"""'-^iT-V'-'"'-:;1 " ' ■•"''•;- jj'" ■ .;' UNITED STATES OF AMERICA * ♦ . FOUNDED 1836 WASHINGTON, D. C. GPO 16—67244-1 C'lir'JVUyjR OUT »S MS!E AS JB So Division J. Division* 5. •H)'- 1 \ . %0 ■ '*&'■"'" ■«% , ,ir '.^fl iflUB^. 4fci- :y< 1 ^H ^s^^jg^j^^M Hk Division. 3 Division 2 Division. 4. fftittBifr £*?mmi InEKjIfumfont forfte "Select Medical JAbrary: A PRACTICAL TREATISE OH THE DISEASES OF THE SKIN, ARRANGED WITH a ©ieto to tneir Constitutional Causes AND LOCAL CHARACTERS: INCLUDING THE SUBSTANCE OF THE ESSAY TO WHICH THE ROYAL COLLEGE OF SURGEONS AWARDED THE JACKSONIAN PRIZE, AND ALL SUCH VALUABLE FACTS AS HAVE BEEN RECORDED BV CONTINENTAL AUTHORS ON THESE SUBJECTS TO THE PRESENT TIME. BY SAMUEL J^UMBE, LATB SENIOR SURGEON TO THE ROYAL METROPOLITAN INFIRMARY FOR CHILDREN, AND ACTING SURGEON TO THE ST. GILES'S AND ST. GEORGE'S PAROCHIAL INFIRMARY, ETC., ETC., ETC. FROM THE LAST LONDON EDITION, REVISED, CORRECTED, CONSIDERABLY ENLARGED, AND WITH ADDITIONAL ENGRAVINGS. 1 ~ '''/ ** PHILADELPHIA: V &■&* _ r K, q& \>' HASWELL, BARRINGTON, AND HASWELL. - 1837. WK TO HENRY HOARE, ESQ. My Dear Sir, It has been the custom from the very dawn of science and literature for an Author to seize the opportu- nity afforded by a new Publication to testify his respect or gratitude to a Friend or Patron in the form of a Dedi- cation. A part of his Book, usually so called, lasts as long as the work itself, which the Author sometimes imagines will live after him. That this Book will live after us both, is my sincere prayer; and that in order that it should remain a testimo- nial of my humble sense of your uniform, conscientious, zealous, and independent conduct in the discharge of those public trusts which your station in society imposes on you, as also of my personal respect. Science and politics have, it is said, seldom much to do with each other; and it has been somewhere written down as an axiom, that they never ought. Still the real and true patrons of science are never, practically speaking, men who do not feel, like yourself, how essen- tial the encouragement of science is to the prosperity of our country. This consideration must be the excuse for 4 DEDICATION. the liberty I have taken with you; I fear not that in doing an act of justice, I am likely to commit an offence, and therefore I omit the too common plea, "dedicated by permission." I am, my Dear Sir, Very truly, Your obedient Servant, S. PLUMBE. Southampton Street, Bloomsbury Square, December 1836. PREFACE. Having in view the extension of the sphere of utility of the fol- lowing work, I have endeavoured to reduce its expense to the student; first, by curtailing as far as possible, consistent with utility, all historical, pathological, and descriptive details; and, secondly, by avoiding numerous and expensive illustrations. In a former editioitl expressed an opinion that careful and accurate descriptions, attentively and carefully perused, possessed great ad- vantages over engraved illustrations (unless executed with extra- ordinary skill and at enormous expense) in conveying practical knowledge to the student and practitioner in a majority of the cases of cutaneous disease which may come under their observation. I am confirmed in that opinion by the results of experience. There is great difficulty in obtaining, through draftsmen's and engravers' and printers' hands—each failing, perhaps, in one point or another of their parts—any thing like vraisemblance as regards the larger portion of such diseases as they occur in the British Islands.* Hence * In using this expression, I would have it understood that there is commonly a wide difference between the delineations and descriptions of French and English authors on this class of diseases. As regards the delineations, either of Alibert or Rayer, if attentively examined, the utmost liberality must be exercised to enable us to admit them to be representations of individual diseases as occurring here and known by the same names. Doubtless both these authors have strongly^ if not faithfully, performed their tasks in this respect; but the delineations often appear to an Englishman to amount to caricatures, and the descriptions to abound with exaggerations. That both may be correct, as regards the cases which come under the French practitioner's eye, it is far from my intention to deny, or even to doubt. It must be considered that the individual portraits are, for the most part, drawn from the persons of the lowest and poorest of the French population,—a class of people so poor and so badly fed in the main as would lead us, a priori, to expect a greatly aggravated form of those diseases among them. A slight examination of the extensive and clever illustrations of these authors will convince the reader of the correctness of my observations on this point; and really the descriptions are still 6 PREFACE. I have given all the attention in my power to historical and descrip- tive details under every different head. , On referring to the works of French authors we are struck with the influences which diet, and regimen, and habits of life have in regulating the degrees of violence of cutaneous disease. As regards the middle and higher classes of the two countries, it would appear that the French have the advantage over the English: most certainly they are not so frequently the victims of those troublesome, annoy- ing, and unsightly affections as ourselves. Nor is this difference more difficult of explanation than that which is manifested between such diseases of the poor of the two countries. If the aggravated sufferings of the poor of the continent depend on starvation or the alternative of using disgusting and unhealthy food, the more fortu- nate of their countrymen enjoy, perhaps, all that is necessary to health without attaining that degree of repletion which so often gives occasion to disease among their equals in this country. It must be highly satisfactory to the philosophic observer to perceive that the habits of all but the very lower classes in England have been, for many years, approximating to those of our continental more widely separated from the reality, as the diseases#re seen in England, than the illustrations themselves. "J'ai recueilli," says M. Alibert, "al'hopital Saint Louis l'observation suivante sur deux petites filles, Virginie et Julie Calandini, Italiennes d'origine. L'une avoit atteint sa septieme annee, l'autre sa cinquieme. Elles jouissoient d'une constitution tres-forte, ainsi que leurs parens. Lorqu'on nous apporta ces deux enfans, leur tete etoit couvertede tubercules faveux circulaires, d'une couleur tresjaune, creuses en godet dans leur milieu, offrant des bords proeminens, tels en un mot, que nous venons de les decrire dans le cas precedent. On observoit une regularite parfaite dans les tubercules; mais la plupart d'entre eux etoient coherens et disposes par plaques sur le cuir chevelu. Au milieu de cette masse crouteuse, devenue informe dans quelques endroits de la tete, par les progres de la maladie, on appercevoit des sillons et des crevasses d'une profondeur considerable. Le cuir chevelu y etoit sanguinolent et presque detruit par l'effet terrible de 1'ulceration existante. II y avoit des croutes brisees qui tomboient en petits grains au travers des cheveux. Mais il est surtout impossible de dire quelle quantite de poux infestoit la tete de ces deux malheureux enfans. Ces animalcules devorans etoient caches en nombre infini sous les croutes; ils excitoient un pruit intolerable. Cette eruption de- goutante exhaloit en outre une odeur de souris difficile a supporter. Au surplus, la Teigne dont il s'agit, n'avoit pas seulement son siege dans le cuir chevelu. II est a remarquer que les deux sceurs avoient des plaques faveuses dans des parties absolument analogues du reste du corps, comme aux sourcils, aux tempes, au bas des epaules, aux lombes, sur la region du sacrum, a la partie externe et superieure des cuisses, a la partie moyenne des jambes." Hillocks of accumulated filthy secretions, rising an inch or two above the surface of the scalp, attached at their bases to the hair, while the more superficial part having become dried to the extent of. resembling rotten mortar, split on the vertex and sides of the head into parts, forming huge chasms, in and round about which are seen myriads of crawling vermin, giving, by their movements, motion to the half-detached parts, are the predominant features of other cases described by these authors, the odour being as disgusting as the sight. This is not bv anv means an extreme case selected to confirm my opinion, there are other instances equally striking to be found elsewhere, PREFACE. 