RELATION OF SKIN TO NONSPECIFIC RESISTANCE 135 



families there exists a so-called "arthritic milieu" as a result of which 

 they are particularly susceptible to a variety of pathological altera- 

 tions. They react to outside trauma or stimuli of such mild degree 

 that would, in the normal individual, provoke either no response at all 

 or at the most a very negligible reaction. Eczema, lichen, urticaria, 

 food and drug idiosyncrasies, herpes, furunculosis, pruritus and psori- 

 asis are regarded by him as belonging in this category. To it he also 

 adds hay fever, asthma, gout, adiposity, migraine and neuralgia. Even 

 Bloch accepts the first five of the skin diseases as belonging to this 

 "arthritic" group of diseases. The French clinicians have carried this 

 conception to its logical conclusion and do not speak of eczema as a 

 disease entity but of "eczematization" (Besnier, Darier, Rapin and 

 V. Hirschberg, etc.). 



It is by no means excluded that this sensitization takes its origin 

 from some primary bacterial infection tonsil, gastro-intestinal (gall 

 bladder and appendix) or respiratory. 



Esophylaxis. The association of skin reactivity and internal con- 

 ditions has recently been illustrated in experiments of a different 

 nature. During the course of investigations on the mechanism of 

 intoxication and death from burns, Pfeiffer observed that a marked 

 mobilization of proteolytic enzymes occurred after even superficial 

 burns of the skin. As a result of this observation and others closely 

 related he felt justified in including the intoxication of burns among 

 those due to protein split products. In view of the relatively rich 

 enzyme content of the skin such a mobilization after stimulation might 

 be anticipated. But in so far as this mobilization, when it is within 

 physiological limits, or under therapeutic control, may play a role in 

 influencing internal diseases, the study of the skin reactivity becomes 

 of interest to us not only in the sense that it protects against disease 

 entrance an "exophylaxis," as Hoffmann has termed it, but because 

 of its importance on the internal organs as well an "esophylactic" 

 effect. 



Bloch and Hoffmann have both discussed this subject in recent 

 papers which seem of considerable interest in connection with the 

 mechanism to which attention has been called. Bloch has expressed 

 the conviction that the skin possesses a biological function, heretofore 

 unappreciated, by means of which the vital organs are protected from 

 bacteria, or at the most have but to deal with a minute amount of 

 attenuated bacteria. Taking into consideration the more recent work 

 concerning the phenomena of allergy as observed in tricophyton infec- 

 tion, in tuberculosis and syphilis he emphasizes the fact that "the 

 skin above all other organs plays a leading role in allergic immunity 

 and sensitization, as contrasted with serum immunity, such as that of 

 diphtheria, tetanus, etc., where the serum is the carrier of the anti- 

 disease mechanism." 



The allergic alterations vaccination against variola the funda- 



