AUTHOR’S REPRINT. 
Lithaemic Affections 
OF THE 
Skin and Mucous Membranes. 
By A. B. Conklin, M. D. Lithaemic Affections 
OF THE 
SKIN AND MUCOUS MEMBRANES. 
BY A. B. CONKLIN, M. D. 
WE LIVE in a period of unprecedented advancement along 
the lines of enlightened progress, and it is pleasing to 
note that the healing art is awakening from the lethargy 
that has characterized it for a thousand years, and is making 
rapid strides to the front to take its rightful place among its sister 
sciences. 
Old ideas no longer command respect simply because they 
come to us with the sanction of years. The accepted fact of to- 
day may be the proven fallacy of to-morrow. In fact, there is such 
an alienation from old teaching, and so many contributions to 
the restudy of disease, that it may truly be said we live in a 
transition period in medicine. 
Gout has been recognized among medical men for ages, but 
it has remained for the closing years of the nineteenth century 
to give us any approach to a clear conception of the full signifi- 
cance of the uric acid diathesis in the aetiology of disease. 
Who would presume to-day to define the limits of the influ- 
ence of this diathesis in moulding pathology ? 
The fruits of our labors thus far have been a surprise to us 
all, and notwithstanding the extended recognition that has been 
accorded it during the past few years, our study is but well 
begun, and 1 opine that the unfolding of time will show that the 
profession of to-day sees but dimly the magnitude of the patho- 
genetic touch cf lithaemia as a predisposing factor in the genesis 
of disease. 
We know to-day that it causes many diseased conditions 
that but recently were viewed in the light of another pathology, 
and so with to-morrow year shall our wisdom extend and our 
vision clear, until the multiform manifestations of lithremia that 
to-day appeal to the credulity of the few, will then become the 
conviction of the many—a compacta-heritage, of the. profession,, a 
truth revealed. 2 
LITH/EMIC AFFECTIONS OF THE 
In former articles a general discussion of the subject of 
lithaemia or the uric acid diathesis lias been taken up, hence for 
the sake of avoiding repetition I will pass over many of the more 
common phases and invite your attention to the manifestations of 
lithaemia that find expression through the skin • and mucous 
membranes. 
As has been pointed out in previous papers, uric acid acts in 
at least a two-fold manner in originating the divers pathological 
states that may be ascribed, to wit: 
(1) In a chemico-mechanicil way, or its direct or local effect 
in setting up irritable and inflammatory states of the urinary tract; 
(2) As a toxine acting indirectly through the nervous system, 
giving us a line of neuroses functional in their incipiency, nut 
often with resultant changes in structural integrity. 
That an excess of uric acid in the system acts as a direct 
Irritant to the nervous system, especially the sympathetic, in its 
vasomotor fibres, is a conviction in the mind of the writer which 
it seems has been clearly shown by the apparently incontro- 
vertible provings' of Haig, as to the effect of an accumulation of 
uric acid upon the circulation. For the logic of the premises the 
reader is referred to former publications, or to Prof. Haig’s late 
work. 
Let the individual reader draw upon his own observation for 
illustrations of the diversified and often diametrically opposite 
variations of function in the two great organs we are considering 
under different conditions of innervation through a common 
channel—the vasomotor portion of the sympathetic. 
The hot blush on the cheek of modesty, the ashen pallor on 
the face of fear, beads of perspiration upon the brow of responsi- 
bility, and the parched breath upon the lip of embarrassment are 
but passing shadows of the fitful play of vasomotor innervation. 
What is true of the vascular condition of a part under dis- 
turbed innervation, is equally true of structural changes that may 
follow also — seemingly opposite conditions resulting from a com 
mon cause. 
That the opposite conditions of anaemia and hyperaemia may 
be induced in a localized tract or throughout the extent of either 
the skin or mucous membranes by the irritating effects of uric 
acid upon the vasomotor nervous system, e»ven the most superficial 
observation would seem to place beyond the range of dispute. 
The various diseases of the skin which the writer has observed 
to have developed in connection with the uric acid diathesis are 
such as to show that no essentia/ property of this organ may 
escape the influence of the toxine. Circulation, color, tempera- 
ture, secretion, sensation, and nutrition — all, singly or collec- 
tively— may be disturbed. 
The setiological relationship of lithaemia to functional dis- 
turbances of the circulation will be readily recognized, inferen- SKIN AND MUCOUS MEMBRANES. 
3 
tially at least, when it is recalled that the circulation is evei obe- 
dient to vasomotor innervation. It has been my observation to 
more often find the vaso-constrictor fibres of the sympathetic 
responding to the irritation of uric acid than the inhibitory fibres, 
and yet the condition of hyperemia is by no means rare. 
The lithmmic patient is prone to chilly sensations, with cold- 
ness of the hands, feet, nose and ears, these parts being pinched, 
shrunken ana pale. The skin is dry, there seemingly being no 
perspiration at all. The peripheral capillaries are contracted, 
the radial pulse small and hard. The opposite condition of relax- 
ation of capillaries may be met, when the patient will complain 
of feeling flushed, the hands and feet will burn, perspire, be red 
and puffed, the face be red and perspiring, the skin hot and moist 
and the pulse open and softer than in the previous case. The 
hyperaemic lithaemic patient, if a female, may complain of hot 
flashes, which are liable to be misinterpreted as arguing some 
wrong of the reproductive organs. 
Should the contraction of the arterioles become extreme 
within a given area, we then have sympathetic ischaemia. Speak- 
ing of the causes of ischaemia, Prof. F. P. Henry, of the Phila- 
delphia Polyclinic, says: “ While the causes of this condition are 
many of them palpable and manifest, * * * the most obscure 
cases are those dependent upon contraction of the vessel walls 
from irritation, either direct or reflex, of the vasomotor nerves.” 
Again, the same author, while upon the same subject, says: 
“Of ischaemia of nervous origin one of the most striking examples is 
the form of angina pectoris known as angina pectoris vasomotoria. 
With a perfectly healthy heart there is a more or less gen- 
eral spasm, manifested by pallor of the visible parts and sensa- 
tions of numbness and a coldness, soon followed by pericardial 
pain radiating to the left shoulder and upper extremity. These 
attacks are relieved by agents which dilate the vessels, such as 
nitrite of amyl and nitro-glycerine.” 
Reynaud has described a form of arterial spasm of the upper 
extremities which he terms “Local Asphyxia.” “It occurs in 
weakly individuals on exposure to cold, most frequently on rising 
in the morning (A significant fact. A.B.C.), and manifests itself 
at first by pallor and numbness, perhaps by altered sensations, 
such as those produced by the crawling of insects, or even by 
severe pain in the ischaemic parts. Bluish spots soon make their 
appearance and gradually extend and coalesce until the entire 
limb may assume a cyanotic hue. The affection is generally 
bilateral. The arterial spasm may last several hours and then 
pass away, with sensations of increased pain or of burning heat; 
or, on the other hand, it may result in symmetrical gangrene. 