7 brethren. Those indubitable evidences of " good fellowship,", blotched and bloated countenances and " Bardolph " noses, are be- coming extinct among the English almost as fast as the seams and pits of another pest of the human race—that of the small-pox. The portion of the field of medical science to which the following pages refer has been taken possession of, to a considerable extent, by the translations from French authors (these having benefited largely by the labours of Willan and Bateman, and others of our countrymen.) Now it is evident that I should have too much to do, consistent with the space I have allotted for this work, to place the pretensions of English practitioners and students of this class of diseases, in every individual instance, on their proper and merited footing, and yet it is a duty which I cannot altogether overlook. The fact is unquestionable, that our countryman Willan lead the way in opening this part of the science to the world. His recorded Facts and his published Illustrations being of origin and date ante- cedent to that of the French school by several years. There have been numerous English contributors too, to the fund of information on these subjects ; and it is not a day of triumph to English practi- tioners when, in the study of these diseases, they are expected to peruse the works of continental authors in preference to those of their countrymen, under an unfounded assumption that they are more valuable and instructive than those of the latter. There are two curious points of evidence affecting this question. First, there has been for years, in a work published in the French capital, purporting to be largely occupied by descriptions of its public institutions, an uncontradicted statement, that though the hospital of St. Louis is dedicated to the reception and treatment of cutaneous diseases, furnished with baths and " all appliances and means to boot," yet the treatment adopted there is not found more successful than that adopted elsewhere under less favourable circumstances. Secondly, in that very institution, the treatment of a very large portion is surrendered by the physicians and surgeons into the hands of secret nostrum mongers. The study of cutaneous diseases, after having been nearly neglected for many years, appears suddenly to have become a favourite one, particularly in France. The splendid Tableaux of Alibert in folio retained for some time full possession of the field, as the best representations of them. The expense of the experiment, however, seems to have deterred his cotemporaries from competing with him, except in the form of unadorned, detached essays and treatises, and very inferiorly executed engravings. Among the most distinguished of the latter was Rayer, who, in 1826, published his work in octavo, with badly executed engravings, manifestly copies to a considerable extent of those of certain English authors. This work having been noticed with praise by one or two teachers of medicine and surgery in their lectures in London was speedily translated by a young English 8 PREFACE. surgeon,* who certainly executed his task with as much faithfulness as talent. Unfortunately for him, however, the same dicta which gave the impulse to him, gave it also to M. Rayer and the French booksellers, both in Paris and London; and before Mr. Dickinson s translation had had its fair chance of sale and circulation, out comes simultaneously in Paris in the French, and in London in the English language, a new edition of Rayer, the letterpress of which, amount- ing to upwards of twelve hundred pages of most closely printed octavo, accompanied by an atlas of twenty-two engravings of royal quarto size; the number of figures in the whole being about four hundred! In the mean time, however, the veteran Alibert had concocted not only a new arrangement, but a new and almost totally different nomenclature, and employing partly his old engravings, and partly some of more recent execution, he had fully supported his reputation for correct representation and colouring, but risked that part which depended on judcious nomenclature and arrangement. He had constructed an " Arbre de Dermatoses," a figure of which he inserted as a frontispiece to his last edition. I must confess, that this design exhibits proofs of great zeal on the part of M. Alibert; and for the information of the reader, who may not have had an opportunity of seeing it, a few short words of description will not be misapplied. The trunk represents the head of the family "des Dermatoses," the branches emanating imme- diately from it, amounting to twelve in number, pass from it and divide into limbs and sprigs, each having its cognomen attached, according to the author's altered nomenclature. The subject was already so seriously encumbered with designations without accurate definitions—with divisions and subdivisions into species under the old nomenclature, that students of the subject had barely obtained a superficial knowledge of them; a few only perhaps arrived even at that, so that it is too much to expect that they will begin de novo with M. Alibert's new nosology. It will be perceived, I hope and believe, that these expensive illustrations—this multipled nomenclature, these complicated trea- tises of twelve hundred pages octavo, &c. will have served me chiefly not as assistants in my task so much, as by affording me landmarks to warn me of my pledge, to make my work as cheap as useful to the reader. Despite the comparatively inexpensive labours of the engravers in France, I feel very strongly impressed with the opinion, that by the judicious employment of those of our countrymen on a more limited scale, we shall be able to convey far more accurate notions of the characters of these diseases as they occur among our- selves. Even in our own country, the engravings of Willan and Bateman have sunk into utter inutility, because of their enormous expense : nor does the more recent attempts to revive them in an economical form, under the superintendence of one of the most industrious and * Mr. Dickinson. PREFACE. 9 talented men of the age, promise much for their effective resuscita- tion.