Part 27

The action of cold upon the cutaneous organ produces many sympathetic effects, especially when this action takes place while we are sweating. The term repercussion of transpiration is not proper to express what then takes place; it gives a very inaccurate idea. Let us suppose that a pleurisy arises from cold suddenly applied, the following is what happens; the organic sensibility of the skin being immediately altered, that of the pleura is sympathetically altered. By it the exhalants become in relation with the blood; they admit it instead of the serum which they before received, and inflammation supervenes. Thus this phenomenon is the same as that in which the application of a cold body upon the skin suddenly arrests uterine, nasal hemorrhage, &c. &c.; the result only differs. Now in this last case, no one ever supposed that there was a repercussion of fluid. The suppression of the transpiration is a thing purely accessory and foreign to the internal inflammation which takes place. When the skin sweats in summer, the vital forces are more raised by the caloric which penetrates it; in this state, it is more capable of acting sympathetically upon the forces of the other systems. Hence why all strong stimulants that act upon it are more to be feared then. It is so true that it is not the suppression of the sweat which is dangerous, but the alteration of the vital forces of the skin which sweats, that many kinds, as the sweat of phthisis, are not so injurious when they cease for a time; they are checked even with much more difficulty, because they are not produced by a cause acting immediately upon the skin. Now if there was a repercussion of the transpiration, every species of sweat that was suppressed would be injurious. We never hear of a peripneumony arising from a suppression of sweat produced by fear, rheumatism, &c. There would be then also a repercussion of mucous matter, when a pleurisy arises from swallowing a glass of cold water. Men judge only by that which is striking. The suppression of the sweat is an effect like inflammation of the pleura, but it is not the cause of it. If there was no sweat the instant the cold was applied to the skin, inflammation would nevertheless come on. In wounds of the head, with abscesses of the liver, &c. there is no repercussion of fluids.

The trembling of which the voluntary muscles become the seat, the debility of the pulse which the weakness of the action of the heart produces, &c. are phenomena which the influence of the skin affected by cold alone causes. In fact, only this organ, the commencement of the mucous surfaces and all of that of the bronchia, are made cold by the external air; all the others remain at their usual temperature.

We know the innumerable phenomena which arise from the disappearance of herpes, the itch, &c. imprudently produced; in all these cases it does not appear that the morbific matter is carried to the other organs, though I do not pretend that this never happens. It is the vital forces of these which are raised and which then occasion different accidents; now as these forces vary in each system, these accidents will be essentially different; thus the same morbific cause disappearing from the skin, will produce vomiting if thrown upon the stomach, in which the sensible organic contractility predominates; pains, if it goes to the nerves which are especially characterized by animal sensibility; derangements of sight, hearing and smell, if it affects the respective viscera of these senses; hemorrhage, catarrhs, phthisis, tubercular inflammation, &c. if it attacks the mucous surfaces, the lungs, the serous membranes, &c. in which the organic sensibility is much raised. Now, if the same morbific matter carried upon these different organs, produced these accidents, they ought to be uniform. Do not their varieties, and especially the constant analogy which they have with the predominant vital forces of the organs in which they appear, prove, that they depend upon the cause which I have pointed out?

We know that the serous surfaces and the cellular texture on the one part, and the skin on the other, are often in opposition in diseases. There is no sweat when dropsies are formed; the dryness of the skin is often even more remarkable than the small quantity of urine, &c.

3d. When the cellular texture contained in the dermoid spaces is inflamed, as in phlegmonous inflammation, in biles, in some malignant pustules, &c. there comes on many sympathies which can be referred to those of the general cellular system, which have been already noticed.

4th. The affections of the chorion itself, all marked with a chronic character, on account of the kind of vitality and structure of this portion of the skin, occasion also sympathies which have the same chronic character, but of which we know but little.

The organic contractility cannot be put sympathetically in action in the skin, as it does not exist there.

_Characters of the Vital Properties. First Character. The Cutaneous Life varies in each organ._

Though we have spoken in general of the vital properties of the skin, they are far from being uniform or at the same degree in all the regions.

1st. There is no doubt that the animal sensibility of the soles of the feet and the palms of the hands is greater than that of the other parts. Many persons are so sensible in the hypochondriac region, that the least tickling there produces convulsions. The anterior and lateral part of the trunk is always more sensible than the region of the back.

