The Relation of Dermatoses to 

 Metabolic Disturbances 



WALTER JAMES HIGHMAN- 



NEW YORK 

 AND 



JEFFREY C. MICHAEL 



HOUSTON 



Tentative as must still remain our views on the relation of dermatoses 

 to general disturbances, we cannot evade the fact that in many skin 

 diseases such a relationship exists. Positive knowledge thereof is slight. 

 Our ignorance depends largely upon the fact that chemical and other 

 laboratory methods of gathering evidence are in themselves still in- 

 adequate. The etiology of many dermatoses will continue to remain 

 obscure until internists and biochemists can bring the light. This does 

 not exonerate the dermatologist, for in the proper sense he is an internist 

 who knows the skin, and his responsibility does not end with the sub- 

 cutaneous tissue. 



Clinical study, alone, has distinct limitations. Without underrating 

 its value in the least, a method so largely subjective, so impalpable, can 

 scarcely be expected to supply foundations. Any one reading descriptions 

 of the same episode written by their several reporters for various news- 

 papers will understand the restrictions inherent in the purely clinical 

 method of stating medical beliefs. We need facts and figures to determine 

 the relationship between skin and general diseases, and despite the shrewd- 

 est surmises of which we may be capable, with reference to the existence of 

 this interrelationship, precisely what we lack are facts and figures. 



There are also objective difficulties ; diseases that look alike may have 

 entirely dissimilar causes, as the zosterform eruption of arsenic, and the 

 ordinary zoster; or the urticaria due to a certain proteid, and the urticaria 

 of syphilis. The mere matter of appearance does not determine a clinical 

 entity. It is the appearance of abnormal tissue together with a knowledge 

 of the mechanism producing it that are required to establish a disease 

 as a thing apart. The morbiliform eruption of belladonna, arsphenamin, 

 and measles itself, is the same so far as the skin is concerned, and yet how 

 different is each condition when one reflects on the cause. Thus ob- 



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