Dermis

“ I preserved a great part of the skin of a man who died at the Hôtel Dieu, and his epidermis, which was treble the thickness from his birth and even in the womb of his mother, that it is in the ordinary state, had been subject during his life to a continual desquamation which made the whole of it appear as if covered with herpes, though nothing similar to this affection existed upon the dermis, which was perfectly sound. ”

“ The dermis, or true skin, consists mainly of a net-work or web of fibrous material, having outside of this a net-work of capillary blood-vessels and lymphatics, interwoven with still another net-work, of nerves, both blood-vessels and nerves terminating in projecting or upright loops, each loop formed of a blood-vessel and a nerve-cord, the two being together side by side. ”

“ Between the two is placed the mucous layer, of which the pigment alone in reality varies in quantity and colour according to the race.
All the colours presented by the human skin have two common elements, the white of the dermis and the red of the blood. Moreover, each has its own proper element, resulting from the colourings of the pigment. The rays reflected from these different tissues combine into a resultant which produces the different tints and traverses the epidermis. ”

“ Experiments in the laboratory and in practice have shown that it is not the dissolving action on the skin substance in the narrow sense which is desired in bating the derm with dogs’ dung, but in order to prepare the hide for the manufacture of a soft and elastic leather, the albuminous intercellular substances and more particularly the layers of fat lying at the roots of the hair, in the corium and in many cases also on the epidermis, must be dissolved and thereby the fibrils of the skin loosened. ”

“ Attention to the state of the skin is of great importance in a hygienic point of view. The perspiration and sebaceous matters which are naturally poured out upon the surface of the body, with an intermingling of particles of detached epidermis, fragments of fibres from the dress, dirt, etc., if not removed, gradually form a crust which soon materially interferes with the due excreting action of the skin. ”

“ But if, the skin being very dry, we suddenly sweat, as after drinking tea, then the little drops which escape from the whole cutaneous surface, not having had time to run together, but remaining separate, we see, by the places where they are, the orifice of the exhalants. Besides, if we examine against the light a considerable portion of epidermis, its transparency allows us to see many small pores separated from each other by interstices, and which pass through it in an oblique direction. ”

“ The skin consists of two layers, the derma, or true skin, and the epidermis, or cuticle. It is the principal seat of the sense of touch, and on the surface of the upper layer are the sensitive papillae, which receive and respond to impressions; and within, or imbedded beneath it, are organs with special functions, viz., the sweat glands, hair follicles and sebaceous glands. Its value as a means of depuration is incalculable, as by it, vast quantities of the aqueous and gaseous refuse matter is conveyed from the body. ”

“ Pimples on the face are usually due to obstruction of the sebaceous glands; sometimes the obstruction leads to inflammation around the sebaceous gland (acne) which often permanently injures the skin.
2. Accumulation of effete matter on the skin occurs, unless frequent ablutions are performed. The epidermis is constantly shedding its older and more superficial parts, in the form of minute scales or “scurf.” In the absence of frequent washing, the scales of epithelium tend to accumulate, the sebaceous secretion matting the scales together, and rendering them more adhesive. ”

“ The appendages of the skin are the hair, nails, the sebaceous and sweat-glands. This complicated structure is supplied with blood-vessels, lymphatics, and nerves.
The Epidermis.—The outer layer of this is the horny layer; when a blister is formed, its fluid raises the entire epidermis from the true skin. The flat scales forming the [Pg 25] horny layer are continually being thrown off; this process of desquamation is increased by the friction of the clothes, of bathing, massage, and so forth, and is as constantly being replaced by new cells from underneath. ”

“ With some aggravation of the condition the skin is felt to be somewhat rough and uneven by reason of the encrustations of epidermis, dried secretions and dust over its surface, which may convey to the finger a slightly oily sensation. ”

