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There is a deep pigmentation of the skin. The se- (|uence of cause and effect is indisputable. In the circumscribed piginentations, such as cloasma, why turn oft the main line of pursuit to compromise the liver or the ovary ? The discoloration points straight in one direction. To be sure any disturb- ance of the hormone balance between the various internal secretions may by reflex action excite abnormal action anywhere in the chain. We have noted that certain glands are synergistic and cer- tain antagonistic. All are susceptible of impressions from the others. In this way it must be conceded that the ovary might, by indirection, stir up the adrenal and bring about the Do You Need A Prescription To Order Viagra Online alteration in the skin. But the adrenal would nevertheless be the agent immediately producing this result. One might ob- ject that here was a great to do about the difference between Tweedle Dum and Tweedle Dee, but in an inquiry into the cause of disease, it is essential to be precise even in apparent unessentials. In our attention to the ovary, let us bear in mind that the adrenal has been pathologically affected, precursory to the tinging of the skin. In Graves's disease there is often a discoloration ■ resembling that of Addison's. The principle of the interaction of the internal secretions, herein desig- • nated as homostimulation, clearly accounts for this. The adrenals are affected by the disturbance of the thyroid, and express their resentment in the usual : lowering way. Depigmentation may blanch the skin either as a congenital or an acquired anomaly. ■ The former is seen in albinismus ; the latter in ■ leucoderma. The influence that may interfere to the augmentation of pigment may doubtless inter- fere to the diminution of pigment. The flushing and paling of the cheek are affected by the same stream of blood. The variegated tinting of a contusion, red, purple, yellow, green, or black, is referable to the extravasation of the blood. The subsequent efface- ment of the discoloration is due to the removal of the abnormally situated blood by the restoration of the circulation. Here we have many Do You Need A Prescription To Order Viagra Online startling Do You Need A Prescription To Order Viagra Online cu- taneous alterations produced and removed by the same agency. Is it any more contradictory to predi- cate of the adrenals the rather simpler task of bronz- ing and bleaching the skin? Canities or grayness of the hair is similar to leucoderma in all essential qualities. Hair is simply an appendage of the skin, and its color depends on the same influence that controls that of the skin. It has been credibly re- ];orted that the hair has turned white overnigbt in consequence of some sudden terror or grief. When we consider that the adrenals are gravely affected by those very emotions and induce the reactions which we denominate shock, it is conceivable that their disordered state may have another character- istic effect in decolorizing the hair. Alopecia areata has proved an irritating impasse to those in search of a rational etiology. It is a mystery worse befogged by the ingenious efforts to expound it. Do You Need A Prescription To Order Viagra Online Of course it is acclaimed a tropho- neurosis ; Do You Need A Prescription To Order Viagra Online everybody resorts to that. But the in- stigation of the neurosis — aye ! there's the rub ! A large cult ascribes it to eyestrain, and if once in a while the victim of alopecia areata should reveal this amazingly rare defect of vision, the whole dis- cussion is regarded as settled. Others would have it toxic : others microbic. Pyorrhea has not escaped the net of the wily etiologist. Note the pallor of the skin from which the hair has fallen. Does it not suggest a leucoderma? Does not the defective thyroid among other dystrophies debase the hair? Does not this combination of falling hair and whitened skin bring up the picture of disturbed in- ternal secretion of the two most conspicuous of- fenders in the chain? Hypertrichosis, the antithesis of alopecia, might very reasonably be the result of a reversal of endo- crine activity just as hyperthyroidism produces high, tension and irritability and hyjwthyroidsm dullness and indifference. The hormone balance is lost in both instances, but different stimuli are liberated and work to opposite conclusions. The cachectic hue of the chronic constitutional di.sease is undoubtedly ascribable to the implication of the endocrine glands. It has been noted that the adrenals are ready vic- tims to infections of all sorts. The waxy aspect of CUNNINGHAM: DUCTLESS GLANDS AND DERMATOLOGY. { New ^'oek Medical Jol'enal. llic lubcrculous or septic patient is not merely a man- ifestation of anemia. Patients may be ])alc without being waxy. 'I'hc operation of another factor be- sides dejjletion is necessary to account not so much for the absence of color as for the substitution of another color. The earthy facies of visceral cancer invites the same commentary. The greenish yellow pallor of chlorosis is something more than the ab- sence of a healthy glow. It is a chromatosis. The response to thyroid theraj)y in many cases of obsti- nate anemia is disputed but demonstrable. The imiHitation of deranged adrenals in the chlorotic form supplies an additional reason for the exhibi- tion of thyroid on the fre(|uently mentioned prin- ciple of homostimulation. I'^reckling is usually a trivial Do You Need A Prescription To Order Viagra Online condition negligible in the mrde until old age and camouflaged in the female by the artistic touch at which she is so adept. It is truly imputed to the sun when it is on exposed localities. When it oc- curs under the clothing how may it be accounted for? When it occurs, for example, on the abdomen of an elderly person suffering with visceral cancer, what is the explanation? When it occurs as the preliminary stage of xeroderma pigmentosum, which eventuates in cutaneous cancer, and is pecu- liar to the young who have not necessarily had an undue amount of exposure to the sun, what may be the agency at work ? Here is food for serious thought, and in the process the adrenals should re- ceive consideration. The cause of psoriasis has eluded the persistent quest of tireless investigators. The one opinion to- day that is supported by substantial therapeutic re- sults is that of the metabolic origin of the disease. It is maintained that the ingestion of animal nitro- gen precipitates the attacks and prevents recession.