It is relieved by friction and warmth, and the best curative 
measure is the constant galvanic current,” which, by the way, 
is one of the best means of allaying irritation of the sympathetic. 4 
LITH/EMIC AFFECTIONS OF THE 
Why should it occur more often on rising in the morning ? 
Of course there would naturally be a little chilling of the surface 
and contraction of the capillaries on getting out of a warm bed, 
but 1 see a better explanation in the fact pointed out by Haig, 
that there is relatively a larger percentage of uric acid eliminated 
in the early morning hours up to 9 A. M. than any other time in 
the twenty-four hours, hence in the early morning the nervous 
system would be most profoundly under the influence of uric 
acid, which, as we have seen, produces a contraction of the 
systemic capillaries. 
Looking for a moment to the opposite condition of vascular 
dilation, it would seem that we must accept the condition of 
hyperaemia to accommodate the blood driven out of the circula- 
tion of an ischaemic region, yet the author above quoted, in ex- 
pressing his disapproval of the use of the word plethora to convey 
the idea of too great a quantity of blood in the vessels, says: 
“The symptoms universally ascribed to plethora: redness of the 
face, throbbing of the cerebral vessels, singing in the ears, vertigo, 
etc., are rather due to products of imperfect digestion. * * * 
As to the existence of plethora, I am extremely skeptical. 1 have 
never seen any morbid condition whatever that could be ascribed 
solely to an excessive number of red cells in the blood. 1 recog- 
nize a condition common to heavy eaters of animal food which 
has been called plethora, but attribute its symptoms for the most 
part to albumenoid indigestion and would classify it under the 
head of lithaemia.” 
Fothergill has most admirably described the same condition. 
Perversions of function in the secretory glands of the skin 
and mucous membranes may be seen in such conditions as ani- 
drosis, hyperidrosis, coryza, hay fever and the various catarrhs 
of the respiratory, genital, urinary and intestinal tracts. 
The anidrosis, or lack of perspiration that appears as a 
sequella of lithaemia, should not be understood as idiopathic 
anidrosis, which Van Harlingen assures us is a very rare disease, 
having been found in five cases only among 60,000 reported by 
the American Dermatological Association. Symptomatic anidro- 
sis, however, is of common occurrence in connection with lithae- 
mic cases. 
“It is apt to occur,” says Van Harlingen, “ in connection 
with certain skin diseases as ichthyosis, eczema, psoriasis, etc., 
also as a result of nerve injury, or of an emotional shock.” Its 
occurrence in connection with skin diseases does not, in the 
writer’s opinion, separate it from lithaemia, as I hope to be able to 
show later on, and assigning it to nerve injury and emotional 
shock clearly places it among the neuroses, and in a most re- 
stricted sense as a functional vasomotor neurosis. 
I have seen lithaemic patients whose peripheral circulation 
was so contracted that the skin was habitually pale and cool, and SKIN AND MUCOUS MEMBRANES. 
5 
even in the warmest weather while exercising vigorously they 
would show no signs of visible perspiration ; nor would they grow 
red in the face from exercise or embarrassment. 
Hyperidrosis may be either symptomatic or idiopathic. It is 
symptomatic of many conditions that need not concern us to-day, 
as well as being at times a sequel of lithaemia. As a secondary 
affection, Van Harlingen says it may occur in connection with 
certain affections of the central, peripheral and sympathetic 
nervous system. As an idiopathic affection he gives us no idea 
of what may cause it. 
James Stewart, in writing of Diseases of the Sympathetic 
Nervous System, speaks of unilateral hyperidrosis and says: 
“It is highly probable that it is owing to a lesion of the sympa- 
thetic itself or of its medullary or spinal centres.” That the 
“ lesion ” need not be other than functional is susceptible of 
demonstration. Unilateral hyperidrosis and lachrymation have 
each been mentioned by numerous authors in the symptomato- 
logy of such vasomotor neuroses as neuralgia, migraine and 
hysteria. 
I have seen such cases too often to think the occurrence a 
mere coincidence. Show me the doctor who has not suffered 
from hyperidrosis when suddenly confronted with the gravity of 
some momentous case, and I will show you a man who is not 
keenly sensitive to the responsibilities of his chosen profes- 
sion. 
Increased secretions from the mucous surfaces in patients 
suffering from the- uric acid diathesis are conditions by no means 
rare if we may judge from the meagre literature upon the sub- 
ject. Says Bishop: “Now, since it is admitted that there are 
both immediate and reflex functional nervous disorders of the 
skin, with what show of reason can it be denied that there are 
similar neurotic disturbances of that other skin which covers the 
interior surfaces of the body ? The latter membrane is more 
vascular, more delicate, more sensitive, and more highly organ- 
ized than the skin. It possesses susceptibility to all agents which 
affect the skin, and to many others beside.” 
That one of the causes which may produce a fluxion from 
one of the mucous surfaces is lithaemia, I have furthermore the 
evidence of my own observation. 
Permit a brief history from memory of a few typical cases 
among many: 
Mrs. S. W., aged 55, had in the winter of 1896-97 an attack 
of inflammatory rheumatism, which ran a course of about two 
weeks without any unusual symptoms, and upon the use of 
Alkalithia had an uneventful convalescence from the arthritic 
symptoms. About a week after I had ceased to visit my patient, 
or about three weeks from the beginning of the attack, and while 
she was still taking the alkaline treatment, I was summoned 6 
AFFECTIONS OF THE 
rather suddenly to see her again by the husband, who informed 
me that something had broken “inside.” 
On arriving at the house 1 found my patient sitting up, suf- 
fering no pain physically, but mentally sorely troubled since she 
could not account for her strange plight. While dressing in the 
morning she was suddenly seized with a copious watery flux 
from the genital tract. 1 was unable to elicit any history of 
previous pain or other pelvic discomfort. Indeed, Mrs. W. 
informed me that she had always been free from “female weak- 
ness.” Digital examination revealed nothing beyond the.fact of 
increased secretion. A speculum examination was then made, 
and 1 think was as convincing as any 1 ever made. Wiping the 
vault and cervix dry with a pledget of cotton, 1 was able to wit- 
ness the gathering of fresh secretions in the form of great beads 
of watery mucus, like drops of sweat upon the forehead, oozing 
through the vaginal walls and coursing down its surface in 
diminutive streams. That the same weeping was going on 
within the cavity of the uterus 1 was convinced by the contin- 
uous drainage of fluid from the os. The fluid oozing away gave 
a decidedly acid reaction to litmus paper. 
The history of medicine in every decade for a century has 
been replete with the records of cases showing the interchange- 
ability of gout with some form of the neuroses, as asthma, chorea, 
epilepsy, migraine, etc. 
