Internal causes of cutaneous diseases

Some of the causes that produce altered states of the blood-current, are:

1. Poisons of acute specific diseases - for example, those of small-pox, etc.
2. The circulation of special poison, be they animal - syphilitic;  medicinal substances - arsenic etc.; or dietetic, such as shell-fish, giving rise to urticaria, roseola, erythema.
3. Dietetic errors, as in wine-drinkers, high-livers, non- vegetarians, etc., leading to the increase of urea and uric acid in the blood.
4. The  tuberculous,  scrofulous,   and  lymphatic dyscrasiae, giving rise to non-specific eruption - impetigo, acne.
5. The gouty and rheumatic diatheses, as in lichen agrius.
6. Altered  and lowered  nutrition  from  such causes  as bad living, poverty, misery.
7. The accumulation of excreta in the blood from non-excretion,    suppression    of    natural    discharges,    kidney disease, etc.
8. Convalescence from severe and lowering diseases by which the body is rendered much less able to resist disease.
9. Climacteric, or endemic influences, often malarial in nature, which act by deteriorating the system generally.
10. Disorders of the liver and spleen leading to pigmentary deposits in various parts, jaundice, and pruritus, etc.

Local irritants frequently lead to alterations of tissue, and rank here with burns, scalds, parasites, the occupations of bricklayers, masons, and washerwomen, etc., as cause of local mischief.

Dyers, and those who handle cheap clothing, frequently suffer from erythema due to the irritant action of dyes.

Certain tissue peculiarities may be inherited. The father may transmit dispositions in tissues to behave in particular ways directly to the child, as a local peculiarity, independent of any blood state, and in this sense psoriasis, cancer, ichthyosis, may be hereditary.

There are two sources of local irritation that deserve special notice. I refer to the use of flannel worn next the skin, and scratching. Some skins are so irritable in health as to be excited to an unbearable degree by the use of flannel. In a very large number of cases of skin disease pruritus is in this way intensified and the disease even protracted, and in proportion to the degree of uncleanliness. Flannel acts, as a mechanical irritant, by augmenting the local heat, and intensifying reflexaction.

Scratching plays an important part in the modification of skin diseases, most of which are accompanied by itching. To relieve itching scratching is the most natural thing to do. What does it do?

1. When there is no eruption it may produce one.
2. It augments and modifies existing eruptions.
3. When the disease is non-contagious, secretion, in scratching, may be transferee! from place to place; and if acrid, set up local inflammation; and when contagious, scratching is the surest method of inoculation, as in the case of contagious impetigo.

Children in this way transplant the disease from the head to various parts of the body. Mothers beyond a doubt, get the disease about their hands from contact with children.

Upon the nature of the cause depends the contagions or non-contagious quality of any disease. It is generally conceded that parasitic and the acute specific diseases are contagious.

Sex has some influence as a cause of disease; males suffer by preference from sycosis, pemphigus, psoriasis, eczema, "and epithelioma; and females from acne, kelis, and lupus especially.

In our own clime race would seem to exert an influence upon lesions of the skin. Dr. Morrison, of this city, has preserved histories of five hundred cases of skin diseases in negroes, and forms the following conclusions:


"Acne and lesions due to pediculi and insect-bites are uncommon. Mosquitoes, the cimex lectularius, and insects in general, do not produce the same ill effects" (My own observation, which has been quite extensive, would lead me to disagree with the doctor in regard to the pediculi. They are very apt to have lesions from this cause). "Ainhum is peculiar to the race, two cases having been seen; one man had lost one little toe, and that of the opposite foot was affected."

Chancre is more indurated, and more frequently complicated with phirnosis.

Chloasma appeared to show a lessening of pigment, instead of an increase. (Dr. Heitzmann takes issue with Dr. Morrison on this subject, and asks how can a diminution of the normal pigment be termed chloasma; an increased pigmentation being usually understood by that name.)

Chilblain is common.

Elephantiasis Arabum mostly followed syphilis.

