On over a dozen occasions, after I had spent half – an – hour in elucidating he life situation prior to the onset of dermatitis in a patient, there had been an aggravation within six or seven hours of such severity that whoever of us happened to be on night duty was summoned from his bed to attend the victim. Such experiences went far to persuade one of the validity of an emotional factor in dermatitis and to enable one to define the factor.
It appeared that, in bringing back to a patients conscious mind half -forgotten wrongs, his emotions relating to past injustice were kindled afresh with a resulting exacerbation of the disease. Although these skin patients were notoriously difficult to cure, it gradually became apparent that it was remarkably easy to make them worse.
The implications of this study pointed to the existence of a physiological mechanisms. The inability to describe step by step, the processes involved, does not invalidate such a hypothesis. Correlations between sadness and weeping of embarrassment and blushing are universally accepted in the absence of complete knowledge in detail of all the mechanisms concerned.
EFFECTS OF PHYSICAL IRRITATION
Further observations seemed to provide additional confirmation of a physiological association between the emotions aroused by a feeling of injustice and reaction of the skin, and to widen the scope of application. Forms of dermatitis, hitherto attributed to physical and chemical agents, became comprehensible if one could accept the view that the skin became sensitized by an emotional state to a degree that induced intolerability to contact with a material substance previously well tolerated.
Much has been written on the multiplicity of cause, but the common man attaches blame to the most variable factor in the picture. For instance, if a motor car mounts a pavement and knocks down half – a – dozen people, the unusual behaviour of the motor car is held to be the cause of the accident, and not the presence of pedestrians on the pavements. When, on the other hand, a young child rushes out on to a busy street after his ball and is injured by a moving vehicle, cause is linked up with the sudden and unexpected action of the child.
Such a line of reasoning will often shift the responsibility for the occurrence of an illness from a material substance outside the body to processes operating within the body itself. In other words, if a hundred men working among lime all contracted dermatitis, one would unhesitatingly attach blame to irritating properties in the lime; but if only one man developed a skin lesion, the more significant relevant factor is his own highly personal exaggerated response to lime.
Many of us find that certain areas of skin, notably the back of the hands, crack and even bleed during a spell of cold frosty weather. However, it is also common experience to find that after a few mild days the skin has regained its normal texture without any treatment whatsoever. The removal of the environmental cause of the disorder is sufficient to bring about cure. It seems curious that, when a patient complains of a skin disorder, accepted as being due to a physical irritant, such as cracks behind the ears which he attributes to the metal frame of his spectacles, the eruption may fail to clear up when he ceases to wear the offending glasses, and may spread over large areas of skin. This occurred in the following case.
CASE 2.
A theatre manager, aged 40, complained of four weeks irritation, followed by cracks, behind both ears. He attributed the cutaneous lesion to his metal spectacle frames but admitted that these had been worn by him for over ten years without previous trouble.
On my advice he temporarily discarded the spectacles. Medicine and an external application were prescribed. The fissures healed but soon reappeared and now seemed resistant to these and various other remedies. Later, dermatitis appeared on the back of the neck and the face.
Life Situation: He had married twelve years ago. Before marriage his wife had been a dancing instructress. She has an extreme mother – attachment, and he said that even yet he felt that her mother meant much more to her than he did. Like most such women she was sexually frigid. Her only pregnancy, ten years ago, was terminated on account of hyperemesis – as might be expected.
He did not usually leave the theatre at night until 10.45, reaching home about 11.15. It was his custom to telephone his wife when some untoward happening made it possible for him to come home earlier. About five months before the onset of his illness he went home one night at 9.30 without making the usual telephone call. On going upstairs he found a man, unknown to him, in his wifes bedroom with her. There was no definite evidence of misconduct, but he became obsessed with doubts and suspicions.
He was an uncompromising type of man, with a limited capacity for seeing anothers point of view. He adhered to his own principles and standards, judging others by them; nor, having once formed an opinion, did he readily change his mind. Since the bedroom episode his wife and he met only at meal – times and rarely exchanged a word. He maintained a cheerful exterior to his business associates but ruminated unceasingly on his domestic crisis. Providence had been unkind to him. For many years he had endured a wife who was not in love with him and who had now, perhaps, added infidelity to her short – comings.
Progress: Although I knew this man socially I had no inkling of the above difficulties until they were disclosed in an interview above difficulties until they were disclosed in an interview about two months after the commencement of treatment. Following the disclosure he became covered in a few days with a papulovesicular eruption from head to toe. After further interviews and discussions he agreed that in all probability his skin disease was determined by his recent emotions, and that the present state of affairs should be ended, either by reconciliation with his wife or by a complete break.
He took a months leave, which he spent in his native town. After a week he reached a decision and instigated proceedings for a divorce. By the end of his months holiday he was free from dermatitis. During the next four months, pending legal hearing and judgment, he had repeated crops of boils, but this affection also vanished soon after decree was granted in his favour. He resumed wearing his spectacles and has now remained trouble – free for many years.
INDUSTRIAL DERMATITIS.
During the war years there was an increase in the incidence of so – called industrial dermatitis. The vast majority of the case occurred among munitions – workers, and the oils used in the engineering industry have been blamed for them. Yet is it extraordinary that a person should be able to work with oil for months or even years without discomfort and then should develop dermatitis, which is rarely limited to the parts of the skin which come into contact with the oil.
Moreover, if the oil was the sole aetiological factor in the production of the dermatitis, one would expect that withdrawal from the noxious agent would be rapidly followed by spontaneous cure, or at least by obvious improvement. But this never happens. On the contrary, the dermatitis, is liable to drag on for months, to spread all over the body, and to resist all medicaments.
During this period the patient becomes anxious about his earning ability, and, besides drawing his weekly compensation, often consults a solicitor with a view to obtaining a capital sum to reimburse him for the damage inflicted on his skin “because, as everyone knows, the dermatitis may return at a later date”.
