Vascut.ar Lesions of Skin 81 



academic arena, that of becoming' mellow before I have grown 

 ripe. 



My brief discussion today concerns vascular lesions in the 

 skin, and their increasing incidence with advancing years. 

 For the most part it emphasizes observation rather than 

 interpretation. I have no evidence to demonstrate 

 preponderant environmental or genetic influences. The study 

 represents merely the first step in clinical research, which 

 is systematic observation and recording of data. I have 

 only vague notions of why the several types of lesions 

 occur at all and can give you only speculation about the 

 effect of increasing age upon them. 



The observations began about fifteen years ago when I 

 failed to get any help about the nature of arterial spiders from 

 the Nestors of American medicine at Johns Hopkins or 

 Harvard. I was sufficiently curious to attack the problem 

 from the simple approach of the natural historian. Having 

 become interested in one kind of vascular alteration of the 

 skin I noticed others closely or distantly related, or sometimes 

 merely confused in the medical writings on the skin. The 

 data reported here are based on a study of about 700 persons 

 with arterial spiders and palmar erythema, 75 persons with 

 Osier's disease, and more than 1,000 patients surveyed in 

 detail for cherry angiomas, venous stars and caviar lesions. 

 The venous lake on the ear has been studied systematically 

 only recently. 



Spider Naevi 



To try to throw light on the significance of the eruptive 

 spider naevus (Fig. 1) of liver disea;Se and pregnancy I made a 

 series of studies which led to the hypothesis that such vascular 

 lesions were overgrown and hypertrophic end arteries whose 

 increase in size was probably caused by oestrogenic hormones. 

 In chronic disease of the liver these hormones are in high 

 concentration in the blood because the liver cannot ade- 

 quately inactivate, destroy or excrete them. In pregnancy the 

 liver functions well but the level is high because the hormones 



