DERMATOSES IN METABOLIC DISTURBANCES 699 



numerous other drugs, are capable of causing dermatoses. These are 

 prevailingly erythematous or urticarial, but the first two provoke vesicular, 

 pustular, and granulomatous lesions also, while quinin and arsenic may 

 cause herpes, and the latter also a zosterform dermatosis. 



To sum up, then, there is no experimental evidence that digestive dis- 

 eases or faulty diet cause dermatoses, except with regard to urticaria and 

 drug eruptions. What proof thereof exists is. clinical, as in rosacea, 

 psoriasis, and the fact that infantile eczema usually disappears spon- 

 taneously with the end of infancy, or when the milk intake is modified by a 

 more varied diet. To find ethereal sulphates in the urine, undigested food, 

 or too much starch in the stool, or gastric hyperacidity, gives circum- 

 stantial evidence which may not be proof at all, but merely coincidence. 

 It is only in urticaria that we observe anything like cause and effect, 

 while in rosacea we see something approximating it. 



Dermatoses Conceived to be Due to or Associated with 

 Cardiovascular Disease 



The relationship between this group of diseases and dermatoses is 

 vague. We may dismiss the petechiae accompanying bacterial endo- 

 carditis with a word, for they are probably due to bacterial emboli, and 

 it is the bacteremia, rather than the heart disturbance, that is responsible. 

 But with chronic endocarditis, particularly during periods of decom- 

 pensation, and irrespective of drug ingestion, toxic erythemas and even 

 attacks of erythema nodosum may be noted. The incidence of these con- 

 ditions has not been calculated, but the phenomenon is rare. 



More directly connected with the theme are dermatoses due, in all 

 likelihood, to disturbed vasodynamics in valvular disease. The simple 

 picture of asphyxia is thus accounted for, and even chillblains, Raynaud's 

 disease, and perhaps scleroderma may have a remotely related origin. 

 Thrombophlebitis obliterans of Buerger, and other gangrenes are due 

 primarily to actual vascular disease determining local necrosis. 



Many of the telangiectasias are due to primary disease in the small 

 skin capillaries. Angioma serpiginosum of Hutchinson and purpura 

 annularis telangiectodes of Majocchi, are in this category. Histologically, 

 an inflammatory or degenerative process is observed in the capillary walls ; 

 probably due to a systemic disease affecting the vessels in a manner analo- 

 gous to Stokes' syphilitic telangiectasia. 



The purpuras, scruvy, and pellagra may be mentioned in this con- 

 nection, but in the final analysis either infection or intoxication is the 

 determining factor, the vascular role being purely incidental. 



On the whole, no work has been done in this particular field, and 

 the diseases enumerated indicate possibilities, the significance of which 