“ In the early phases it is impossible to discover the little galleries under the epidermis, but closely placed reddish papules may be seen. The active proliferation of the epidermis, together with discharge, causes the formation of dry crusts of a greyish-white, silvery tint, adherent while still thin, easy to detach at a later stage, and sometimes 3⁄8 of an inch in thickness. The skin becomes wrinkled, the bristles are shed or loosened in their follicles, and are glued together in little bunches before falling. ”

“ Remember that the fluid must act upon the inside of the skin, for the epidermis is often almost impervious to it. If you allow the skin to lie upon itself in thick folds, stuck together on the inside, those spots are liable to lose their hair in a most unaccountable and aggravating way. If the skin is small and thin, the bath soon does its work; but if it is a large skin, move it up and down, and all about, every day for the first two or three days. By the end of that time its preservation will be complete. ”

“ We attach the idea of a beautiful skin, to that in which these small tubercles are not found, and in which the chorion is united at its external surface. Women have commonly this last arrangement more evident than men. The epidermis which covers these eminences very often scales off at that place, especially from strong friction, which contributes still more to render the skin uneven, rough and harsh to the touch where they exist, which might induce a belief that they are formed by it, though it is always only accessory to them. ”

“ In psoriasis the epidermis separates in flakes at various spots which have not been subjected to pressure, and to cure it ointment Inflammation.containing tar or other products of the dry distillation of wood is employed. When the true skin is inflamed various appearances may arise, according to the intensity and extent of the inflammation, and the eruption may be papular, vesicular, pustular, tubercular, bulbous or ulcerative. To lessen irritation the skin is protected by dusting powders, such as oxide of zinc, starch, fuller’s earth, &c., or by ointments. ”

“ The organic sensibility of the skin is not less blunted in old age, than its animal sensibility; hence the following phenomena; 1st, contagious miasmata are absorbed with difficulty at this age; almost all pass over the cutaneous surface with impunity. 2d. The exhalation of sweat is uniformly less; it is hardly ever subject to those great increases, that are seen in the adult. 3d. The oily fluid is also furnished in much less quantity; hence the constant dryness of the exterior of the skin, the cracking of the epidermis in some cases, &c. ”

“ Diseases of the skin tend to manifest themselves in certain parts of the body; i.e. certain diseases exert a selective influence on the sites of their eruption. Symmetry is characteristic of eczema, psoriasis, drug rashes and the eruptions of specific fevers, while others, such as herpes zoster, ring-worm, tertiary syphilis and new growths, tend to be asymmetrical. Eczema selects the flexor aspect of the limbs and the neighbourhood of folds of skin and opposed surfaces, while psoriasis favours the extensor surfaces and the outer side of the elbows and knees. ”

“ Describe the bullous type of dermatitis herpetiformis.
The bullous expression of the disease is usually of a markedly inflammatory nature, often innumerable blebs, small and large, appearing almost continuously, and in some instances involving the greater part of the surface. The lesions arise from erythematous skin, from preëxisting vesicles or vesicular groups, or from apparently normal integument. There is a marked disposition to appear in clusters. A change of type to the erythematous or vesicular varieties is not unusual. ”

“ Dermatitis herpetiformis is a somewhat rare inflammatory disease, characterized by an eruption of an erythematous, papular, vesicular, pustular, bullous or mixed type, with a decided disposition toward grouping, accompanied by itching and burning sensations, with, as a rule, more or less consequent pigmentation, and pursuing usually a chronic course with remissions. ”

“ In the pustular and bullous varieties there may be mild or grave systemic symptoms, but even in these types the constitutional involvement is, in most instances, slight in comparison to the intensity of the cutaneous disturbance.
What is the course of dermatitis herpetiformis?
Extremely chronic, in most instances lasting, with remissions, indefinitely. The skin is rarely entirely free. From time to time the type of the disease may undergo change. From the continued irritation and scratching more or less pigmentation results. ”

