136 PROTEIN THERAPY 



mental observations of Koch on the production of tubercles in the 

 skin, which, in the infected animal, assume a much stormier and rapid 

 course the researches of v. Pirquet on the vaccination allergy in 

 tuberculosis, syphilis, and fungus infections all point to the skin as 

 fundamentally involved in the mechanism of resistance. Perhaps it 

 plays some role even in recovery in the acute exanthemata, such as 

 measles and scarlet fever; in variola its importance is obvious. Heim 

 has recently expressed the opinion, which was current many years ago 

 and still is more or less popular in folk medicine, that the skin eruption 

 of the acute exanthemata is involved as part of the mechanism of 

 recovery. His conception is that the organism endeavors to rid itself 

 of the toxic substances through the skin, that a leukocytosis occurs 

 there and that the latter is of utmost importance in digesting the toxic 

 material. While in bald outline the theory may seem crude, it is 

 possible that there may be some connection, as Heim has suggested, 

 between the skin eruption and the mechanism of recovery, as I shall 

 endeavor to point out later. 



Hoffmann calls particular attention to the clinical observation that 

 the internal organs are frequently spared from serious involvement 

 both in syphilis and in tuberculosis when the skin lesions are extensive. 

 In order to emphasize the importance of the skin in its relation to 

 internal medicine he calls attention to a number of other facts that are 

 more or less pertinent. The fact that an intoxication ensues when large 

 areas of the skin are put out of function by varnishing or burning; 

 that the large bulk of epithelial tissue, with its elaborate network of 

 intercellular canals and its proximity to the vascular corium would 

 facilitate absorption of secretions; that the folklore of many genera- 

 tions expresses the idea that in the exanthematic diseases the internal 

 organs are spared to the degree that the eruption is manifest in the 

 skin, with the therapeutic conclusion that anything that will increase 

 the eruption influences the patient favorably (Heim also calls attention 

 to this tradition) , all indicate, even if only in a general way, that the 

 skin may be of importance in overcoming infection. 



Hoffmann's Theory. Hoffmann makes the epigramatic statement 

 that "the skin is the grave of the parasites." The fact that so many 

 acute infections involve the skin measles, scarlet fever, variola, ty- 

 phus, syphilis, etc. has led him to the conclusion that the skin plays 

 some active role in immunity. In how far some internal secretion of the 

 epithelium, to what degree the vascularized papillary body with its 

 ready inflammatory response enters into this mechanism, he does not 

 suggest. This ability to respond readily with inflammation might be 

 anticipated both from the phylogenetic as well as from the ontogenetic 

 development. Thus the skin of the adult reacts more rapidly and to a 

 wider range of substances than that of the infant, the skin of the 

 human more readily than that of lower animals. 



Light Rays. Perhaps the effect of light on the skin and the recent 



