704 WALTER J. HIGHMAN AND JEFFREY C. MICHAEL 



between the integument and the tissues it envelops. It is important to 

 trace this relationship until the problems are elucidated. As Engmaii 

 said, the skin is the mirror of the body. In the foregoing the value of 

 the work done has been rather understated, in the hope of avoiding un- 

 warranted enthusiasm. As a matter of fact, the application, of the 

 principles implied in the work reviewed makes for greater alertness in 

 diagnosis, and for more efficacy in treatment, even though surmises rather 

 than facts guide us. In addition to the foregoing, the more important 

 dermatoses will be catalogued, accompanied by thumb-nail sketches of 

 related general disturbances. 



Acne or Acne Vulgaris. This well-known pustular disease has been 

 ascribed to the stormy metabolic disturbances inherent in the unfolding 

 of puberty. More especially it has been ascribed to overindulgence in 

 starchy food and sugar, and to carbohydrate indigestion, hyperglycemia 

 (Schwartz, Hlighman and Mahnken), while Schamberg and Strickler 

 found complement fixation possible between the serum of acne patients 

 and bacterium coli used as antigen. 



Acroasphyxia. Cyanosis of the smaller extremities has been associ- 

 ated with organic heart disturbances, notably mitral disease, and with 

 ordinary so-called vasomotor instability. As a forerunner of erythrome- 

 lalgia, Raynaud's disease, and the various gangrenes, it is due to organic 

 central nervous or vascular disease. It is an objective indication of pre- 

 disposition to frostbite. 



Dermatitis (The Simple Variety, Including Eczema). This is a 

 simple, acute, subacute, or chronic catarrh of the skin, caused by a wide 

 variety of external agents, chemical, physical, infectious and, undoubtedly, 

 often by internal disturbances, some of which are surmised, others not yet 

 even remotely understood. For the most part nitrogen retention or some 

 other type of disturbed nitrogen metabolism has been incriminated, but 

 proof is still lacking, as is shown in earlier paragraphs. 



Dermatitis Exfoliativa. Arsenic poisoning can produce a general 

 exfoliative dermatitis. Scarlatina terminates with a similar process. 

 Thus it is argued that in the unexplained varieties of the group, the cause 

 must be either infectious, or toxic, and in the second event, that the poison 

 must be ingested, or manufactured in the body. The favorite belief, 

 although entirely unsubstantiated, is that there is a disturbance of nitrogen 

 metabolism. 



Dermatitis Herpetiformis. The remarks on the internal causation of 

 eczema apply in this disease too. . 



Erythema Multiforme. In some of its manifestations, particularly 

 erythema nodosum, this disease is allied with acute rheumatism, but more 

 with subacute. It is also considered anaphylactic, as urticaria, and 

 one form of multiform erythema participates in the Osier syndrome. 

 Many drug eruptions resemble multiform erythema, and the bullous 