“ Der′mal, Der′mic, Dermat′ic, pertaining to the skin: consisting of skin.—n. Dermatog′raphy, anatomical description of the skin—also Dermog′raphy.—adjs. Der′matoid, of the form of skin: skin-like; Dermatolog′ical.—ns. Dermatol′ogist; Dermatol′ogy, the branch of physiology which treats of the skin; Der′matophyte, a parasitic fungus on the skin; Der′matoskel′eton, the bony integument of many reptiles, insects, and crustaceans—also Dermoskel′eton.—adj. Dermogas′tric, connecting the skin and the stomach. [Gr. derma, dermatos, the skin—derein, to flay.] ”

“ Sometimes they are discolored by dirt, and in some cases they become inflamed and present a dull-red hue. The fine hairs growing upon the affected skin are often broken off or coiled up in the follicles. When the disease is severe and of several years' duration the .skin has an ichthyotic appearance and to the touch feels like a nutmeg grater. The disease is described in some text books under the name of lichen pilaris or keratosis pilaris, but the follicle is primarily involved and not the hair. ”

“ In the former, after nerve-injuries more especially, we observe loss of thickness, glossiness, and perverted circulation and secretion; the hairs may fall out or grow abnormally; the nails are slow of growth, thick, rugose, incurvated, and brittle. In other cases, as in cerebral and spinal paralyses, the skin of the paralyzed part is abnormally dry, rough, and furfuraceous, and it loses its elasticity. In some varieties of so-called skin diseases the patches of altered nutrition (eczema, bullæ, herpes, psoriasis, leucoderma, scleroderma, etc.) ”

“ Describe the symptoms and course of prurigo.
The disease first appears upon the tibial regions, and its earliest manifestation may be urticarial, but there soon develop the characteristic small, millet-seed-sized, or larger, firm elevations, which may be of the natural color of the skin or of a pinkish tinge. The lesions, whilst discrete, are in great numbers, and closely crowded. The overlying skin is dry, rough and harsh; itching is intense, and, as a result of the scratching, excoriations and blood crusts are commonly present. ”

“ There may be marked inflammatory exudate, causing the surface of the skin to become excessively moist and more or less itching. Redness, vesicles and pustules may characterize the inflammation. In the chronic form the skin may become thickened and greatly changed in structure. ”

“ Describe parchment skin, and state the treatment.
Parchment skin (xeroderma pigmentosum, angioma pigmentosum et atrophicum) is a rare disease, the exact nature of which is not understood. It is characterized by the appearance of numerous disseminated, freckle-like pigment-spots, telangiectases, atrophied muscles, more or less shrinking and contraction of the integument, and followed, in most instances, by epitheliomatous tumors and ulceration, and finally death. It is usually slow in its course, beginning in childhood and lasting for years. ”

“ They are, as a rule, sharply defined, with a smooth, often shining and atrophic-looking surface; are soft, fine or leathery to the touch, on a level or somewhat depressed, and appearing not unlike a piece of bacon or ivory laid in the skin. Occasionally the patches are noted to occur over nerve-tracts. The adjacent skin may be normal or there may be more or [Pg 173] less yellowish or brownish mottling. The subjective symptoms of tingling, itching, numbness, and even pain, may or may not be present.
What is the course of the disease? ”

“ The skin is harsh, dry and rough, feeling to the touch somewhat like the surface of a nutmeg-grater or a coarse file. More [Pg 100] or less scaliness is usually present in the confluent patches and on the palms and soles; in these latter regions the papules are rarely seen. The duration of the disease is variable, and relapses are common. It bears resemblance at times to keratosis pilaris, ichthyosis, dermatitis exfoliativa; it is considered identical with the lichen ruber acuminatus of Kaposi, and by many also with the lichen ruber of Hebra. The etiology is obscure. ”

“ The skin of the face is constantly exposed. In every tiny pore dust and dirt are bound to accumulate. Unless your skin is kept in perfect health, with every tiny pore active, these impurities make themselves evident in the form of blackheads. These little black pests are frequently found where the circulation is sluggish and the pores less active—on the forehead, between the eyes, over the nose, about the chin and sometimes on the ears.
Cleanliness is the principal secret of the clear, blackheadless skin and nothing will so effectively get down into the pores as a cream. ”