Patients.....................................................................................................269

23. Approach to the Alopecia Patient......................................................................................................................................................273

24. Hair Aging and Anti-Aging Strategies..............................................................................................................................................281

Index ................................................................................................................................................................................................... 301

Sharone K. Askari, MD Abby C. Ellison, BA

Douglas Canﬁeld Maria Fernanda Reis Gavazzoni Dias, MD, PhD

Zoe Diana Draelos, MD John Gray, MD

Lady C. Dy, MD, FAAD Janet G. Hickman, MD, FAAD

Ariana Eginli, MD Maria K. Hordinsky, MD

Sara A. Hylwa, MD Paradi Mirmirani, MD

Erin M. Warshaw, MD, MS David A. Whiting, MD, FRCP

Introduction Structure of Hair

Hair texture is a less precise term but is usually classiﬁed as

Fine less than 60 microns

Many women, on questioning, believe their hair to be ﬁner than

Hair’s Microﬁbril (three Called keratin

Volume control is an issue, and chemical permanent procedures

FIGURE 1.7 (CONTINUED) Strategies managing tightly curled hair. (c) A

Indo-European hair diameter tends to be in the lower range, and

Hair Phenotypes in the Americas

The three classic hair phenotypes are illustrated in Figures 1.12

Developments of Human Hair Differences

Alexis returned home.

To the Tsarevitch it seemed that “The Roller” was some dark

“My mother bore me while she danced,