* If information be expected to be conveyed extensively, it must be conveyed cheaply ; and neither the engravings of Willan and Bateman, those superintended by Thompson, or those of Rayer, can be brought within that moderate expense which is necessary to secure their extensive circulation. I have not been unmindful, while I have steered as clear as pos- sible of diffusiveness, of the really valuable matter of recent conti- nental authors ; a proof of which will be seen in the illustration of the structure and anatomy of the skin, furnished in a following page, with descriptive details. The researches of MM. Breschet and Roussel de Vauzeme, have furnished me with a large portion of these. The figures No. 11 and 12, which I have added, will be found useful in illustrating my views of the pathology of the different forms of Acne, Sycosis, Porrigo, and some others. Any notice of Measles, Scarlatina, Small-pox, or, indeed any portion of the exanthemata, in this work would be out of place. They are diseases, of which the condition of the surface forms a very small feature, and their treatment is for the most part fully understood. Lest the profession and the public should expect from me an elaborate account of all diseases of the skin, "British and Foreign," it behoves me to say, that, being able to speak conscientiously and confidently by the results of practice and experience of those most frequently seen in the different classes of society in this country, I have not expended my own time, or drawn on that of my reader, by recording second and third hand accounts of authors of my own or other countries. I have, nevertheless, I hope, with some pre- tensions to diligence, availed myself of all sources which I could command, to make my work such as the English practitioner may place some confidence in. If a valuable fact or idea has appeared in print, no matter in what book, journal, or country, I have spared no pains to obtain possession of it, and if possible, to convert it to my object of making my present undertaking a register of things not theorized on, but known. If the records of ancient authors have obtained but little attention from me, it is not because I have undervalued them, but because they have been so thoroughly sifted by Willan, Bateman, Alibert, and lastly Rayer, as to leave no chance of finding an unappropriated grain among the remaining chaff for my own or my reader's use. Of the writings of modern French authors generally, it will be perceived, that I have in two senses of the word made a liberal use. " Palmam qui meruit ferat" has been my motto in dealing with them, and the " utile et dulce," my guide in handing the fruits of * Mr. A. T. Thompson's Atlas, and Seventh Edition of Bateman's Synopsis. 10 PREFACE. their labours to my countrymen.* I despair not, therefore, though this edition meet as another did with concealed enemies/I" it may make for itself a few open friends. S. P. * The cases multifarious and long which are to be found in the French Authors whom I have so often quoted, I have not considered of sufficient value to obtain possession of more than a very few pages, and these only, where they seemed likely to be useful in solving the doubts of the student, and of an unquestionable illustrative character. t » We have received some severe strictures on Mr. Plumbe's work from more than one or two anonymous sources. Most of them bear _ the impress of the detes- table odium medicum, the disgrace of the profession.''''—Editor of the Medico-chi- rurgical Review. DESCRIPTION OF THE ENGRAVINGS. PLATE I. DIVISION I. Fig. 1.—The upper paTt of this cluster of figures is intended to represent the uninflamed follicle; the lower the commencement and progress of inflammation, and its termination in the formation of matter.—2. The enlarged and indurated tubercles (A. indurata), with matter formed in their centre, which occur in bad constitutions.—3. Inflamed and suppurated follicles, forming sycocis on the beard.—4. The appearance of spots of Porrigo scutulata, where no fluid secre- tion or scab has been formed.—5. The partially denuded scalp of long-established cases of the latter, where scabs have been allowed to accumulate, and where great irritation prevails, the remaining hairs insulated by pustules. division II. Fig. 20.—The two inferior spots representing the first appearance of the spots of Lepra before the first scale separates. The superior, large, round, and scaly ; the disease in a spreading state.—21. Psoriasis.—22. An enlarged representation of the morbid and discoloured cuticle forming Ichthyosis. The numberless fissures caused by the cracking of this hard, dry substance, and dividing it into thou- sands of pieces, are well represented. It is introduced here out of its proper place, it being the only subject of the 6th division worthy of representation. DIVISION III. Fig. 11.—Porrigo favosa.—12. P. larvalis, both from cases of considerable standing.—13. The pimples of infants, some of them surrounded by considerable inflammation; their representation in clusters connected by patches of inflamed skin (S. intertinctus, &c.) has been omitted.—14 and 15. The pimples of adults, termed Lichen; >the first of these, as it sometimes occurs on the arms and other parts covered by the finer kind of hair, each hair occupying the centre of a pim- ple: the second as it appears on other parts.—16. The pimples of Prurigo, the tops of some of them scratched off, leaving a peculiar little, black, bloody scab on their apices.—17. Two of the commoner forms of Urticaria.—18. The vesicles of Herpes in an advanced and partly flaccid state.—19. The carbuncular Furuncle. 12 DESCRIPTION OF THE PLATES. DIVISION IV. Fig. 23.—The inferior portion exhibiting an enlarged view of the vesicles of Impetigo. The superior, the disease in an advanced stage, with the scab partially covering it—24. The vesicles and enlarged pustules of the itch.—25. Ine ap- pearance of the skin in Eczema mercuriale.—26. The tubercle of Erythema nodosum. DIVISION v. Fig. 6__Petechia or Purpura simplex.—7. The enlarged spots of Purpura haemorrhagica.—8. Different stages or degrees of the Ecthymatous eruption.—9. The conical scabs of Rupia. The similarity of character between the two latter is rendered very distinct—10. Pompholyx. The superior vesicle discoloured by the admixture of blood from the vessels of the surface. PLATE II. For Description, see pp. 27,28. PLATE III. The changes produced on the scalp in long-established cases of Porrigo have been attempted to be represented in this plate. The adipose structure, described as secreting the hair, undergoes a considerable diminution or wasting, as the effect of the ceaseless irritation and discharge from the surface of the scalp, while the hair is for the most part extirpated; small tufts here and there distributed over the diseased surface only remain, and these are observed to have pustules among them. The diseased skin covering the wasted adipose structure appears to the touch to have nothing between it and the pericranium; and the greater degree of thickness of the healthy skin along the superior line of margin of the disease presents the appearance of a sudden declivity or depression. This wasting, however, is not permanent; and as the irritation on the surface is subdued by the plan detailed in the preceding pages, and the remaining hair removed, the skin gradually, except where deep ulceration has occurred, re- assumes its original solidity and thickness, and the new hair begins to make its appearance. PLATE IV. The intention of the little engraving here presented is to convey to the reader an idea of four occasionally changing forms of disease of the scalp which have been differently designated, according to their existing states, by French and English authors. Teigne furfuracee—Amiantacee.—Faveuse.__P. Favosa.__P. Larvalis.—P. Lupinosa, &c. &c. The scabby and inflamed state of the forehead fairly represents the Porrigo favosa. The scalp covering the parietal bones is occupied by the honey-comb, cupped or lupin-seed scab—the occiput by the furfuraceous form of the disease, or P. furfurans of Willan and Bateman. If not interfered with, which is often the case in France, the scurf accumulates the exfoliations from the surface assume the appearance of silvery scales which as they mix with the hair and approach the surface, have certainly from time to time justified the comparison to asbestos. The back of the ear again gives an accurate notion of what would possibly be called P. Larvalis, showing, however the occasional tumefaction of the glands adjacent. CONTENTS. Preliminary Remarks on the Anatomy and Physiology of the Skin, 17___Baron Alibert's remarks on\t,ibid.