Czerny regards his exudative diathesis as a congenital abnormality observed in the descendants of pathologic parents, an inherited defi ciency of the organism, and he finds this deficiency in the chemistry of the body, in an insufficient supply in the newborn of certain materials, of reserve-matter, which is gradually used up in extra-uterine life and which is therefore prematurely exhausted in unfavorably predisposed children. He considers this unfavorable predisposition not as a conse quence of any kind of bodily inferiority of the parents (from alcohol, lees, tuberculosis, etc.) but as a specific family-disease.
This hypothesis of Czerny is amenable to experimental investiga tion (analysis of the composition of the tissues, of the physiologic chemical condition of the organism, of metabolism). Similar questions have been discussed ten years ago in the investigation of exudative diath esis (which was then still called "scrofulosis"), though no positive results have come from this to date. Czerny regards as one strong argu ment against its connection with gout the reversed disposition as to age and also the reaction to a meat-diet.
Moro, who has made a thorough clinical analysis of lymphatic diathesis, finds its most important peculiarity in a special congenital disposition of the system for obstinate inflammatory reactions with exu dation of "lymph," in which the lymphatic tissue plays an important primary as well as secondary role. He attempts to trace this predisposi tion to an "angioneurotic inflammation" (as it was called by Kreibich), to an abnormal function of the sympathetic nervous system and he puts special stress upon the neurogenous origin of the symptoms, especially from thermic, toxic and infectious stimulation.
According to the older as well as to the more recent investigations, the following conditions are of the greatest importance in causing the manifestations of the lymphatic (exudative) diathesis: 1. The Kind of diet may have a two-fold influence according to the latest publications of Czerny.
(a) Owing to the unfavorable development peculiar to exudative diathesis (the insufficiency in reserve material) human milk (as well as cow's milk) is an insufficient food as regards its plastic properties; exclu sive breast feeding (as well as exclusive feeding with cow's milk) will, therefore, favor the appearance of the symptoms. About the therapeutic
consequences, see below.
(b) Other digestive disturbances will also produce symptoms of exudative diathesis. Most ominous are the digestive disturbances expressed by the different types of obesity (principally retention of water in the body). In cases in which there is an unfavorable pre disposition, these disturbances will cause, next to infectious injuries, most frequently the syndroma of a systematic swelling of the lymphatic organs. Rhazes, who lived a thousand years ago, knew of this, and more recently, amongst others, Flesch has mentioned it (in Gerhardt's Handbuch, 1STS).
The author himself has raised the question, if it was not possible that under certain conditions (an unfavorable predisposition as to the functions of intestinal and cellular digestion) foodstuffs ingested into the gastro-intestinal tract might act in the body like an antigen; if this. should be the case, then it would be quite natural to assume that the lymphatic diathesis represents a kind of food-allergia (food-anaphylaxis) and to explain thus the over-sensibility of the tissues against the group of originators of the allergic condition.
2. The Condition of the Nervous of certain nerve-regions, especially of the sympathetic system, also psychic alter ations have a tremendous influence upon the pathogenesis of this affection.
According to Czerny, the eczema of children, for instance, is frequently the consequence instead of the cause of the itching and scratching; he claims that it is caused by the primary sensation of itching and that it can easily be cured by psychotherapy. The vasomotor disturbances do not only cause the quick changes in the color of the external skin, hyperidrosis, etc., but also hyperannia and catarrhal swelling of the mucous membranes. Upon the mucous membrane of the pharyngeal tonsils these swellings may cause the formation of crypts, the stagnating contents of which will cause inflammations and infectious processes by their putrefaction.
Czerny believes, however, that the neuropathies and psychopat hies which we observe in cases of exudative diathesis are to a large extent not caused by this disorder, but are brought on by injudicious treatment, and that only some of these are hereditary abnormalities.