138 PROTEIN THERAPY 



sunlight in some hypothetical internal secretion of the skin which is 

 stimulating the entire organism, it will be found much simpler to con- 

 sider that the effect of the sun raying of the skin tissues brings about 

 a mild (or severe, depending on the degree) form of nonspecific shock. 

 We know from Pfeiffer's work that actual burns will do this. Between 

 the erythema of a burn due to actual heat and that due to sunlight 

 there is not much difference as far as the patient or the effect on the 

 organism is concerned. The epithelial tissues become hyperemic and 

 absorption from them is accelerated. Skin enzymes protease and 

 lipase, perhaps some ereptase in younger individuals, are swept into 

 the circulation, together with some protein split products due to diges- 

 tive stimulation in the skin. The agents that ordinarily provoke the 

 nonspecific reaction are therefore available the enzymes present in 

 the serum can now attack seminecrotic or necrotic foci and there 

 accelerate the preexisting inflammatory reaction i.e., set up a focal 

 reaction a tuberculin reaction with its resulting train of increased 

 temperature, malaise, etc. As a result of the protein split products 

 derived from the skin the organism is of course stimulated in the 

 typical nonspecific manner and the effect on the hematopoietic system, 

 on the irritability of the nerves (Singer, Pottenger), on the general 

 metabolism, is similar to that which we have seen with the other non- 

 specific reactions. Differences exist in the type of leukocytic response, 

 which seems to be more lymphatic in the case of heliotherapy. An- 

 other possibility of particular value in tuberculosis may be found in 

 the relative richness of the epidermal tissues in lipases which, when 

 mobilized after heliotherapy, might, theoretically, prove of decided 

 value in resistance to tuberculosis. 



The effect of heliotherapy in causing a focal reaction can best be 

 illustrated when one follows the effect on a tuberculous focus such as 

 an area of lupus. Even when all direct effects of the rays are excluded 

 by means of black paper, a lupus lesion will react with a typical focal 

 reaction after a general sun bath just as it does after tuberculin injec- 

 tion, after milk injection or any of the other nonspecific agents. Tuber- 

 culous foci have been observed to become much more "sensitive" or 

 reactive to other stimuli such as x-rays or concentrated red rays, etc., 

 after general heliotherapy. 



Local Applications. Hoffmann calls attention to the fact that other 

 therapeutic measures, soap inunctions, mustard baths, sweating, coun- 

 terirritation, etc., may involve precisely the same mechanism. When 

 we examine the acute exanthemata from this point of view, it will 

 become apparent that the skin manifestations and their severity may 

 well have some influence on the general course of the disease. Granted 

 that the nonspecific reaction produced by injecting various substances 

 may terminate an infectious disease abruptly and the clinical evi- 

 dence is sufficiently varied by this time to permit such a general state- 

 ment we have seen that it is immaterial how this reaction is elicited. 



