RELATION OF SKIN TO NONSPECIFIC RESISTANCE 139 



For therapeutic effects certain agents have been found more effective 

 than others, but within certain limits they are all more or less effective. 



Acute Exanthemata. If in an acute exanthema we regard the 

 huge skin involvement in the nature of an inflammatory reaction, it 

 follows that from it not only enzymes but toxic split products are being 

 absorbed very rapidly when the hyperemia that is part of the inflam- 

 matory reaction becomes pronounced. When the skin reaction reaches 

 its height we know that it is accompanied clinically by an increase in 

 the temperature and that defervescence usually follows in the wake of 

 this increase. The normal mechanism of recovery in these acute dis- 

 eases may therefore involve precisely the same nonspecific reaction that 

 we now seek to make use of therapeutically in other conditions. 



In variola the appearance of the skin eruption is of course coinci- 

 dent with the improvement in the general condition that is so char- 

 acteristic of the disease the lowering of the temperature, the pulse 

 rate, the pronounced euphoria, etc. and the secondary fever is purely 

 an absorption fever when suppuration sets in, similar in its character 

 and course to that of any other suppurative condition. 



Focal Activation from Intracutaneous Injections. Perhaps one 

 of the most striking illustrations of the importance of skin stimu- 

 lation and its effect on remote disease processes is afforded by the 

 recent work of Miiller. The interesting fact has been brought out 

 by him that the intracutaneous dosage required to bring about a 

 focal activation may be l/30th less than the dose required if given 

 intramuscularly or intravenously, and it is of course immaterial what 

 agent is used in the skin injection. Thus he found that "arthigon," 

 typhoid and cholera vaccine, tetanus or diphtheria antiserums and even 

 salt solutions were able to elicit focal provocative reactions as tested 

 in gonorrheal urethritis. His results emphasize the fact that relatively 

 minute and seemingly insignificant skin reactions may exert a tre- 

 mendous effect on remote pathological lesions and that we must seek 

 the mechanism of this phenomenon in metobolic alterations produced 

 in the skin, not in peculiarities of the agent that we happen to use to 

 bring about the reaction. Needless to state, the tuberculin therapy of 

 Ponndorf (which consists of intracutaneous injections of tuberculin) is 

 related to the alterations that Miiller has studied. And, as we might 

 expect, a variety of clinical conditions have been reported to improve 

 after the Ponndorf technic. Thus Kroschinski found that neuralgia, 

 neuritis, tabetic pains, acne and furunculosis responded to the tubercu- 

 lin injections made in this manner. 



Syphilis. When now we turn to examine the clinical statement 

 that is often made, namely that in syphilis accompanied with extensive 

 skin lesions, or in tuberculosis that has its chief site in the skin, the 

 internal organs are as a rule free from pathological changes, we find 

 considerable evidence of a clinical character to support the assertion. 