Here was a case of utero-vaginal flux as a neurosis occurring 
in alternation with rheumatism. It seemed a demonstration of 
Haig’s theory as formulated in his late work, viz.: That when- 
ever the alkalinity of the blood is lowered so that it is no longer 
a good solvent for uric acid, it is precipitated out of this fluid into 
the fibrous and cartilaginous tissues of muscles and joints, where 
it sets up rheumatism ; and whenever the alkalinity of the blood 
is raised again, as by giving the alkaline treatment, the uric acid 
again enters the blood, and, going the rounds of the circulation, 
acts as an irritant to the nervous system, inviting an outbreak of 
the neuroses. 
The history of the case as to renal elimination furthermore 
seems to bear out Haig’s theory. When first called to see my 
patient her urine was light colored, of low specific gravity, acid 
in reaction and below normal in amount—a condition showing a 
retention of the solids. After taking Alkalithia the urine increased 
in bulk, the specific gravity rose, and on cooling there was a heavy 
deposit of amorphous urates. It was while eliminating freely the 
urates that the flux seized her. 
To use an inelegant but forcible expression, my patient was 
“between the D 1 and the deep blue sea.” What could 1 do 
for her ? To have given mineral acids would probably have 
checked the flux but invited a return of the arthritis. To continue 
the Alkalithia was to foster the continuance of the flux, but would SKIN AND .Wl’COl'S MEMBRANES. 
7 
not endanger my patient from rheumatism. Placing her upon 
strict non-nitrogenous diet, I decided to push the alkaline treat- 
ment and by thoroughly depurating the system of uric acid, exhaust 
the cause of the flux. 1 prescribed Alkalithia one teaspoonful 
every three hours, in half a glass of water, and gave no local 
treatment beyond the cleansing douche of warm water and sodium 
biborate. After a few days the flux grew less and less, and finally 
ceased, at which time 1 had rendered the urine free in amount 
and alkaline in reaction. 
Where the consequences are not too severe 1 believe it is 
better to depurate the blood through the kidneys than to pre- 
cipitate the acid from it into tissues susceptible of gouty inflam- 
mation. 
Mrs. C., who was born of parents and had herself 
been a sufferer all her life from uric acid headaches, until 1 put 
her upon the alkaline treatment through Alkalithia for a period 
of three months, after which she had no headaches for over a 
year—had never been troubled with so much as a simple leucor- 
rhcea, when suddenly she was taken with a profuse, thick, 
creamy, vaginal catarrh. Knowing her to be a pronounced 
lithiemic, the case was carefully looked up along that line, with 
the result of disclosing the evident fact that the flux had taken 
the place of a headache in her case, which she was again having 
at times, as she had long since discontinued treatment and would 
brook no restri tions in her diet. The leucorrhoea was such as 
to saturate a large napkin in a couple of hours and left a bright 
yellow stain. It was acid in reaction, excoriating, and set up a 
considerable pruritus. 
The urine was scanty, highly acid, of high specific gravity 
and contained an excess of uric acid. 1 put her upon the alkaline 
treatment, as in the other case, and after about ten days had so 
far removed the excess of uric acid from the blood that the 
leucorrhoea ceased without any local treatment, beyond that for 
sanitary purposes and to relieve the pruritus. I made use of the 
speculum, as in the former case, to facilitate the stuoy of the 
condition, and found it apparently vaginal only, there being in 
the os and cervical canal a glairy transparent mucus not unlike 
normal secretion. Like the first case, this case has since had a 
second attack, not unlike the first, and due to the same under- 
lying systemic condition. 
Furthermore, this patient is a victim of nasopharyngeal 
catarrh — hypertrophic rhinitis — and has many times observed 
that there is a coincidence, at least, between a condition of 
excessive elimination of uric acid and an increase in the nasal 
discharge. 
After having taken the alkaline treatment for three months, 
as above mentioned, she assured me she had never, within her 
memory, been so free from catarrh. This patient was well 8 
LITH/EMIC AFFECTIONS OF THE 
nourished and as plump as a sculptor’s model, but always looked 
pale and bloodless, because her peripheral capillaries were always 
contracted from irritation of the sympathetic by uric acid. 
She assured me she had taken enough iron when a girl, in 
an endeavor to improve her complexion, to make herself sheet- 
iron lined, and all to no purpose. Of course not. Her color was 
not the greenish yellow color of chlorosis. 
While on this subject, let me give you the words of William 
H. Thompson on chlorosis: “It is one of the evidences, in fact, 
that a case of anaemia is not chlorotic, if it does not show any 
result from medication, for even in the most relapsing forms of the 
disease, iron will show its powers as often as it is admin- 
istered.” 
Alkaline treatment did for her what no amount of iron could 
do—it opened up her capillaries and sent the bright blood tingling 
through every peripheral part, carrying with it healthy nutrition, 
that gave her a pink complexion and about twenty pounds 
increase of avoirdupois. 
Miss J. C., aged 30, has chronic hypertrophic rhinitis; is a 
sufferer from lithasmia in various ways; has a very variable 
urine, both as to quality and quantity, often being very scanty, 
concentrated and highly acid, at which time it throws down, on 
cooling, a heavy precipitate of pink urates. Gritty particles are 
often found in the bottom of the urinal and there is a great deal 
of “backache” from the local irritating effect of the uric acid 
upon the kidneys and ureters. 
The relationship between the catarrh and the lithaemic dia- 
thesis is shown in her case — 
(1) By the fact which has often been noticed that, whenever 
the urine shows the greatest excess of uric acid the catarrh is 
most profuse, and vice versa; and 
(2) A course of alkaline treatment long enough continued to 
depurate the system of uric acid always works an improvement 
in the catarrhal condition. 
N. R. M., male, aged 46, was a neurotic lithremic, whose only 
ailment, when 1 first formed his acquaintance in a professional 
way, fifteen years ago, was an irascible temper, nervousness, 
exalted sensibilities at times, cold hands and feet, pinched, care- 
worn features and pale complexion — a complex of symptoms, 
noticeably worse whenever the urine showed an excess of uric 
acid circulating in the blood. 
Several years later, when my patient began to show more 
plainly the ravages of the lithaemic octopus that had him in its 
grasp, on several occasions when there was an unusually large 
amount of uric acid and urates in the urine, he had attacks of a 
copious watery flux from the bowels, acid in reaction, with pain 
and griping in the bowels, and cutting, smarting pains at the anus 
and excoriations later on. SKIN AND MUCOUS ME.MBRANES. 
9 
Although Mr. M. was my patient when he treated with any 
one, yet it was only when he would get way down that he would 
do anything for himself; however, being a near neighbor, 1 saw 
him almost daily and watched the case slowly go down until it 
terminated in diabetes and death. 
In a paper read before our State Medical Society, at Detroit, 
in 1888, I took the ground that diabetes in most cases was pri- 
marily a functional vasomotor neurosis, the final result of an 
antecedent and underlying lithcemia, and I have seen no reason 
for changing my views with the passing of the decade. 
