The microscopical examination of the club-shaped hair shows that its special form is due to a progressive atrophy of the papilla which forms it. A histolog ical examination will separate alopecia areata clearly from the cryptogamic tineas.
In 300 cases examined by him, Sabot, rand found that all the morbid conditions indicate a pre-existent intoxication. the cause of which had disappeared. In the earlier stages, however, he found that one out of every two or three follicles at the margin showed an ampulliform dilatation at its upper part, which he calls the utricle. (See colored plate.) This, when first perceptible, is roofed by a dome having a minute window in its centre. In this cavity alone the micro organism is to be found. So long as the aperture remains closed the microbacil lus exists in a pure state, but when it opens it disappears, and saprophytic fungi enter. The bacillus is one of the smallest known, and is in innumerable numbers. It is, according to him, con stant in the early stage of the benign form. In total alopecia of this type there seems to be two stages: in one the bald skin is oily and shining, and in the second it is dry and rather scaly, and in which there is a tendency to restoration of hair. If, in the seborrhmic stage, the contents of the follicles are expressed by massage, the same organisms found in the utricle are recognizable in immense numbers, less numerous in the drier stage, and not to be found when healthy lanugo hairs begin to clothe the surface. Sabouraud hesitates to pronounce the microbe he has discovered, as the causal element, for one both identical in ap pearance and in reaction to stains has been found habitually in the comedo and in seborrhoea of the oily type.
The microbes which are found in the hair are diverse; they are habitually ob served even upon scalps that are not affected with alopecia, but only in hairs which show evidence of papillary altera tion anterior to the microbic invasion.
Indeed, none of these microbes, almost all of which have been described by vari ous authors as specific, can, according to Sabouraud, have any causal importance in the disease.
Three facts which militate in favor of the infectious nature of alopecia areata: (1) the erythematous tint of recent patches; (2) tumefaction of occipital lymph-nodules, which often accompanies the beginning of the disease; (3) the fact of experimental contagion. Blaschko (Third Cong. of Derm. and Syph., '97).
Prognosis.—The prognosis of alopecia areata is exceedingly variable; in many cases treatment must be continued for years.
The more ancient the patch is, the more difficult it is to promote a return of the hair.
Occipital or temporal alopecia areata recovers more slowly than that of other regions of the scalp.
When the hairs begin to grow anew they are frequently white at first, and only later, by the continuance of the treatment, do they resume their normal hue.
Treatment. — The general treatment usually recommended has for its object to strengthen the patient. Increased nutrition and general tonics play an im portant part in the methods indicated. Country-air, physical exercise, rest from mental overwork, warm sulphur shower baths (Besnicr and Doyon), cold shower baths on the vertebral column, iodide of iron, codliver-oil, strychnine, sodium arsenate, the preparations of cinchona, and the valerianates have each their sponsors.
Food containing much butter, fat and milk, phosphates and fish, strychnine, and phosphoric acid are of service.
Patients should be well fed. The fats and phosphates should be increased. Milk taken alone and between meals, crushed wheat, cream, and fish the most valuable aliments for this purpose. The best results have been obtained under the free and continued administration of strychnine with phosphoric acid. Arsenic should be given alternately with the for- I mer. Bulkley (N. Y. Med. Record, Mar. 2, *S9).
The progress of the disease must be arrested by shaving the hair around each patch for about half an inch or, even better, by shaving the entire head. Epil ation may be done, instead of shaving, around the bald patches. (Brocq.) To effectively treat alopecia areata, it is necessary to act upon the derma, and the horny layer must first be destroyed by the application of a vesicating fluid, preferably the ethereal solution of can tharides. On the following day a 15 per-cent. solution of nitrate of silver is applied upon the denuded chorium, with or without. previous cocaine anes thesia. This may be renewed in ten or fifteen days if necessary. The results of this treatment greatly surpass in effectiveness those following other pro cedures. (Sabouraud.) The success of epilating a ring of hairs in the early stage as a means of protective demarkation against extension is explained, if Sabouraud's discovery should be verified.