This subject, although of particular interest, has as yet received but very little attention. Pidoux2 considered all cases of dyspepsia due to a herpetic state of the system. The appearance of eczema, psoriasis, pityriasis, lichen, or acne in any case he considered as outward manifestations of that constitutional anomaly which he called herpetisme. Nowadays no one will be inclined to accept this theory of a general constitutional anomaly for the origin of these troubles of the alimentary tract. Notwithstand-ing this there is no doubt that occasionally some connection is found between some skin manifestations and digestive disturbances.

1 Leube: Deutsch. Arch. f. klin. Medicin, Bd. 33. 2 Pidoux: "Rapport de I'herpetisme et des dyspepsia." L'Union medicale 1866 p. 235.

Pemphigus of the mouth has been described under the name of stomatitis neurotica chronica by A. Ja-cobi,1 of New York. I observed this affection present in three patients suffering from neurasthenia gastrica and hyperchlorhydria respectively. In two of these cases there was an improvement of the affection of the mouth (also tongue) in connection with the abatement of the gastric symptoms. In the third case, however, the pemphigus resisted every kind of treatment and persisted even during periods in which there were no complaints referring to digestion. In this case there were frequently present a burning sensation within the oesophagus and slight symptoms of dysphagia. Most probably they were also caused by the formation of vesicular patches along the oesophageal wall.

Urticaria and erythema due to absorption in the digestive tract of some poisonous substances ingested with the food (especially lobsters, soft-shell crabs, fish, and the like) are well known and have been referred to above under the head of idiosyncrasies.

With reference to eczema Hyde2 says: "No one, however, can doubt for a moment that many visceral disorders have an influence upon the production of eczema, repeated attacks even following accesses of morbid affections of these organs; and it is equally certain that many varieties of eczema are directly dependent upon several systemic states such as, most effective in the list, "gout and rheumatic gout, dyspepsia, constipation, and scrofula." Considering the large number of dyspeptics which come under my observation, I must say that the occurrence of eczema among them is very infrequent indeed. This would rather speak against an intimate connection between these two affections, although I have seen a case of eczema of the scrotum which had resisted the most rational methods of local treatment, in which the skin trouble very quickly disappeared after amelioration of the gastric symptoms.

1 A. Jacobi: Transactions of the Association of American Physicians, 1894.

2Hyde: "Twentieth Century Practice of Medicine," vol. v., p. 170.

Acne simplex and acne rosacea seem to occur more frequently in connection with affections of the stomach than eczema. Two patients of mine with acne rosacea and chronic continuous gastric succorrhoea have both shown a decided improvement of the red nose after an amelioration of the gastric symptoms. In one of these patients I frequently noticed that the skin affection became worse as soon as there was an exacerbation of the gastric symptoms, but changed for the better upon improvement of the latter.

In some cases of psoriasis, accompanied by digestive disorders, I did not observe that the improvement in the latter condition exerted any direct influence upon the skin affection.