13 4 PROTEIN THERAPY 



to proceed much farther and more rapidly than in the uniodized 

 patient. When the injection is made a certain amount of tissue injury 

 is done. Some of the cells will be injured both from the trauma and 

 from the toxic material injected. In the uniodized patient the in- 

 hibition of digestion due to the antiferment checks autolysis to a 

 degree, the process is delayed sufficiently so that no great amount 

 of split products are present at any one time. The rate of formation 

 will not exceed the rate of diffusion. In the iodized patient, on the 

 other hand, the rate of digestion being greatly accelerated, protein 

 split products will accumulate in the cutaneous tissues in an amount 

 greater than the rate of diffusion, more tissue injury will be done; 

 with autolysis leukocytes will be attracted and a pustule will re- 

 sult where under ordinary circumstances merely a papule would have 

 been formed, or a papule will result in an individual in which the 

 reaction normally would have been absent. 



While from these observations it is apparent that nonspecific fac- 

 tors can undoubtedly influence the tuberculin reaction or the other 

 skin reactions both in the sense of depressing them or accelerating 

 the reactivity of the skin, we must by no means lose sight of the fact 

 that a specific element enters into the cutaneous reactivity. In my 

 opinion it is probable that the explanation for the fact that the tuber- 

 culin reaction , is clinically specific and fairly reliable while similar 

 skin reactions (typhoidin reaction, etc.) are not, is to be found in the 

 fact that the tuberculous individual, because of his continuous ab- 

 sorption of proteins, is in a state of generally increased sensitiveness 

 to proteins. This hypersensitiveness is of a degree sufficient in tu- 

 berculosis to overbalance the nonspecific factors which in other dis- 

 eases interfere so greatly that the interpretation of the skin reactions 

 becomes both difficult and unreliable. 



The Relation of the Skin to Internal Medicine. While in a 

 general way these studies have been undertaken from the point of 

 view of the dermatologist, a wider viewpoint that includes the 

 relation of the skin and its reactivity to problems in internal medi- 

 cine has found expression in a number of papers. Particularly 

 the study of the various diatheses has interested a group of investi- 

 gators. Thus Schulz, using dilutions of carbolic acid to bring about 

 skin reactions, determined that children with exudative diathesis 

 usually revealed an increased irritability of the skin. It seems prob- 

 able that the severity of the vaccina reaction and the reaction to the 

 parenteral injection of proteins that such children often show is to be 

 associated with this change. But the hypersensitiveness, according to 

 Schulz, is not limited to children; many adults suffering from eczema 

 have been found by him to be decidedly hypersensitive. 



Brocq's investigations in this connection are of importance. It has 

 been Brocq's contention that in such hypersensitive individuals and 