Erythema multiforme is difficult to diagnose, as are all erythematous conditions.

Eczema appears to be more amenable to treatment; 129 cases are recorded.

Favus and pediculi capitis are rare. (The latter is com­mon. D.)

Keloid appears common, especially false keloid after in­juries. It is seen following variola and zoster, and after piercing the ears.

Lupus is seldom encountered.

Lymphadenitis is quite common.

Pruritus is much complained of, and it is said that syphilitic lesions itch in this race.
Scabies was rarely seen.

Syphilis is abundant.

Scaly and pustular lesions are often seen.

Urticaria wheals do not seem to be so elevated, but very itchy.

Dr. Atkinson reported a pustular follieulitis very fre­quent in young, closely-shaven negroes. The pustules penetrate into follicles of the beard without producing that degree of irritation which is to be called sycosis. He thinks that fifty per cent, of the young negroes who shave very close have it.

He has noticed that it is common to find deep and per­manent pigmentation after the application of a mustard plaster.

Involution occurs after a time in keloidal tumors; they become flaccid, and, after some years, soft.

Pediculosis appeared to him to be as frequent in colored as in white .children.

Acute exanthemata produce, upon desquamating, a peppered appearance, looking as though the skin were dusty or sprinkled with fine powder. In scarlatina it is due to the slight elevation of the papules, which is not evident in Caucasians.

Whatever be the causes of the various cutaneous affec­tions, we are chiefly concerned with the means that the physician has at his command with which to treat them successfully. First of these is hygiene. It goes without saying that recovery is facilitated by the substituting of good hygienic surroundings for bad ones; and under this head we may include fresh air, wholesome food, cleanliness, exercise, and seasonable clothing. It is hardly necessary to go into details on these points, if the fact is recognized and remembered; and in all chronic affections of the skin, and in some of the acute ones, these matters should be inquired into, and corrected when possible. Our resources further include mechanical, chemical, and pharmaceutical remedies, and also electricity. An elastic bandage applied to an old, infiltrated eczema of the leg is an illustration of the first; and active caustic applied to an obstinate ulcer may be considered as an example of the second; but by far the largest proportion of remedial agents will be found in the pharmaceutical division. This class embraces re­medies used both internally and externally. The homoeopathic materia medica is rich in remedies having a direct and specific action upon the skin. And the fact that we always prescribed for the totality of symptoms manifested in our patient, laying stress upon the affection as shown in the skin only as a symptom of the diseased condition, often leads us to prescribe, with the happiest results, a remedy not ordinarily classed among the skin remedies. Great improvements have been made by both schools, in the last few years, in the external applications. Formerly lotions and ointments were almost the only means of making ex­ternal applications, but within recent years we have learned the value of collodion, of solutions of gutta-percha (traumatidn), mixtures of gelatin with glycerin, starch, etc., plasters and other bland compounds and mixtures, as excipients for the drugs that we desire to bring into direct contact with the diseased parts.

Electricity, also, as a destructive agent (electrolysis), or as a modifier of local nutrition, or as an excitant of reflex action, plays a by no means humble part in the treatment of these diseases.

If physicians would give as much thought and eare to the study of these affections as they do to others, not only would our armamentarium be enriched and purified, but our successes would be greater and failures less. They should not be content with the mere diagnosis and naming of the disease, but should study the peculiarities of each case, and the influence exerted by the general health or condition of the patient on the special lesions in question.


When treating of the several lesions, therapeutically, it shall be my endeavour to give the best that is recommend­ed by both schools of medicine. We must bear in mind that "The physician's highest and only calling is to restore health to the sick." "The highest aim of healing is the speedy, gentle, and permanent restitution of health, or alle­viation and obliteration of disease in its entire extent, in , the shortest, most reliable, and safest manner, according to clearly intelligible reasons."

Keeping these aphorisms of our illustrious master ever before us, we will proceed in the next chapter to take up the different lesions of the skin, and study them with the best light we have at our command.