694 WALTER J. HIGHMAN AND JEFFREY C. MICHAEL 



jectively, too, there are great limitations to our ability to widen the 

 scope of actual knowledge. 



Tradition brings further burdens of complexity the nomenclature in 

 dermatology. It is overwhelming to read the number of terms applied 

 to the same clinical condition. We cannot go too far in eliminating ac- 

 cepted designations, for clinically identical conditions may pathogenetically 

 not be the same; nor can we venture too far in clinical differentiation, for 

 dissimilar looking dermatoses may have the same causation. Still, over- 

 elaboration of language is always a handicap. Thus dermatology remains 

 a speculative science in which the objective data are not entirely reliable, 

 the designations often inapt, if not actually incorrect, and to which methods 

 of investigation, in themselves inadequate, have not yet been applied even 

 indifferently well. 



Nevertheless, it is obvious that, although the skin is subject to many 

 local disturbances, there must be many which participate in, or cause, or 

 reflect general disturbances. The skin, no more than any other organ or 

 tissue, can follow an entirely autonomous pathological career. Many of 

 its disturbances must depend upon factors in the general body economy. 

 It is difficult to trace these. In the very sparse literature all views are in 

 conflict. One author reports a series of conditions associated with hyper- 

 glycemia ; other investigators find another group. A diminished alkali 

 reserve is found in certain dermatoses by one, and in others, by another, 

 and so it goes. Nor is there any reason to assume that a relationship 

 such as that indicated in the previous sentence is more than coincidence, 

 unless practical application of the findings supports another view. In 

 furunculosis, for example, hyperglycemia is often present, and in diabetes 

 furunculosis often arises. Reducing the starch intake often limits or 

 cures the cutaneous manifestation. Here there is something suggestive of 

 causo and effect. This is exceptional. 



Yet the toxic erythemas, arising as they do in sepsis, in follicular ton- 

 silitis, and in intolerance to drugs such as atropin, arsenic, copaiba, phe- 

 nolphthalein, etc., indicate that our ignorance of the causation of der- 

 matoses depends entirely upon our inability to discover facts. The relation 

 of the multiform erythemas to rheumatism or to asthma substantiates this 

 view. The association of primary purpuras with visceral disturbances in 

 scurvy and perhaps pellagra, and the relation of these to unbalanced diet; 

 and of urticaria to specific food poisoning all give some idea, however im- 

 pressionistic, of the dependence of skin manifestations upon remote causes. 

 The leucemias provoke dermatoses, the pathogenic mechanism of which 

 is in part metabolic derangement, and in part not. The first are ery- 

 themas, toxic in character, and anatomically not suggestive of leucemia. 

 The second are actual leucemic infiltrations resembling various dermatoses 

 that are in no wise leucemic. Even Hodgkin's disease may involve the 

 skin, producing characteristic tumors containing Dorothy Reed cells, as 



