THE RELATIONS 
-OF- 
Skin Diseases to Marriage. 
B Y 
A, H, Ohmann-Dumesnil, A, M„ M, D. 
Professor of Dermatology and Syphilis. St. Louis College of Physicians and Surgeons. 
Reprinted from the St. Louis Medical and Surgical Journal, May, 18S5. 
ST. LOUIS: 
MEDICAL JOURNAL PUBLISHING COMPANY. 
2622 Washington Avenue. 
1885. The Relations of Skin Disease to Marriage. By A. II. Ohinann- 
Diiinesnil, A. M , M. I). 
Marriage and syphilis has been so thoroughly discussed and 
so much attention has been paid to it, not only by syphilo- 
graphers, but by the profession in general, that all the phases of 
the question have been considered. Despite this, all authorities 
are by no means united in their conclusions, although all agree 
that, during certain stages of the disease, marriage is entirely 
precluded. That syphilis is hereditary and transmissible is 
acknowledged by all who have had any experience whatever in 
the observation and treatment of the disease. Those physicians 
who have paid any considerable attention to insanity and affec- 
tions of the nervous system, claim for many forms of the neu- 
roses if not a direct transmission, at least a hereditary ten- 
dency to the same or allied forms of nervous lesions, derived 
from one or both parents. Rheumatism, gout, hemophilia,, 
phthisis, and a number of other general affections are accused 
by a number of experienced writers to have that power in 
them by which the patient will hand down the peculiar suscept- 
ibility to those diseases, to his unlucky progeny. On the other 
hand, some very respectable authorities deny heredity as such, 
while acknowledging that the physical weakness is perpetu- 
ated. 
A few of the more common, and at the same time most trou- 
blesome diseases of the skin will be briefly noticed in this 
paper, and an attempt made to point out the probable chance 
of their reappearing in the offspring, together with the reasons 
why patients suffering from certain dermatoses should, if not 
entirely give up marriage, at least postpone that relation until 
circumstances justify such a course. As a prefatory remark it 
may be stated that it is not necessary for the mother or father to 4 
be the recipient of the trouble from the consort in order that 
the child may be the subject of the disease. 
It is not the local manifestations of the disease that consti- 
tutes the active factor, but rather the general condition of the 
entire economy of one of the progenitors, which has under- 
gone certain more or less profound changes which manifest 
themselves more or less distinctly upon the external surface of 
the body, as a sort of danger signal ; and, generally, there are 
certain appearances connected with these lesions that, to him 
who can read, constitute a fair index of the severity of the ex- 
isting condition. 
It is manifestly obvious that a person suffering from an in- 
fectious or contagious disease should not marry during the ac- 
tive period of the trouble. No one afflicted with any one of the 
parasitic diseases would object to submitting to a proper course 
of treatment before marrying. But there are some troubles of 
the skin which, although we may admit that they are neither 
contagious nor directly transmissible, or only rarely so, are suf- 
ficiently dangerous, in this respect, to awaken our attention and 
deserve more study. It will be noted that the extreme views of 
the French and German schools of dermatology have been 
avoided, as we are not willing to admit, upon the one hand, the 
universal constitutional nature of all dermatic affections; nor will 
we, on the other, concede that they are all purely local and due, 
almost without exception, to external causes alone. For this 
reason, whatever authorities we have consulted are chiefly those 
occupying what we'consider the most rational position, which is 
one situated midway between the two extremes, and from those 
who are willing to let theory bend to facts. 
The object of these few remarks is not so much to uphold a 
theory as to inquire whether there may not be enough in the 
question of the heredity of skin diseases or the predisposition 
thereto, to make it of some moment to the medical practi- 
tioner who may be questioned as to such being a bar to mar- 
riage. 
Eczema is by far the most common and, unfortunately, it of- 
ten becomes the most intractable of the troubles afflicting the 
skin. When first studied the disease was for a long time re- 
garded as purely local ; then it was admitted by a large number 
that it might be somewhat dependent upon internal causes. Ils 
heredity was denied in toto at first. We find that, later on, in 5 
speaking of the etiology of this protean disease that some au- 
thors acknowledge having seen a few-a very few-cases, which 
they considered hereditary. The latest work on the subject and 
one which we, as Americans, are proud to point to, is Bulkley's 
sterling work. lie says*: " But, on the other hand, although 
the disease appears to come by direct inheritance in but a few 
cases, it is still true that in a certain number it is seen to be he- 
leditary, and whole families are sometimes affected, not only in 
one generation but in several." . . . Again, "Scrofula or 
struma undoubtedly appears as a predisposing cause of eczema 
in the way of inheritance, quite as effectually as when existing 
in the individual." Van Harlingen, Piffard, Liveing, Duhring, 
E. Wilson, and even Neumann acknowledge that, in some cases, 
this disease is undoubtedly hereditary. There is also a greater 
probability of its being transmitted, if it exists as an old, chronic 
and intractable form of the disease in the parent. 