—Absence of due consideration of the Sub- ject in conjunction with its Diseases, ibid.—Imaginary Structure as con- nected with its Diseases, ibid.—Dr. Jackson's Dermatologia, 18.— Former Descriptions of its component Parts, ibid.—Properties, physi- ological, mechanical, and chemical of the Cuticle, ibid.—M. Chevalier's Researches, 19.—Effect of Blisters, ibid.—Mutual dependence of the Cuticle and Cutis, ibid.—Effect of suppressed Perspiration, 20.— Breschet and Roussel de Vauzeme's Researches, 21.—Sandcrack of the Hoof of the Horse, 22—Constituent parts of the Skin, 23.—Their different Offices, 25.—Explanation of Engraving, 27.—Circumstances influencing the Character, &c. of Cutaneous Diseases, 28 to 38.— Classifications, 38.—Merits and demerits of them, to 46. SECTION I. CHAPTER I. On Diseases which obtain their distinguishing characteristics from, or originate in, local peculiarities of the Skin.........46 Acne, or Inflammation of the Cutaneous Follicles, 47.—Its different Forms, as given by English and French Authors—A. Indurata— Rosacea—Couperosa—Dartre Pustuleuse—Cuperosa, &c, 53.—History and Treatment, 47 to 60. CHAPTER II. On Scrofulous Inflammation and Ulceration of the Follicles......60 History and Treatment.................61 CHAPTER III. Dartre Pustuleuse, Mentagre, &c...............65 Its analogy to Acne, 65.—Causes of the difference, ibid.—Razor- scissors, 68.—Treatment, ib.—Quotation of Rayer's Opinions, ib. CHAPTER IV. Of Lupus, Noli me tangere, Herpes exedens, Dartre rongeante, &c. &c. . . 71 Obscurity of its Pathology.—History of it, by French and E nglish Authors, ibid.—Occasionally confounded with Scirrhus, 83.—Its tediousness approximating it in some respects to Scrofula, ibid.—Differences be- tween it and Cancerous Disease, 84.—Treatment, 86. CHAPTER V. PORRIGO. Les Teignes, or Dermatoses Teigneuses of Alibert, Favus of Rayer, Ring- worm, Scalled Head, &c. of English Authors........88 Engravings of different Forms of the Disease, with Explanations, ibid.— Non-utility of the multiplicity of Terms, ib.—Alibert's Descriptions, 89. December, 1837.—-S1 2 14 PLUMBE ON DISEASES OF THE SKIN. PAGE —Teigne Muqueuse, or Porrigo, or Impetigo Larvalis, 92.—Table, explanatory of the Terms employed by English and French Authors, S3__The Secret of the MM. Mahon, 94—Treatment of the different Forms, 103.—Treatment of old-standing Cases, 107—Barbarity of the Pitch Cap, 108. SECTION II. On Diseases chiefly marked by Chronic Inflammation of the Vessels secreting the Cuticle, producing morbid growth of this Structure, and generally dependent on Debility of System. CHAPTER I. Confusion among the older writers as to the use of the Term.—Heberden and Cullen's Opinion.—Its great prevalence in England, 112.—Species of British and Continental Authors.—Description and History, 113— Its constitutional dependence on Debility, induced by whatever Cause, 117.—Hereditary Origin, 118.—Treatment, Descriptions, and Opinions of French and other Continental Authors..........125 CHAPTER II. OF PSORIASIS, Or, Dry Scaly Tetter, Chronic Inflammation of the Cutis, Dartre, Itch, Scale, &c.....................134 Description, ibid.—Confluent form of the disease, ibid.—Distinct, 135.— Gyrata, &c, 136, also 142, &c__Of the Scrotum, 135.—Of the Palm, 137.—Its resemblance to Lepra, 144 —Treatment, ibid.—The manner in which the return to a healthy state takes place in each, 145.—Effect of Arsenic, its modus operandi, &c. ibid.—Different extracts on the sub-; ject from periodical works, 149.—Psoriasis infantilis, 152.—Treatment, ibid.—Pellogra, the Psoriasis of Lombardy, &c, 153. CHAPTER III. PITYRIASIS, SCURF OR DANDRIF. French and English history and treatment..........156 SECTION III. On Diseases exerting a probably salutary influence on the System originally produced by, and usually symptomatic of, deranged Digestive Organs, and characterized by active Inflammation. . CHAPTER I. PORRIGO FAVOSA. Honeycomb-scall of Bateman.............. Ig7 Reasons for separating it from other forms of Porrigo explained, 168.__ History and treatment, ibid.—Necessity of clearing away diseased Secretions, 170.—Porrigo, or Impetigo larvalis, 172__French and English history and treatment, 173.—Plica Polonica, 171. CHAPTER II. ON THE PAPULAR ERUPTIONS OF INFANTS AND ADULTS, DENOMINATED STROPHULUS, LICHEN, &C. 1. Strophulus................ # joj Causes of this class of Eruptions, ibid__Description, 182___Intertrigo of Infants, 183. r 5 CONTENTS. 15 2. Lichen.....................**™ Description and history, ibid.—Treatment, 187—Lichen tropicus, or prickly heat, ibid.—History as given by different Authors, 188. 3. Prurigo.............. 190 Description and History, ibid.—Extraordinary description of Larrev, quoted by M. Rayer, 191. JM CHAPTER III. urticaria, or nettle-rash. Dartre Erythemoide of Alibert, &c, 197—Aptness of the designation. Idiosyncracy as a frequent Cause, 199.—Poisonous properties of certain kinds of Fish, 200—Symptoms which arise from eating such, or stale Fish, 201.—Febrile Urticaria, 202.—Substances obnoxious to certain individuals found to produce it, 207. CHAPTER IV. Herpes................. ong M. Rayer's views as to its Relationship with other diseases, ibid.—Des- cription and History of its different forms. Herpes Zoster, or Shingles, 211—Valuable contributions of different Authors as to its different local forms. CHAPTER V. Furunculus or Boils............. 219 Reported successful methods of treatment, 220. SECTION IV. On the Diseases of a mixed character essentially dependent on active In- flammation, with which the constitution is not necessarily connected. CHAPTER I. Impetigo..............„ . . . , 223 Reputed species, 224.—Disadvantages of the medical attendant not seeing it at its commencement, 226—Description, 225.—Treatment, 226—M. Rayer's details, 228. Of Scabies.....................229 Mode of Infection, 234—History, Acarus Scabiei, Dr. GaleVdemonstration of it, 235.—The operations of the Insect, 236.—Treatment, ibid, also Appendix. CHAPTER II. Its History and different forms, Solare, Mercuriale, &c, 237.—Descrip- tions of French Pathologists from Rayer, 243. SECTION V. On diseases dependent on debilitated and deranged states of System, and consequent diminished tone of the Vessels of the Cutis. CHAPTER I. Purpura......................258 Its History, French and English, 258 to 291. 16 PLUMBE ON DISEASES OF THE SKIN. CHAPTER II. PAGE 29° Aphtha, or Thrush.................. French and English Authors' accounts of it, 292 to 297. CHAPTER III. DISEASES ANALOGOUS TO PURPURA OR SCURVY. 1. POMPHOLVX.................... ' 2. Pemphigus....................x Conjoint History of these, 302. CHAPTER IV. Ecthyma and Rupia..................302 Rupia (Monic Ulcers, and their Incrustations) 306. CHAPTER V. Erythema Nodosum..................310 SECTION VI. Fungoid Diseases of the Skin...............311 CHAPTER I. Ichthyosis, or the Fish-skin Disease.............311 Warts....................-320 Concluding Remarks.................321 Rashes, i. e. Roseola, &c. ibid.—Different Species, 322. Appendix, and History of Parasitic Insects, Horny Formations, &c. . . 334 DIRECTIONS FOR PLACING THE ENGRAVINGS. Plate 1.—Copperplate (coloured,) to face the title-page. Plate 2.—Lithograph (not coloured,) to face page 27. Plate 3—(Lithograph) exhibiting the destructive effects of lornr-standinc Por' rigo, to face page 88, with its description appended. 