James T. Putnam, while instructor in Diseases of the Nervous 
System at Harvard Medical College, in speaking, a few years ago, 
of neurasthenia, which he called a functional neurosis, often 
with a litha?mic antecedent, says that these patients may have 
“attacks of diarrhoea, or more strictly, discharges of watery 
fluid, coming on suddenly as a result of slight fatigue or excite- 
ment, * * * or discharge of large quantities of mucus in 
masses or strips with or without faeces.” 
While a discussion of neurasthenia is foreign to our subject, 
I will say, parenthetically, that the disease is one which we have 
recognized for years as a possible sequel of lithaemia, and the 
diarrhoeas reported by Putnam, it seems to me, may admit of the 
same explanation as the intestinal flux of N. P. M., the utero- 
vaginal flux of rheumatism in the case of Mrs. W., and the 
vaginal flux of migraine in the case of Mrs. C. Whether the 
complex of symptoms be such as to receive the diagnosis of 
neurasthenia, or diabetes, or rheumatism, or migraine, is really 
of small import, for they are each and severally but the mini- 
festations of a common cause — uric acid toxaemia — ard the 
several fluxes are simply the result of the disturbance wrought 
in vasomotor innervation by this toxine. 
The direct chemico-mechanical effect of uric acid in setting 
up divers pathological conditions of the urinary organs is too 
comprehensive a subject to include in our present paper, and yet 
it is eminently pertinent to cur subject to call your attention in 
passing to some of the lesions of the urinary mucous membrane 
for which uric acid is directly and solely responsible. 
Whenever a highly acid urine, heavy from an excess of uric 
acid, is excreted for any considerable length of time, there is no 
part of the urinary tract, from the uriniferous tubules to the 
meatus, that may not suffer from its irritating contact. 
Should the anatomical formation of the urinary channel be 
such as to furnish pockets for the retention of residual urine, 
such an excretion as I have described would set up, for instance, 
in a long prepuce with a contracted orifice a typical balanitis. If 
behind an old stricture, a fresh urethritis would ensue as a 
reminder of former transgressions. If within or behind an 
enlarged prostate, an acute exacerbation of prostatitis may be the 10 
L1TH/EMIC AFFECTIONS OF THE 
result, and if upon the tribone of the bladder a trachelo-cystitis, 
to the extent of strangury and tenesmus may follow. 
The congestion and irritation set up along the ureters by a 
highly acid and concentrated urine produces a sickening pain, 
which is characteristic in location, being felt in the back as high 
as the kidneys, extending diagonally forward and downward over 
and within the point of the hip to the base of the bladder in front. 
Within the kidneys the inflammation set up may be confined 
to the pelvis of the organ or involve the uriniferous tubules as 
well, and as with the ureter, the trouble may be unilateral or 
affect both sides simultaneously. 
Any of the inflammatory conditions 1 have pointed out may 
be simple or catarrhal, and the urethritis will almost certainly be 
purulent if there has been a specific inflammation of the part 
within a year. 
While upon the subject of uric acid causation of inflammatory 
lesions of the urinary tract, it fortifies our position somewhat to 
be able to call to our support the teachings of so able a medical 
writer as Professor Da Costa, of Philadelphia, though, should he 
share the fate of his less illustrious contemporary, we fear he 
may have exposed himself to the charge, from the ultra-conserv- 
ative obstructionists in medicine, of being “a crank on uric acid,” 
for presuming to attribute more to its influence than is to be 
found on those moss-grown tablets of medical record vouchsafed 
to us from an antiquated past. 
Four years ago, in a carefully prepared paper, Prof. Da Costa 
denied, as had been held up to that time, that tube-casts in the 
urine constitute unmistakable evidence of interstitial nephritis — 
true Bright’s Disease — and stated that they might occur t#om 
simple inflammation of the uriniferous tubules from the passage of 
an excess of uric acid — simple, desquamative tubular nephritis. 
An excess of uric acid in the blood, by contracting the peri- 
pheral capillaries, as will readily be seen, must exert a very 
depressing influence upon the nutrition of the skin. 
The more common and less severe dermal manifestations of 
lithaemia are a pale, anaemic-looking skin, already referred to, 
which is in some cases glossy in appearance ; again, is relaxed, 
often dry, horny, inelastic, furfuraceous or desquamating. The 
nails are dry and brittle, the hair also being dry and dead, thin, 
broken and shedding, the scalp itching and covered with a fine, 
dry, white dandruff. 
The more aggravated conditions which ensue at times are 
localized patches of rosacea, psoriasis, pityriasis, acne, hives, 
urticaria and eczema ; herpetic and pemphygoid eruptions ; pur- 
puric, ecchymotic and gangrenous spots; oedematous areas; 
pimples, boils and atrophy. 
Neumann says: “There is no doubt that a large proportion 
of cutaneous diseases depend upon disorders of the vasomotor SKIN AND MUCOUS MEMBRANES. 
11 
nerves, which cause certain derangements of circulation in the 
arteries, veins and cutaneous glands. Anaemia and hyperaemia 
of the skin happen from vasomotor irregularities.” 
J. Nevin Hyde, of Chicago, a dermatologist, certainly entitled 
to speak as one in authority, recently informed me that he was 
treating a great many cases of skin disease as dermal manifesta- 
tions of lithaemia, and the uniformly good results he derived from 
the use of Alkalithia place their pathology beyond question. 
N. S. Davis attributes to “ uricacidaemia ” such conditions as 
numbness and intense itching of the skin, creeping sensations, 
formication and hypercesthesia. 
Arthur Van Harlingen, while Professor of Diseases of the 
Skin, Philadelphia Polyclinic, in writing an article upon skin 
diseases, said: “The cause of psoriasis is not known. It is apt 
to occur in well-nourished, rose-complexioned, light-haired people, 
the ‘picture of health,’ excepting that they are apt to be a little 
rheumatic.” 
Alas for the “little rheumatic.” How ominous ! 
Under treatment he recommends acetate of potash and 
alkaline mineral waters—also very suggestive. 
Of eczema he wrote, “ The occurrence of gout and rheuma- 
tism also may be mentioned among the factors of 
eczema. In certain individuals the presence of an excess of uric 
acid in the system is sufficient to produce and keep up 
eczema.” 
The same writer also mentions a rheumatic form of purpura, 
which may occur in connection with arthritic symptoms or inde- 
pendently of them. 
Bazin, of Paris, as far back as i860, in writing of herpes, 
expressed the belief that many cases were due to arthritic in- 
fluence, “and when occurring in children, always so.” 
William Oliver Moore, of New York, says, “Zoster appears 
to be due to disease of the ganglionic system more often than 
dependent on affections of the spinal cord. It occurs infre- 
quently as a reflex neurosis.” 
Walter Mendelssohn, in writing of the minor pathological 
changes in gout affecting the tegumentary system, mentions as 
chief among them “Certain skin lesions, especially eczema and 
various forms of acne, psoriasis and urticaria.” 