2d. The organic properties do not vary less. The extreme susceptibility of the face to receive the blood, is a proof of it, as I have said. It is generally known that some parts are more proper than others for the application of blisters. Observe on this subject that the places where the animal sensibility predominates, are not the same as those in which the organic is in the greatest proportion. The soles of the feet and the palms of the hands hold the first rank in relation to one, and the face in relation to the other.

In diseases we also see these varieties. Who does not know that some particular parts of the skin are especially the seat of some particular cutaneous affections, and that when these affections are general, they always predominate in certain places. We ought not to be astonished at these varieties, since we have seen that the dermoid texture is infinitely variable as it respects its papillæ, its reticular body, its chorion, &c.

_Second Character. Intermission in one relation; continuity in another._

The life of the cutaneous system is essentially intermittent in relation to animal sensibility. All the senses exhibit this phenomenon. Thus when the eye has for a long time gazed upon objects, the ear heard sounds, the nose received odours, and the mouth tastes, these different organs become unfit to receive new sensations; they become fatigued, and require rest to regain their forces. It is the same with regard to feeling and the touch; wearied by the impression of surrounding bodies, the skin requires an intermission of action to regain excitability adapted to new impressions. We know that a short time before sleep, external bodies produce but an obscure sensation upon it, and that their contact has no effect in this state, in which animals seem to lose half of their existence. The more powerfully the cutaneous sensibility has been excited, the more profound is sleep; hence why all painful exercises, great frictions, &c. are always followed by a deep sleep. Yet this sense can sometimes exert itself, while the others sleep; pinch the leg of a man asleep; he draws it away without waking, and has afterwards no remembrance of the sensation. Thus somnambulists often hear sounds, even eat, &c.; for, as I have said elsewhere, sleep may affect but a very limited part of animal life, as it may the whole.

Under the relation of organic sensibility, the life of the cutaneous system is essentially continuous. Thus the functions over which this property presides have a character opposite to the preceding. The insensible transpiration takes place continually, though there may be some periods in which it is more active than in others. The oily fluid is incessantly carried away and renewed; we might even say sometimes that it is when the animal sensibility is interrupted, that the organic is in the greatest exercise.

It is especially in diseases that they have made this observation, which is besides generally applicable to organic life. All this life is as active and even more so during the night than during the day. Most of the diseases that attack the functions which belong to it, are marked by an increase of activity during the night. All fevers which particularly affect the circulation have their exacerbation towards night. In diseases of the heart, the patients are more oppressed at this period, &c. In phthisis which affects respiration, it is in the night especially that there is hectic fever, sweats, &c. Pneumonia and pleurisy, exhibit frequent exacerbations towards night. In glandular diseases, either acute or chronic we make the same observation. It would be necessary to refer to almost all the affections which alter especially an organic function, in order to omit nothing upon this point. On the contrary, observe hemiplegia, epilepsy, convulsions, various paralysies of the different organs of sense, most mental alienations, apoplexy and other affections which exert their influence more particularly upon animal life, they have not, so often at least, their exacerbations towards evening and during the night, no doubt because in the natural state, this life is in the habit of becoming drowsy and not of being raised like the other which seems to imprint this character upon its alterations. Other causes no doubt have an influence upon this phenomenon; but I believe this to be a real one.

_Third Character. Influence of the Sexes._

The sex has an influence upon the cutaneous life. In general the animal portion of this life is more raised in women, in whom every thing that belongs to the sensations is proportionally more marked than in man, who predominates by the power of his locomotive muscles. The effects of tickling are infinitely more powerful in females. All the arts which require nicety and delicacy of touch are advantageously cultivated by women. The peculiar texture of the chorion, a texture generally more delicate, has no doubt an influence upon this phenomenon. As to the organic portion of the cutaneous life, the difference is not very great. Man appears to be superior in this respect; he generally sweats more; his skin is more unctuous, which proves a greater secretion.

_Fourth Character. Influence of Temperament._

The temperament peculiar to each individual is not a less real cause of differences in the skin. We know that the colour, roughness and pliability of this organ vary according as individuals are sanguineous, phlegmatic, &c. that these external attributes are even a character of the temperaments. Varieties of structure no doubt coincide with these. Is it then astonishing that the animal sensibility differs so much, that the touch itself should be delicate in some and dull in others, that some should be very ticklish, whilst others are not so at all, &c.? Ought we to be astonished if the organic sensibility, which is very variable, should determine, according to the individuals, many varieties in the phenomena over which it presides; if in some, it allows much blood to go to the face, and if it repels this fluid in others who are always pale; if some men sweat much, whilst others have the skin almost always dry; if the cutaneous oil varies in quantity; if there are some skins much disposed to eruptions, either acute or chronic, to pimples of different natures, and if others are almost always free from them, even when the individuals expose themselves to the contagion of these diseases; if superficial wounds, of the same extent and made by the same instrument, are sometimes quicker and sometimes slower in healing; if the cure of cutaneous diseases is also very variable in its periods, &c. &c.?