6 Plate 4—(Lithograph coloured,) with its description, to be inserted with plate 3 at 88. A PRACTICAL TREATISE, PRELIMINARY REMARKS On the Anatomy and Physiology of the Skin and its append- ages, as connected with its diseases. "Men," saysM. Alibert, "commonly see nothing in the skin of the human race beyond the means of defence which it affords, against the contact of external substances, capable of injuring more vital parts; but the physiologist and clinical physician look at it as the double instrument of exhalation and absorption—as the deposit or reservior of an exquisite sensibility—as a means of conveyance of salutary remedies—as the agent of most favourable crises in disease, and as the seat of a multitude of diseases, the very nomenclature of which excites terror." The absence of due consideration of the anatomy and physiology of the skin, which a large portion of those who have written on the subject of cutaneous diseases have manifested, as well in their des- criptions as methods of treatment, will, it is hoped, afford ample excuse for introducing a work of this nature with the following re- marks. The most distinguished authors on dermoid pathology, have boldly fixed the seat of important and obstinate diseases in parts of the skin denied by equally distinguished anatomists to have any existence in reality; while whole pages have been wasted in the description of affections obviously consequent on derangement of a well known function of this structure, without the slightest reference to such function, or the part of the skin in which it exists. Hence, methods of treatment have been adopted, destitute of sound principles, and productive of nothing but mischief; while principles have been over- looked which would have pointed out methods of treatment as ef- ficient as simple, and utterly incapable of any deleterious influence. Always excepting due regard to those universal agents in the pro- duction and modification of local diseases, disordered states of the November, 1837.—.# 3 18 PLUMBE ON DISEASES OF THE SKIN. organs of digestion,* there is nothing affords so fair promise of improvement in the management of cutaneous affections, as a due regard to the anatomy and different functions of the skin. A careful reference to these will be found the only road to a principle of treat- ment of many affections of this structure, and these not the least unpleasant and unsightly which come under our notice, while it is calculated to disclose important facts in the history and. character of others which have been hitherto entirely overlooked. The skin has been hitherto understood to consist of three layers of differently formed structure. It has been so described by ana- tomists since the days of Malpighi, each layer having its different offices assigned to it. The true cutis or skin, that substance which is so readily converted to the purposes of the mechanic in the vari- ous forms of leather, being the most deeply-seated of these strata ; the rete mucosum next superposed ; and, lastly, the epidermis, cuticle, or scarf skin ; designed by its peculiar properties to protect the more sensible and vascular structures beneath it from the irrita- tion of extraneous substances or violence.! The cuticle is manifestly endowed with properties fitting it for such offices. It is of a dry horny structure, and it is insensible ; but it is at the same time, so elastic and accurately fitted to the folds and flexures of the more vital and nervous structure beneath, as readily to be able to accommodate itself to all the flexions and exten- sions of the latter in the different parts of the body. The inquiry of the chemist into the composition of the cuticle, just furnishes us with evidence that thin and filmy as it may be in the human or other class of animals, it is easily identified with that of the horns and hoofs of the larger animals. It is an insensible cov- ering to parts most peculiarly endowed with sensibility, the protec- tion of which is vitally necessary to the health and existence of the animal, of whatever species it may be. This appears to be its pri- mary and chief office as regards the animal economy. It is evident, however, that such a structure, while exercising the office of a pro- tector of the parts beneath it, must be endowed with power to ad- minister to other wants and necessities of those parts. It must be pervious, to admit of exhalation ; it must be pervious, to admit of the passage to the surface of the contents of the sebaceous follicles ; it must be, in short, while deriving its own supply and means of * That the skin should be susceptible of the slightest deviation from health in the action of internal organs, is not surprising. It is a most important emunctory, and the chief office of these is to keep up the balance between the ingesta and egesta: hence, the effects upon it of disordered stomach, impeded biliary and urinary secretion, &c.; if more blood is sent to it, or its usual supply abstracted inconsequence of such disorders, it suffers.—Dr. Jackson's Dermato-pathologia. f Gaultier, an enterprising French physician, seems to have established the existence of a distinct papillary structure. According to M. Breschet he had industriously investigated these structures, and was only prevented from continu- ing to prosecute them by his duties in the field. " He died," says M. B. "in the disastrous campaign of Moscow." PRELIMINARY REMARKS. 19 existence from the cutis, available to all the services and objects of that structure. Anatomists have differed very much as to the mechanical struc- ture of the cuticle. That medicinal remedies for disease could be introduced through its substance,and by its agency, has been along established axiom, but the manner in which this takes place or is effected, is still, notwithstanding the researches of British and French authors, a matter of extreme doubt. The subject is, and has been for a long time unsettled, and probably is still destined, in the opinions of many, to remain so. Mr. Chevalier, the only English physiologist who had of late years directed his attention to this subject, thought that the cuticle was permeable by means of a "velaminous structure;" others have been content to ascribe this property to pores, or minute and direct orifices in it, leading to the subjacent structures. More recently, ideas somewhat different from either of these have been entertained, but they are all alike subject to the objection of having been found- ed on microscopic observation and experiment, or by comparison with structures supposed to be similar to that of man in the larger species of animals. In former editions of this work I took occasion to observe, that evidence obtained by these means was very likely to be fallacious ; for that microscopic inquiry, in order to be efficient, must at least have the advantages of light posterior as well as anterior to the ob- ject examined. That this desideratum is not attainable by such means in the living or dead animal, is obvious enough, supposing the different layers of the skin to remain in situ naturalis. The forcible, or ever so ingeniously contrived separation of the cuticle from its parent membrane, the cutis, must destroy of necessity either a poriferous or velaminous apparatus. A familiar illustration of this fact is seen in the application of a blister ; if the latter be applied to a surface teeming with perspiration, (and it is now and then so applied) the moment the irritation is sufficient to produee an effusion of fluid from the vessels of the cutis, the elevated cuticle becomes a water-proof impervious bag. Its connexion, whether with the cutis or