Huntington Richards, of New York, an aural surgeon of 
some prominence, in writing of acute eczema of the external 
auditory canal, finds it difficult to distinguish the eczematous 
character of the dermatitis from a simple dermatitis, and says 
many times it can be shown finally, “ By yielding to treatment 
only after a course of internal medication directed toward im- 
provement of the gastro-intestinal and hepatic digestion, and in 
this way toward an elimination of the imperfectly oxidized matter 
from the blood, has :ndirectly proven the existence of a so-called 12 
AFFECTIONS OF THE 
‘gouty dyscrasia’ to be a part cause or a chief cause of the skin 
lesion.” 
In dealing with chronic eczema the same writer expresses 
his faith in the lithaemic origin in no ambiguous language, when 
he defines it as, ‘‘A condition that, whatever be its exciting 
cause, or origin, or whatever its method of manifestation, prob- 
ably owes its existence in the first instance, in the vast majority 
of cases, to a perversion in the constitution of the patient’s 
blood, brought about by faulty elaboration of its constituents, 
and existing in what is known as the ‘gouty’ or ‘ lithasmic 
dyscrasia.’ ” 
He has also observed that “the ill-understood condition of 
the nervous system known as neurasthenia, may in some 
instances.play the part of causative agent in instituting or main- 
taining this chronic dermatitis.” Its existence in connection 
with neurasthenia, in some cases, should not be denied, but 1 
for one should certainly question the interpretation of symptoms 
that would magnify the significance of an intercurrent neuras- 
thenia to the extent of making it a primary cause. Recognizing 
in neurasthenia an expression of lithaemia, would it not be more 
in keeping with the truth to view the eczema and the neuras- 
thenia as dual symptoms of a common cause, coincidently 
appearing. 
We can only infer that the writer quoted did not recognize 
the lithcemic origin of neurasthenia, else he would have expressed 
himself relative to a triplet of pathological conditions instead of a 
couplet in the following able position : “The rather common co- 
incidence of a more or less distinctly eczematous dermatitis of 
the auditory canal, acute or chronic, with a catarrhal condition of 
the naso-pharyngeal mucous lining, has led some observers to 
suspect the existence of a reflex connection of cause and effect 
between the throat lesion and the ear ; and such a relation 
between the two sets of lesions and symptoms can not be posi- 
tively denied; yet to the writer it appears equally reasonable to 
assume that in such a case the pharyngeal and aural troubles are 
simply coincident, and that both are equally the secondary mani- 
festations of an underlying dyspeptic or ‘ gouty ’ poisoning of 
the patient’s blood.” He again shows with what diagnostic 
acumen he interprets facts when in giving his treatment of 
chronic dermatitis of the auditory canal he classifies it under two 
heads comprising respectively the “ constitutional treatment of 
the dyspeptic condition or of the ‘ lithaemic dyscrasia ’ * * * 
and the purely local treatment of these local manifestations.” 
Oulmont and Fourchard, of France, report such trophic 
changes in hysteria as brittleness of the nails and eczema; 
changes of purely vasomotor origin. 
Raymond, of France, also reports a case of eczema, ecchy- 
motic spots and pemphygoid eruptions in hysteria. SKIN AND MUCOUS MEMBRANES. 
13 
I have already, in a paper presented to the World’s Congress 
in 1893, recorded my conviction of the lithcemic origin of hysteria 
in some cases and supplemented it with a report of two cases, 
hence the association of various dermatites with hysteria is most 
natural in the writer’s opinion, hut hysteria is but a symptom 
itself and we should look beyond it for the real cause of any 
concomitant dermatites. 
Quinquaud studied the effect of uric acid upon the functions 
of the skin, by administering from three to six grains a day of 
the acid to his patients, and observed as the most common 
results “boils and patches resembling eczema,” “the dermal 
analogue of coryza,” as Bishop aptly puts it. 
1 have many times in the last fifteen years successfully 
applied potassium acetate to the relief of boils by removing the 
products of imperfect metabolism. 
I am led to believe that the case reported below is of infre- 
quent occurrence, as 1 have seen but the one case in eighteen 
years. 1 was called to see Mr. H. N., in consultation with Dr. 
A., who had carried him successfully through a three months’ 
run of inflammatory rheumatism to complete recovery from all 
arthritic symptoms. 1 found him suffering from a superficial 
necrotic spot, on the back of the left hand, about the size of a 
twenty-five cent piece, that was slowly extending laterally, as 
well as to the deeper tissues, and had resisted all local treatment 
for two weeks. An examination of the urine showed uric acid 
present in excess. I diagnosed rheumatic purpura, a condition 
described by Van Harlingen, advised the alkaline treatment, 
which was agreed to, and the gangrenous spot soon took on 
healthy action and disappeared. No local treatment was 
advised. 
F. R. W., a good feeder, and a man of sedentary habits, has 
invited the insidious growth of the Iithaemic habit, and is never 
free from some of the dermal manifestations of the fruits of his 
indulgence. The contracted condition of his capillary circulation 
makes three suits of underclothes in winter a part of his daily 
wearing apparel. 
He has a chronic eczematous condition of the auditory canals 
that causes him to dig at his ears frequently, and even at times 
unconsciously. 
His beard is short, irregularly broken, crinkled and full of 
brawny exfoliation that finds lodgment in profusion upon his 
clothes. A few desquamating spots of horny epidermis mark his 
face. Patches of pityriasis maculata are to be seen upon the 
chest, and a most exasperating and stubborn eczema surrounds 
the anus, extending along the median raphe and at times cover- 
ing a portion of the scrotum. Local treatment is but partially 
palliative, alkaline treatment with Alkalitha has proven the best 
internal measure, but he will never be cured because selTdenial 14 
LITH/EMIC AFFECTIONS OF THE 
in eating, drinking and smoking are an indispensable part of cura- 
tive treatment, which he will not carry out beyond the period of 
immediate relief. 
E. A. P. Consulted me with regard to a distressing eczema 
of the scrotum. He was indeed a great sufferer. The scrotum 
was relaxed and had suffered a complete loss of the epidermis, 
being as raw as a piece of meat, which it resembled, and con- 
tinually weeping. The best local treatment I could give him 
had little or no effect. It continued to weep and smart and burn. 
Looking now upon the scrotal condition not as a local disease, 
but as the evidence of things unseen, 1 inquired more carefully 
into my patient’s history, which 1 found rheumatic, and the ex- 
amination of the urine convinced me 1 had a dermal manifesta- 
tion of lithaemia to deal with and the scrotal condition was not 
the disease per se> 
I put my patient now upon a non-nitrogenous diet and in- 
stituted the alkaline treatment by prescribing A1 kalithia, with a 
liberal portion of water, and with but local hygienic measures; 
my patient in a few days began to show signs of improvement, 
and in due time made a complete recovery. 
Miss P. consulted me for chronic “ sick-headache,” from 
which she had suffered for years at intervals from one to three 
weeks. Having learned from personal observation extending 
over a period of fifteen years that many of the so-called “sick- 
headaches ” are due to an excess of uric acid circulating in the 
blood, 1 at once satisfied myself upon this point and put her 
upon A1 kalithia in teaspoonful doses three times a day, with a' 
liberal indulgence in water, and proscribed the further indulgence 
in nitrogenous foods. 