ARTICLE FOURTH.

DEVELOPMENT OF THE DERMOID SYSTEM.

I. _State of this System in the Fœtus._

In the first periods after conception, the skin is but a kind of glutinous covering, which seems to be gradually condensed, forms a transparent envelope, through which we see in part the subjacent organs, the vessels especially, and which is torn by the least jar. This state continues for a month and a half or two months. The consistence constantly increasing, soon gives to the skin an appearance more nearly like that which it has in infants after birth. Its delicacy is extreme at this period. It has not one quarter the thickness of that of the adult. The moment in which it begins to lose its mucous state appears to be that in which the fibres of the chorion are formed. Until then the cellular texture and the vessels especially composed it, and as the first is abundantly filled with juices during the early periods, it is not astonishing that it should then give way under the least pressure. But when the fibres are formed, the cellular texture diminishes on the one hand, and is concentrated in the spaces that are developed, and on the other the dermoid fibres, more dense than its layers, increase the resistance.

We do not see upon the external surface of the skin of the fœtus most of the wrinkles of which we have spoken above. Those of the face in particular are not seen; the kind of immobility, in which the facial muscles are, is evidently the reason of it. The forehead, the eyelids, the edges of the lips, &c. are smooth. Besides, the abundance of fat which then distends the integuments of the cheeks, prevents every species of fold there. As the hands and the feet are found in part bent at their articulations, by the attitude of the fœtus, different wrinkles are already formed about these articulations, principally on the hand, where however they appear less in proportion than afterwards. The curved, papillary lines are not very evident on the foot and the hand, even when the epidermis is removed.

The internal surface of the skin is remarkable for the slight adhesion of the subjacent cellular texture, the cells of which filled with fatty particles are removed with great ease, by scraping this surface with the edge of a knife. We see then there the spaces already well formed, and as distinct in proportion as afterwards. By pursuing their dissection from within outwards, we insensibly lose sight of them towards the external surface where the skin is condensed.

More blood enters the skin of the fœtus, than at any other period of life. It is easy to observe this in small animals taken alive from the womb of their mother; for in the fœtuses that are dead at birth, or born prematurely, the cause which destroys life, increasing or diminishing in the last moments the quantity of cutaneous blood, prevents us from drawing any conclusion as to the ordinary state by an inspection of them. The nerves are, as in all the other parts, more evident; but the papillæ, though sensible, as I have said, have not a proportionable increase.

The animal sensibility is not in exercise in the skin of the fœtus, or at least it is very obscure there. This is owing to the absence of the causes of excitement. These are the surrounding heat, the waters of the amnios and the parietes of the womb, which can furnish materials for sensations; but as these causes are always uniform, and have no varieties, the fœtus can have but a very feeble perception, because acuteness of sensation requires change of stimuli. We know that heat long continued at the same degree becomes insensible, that a long continuance in a bath takes away almost entirely the sensation of the water, because habit is every thing as it respects sensation; nothing but what is new affects us powerfully.

Is the organic sensibility of the skin in activity in the fœtus? does it preside over the alternate exhalation and absorption of the waters of the amnios? This is not the common opinion, it is not even a probable one; but this question is far from being settled in so precise a manner as many other points of physiology.

Besides, it cannot be doubted that there is a copious secretion of an unctuous and viscid fluid, which covers the whole body of the fœtus, but which is more abundant in some places than others, as behind the ears, in the groin, the axilla, &c. either because it is secreted there in greater quantity, or accumulated on account of the arrangement of the parts. Accoucheurs have it wiped off after birth, and the females of animals remove it by the repeated application of their tongues to the surface of the body. This fluid appears to be to the skin of the fœtus what the oily fluid is to that of the adult; it defends this organ from the impression of the waters of the amnios. If the sebaceous glands exist, it would appear that they furnish it, for it is certainly from a different source from the sweat. When care has not been taken to remove this covering, it irritates the skin, and may produce excoriations, and a species of erysipelas. The air cannot remove it by solution. Nothing similar oozes from the skin of the infant after birth. Is it because the black blood alone is capable of furnishing the materials of this substance?