supposed rete mucosum, is at once destroyed , and whether the connexion be originally of the one or the other of the two kinds mentioned, the apparatus is evidently broken up, and incapable of renewal. The dead corneous substance, of which the cuticle is formed, may be, and often is, carelessly allowed to rest on the in- flamed cutis after the fluid is discharged, and it is never found to be possessed of vital powers sufficient to renew its connexion with that structure : on the contrary, it exercises all the deleterious influence of an extraneous body, and often produces, by irritating the abraded cutis, very unhealthy sores. The latter result is very common among the children of the unhealthy poor of the metro- polis, not unfrequently endangering the life of the sufferer, and even proving fatal. There is an evident dependence on each other, between the cutis 20 PLUMBE ON DISEASES OF THE SKIN. and cuticle. If the latter by collision, by external injury of any kind, becomes separated from the former, the means of forming a fresh supply vested in the cutis are found in instant operation ; there is no appearance of attempt to resuscitate or amend the torn and old cuticle, but, like magic, a new structure is produced from the vessels of the cutis, as efficiently administering to the wants of the cutis as the original. It has been truly observed by Mr. Chevalier, " that the skin is as dependent on the cuticle, as the cuticle is on the skin. Neither can subsist in a state of integrity without the other." In vesicular eruptions, not artificially induced, as, for instance, the herpes zoster, &c, a similar result follows to that produced by cantharides ; the vesicle being once formed, however minute it may be, the vitality of the cuticle is taken away ; and if the latter be suffered to remain in contact with the abraded cutis, irritation on a proportionately smaller scale is found to be produced. It is evident, therefore, that the separation of the cuticle from the cutis, and its consequent impermeability, is not the mere effect of any peculiar influence of external stimulants, but results from that separation only, whatever its cause may be. Although the office of perspiration, so far as the cuticle is concern- ed, has never, in an obvious degree, been connected with the origin of cutaneous diseases, it is yet a common practice to refer many of them to the suppression of this excretion. That this occur- rence may be an indirect cause of eruptions of different kinds is easily enough understood. Several forms arise as the evident results of reaction after a chill, becoming the agents by which mischief to internal organs is averted, but the influence of cold on the cuticle itself can be but little; it becomes shrivelled and contracted, because the vessels of the cutis have been emptied by the determination of its blood to internal organs; but its elasticity soon enables it to con- form to, and re-establish its connexion with the cutis, when reaction is established. There are, however, occasionally occurring slight inflammations of the skin, and disturbances in the production and growth of cuticle, manifested by redness and scurfy exfoliation, in consequence of the internal use of cold drinks, when the individual has been in a state of perspiration ; and it appears to me, that the only rational mode of explaining this effect is this : the collapsed state of those vessels or structures, produced by the shrinking or half emp- tied condition of those of the cutis during the chill, offers an obstruc- tion when sudden reaction takes place to the increased quantity of excretory fluid produced. These slight cutaneous disorders are commonly designated surfeits, but though generallv evanescent they sometimes lead to the establishment of chronic irritation of the cutis, of an obstinate character. '•How," inquires Mr. Chevalier, "is the office of perspiration carried on through the cuticle ? What and where are its pores which have been supposed to transmit this fine exhalation? Are there anv in reality ?" and he very confidently, seeing in his own opinion PRELIMINARY REMARKS. 21 that the separated cuticle ought to be just as porous as in its natural state with its natural connexions, infers that it cannot be by a porous structure that perspiration or inhalation is effected. " Pressed by this difficulty," said he, " I began an examination of both surfaces of the cuticle, the exterior and the interior." Duly considering the different duties of the two surfaces, the ex- ternal being an insensible and hard defence against external injury, the other destined to lay in soft contact with the highly sensible sur- face of the cutis, he separated the cuticle of different parts of the body from the cutis, and laid it in the field of a microscope magnifying one hundred and forty times, hoping to detect the pores; and failing in that, he discovered "an infinite number of minute velamina, re- gularly arranged, of exquisite tenuity, presenting a follicular appear- ance, and separated from each other by bands of a thicker structure, crossing and intersecting them so as to render them distinct." Now it is just as possible that the appearance of these said vela- mina was produced by the act of separation of the cuticle from the cutis, as that any original organization or formation of the kind ex- isted ; and whether the perspiration passed through pores of through a structure like that described by Mr. Chevalier, it is quite clear that either of such structures must have been destroyed by the degree of force necessary to break the connexion existing between the cutis and cuticle, even under the most favourable circumstances and most careful management. Nevertheless he expressed his conviction that the terminal vessels of the cutaneous apparatus are lodged in these velamina : that "so long as the vessels maintain a vital connexion with them, they trans- mit their secretion through them as through a bibulous and exqui- sitely hygrometrical covering of the finest delicacy and perfection, while through the same medium, and dependent on subjacent tubes taking a contrary course inwards, absorption is carried on to a great but less certain extent and continuity." If such an apparatus as this be really in existence, it amply accounts for the failure of other ana- tomists in discovering pores or holes for the transmission of the se- cretions of the perspiratory organ to the surface of the cuticle. It appears to me that so long as it is necessary to separate the supposed layers of the cutaneous covering from each other, and subject them to inquiries made through a microscope, we have little chance of adding to our anotomical or physiological knowledge of either. MM. Breschet and Roussel de Vauzeme appear to have prosecuted very industriously and philosophically a lengthened inquiry into the structure and functions of the skin. These gentlemen agreed to designate by the name of epidermis the entire corneous substance which invested the cutis. "This epidermic matter," they say,"is applied on the cutis in the same manner as a mask of liquid plaster with which it is usual to cover the face of a person when modelled, and which becomes adapted to the inequalities of this surface." The comparison is well founded. The foetus in utero has no sooner ob- tained shape and form, than it has obtained a cuticle modelled on 3* 22 PLUMBE ON DISEASES OF THE SKIN. the form and fitted to all the flexures of the cutis; and from this pe- riod the wear and tear of the cuticle, and supply by new formation begins and continues through life, the surface exfoliating in the form of scurf in a proportion equal to that of its re-production by the vessels of the cutis when the process is