She had but one more headache of any severity before the 
habit was broken up, and, what was equally pleasing and unex- 
pected to us both, was the removal of an unsightly roseola of the 
nose that had withstood the onslaught for years of divers doctors, 
with no paucity of remedial ammunition. 
One of the most interesting and typical cases of the dermal 
manifestation of lithcemia that ever came to my notice was about 
two years ago. It was a case of diffuse psoriasis in the person 
of Mr. C. T., aet 34, white. The early history of the case I am 
unable to eport, it having existed for months before falling into 
my hands. 
From the crown of the head to the ends of the toes was 
hardly a spot of normal skin to be seen. It was of an inflamma- 
tory redness throughout a greater part of its extent, and covered 
with the characteristic grayish mother-of-pearl-colored scales, 
imbricated in arrangement and so abundant that after my first 
examination I was able with a broom and dust-pan to collect a 
handful of scales from the carpet at my patient’s feet. Mr. T. 
had been the patient of a number of other physicians before con- SKIN AND MUCOUS MEMBRANES. 
15 
suiting me, and some of them, as I knew from personal acquaint- 
ance, were a creditto the profession, so 1 did not doubt but that he 
had had most approved treatment. Without considering I had 
any “ snap ” I began by giving my patient the routine treatment 
with Fowler’s solution and a tonic of quinine, iron and strychnia to 
correct the ancemia that had supervened upon his long suffering. 
Locally 1 prescribed oil of cade one part, olive oil three parts. 
In ten days 1 saw my patient again with no noticeable improve- 
ment beyond an improvement in his appetite, presumably from 
the tonic. 
Avoiding details I will say I gave the case no small amount 
of thought and no small amount of medicine, including iodide 
of potassium, berberis aquefolium, iris, phytolacca, alnus, “ Suc- 
cus Alterans ” and an infusion of cornus circinatus internally, 
which latter 1 have found a very efficient remedy in many skin 
troubles ; and locally green soap, chrysarobin, oleates and juniper 
pomade with the result, at the end of two months, of having 
wrought no material improvement in my patient’s condition. I 
had run the whole “gamut” but somehow had not struck the right 
note. However, there was hope for me if there was not for the 
sufferer for 1 knew 1 wasn’t “onto my job.” In short, I knew 
some things about the case I was not telling the patient. Because 
I had never before recognized a case of psoriasis of lithaemic origin, 
1 did not even inquire after any evidence of faulty metabolism 
or excessive elimination of uric acid in studying my case, and it 
was only an accident when I “ caught on ” when 1 did. On the 
occasion of one of his trips to my office, my patient asked for 
something for his “ water,” which he said was scanty, dark and 
scalding. Taking a sample then and there 1 found the specific 
gravity 1.028, color dark, reaction highly acid, albumen and 
sugar, none. 
1 felt a chagrin which 1 did not confess upon learning that 
this was a more or less constant feature in the case. 
Could it be possible that his lithaemic condition was respon- 
sible for the psoriasis ? I resolved upon a demonstration. 1 put 
Mr. T. upon alkaline treatment in large doses, omitting every- 
thing else, ordered him to drink freely of water and avoid nitro- 
genous foods. 
In ten days he returned showing a most remarkable im- 
provement. 
Being anxious now to make a test case of it and see what 
anti-lithaemic treatment would do, I continued my alkali, and in 
the incredibly brief period of four weeks from the beginning of 
alkaline treatment my patient was cured of his psoriasis and has 
had no return. 
While this was one of those cases we often meet that is 
more interesting than profitable, yet my reward was, after all, 
invaluable,—the satisfaction of having recognized a hidden truth. 16 
LITH/EMJC AFFECTIONS OF THE 
I have recently met two other physicians who have recog- 
nized in psoriasis a dermal manifestation of lithaemia, and the 
success that fallowed the use of Alkalithia, as in my own case, 
was a clinical demonstration of the correctness of the diagnosis. 
Van Harlingen says: “The causes of psoriasis are not 
known.” 1 know what was the cause of psoriasis in one case. 
While “one swallow does not make a summer,” and 1 would not 
jump to the conclusion that every case of psoriasis is due to 
lithaemia, still 1 must repudiate the sweeping confession of ignor- 
ance of Van Harlingen, who wrote as one in authority. Disturb- 
ances of sensation in the skin, supervening upon -the lithaemic 
diathesis, comprise such common conditions as hot and cold 
flashes, morning chills, localized or unilateral areas of numbness, 
formication, anaesthesia or hyperaesthesia, dermatalgia and 
pruritis, eith r aural, vulvar or scrotal. 
As before stated, the hot flashes, if occurring in a female 
subject, may be attributed to some pelvic neurosis, by mistake. 
When the lithaemic neurotic female comes to the menopause, let 
it be borne in mind that the susceptibility of the ganglionic 
centres may be materially diminished by an anti-lithaemic regime, 
including alkaline treatment, thereby rendering them more toler- 
ant of the newly-developed condition of uterine and ovarian con- 
gestion, which no longer finds relief in the periodical flux, and in 
this manner a measure of freedom may be secured from those 
vasomotor disturbances that send the pent-up blood surging to 
the head and upper extremities, with the accompanying sensation 
of “hot flashes.” 
Morning chills, accompanied by fever or other hectic pheno- 
mena, occurring day after day, should lead every careful physi- 
cian to look for the existence of lithaemia, lest a more superficial 
examination lead him to attribute them to the already much 
maligned “malaria.” 
Numbness of the hands or feet, or of an arm or leg, or of a 
localized spot upon the limb, as I have witnessed, or a unilateral 
partial anaesthesia, with numbness and tingling, are common 
symptoms of the lithaemic dyscrasia, and, indeed, 1 am not pre- 
pared to deny that a true hemiplegia of intermediate central 
origin may not follow upon effusion from cerebral congestion, as a 
result of the primary peripheral capillary contraction of lithaemia. 
Before closing our paper, some consideration should be given 
to the treatment of the various phases of lithaemia we have 
pointed out, else the object of all our study is not attained. 
In the first place, let it be borne in mind that the lithaemic 
dyscrasia is either the predisposing cause of the peripheral dis- 
ease or is the disease itself, of which the local wrongs upon the 
skin and mucous membrane are but the symptoms. 
In either case, anti-lithaemic treatment is certainly indicated. 
Not that lithaemia is the only cause of the conditions I have SKIN AND MUCOl'S MEMBRANES. 
17 
pointed out; not but what other causes may be operative at the 
same time. 
Unquestionably there are exciting or determining causes in 
every case that shape the character of the lithasmic display, 
giving us an eczema in one case, a vaginal flux in another, a 
psoriasis here, there a migraine or naso-pharyngeal catarrh or 
neurasthenia, or any other of the manifestations of this hydra- 
headed monster. 