II. _State of the Dermoid System during growth._

At the moment of birth the dermis experiences a sudden revolution. Hitherto entered only by black blood, it is at the time the fœtus is born, more or less coloured by it. Some fœtuses come wholly livid, others are paler; there is a remarkable variety in this respect. But all, shortly after they have respired, become more or less decidedly red. It is owing to the arterial blood which is formed and succeeds the venous blood that circulated in the cutaneous arteries. In this respect the state of the skin is in general an index of what goes on in the lungs. If an infant remains a long time of a violet colour, he either does not breathe or breathes with difficulty. The extremities of the hands and the feet in general become red the last. They are those in which the lividity consequently continues the longest, when this lividity is very evident. The blood which goes to the cutaneous organ, enters it in general in a very uniform manner; the cheeks do not appear to receive more of it in proportion. The sudden excitement it brings to the organ, raises its vital forces and renders it more fit to receive the impressions, which are new to it, of the surrounding bodies.

Observe in fact that a thousand different agents, the surrounding temperature, the air, dress, the fluid in which the fœtus is washed, the tongues of those quadrupeds who lick their young, carry to the skin an excitement which is so much the more felt by the fœtus, as it is not accustomed to it, and as there is an essential difference between these stimuli, and those to which it had been previously subjected. It is then that the remarkable sympathy which connects the skin with all the other organs, becomes especially necessary. Every thing within soon perceives the new excitements that are applied without. It is these excitements, those of the mucous surfaces at their origin and those of the whole of the bronchia, which especially bring into action many organs hitherto inactive. There happens then, what is observed in syncope, in which respiration, circulation, the cerebral action and many functions suspended by the affection, are suddenly roused up by external friction, by the irritation of the pituitary membrane, &c. The phenomena are different, but the principles from which they are derived in both cases are the same.

Then the organic sensibility is also raised. Transpiration is established. The skin begins to be an emunctory of different substances, which it did not before throw out; it becomes also capable of absorbing different principles applied to its surface. The skin of the fœtus is hardly ever the seat of any kind of eruptions; then pimples of different kinds frequently appear.

All the parts of the cutaneous organ do not however appear to be raised to the same degree of organic sensibility. For a long time after birth the skin of the cranium appears to be the centre of a more active life; it becomes the frequent seat of many eruptions, all of which denote an excess of the vital forces. The different kinds of scurf with which it is covered do not appear elsewhere. In this respect, the skin of the cranium follows, like the bones of this part and the cerebral membranes, the early development of the brain, which, on this account is the seat of diseases in infancy more than at any other age.

The skin of the face seems to be sometimes in less activity. In the first months after birth, it has not that bright colour which it will afterwards have upon the cheeks, and which does not commence until the development of the sinuses and dentition bring to this part more vital activity for the nutritive work. It is also towards this period that the eruptions of which this part of the cutaneous system is especially the seat, like those of the small-pox, measles, &c. begin to take place.

For a long time after birth the skin still preserves a remarkable degree of softness; a very great quantity of gelatine enters it; this substance is obtained from it with great ease by ebullition, which, continued for some time, finally melts this organ entirely. The fibrous part noticed by Seguin, is in very small quantity. I think it is this predominance of the gelatinous portion of the skin, which renders that of young animals easy of digestion. We know that in calves’ heads, roasted lamb, and small sucking pigs, prepared for our tables, it presents an aliment which the digestive juices alter with the greatest ease; whilst that of animals of mature age and especially old ones, cannot be digested by them. The carnivorous species tear their prey, feed upon its internal organs, the muscles especially, and leave the skin. Now what is it that makes the skin of young animals differ from that of old ones? It is because the gelatinous substance predominates over the fibrous in the first, and the fibrous predominates in the second.

The skin of children is gradually thickened; but it is not until the thirtieth year that it acquires the thickness that it is always to have afterwards. Till then the different ages are marked in this respect by different degrees. Take a portion of skin at birth, at two, six, ten, fifteen, twenty years, &c. you will see these differences in a remarkable manner. The more its thickness increases the more compact it becomes; it is because the fibrous substance tends constantly to predominate over the gelatinous.