DERMATOSES IN METABOLIC DISTURBANCES 697 



Pruritus ani has been widely ascribed to acid stools. There is some- 

 thing to be said in favor of this belief, although the literature reflects 

 nothing thereof. Beyond question many cases of anal itching are relieve' 1 

 only after a demonstrated intestinal disorder has been controlled. 



Urticaria and its cousin, angioneurotic edema, are largely anaphylactic 

 manifestations, but evidence exists that no internal absorption of ana- 

 phylotoxins is possible without alimentary disease, however slight. For 

 the most part constipation is present ; at times mucous colitis (Highman 

 and Michael). 



Dermatoses Conceived to Be Due to or Associated 



with Diet 



Intimately associated with alimentary disturbances is the relation of 

 diet to dermatoses. Precisely as scarcely a skin disease has failed to be 

 treated internally by catharsis, so is there scarcely one that has not been 

 ascribed to dietetic indiscretion. It may be conceded without argument 

 that food should be chewed properly, eaten deliberately at regular times, 

 and simply prepared, and that a meal should represent a properly bal- 

 anced mixture of proteid, carbohydrate, fat, fluid, vitamins and salts. 

 Overeating and undereating are equally to be condemned. With less 

 detail, the above might be summed up in the words "common sense," and 

 included in this concept should be proper regard for the temperature and 

 seasoning of food. But, aside from these factors, there are certain others 

 more directly responsible for the causation of cutaneous reactions. The 

 relation of proteids, whether animal or vegetable, to urticaria is uni- 

 versally admitted. Bulkley, years ago, considered psoriasis due to over- 

 indulgence in meat. The number of vegetarians with psoriasis amply 

 discredits this belief. More recently, Schamberg and others have asso- 

 ciated the disease with excess nitrogen ingestion, including that of 

 leguminous sources a much more scientific concept than Bulkley's. 

 Even this cannot always be substantiated. The consensus of opinion is 

 that diet plays a small role in producing psoriasis. 



Eczema has also been ascribed to dietetic errors. The writings of 

 Towle and Talbot, Freeman (&), Sturtevant, Charles White (a), and many 

 others are examples. What applies to the relation of alimentary disease to 

 eczema equally applies to diet in this connection. If eczema were often 

 due to food, certainly we should readily find proof in the infantile form, 

 for babies prevailingly get one food, milk. Nevertheless, in spite of an 

 immense literature on the subject, pediatricians have proved nothing. 

 One school thinks infantile eczema due to proteids, another to fats, another 

 to carbohydrates. There could hardly be a fourth school of believers in 

 the dietetic cause, unless they blamed whole milk, and what a delicious re- 



