696 WALTER J. HIGHMAN AND JEFFREY C. MICHAEL 



curring in overfed infants. Fatty stools, or stools with undigested food, 

 were, he believed, associated with this condition. 



The adult form of eczema has been widely ascribed to proteid indi- 

 gestion. It is difficult to define the relationship. Without questioning 

 the advisability of treating any digestive disturbance, it may be questioned 

 whether any one has ever seen a dermatosis of the above class disappear 

 under treatment of the alimentary canal alone, without suitable local man- 

 agement. Only such a control would provide positive evidence. Never- 

 theless, clinical experience is replete with evidence that certain dermatoses 

 depend for their very existence upon digestive diseases. Rosacea is of 

 this number. Aside from those cases ascribed to alcoholism and tea 

 drinking, the great majority are conceded to be caused by chronic gastritis, 

 gastric ulcer, hyperacidity (whatever that may mean) and remoter con- 

 ditions underlying or associated with these, as well as by functional 

 gastric derangements, if there really are any, including vagoto-iia. The 

 conventional use of these terms will be pardoned, for so employed they 

 convey something, in spite of their indefiniteness. Undoubtedly rosacea 

 may be controlled by controlling the gastric condition. 



In a less direct manner acne vulgaris has a similar relation to these 

 conditions. Acne vulgaris is a disease with marked features. It arises 

 in relation to puberty and disappears with the establishment of sexual 

 stability after adolescence. Many of its victims present hyperglycemia, 

 and have slightly enlarged thyroid glands. Whether this picture hangs 

 together as a unit or not cannot be stated, for doubtless many people have 

 acne who have no other ascertainable derangement. Although in the 

 majority of cases acne will disappear under x-ray treatment, in some it will 

 not without the cure of the underlying gastric or gastro-intestinal dis- 

 turbance, even if this be only constipation. 



It is impossible to discuss this phase of the subject without further 

 reference to eczema. This disease, if it be a disease, a matter subject to 

 reasonable doubt, has been divided, etiologically, into two groups, one 

 acknowledged to be the result of some external irritant, the other of an 

 internal derangement. In the second group the alimentary tract has been 

 most widely incriminated. As time has advanced evidence has been 

 accumulated that has forced, more and more, the reallocation of eczema 

 types, placing the majority of cases in the group due to external causes. 

 The day will arrive when the entire literature on eczema will be read, if at 

 all, only for the historic amusement it may furnish. There is absolutely 

 no convincing proof that this dermatosis has any relation to the alimentary 

 tract, unless it is to be found in writings on pediatrics ; the opinion is here 

 ventured that more babies have been starved than cured by trying to treat 

 their skin through their intestines. Physicians have been forced by 

 anxious mothers to sacrifice offspring at the altar of maternal neuroses. 