As the one great predisposing cause, it should have more 
significance attached to it than any number of mere exciting 
causes that may appear in a given case and act only as modi- 
fying factors. 
As another has very plainly stated it, “If the overwrought 
nerves are relieved of this source of irritation they are much less 
likely to respond to other excitants; and, if the morbidly- 
susceptible condition of the nerve centres is due to the action of 
the uric acid, its oversensitiveness to all excitants may be relieved 
by correcting the uricacidsemia.” 
What, then, is to be prescribed for these various lesions of 
the skin and mucous membranes which we have described as 
lithaemic ? If distressing in character, local palliative treatment 
may become necessary; as a curative measure, 1 believe it is 
well-nigh impotent. Curative treatment certainly lies in the.line 
of removing the cause. That anti-lithaemic measures constitute a 
curative treatment I have had frequent and ample verification. 
The indications are, then, to reduce to a minimum the 
amount of uric acid in the blood. This may be done in two ways, 
either by precipitating it out of the blood by lowering the alka- 
linity of this fluid by the administration of mineral acids, or by 
increasing the alkalinity of the blood with alkalies, making it a 
better solvent for uric acid, thereby fitting the latter for elimina- 
tion through the kidneys. Should speedy relief dictate our 
manner of procedure, possibly the acids would give us quicker 
results, but it would be given at the risk of precipitating a 
rheumatic condition upon some of the cartilaginous or fibrous 
structures, and whenever uric acid appeared again in the circula- 
tion a repetition of the former attack might be expected. 
Sooner or later it must be eliminated from the body entirely, 
to give the patient complete immunity. 
In the absence of more speedy, but temporary, relief I 
should stand unequivocally for the alkaline treatment. There 
are alkalies and there are alkalies. That any one is superior to 
all the rest I am unwilling to say. We all have our preferences. 
There are a few points, however, in connection with the giving 
of alkalies which should not be lost sight of. Some are more 
palatable than others to take ; some have much more unpleasant 
effect upon the stomach than others; some produce still other 
unpleasant results, as the tinnitus aurium from soda salicylate; 18 
LITH/EMIC AFFECTIONS OF THE 
and all the lithia waters contain but a very small percentage of 
lithia salts. 
Of late, effervescing alkaline preparations have come into 
favor quite rapidly, including tablets and granular salts. Non- 
effervescing tablets should be classed with plain alkaline salts, 
the only advantage possessed being the convenience of adminis- 
tration. It is the writer’s opinion that effervescing preparations 
offer some advantages over preparations not effervescent. 
The advantage, of course, lies in the carbonic acid gas liber- 
ated during effervescence, and this, by virtue of its local sedative 
or anaesthetic effect, obtunds the sense of taste, rendering palat- 
able preparations that would otherwise be disagreeable to the 
taste. In the stomach, the carbonic acid gas, by virtue of its 
sedative effect upon the terminal nerve filaments, reduces to a 
minimum such unpleasant effects that are apt to follow upon 
the administration of plain alkalies, as pain, impaired digestion, 
flatulence, “ waterbrash,” etc. 
The carbonic acid gas being the one factor then which de- 
termines our choice of an effervescing preparation, it follows that 
that line of effervescing preparations from which the patient may 
derive relatively the largest percentage of gas is the most 
eligible. I have used both tablets and granular salts (effervesc- 
ing), and judging from my own experience an effervescing tablet 
is much inferior to an effervescing granular salt, as will be readily 
seen when the di'screpancy is pointed out. 
An effervescing tablet, like any other, needs to be com- 
pressed hard in order to hold its shape and keep from breaking 
up when handling. This makes it effervesce very r-lowly, the 
gas in fact escaping bubbles at a time, which phenomena, how- 
ever, is pointed to by the manufacturers and introducers of 
tablets as a “beautiful display.’’ 
The patient must needs wait until the tablet is dissolved be- 
fore the dose can be taken, when it will be found the gas has 
escaped and your patient gets, instead of a strongly effervescent 
draught, an ordinarily plain solution. 
With a granular salt, it all effervesces at once, is imme- 
diately soluble and the patient gets a large volume of carbonic 
acid gas, whereas with an effervescing tablet he gets practically 
none, and as the gas is the essential feature the argument is 
altogether in favor of an effervescing preparation. 
For the past two years I have been making a careful study 
of a preparation called Alkalithia, a granular effervescing salt 
with the following formula : 
R Caffina? gr. I. ] 
Lithia? Carb gr. V. | 
Sodii Bicarb gr. X. 1- Alkalithia. 
Potassii Bicarb. gr. X. | 
Eff. Salt q. s. ad 3 i J SKIN AND .MUCOUS .MEMBRANES. 
19 
As will be seen from the formula, each drachm contains 
twenty-five grains of the combined alkalies, and while the dose 
is put down as a drachm, I would say to the individual physician, 
make your own dose upon the basis of the amount of contained 
alkalies, according to the case in hand. It is at once palatable, 
tasting not unlike plain soda water from the fountain, agrees 
nicely with the stomach and furnishes results more rapidly than 
any other alkaline preparation 1 have ever used, at the same 
time producing little or no unpleasant after effects. 
In the interest of palatable medication Alkalitliia is certainly 
a valuable addition to our materia medica. 
Anti-lithaemic treatment, however, comprehends much more 
than the mere administration of one’s favorite alkaline treatment. 
All treatment of the lithamiic diathesis may be embraced 
under two heads, viz.: 
(1) To stimulate the elimination of the uric acid already on 
hand, and 
(2) To prevent as far as possible the further formation of 
uric acid in the system. To accomplish the latter is much the 
more difficult task of the two, and the best efforts of the physician 
often prove futile because his patient becomes rebellious against 
the restrictions thrown around his manner of living. 
Looking upon uric acid as one of the products of the con- 
structive metabolism of albumenoid food stuff upon the one hand, 
and of the destructive metabolism of body tissue upon the other, 
it follows that, to reduce to a minimum the formation of uric acid 
in the system, the nitrogen bearing foods should be stricken from 
the dietary and oxidation in every way promoted. Notwith- 
standing the weight of authority 1 oppose, 1 believe that animal 
food but feeds the flame we seek to smother. 
The lithaemic should be emphatically denied the heavier 
meats, and nitrogen bearing foods like cheese, eggs, ripe peas 
and beans. 
Fish may be borne with a measure of impunity by some 
patients, while others will have to be reduced to a strict vegetarian 
diet of fruits, vegetables and cereals, eliminating those richest in 
nitrogen. 
The thorough digestion of such foods as may be selected 
should be sedulously guarded, and my experience leads me to 
believe that the two remedies, Fowler’s solution of arsenic and 
hydrochloric acid, are worth more than all others in combating 
the digestive disturbances of the lithaemic. 