The next most common affection which we meet with in 
practice is, no doubt, psoriasis. This disease is acknowledged by 
all authors of any prominence to be hereditary. It is contended, 
however, by a number of recent observers that the heredity 
is more marked, or more liable to be seen, if one or both parents 
have had the disease in a marked and recurrent form. In those 
cases in which it assumes the "universal" form, it is pretty 
certain that the offspring of the affected parent will either ex- 
hibit the same disease, or some allied cutaneous affection. 
Lupus vulgaris, whose pathology is as yet involved in more 
■or less obscurity, is another one of those dermatic affections 
-which would seem to be transmitted from parent to child. 
We will not inquire whether the neoplasm which constitutes it 
is scrofulous, tubercular, or of some other origin. Any one 
of these causes is sufficiently impressed upon the constitution 
of the progenitor to involve that of the progeny by direct in- 
heritance. 
Ichthyosis, especially of that variety known as " ichthyosis 
hystrix," is undoubtedly a hereditary affection, or, rather, de- 
formity. There is no single author who has ever observe1: any 
number of cases, limited though it be, who has not immediately 
had his attention called to this important fact. It would be use- 
less here to advert to the dicta of the many dermatologists 
*Second'Edition, p. 93. 6 
who have expressed an opinion upon the subject. The disease- 
is undoubtedly the most markedly hereditary one with which 
we are acquainted. 
Lepra, or true leprosy, whether it be dependent upon a ba- 
cillus or not, is transmissible from parent to child. Although no- 
well-authenticated cases exist to show that it has been acquired 
by contagion, or that its bacillus has been successfully inocu- 
lated, examples of its occurrence in families which have con- 
tinued leprous for several generations are numerous and well at- 
tested. Whether the primary cause be climatic or parasitic, the- 
fact of its heredity remains. 
Chronic pruritus has been observed in a mother, her daughter 
and granddaughter, as detailed in the Journal of Cutaneous 
and Venereal JJi.sevses, February, 1885, by Dr. Wm. J. May- 
nard. An interesting fact in connection with -this is that the 
male members escaped. 
Sarcoma and carcinoma of the skin are further examples-of 
a malignant type of disease-of dermatoses which are transmis- 
missible from generation to generation. 
The writer has observed cases of vitiligo in which the trouble 
was transmitted to the offspring apparently. Not only was there 
a reappearance of the disease in the children, but all were af- 
fected in a manner similar to that of the parent, and identical 
parts were the first to be involved in the process. 
We know well that the .color of the skin is very susceptible 
of being transmitted to the children, and we daily observe- 
such as the result of mixed intercourse. Each race has cer- 
tain pigmentary peculiarities of the skin, which, by some pro- 
cess or other, seem to be stamped upon the child to a greater 
or less degree. In certain families we find that a lock of white 
hair in a particular locality is transmitted from generation to 
generation, just as other peculiarities or deformities are. Often,, 
again, whole generations escape, and the "sign" reappears upon 
a remote descendant, showing that although this peculiar force 
may become latent, it does not necessarily lose any of its 
strength on that account, as all those acquainted with the facts of 
atavism know. 
A cursory glance at these various examples would seem to 
indicate that heredity plays a very unimportant pai t in the gen- 
esis of skin diseases. But when we take into consideration the 7 
small amount of care taken, not only to trace diseases back to 
their origin, but also the inability to follow the various succes- 
sions through different generations, the amount of evidence of- 
fered acquires more force than would be at first accorded to it. 
Besides this, the cause can often be recognized as being some 
condition which has shown itself in different ways, and only 
evidence itself as a skin disease in the last member of a long- 
line of individuals. Were our observers to pay more attention 
to this subject, there is no doubt whatever that the role played 
by heredity would be found to be much more important than it 
is regarded at the present time. 
As a natural conclusion it will follow that, if certain skin dis- 
eases are directly transmissible, or if the causes thereof are, mar- 
riage between individuals affected with these troubles, whether 
the disease be confined to one or both of the high contracting 
parties, should be very carefully considered, if not prohibited. 
Before permitting such an union to take place, the dermatic gen- 
ealogy should be carefully examined, and all the possibilities 
conscientiously weighed. The intention of this paper is rather 
to call attention to a few isolated facts, and to direct observation 
to a new point in connection with the etiology of skin diseases 
which may prove serviceable in the prevention of a number of 
the most intractable and chronic affections which afflict the hu- 
man skin. There is no doubt whatever that the more these re- 
lations are sought after the more often will they be found, and 
enable the physician to give safe and reliable advice, to those 
cases where it will be needed or sought. 
o