children the prognosis is comparatively favorable even when the head is as hairless as a billiard ball (Fig. 4).
The etiology of alopecia areata is a vexed question. Despite the great amount of study and careful observation which has been devoted to this interesting affection, there is much difference of opinion as to its pathology, and its true nature still remains obscure. For a long time it was believed to be a neurotic affection, the bald patch resulting from a faulty innervation of the affected area. With the development of the germ theory of disease there has arisen a strong belief on the part of many dermatologists that the affection is parasitic in character. Clinical facts are not wanting in support of either view, but, while the facts are indisputable, it cannot be admitted that they prove beyond all shadow of a doubt the truth of either the neurotic or parasitic hypothesis. Recently it has been suggested, in view of the conflicting facts and theories, that there are two varieties of the affection, one of which, occurring in epidemic form, must certainly be parasitic. Without attempting to introduce evidence and argue the question, it is sufficient to state that the nature of this disease is still subjudice and will doubtless so remain until more careful observations have been made or stronger arguments presented upon one side or the other. The disease occurs in both sexes, but is said to be somewhat more frequent among boys than among girls. It has been claimed that cats and other domestic animals suffer from the affection, and cases have been reported of its transmission from these to their human playmates; but in this connection the question naturally arises as to the correctness of the diagnosis between alopecia areata and ringworm, which not infrequently originates in this manner.
In the treatment of alopecia areata no brilliant results have been obtained. Many cases recover spontaneously in a short time, while in other cases the most assiduous and persistent treatment fails to effect any notable result. Many remedies are recommended and certain methods of treatment are warranted to cure in so many weeks, but, however valuable these methods may be in the hands of their originators, they often fail utterly when employed by other hands. I have photographed many cases and have observed that a few of these have gotten well speedily without further treatment. But photography will not cure all cases ; neither will some of the vaunted methods of treatment, as I have had occasion to learn from experience. In fact it must be frankly confessed that the