In those cases of lithaemia where the gastric disturbances are 
neurosal in form, and accompanied by pain, often neuralgic in 
character, sour stomach and eructations, give the Fowler’s solu- 
tion in three-drop doses after meals, and hydrochloric acid in two- 
drop doses after meals, in water, for those patients whose lithae- 
mic condition is due to the imperfect digestion of proteids from a 20 
LITHAEMIC AFFECTIONS OF THE 
lack of hydrochloric acid in the gastric juice. The bowels should 
be made to move a couple of times each day, and for this pur- 
pose,—as well as to stimulate the liver, to the functional in- 
activity of which some writers attribute the elaboration of uric 
acid,—I know of no better remedy than sodium phosphate, and 
here again 1 have found the Granular Effervescing Salt superior 
to the plain salt. Let it be taken in thirty-grain doses on rising 
in the morning and on retiring at night, in half a glass of water. 
Being an alkali so much the better. It is par excellence the laxative 
for the lithaemic. 
Daily baths should be ordered, to the end that the skin, as 
a great eliminating surface, be kept active, and by thus improv- 
ing its circulation and nutrition in accordance with the recognized 
principles of hydrotherapy, much real good may be accomplished 
in combating lithcemic skin troubles. 
As a direct aid to oxidation systematic exercise should be 
taken daily and a liberal supply of pure air be vouchsafed to the 
sleeper at night. The use of tobacco and alcohol, which cripple 
oxidation, should be prohibited. 
And last but not least, insist that the lithaemic drink freely 
of water, for only by flushing the kidneys thoroughly can the 
uric acid be effectively gotten rid of. 
1 cannot conceive of a more fitting conclusion of a discussion 
of the effects of lithaemia upon the skin and mucous membranes 
than to invite your attention to the uric acid origin of hay fever, 
as championed by Dr. S. S. Bishop, of Chicago. 
The doctor has written a recent and valuable work upon 
Diseases of the Ear, Nose and Throat, in which he has devoted 
two entire chapters to a discussion of the influence of uric acid 
upon hay fever. 
It was recently my good fortune to make the acquaintance 
of Dr. Bishop while in Chicago, and in a pleasant and somewhat 
extended interview with him along the line of uric acid troubles 
in general and hay fever in particular, I was given an increased 
interest in the theory he has with such plausibility promulgated, 
and until opportunity is given to demonstrate the truth or falsity 
of his proposition 1 am not in position to gainsay his argument. 
His position is as bold as it is novel, and 1 admire him for the 
courage of his convictions: convictions born of union of a 
rich experience with painstaking methods of investigation; con- 
victions before which the less studious should pause with 
becoming respect before passing judgment, or flippantly attempt- 
ing to set aside, with the mere fiat of unbelief, truths born perhaps 
to adorn the pages of enduring history. 
In 1885 Dr. Bishop proposed the term “nervous catarrh” as 
a substitute for the too restricted term hay fever. A number of 
writers have since adopted the term. SKIN AND MUCOUS MEMBRANES. 
21 
In 1887, before the section on Psychological Medicine and 
Nervous Diseases of the Ninth International Medical Congress at 
Washington, he argued the neurotic character of the disease and 
received the almost unanimous support of the assembly. In 
1893, in the first prize essay of the United States Hay Fever 
Association, and in the same year before the American Medical 
Association, he proposed the uric acid theory of hay fever. 
About the same time, one Shaw Tywell, of Toronto, had pub- 
lished a paper entitled “A Predisposing Cause of Hay Fever,” in 
which he advocated the same theory. 
Thus we have two men about simultaneously, each ignorant 
of the work of the other, giving to the world the fruits of their 
labors in the way of a valuable discovery in medicine. The con- 
tribution of each is doubly valuable because each confirms the 
teachings of the other. 
The role which uric acid plays in the genesis of hay fever is 
that of a predisposing cause. It acts as an irritant or excitor of 
the nervous system, exalting its impressibility, thereby making 
it more susceptible to exciting causes (dust, odors and nasal hy- 
pertrophies), thus giving us exaggerated results from trifling 
causes. 
Says Bishop, ‘‘It appears from the manner in which par- 
oxysms of hay fever are started and developed that there are 
three conditions upon which the existence of the disease depends: 
(1) Abnormally susceptible nerve centres. (Lithasmia. 
A. B.C.); 
(2) Hyperesthesia of the peripheral termini of the sensory 
nerves, and 
(3) The presence of one of a large variety of irritating 
agents. 
Exclude one of those conditions and the paroxysms are pre- 
sented. Allay the susceptibility of the nervous centres by certain 
cerebral sedatives and an attack is averted or arrested. Anaes- 
thetize the nervous supply of the over-sensitive areas and the 
result is the same. Remove the patient beyond the reach of 
exciting causes and he is as comfortable as any mortal.” 
The uric acid cause of nervous catarrh is not antagonistic 
to the present -status of medical opinion or surgical treatment, 
but, on the contrary, explains questions that were inexplicable 
before. 
Speaking of ‘‘new growths and other lesions of the nasal 
mucous membranes,” as precipitating causes acting in conjunc- 
tion with lithiasis, he observes, ‘‘The particular form of manifes- 
tation may be determined by the growth or seat of irritation 
located in the nasal cavities. When this is the only determining 
factor of the nature of the morbid symptoms, no other organic 
disease having resulted from the long standing trouble, the 
removal of such a peripheral source of irritation may give relief 24 
LITH/EMIC AFFECTIONS. 
Abortive Treatment:—With the uric acid phenomena in 
mind I attempted to break up th$ morning attacks of sneezing 
and nasal stenosis by doses of acid at bedtime and on first 
awakening in the morning. The experiment was a success. A 
series of wretched mornings was followed by freedom of respira- 
tion and a sense of well being that seemed like a physical mil- 
lenium. After this result of preventing the morning increase in 
the alkalinity of the blood in order to prove the correctness of 
my deductions, I used an alkaline treatment, and was both de- 
lighted and disgusted with my results. The old enemy raged 
again, but here was clinical proof of my first proposition. 1 
have successfully repeated these experiments, until 1 am satisfied 
of the correctness of these conclusions. 
After relieving the suffering with the acid phosphate, I have 
produced it again by neutralizing the acid with an excess of 
bicarbonate of sodium and employing the usual dose. This con- 
verted the acid into a ready solvent of uric acid, flooded the 
blood with it, and produced the attacks. In turn 1 have followed 
this up with the acid, relieved all the catarrhal symptoms by pre- 
cipitating the uric acid from the blood into the tissues and pro- 
duced the characteristic gouty pains. Again, by substituting 
drachm doses of phosphate of sodium for the acid, I have precip- 
itated all the symptoms of a severe nasal catarrh. 
I am of the opinion that, with this new theory, therapeutics, 
and proper diet of this disease, the medical profession need no 
longer say to hay fever patients, in a patronizing way, “ suffer 
little children, for of such is the kingdom of heaven.” But we 
must recognize and combat the uric acid diathesis if we would 
bring comfort to these patients and obliterate a stigma that dims, 
the lustre of our great art. 
April, 1898.