not interfered with by disease or disordered action. Following the example of Breschet and Roussel de Vauzeme in reasoning from analogous structures, we find in the hoof of the horse an illustration of our subject. Experiments instituted some time since afforded the following results. An aged horse, with the disease termed sandcrack, was selected, which, under the care of an experienced veterinarian, promised to afford satisfactory results as to the cure. This disease of, or rather mechanical injury to, the hoof, appears to have obtained its name from the crack or fissure in the hoof being usually found partially filled by sand or other extraneous matter. It is an injury under any circumstances producing lameness and much inflammatory action. The fissure emits, generally, an abundant discharge, in which is usually found flakes of a curdy consistence apparently half dissolved. The treatment found to be most successful consists of paring down the edges of the fissure to the sensible parts—of freely cutting away even to the extent of producing a discharge of blood. The flakes in question were evidently composed of ill-formed horn, generated by the sensible structure intervening between the hoof and coffin bone in a highly irritated state, and the cause of that irritation was as evi- dently the motion of the broken insensible edges of the fissure of the hoof. Fungous granulations were found to spring up notwith- standing the excision of the horny edges, if merely simple dressings were employed ; but where pressure was had recourse to by means of pledgets and bandages, the discharge ceased, and the bottom of the chasm became speedily covered by a thin film of horn, in all respects similar to that of the original substance of the hoof. The existence of a rete mucosum covering fungous granulations could not in such a case be believed; the new horny structure must have been produced by the direct agency of the sensible structure. The results obtained were found exactly to correspond,, in other cases in which the experiment was made. In former editions of this work I had uniformly expressed my dis- belief of the existence of a rete mucosum, separate and distinct from either the cutis or cuticle, or as the peculiar deposit of the colourino- matter of the skin as attached to or forming a part of either. Such evidence as I could adduce, however, seemed to be rather of a nega- tive than'positive character. I could neither trace it in the human race or any other species of animal, of whatever complexion or co- lour of the hair. Its existence had been doubted by several anatom- ists of repute; but it was described, and still continues to be described though not demonstrated by teachers, in our schools. It is more- over, said to be shown in a variety of preparations in the museum of the College of Surgeons. Besides all this, there was the authority PRELIMINARY REMARKS. 23 of Malpighi for its existence ; the question has however now, I think, been set at rest by the report of MM. Breschet and Roussel de Vauzeme.* As these gentlemen's views cannot be out of place here, I may submit a brief summary of them. Their inquiries seem to have been conducted under circumstances exceedingly favourable, and the results are likely to carry convic- tion to all who have confidence in the powers of the microscope, and belief in the existence of uniformly analogous structures in the organs of animals having similar offices with those similarly designated in man. To have been defeated ourselves in arriving at satisfactory conclusions by measures of the same nature as those employed by others, is no reason why we should withhold confidence from them, when, as I must confess is the case in these gentlemen's inquiries, they produce reasonable evidence of their success. They appear, moreover, to have entered the field with the utmost caution, distrust- ing the microscope, and confessing that they were often deceived by it,—a fact which entitles them to much more confidence than is due to the professed and sanguine microscopist, who is but too apt to deal with illusions as realities. The skin of the whale and other cetacea appears to have been rendered largely instrumental, in this inquiry, to the establishment of the opinions now promulgated by MM. B. and R., and, doubtless, comparative anatomy generally, as regards the structures in question, has been scientifically and liberally drawn upon. The results of these inquiries, they say, leads them to consider the skin as formed of six constituent parts. 1. The dermis. A cellular canvas, dense, fibrous, enveloping and protecting the capillary blood-vessels, the lymphatics, the nervous filaments, and the parenchyma of other organs contained in its substance. 2. The papilla?. The organ of touch, termination of the nervous system, developed under the form of nipples, slightly inclined, ter- minating in blunt points, concealed under several envelopes. In the whale, the summits, or points, are olive formed, while in man they are conical. 3. The perspiratory apparatus. The organs of secretion and ex- cretion of perspiration. It is composed of a glandular parenchyma and the sodoriferous canals. The parenchymous, or secretory organ, is seated in the dermis, and from it arises the excretory canals, spirally shaped, and taking their course obliquely, passing between the papillae, and terminating on the surface of the cuticle. 4. The apparatus of inhalation, or absorbent canals. These canals resemble lymphatics, they are situated in the corneous substance or mucous body which forms the bed of the external dry cuticle, for the latter is dependent on the former for its production and support. These inhalent vessels do not appear to have open mouths on the * Nouvelles Recherches sur la Structure de la Peau. Paris, 1835. 24 PLUMBE ON DISEASES OF THE SKIN. surface, but seem to originate in the form of a cul-de-sac, or small round protuberance ; all else is unsatisfactory as regards their origin on the surface. At their opposite extremity they communicate with and terminate in a net-work of vessels, composed of an inter- mixture of lymphatics and veins. 5. The apparatus producing the mucous matter.—Composed, lstly, of a glandular parenchyma, or organ of secretion, situated in the substance of the dermis ; 2dly, of excretory canals originating in that structure, and depositing the mucous matter among the papillae before described. 6. The apparatus producing the colouring matter, or " appareil chromatogene."—Composed of a glandulous parenchyma, situated a little more deeply than the papillae. The excretory ducts passing from this structure terminate under the cuticle amidst the papillae. The excretory vessels of the organ of the colouring matter distribute that secretion over the surface of the dermis and its papillae, and this being mixed with the mucous secretion before described, seems to have led to the mistake of Malpighi. " De ce melange resulte le pretendu corps reticulaire de Malpighi et Pepiderme ou cuticle."* This complicated and minute apparatus, if it really be in existence, (and that it is, or at least something resembling it, is rendered mani- fest to the naked eye in a variety of ways by its productions and effects,) must necessarily be subject to an infinity of derangements. Disturbance in its movements, even in the slightest degree, would a priori be expected to be followed by some external signs or devia- tions from health on the cuticle, the joint production of, and neces- sary part of the whole. The question as to the manner in which the cuticle is produced or secreted appears to be settled. It is formed by the gradual adhe- sion to, and union with its inner surface, of the mucous secretion described as poured out amidst the papillae, which becoming gra- dually dry and hardened by the action of the absorbents in depriving it of its fluid parts, assisted probably by evaporation from the surface, assimilates itself to, and becomes identified with this structure, supplying it from time to time with new substance proportioned in quantity to the necessities of the cuticle in all parts of the body. MM. Breschet and Roussel de Vauzeme selected the skin of the heel posterior to the plantar arch for particular inquiry, on account of the thickness of the skin and corneous tissue affording a develop- ment most favourable to the study of the subject, availing themselves of the advantages of comparing it with similar structures in other n.mals at the same time. It must remain for the reader to decide what degree of confidence may be placed in microscopic examina- tions of a part so differently situated from all other portions of the cutaneous structure. The heel, it should be remembered in the natural erect position of the body, sustains by far the greatest degree of pressure, and nature may in its wisdom have provided to meet exigences arising out of this circumstance, an apparatus very different * Breschet and Roussel. PRELIMINARY REMARKS. 25 from that of other parts. Perhaps, therefore, we ought not to take the structure of the skin of the heel as a fac simile of the whole? The reception of the whole of the report in question, as composed of indisputable fact, is, I must confess, rather too much to be expected by our continental brethren from us at present. True it is that the reporters pursued their inquiries under the eyes of a large portion of their scientific cotemporaries, and secured the confidence of the latter ; but it is equally true that Mr. Chevalier, in a somewhat similar position,pursued his investigations here, andarrived at results so different, as to leave no doubt that either he or MM. Breschet and his confrere must have been deceived by their microscopes. The object before me, however, being in as brief a manner as possible to notice the organization of the skin as connected with or influencing the character of its diseases, it remains for me to remind the reader that, in addition to the complicated and beautifully repre- sented structures placed with the unpresuming character of copies before him, there is, First,—the apparatus secreting the hair. Se- condly, the cutaneous or sebaceous follicles, each of which are too frequently connected with the more formidable diseases of the skin to deserve secondary consideration. The representations in the engraving of these two structures have not been copied from any other author, they have been drawn with the assistance of the microscope with the utmost care. I believe they are correct representations of the mode in which the hair and follicles derive their support from the blood-vessels destined to supply them. We have then to consider this vastly complicated structure as being the seat of or involved in the duties of no less than seven or eight different functions. 1. The sudatory pores, or hydrophorous canals. 2. The papillary structure, the seat of the senses of taste and touch. 3. The absorbent or lymphatic vessels. 4. The structure secreting the colouring matter. 5. The organs producing the germ of the cuticle. 6. The sebaceous follicles. 7. As perforated by, and lending its assistance in the growth and nourishment of the hair. These are all things which we must deal with as realities, because we have the best evidence of their existence in their products, and the obvious necessity for them in the animal economy. The forms and figures of the different organs under the eye of the microscopist, __ is perhaps of little importance; but the pathologist must plainly pe?^ ceive that here is a structure so complicated,—with so many duties, ■ to perform, and so dependent on the healthy performance of internal and vital organs, as to leave no doubt that neither local applications nor internal remedies are to be exclusively relied on in treating the diseases of theskin, whether they wear an active or chronic character. The absence of prominent features of general good health justifies dependence on internal remedies no more than their presence jus- tifies dependence on merely local remedies ; comprehensive views 26 PLUMBE ON DISEASES OF THE SKIN. must be taken by all professional men who hope to treat cutaneous diseases successfully ; and although the application of caustic in its different forms in some of the more formidable of these diseases in our hospitals, has obtained a reputation, and I may almost say estab- lished a practise by its success, the surgeon has been often deluded by neglecting to "consider how differently his patient is situated in the wards of that hospital, and under control as to diet, &c. from that when he was first admitted to its advantages. If there be any truth in the representations of the structure of the skin we have before us, there is obvious risk of doing harm by the undiscriminating use of any particular application, not even except- ing the warm bath. Simple as that is in its operation, and beneficial as it undoubtedly is in all those cutaneous diseases which wear an active character, it is still an instrument of great mischief where the energy of the circulation has been diminished. On the other hand, looking to the complicated organic structure of the skin, what is to be expected from caustic and stimulating applications when the. habit of the patient is full ? The answer to this query is soon afforded to the practitioner who is tempted to rely on them. I am of opinion that the variation of form of cutaneous disease is produced by the derangement, more or less, of certain portions of the cutaneous apparatus. Now the application of stimulants and caustics deranges all these, and therefore generally lessens our chance of success, because, although we may be acting beneficially on one, we are probably exciting and disordering another. Unless indeed we make up our minds to destroy the original structure entirely, and draw largely on the powers of nature to replace it by new ; stimulants and caustics are rarely justifiable, and even then comes again with redoubled force the consideration of those powers, or in other words, of the general health. Is the latter manifestly such as to justify the destruction of a part of the surface, the seat of long-standing disease, with the expectation mentioned ? I believe this question will seldom admit of being answered in the affirmative. In any such cases as it has been customary to use these agents, such, for instance, as those denominated lupus, or the knawing ulcer, a large portion of the cases of which are of scrofulous, or other he- reditary origin, and few or none co-existent with an ordinarily healthy state of the constitution, it is impossible to take measures of this kind, and call it less than a mere experiment • and it is seldom that the skin remains long the seat of serious derange- ment where there is no deviation from health in what we 'are accustomed to consider more vital organs. I have availed myself largely of the labours of MM. Breschet and Roussel de Vauzeme,in the following illustrations of the anatomy of the skin and its functions : indeed, with the exception of the figures Hand 12, it is but fair to repeat that I have selected them from the engravings of these authors ?* An inquiry conducted as theirs * Nouvelles Recherches sur la Structure de la Peau nar M C R h Docteur en Medicine, &c. et M. Roussel de Vauzeme. Paris, 1835.' ExSdes Annales des Sciences Naturelles. un r r <* A " £ /■ Wtf fy • * £ I? I' &&£ 1 l-'-JL t^lV Vv^ a. i .I''.-;..-./.// i;4 1.,/ <2 y.u.?\ 'f\ i (r