A theoretical and practical treatise on the diseases of the skin / by P. Rayer.
- Pierre François Olive Rayer
- Date:
- 1845
Licence: Public Domain Mark
Credit: A theoretical and practical treatise on the diseases of the skin / by P. Rayer. Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
53/582
![d. Cutaneous inflammation of the outer surface of the, corion, more or less circumscribed, affecting its secreting power, and thus producing first, exfoliation of the scarf-skin, afterwards vitiated scarf-skin. Though the scarf-skin (cuticula, epidermis), and nails are. inca- pable of injection, and are therefore believed to be inorganic, the former is remarked to be more sensible when thin and semitrans- parent, than when thick and opaque, which it may be in certain regions. It is also observed, that when it is removed by a blister, or the effect of a scald, the surface of the corion, when it ceases to discharge the sero-albuminous fluid already noticed, becomes covered by a thin pellicle of transparent membrane, so delicate that it affords very little defence to the subjacent skin. This same transparent pellicle is observed in the skinning or cicatrization, as it is named, of cutaneous wounds. If, under these circumstances, the formation of this pellicle be observed, it will be found that it is deposited from the outer or cuticular surface of the corion, like a secreted substance in a viscid or semifluid state, and afterwards becoming hard, dry and semitransparent. When the outer surface of the corion becomes inflamed or other- wise disordered, its secretion is no longer performed with the same perfection or regularity. The effect of this is seen in the vitiated state of the scarf-skin, which is no longer the uniform, continuous, firm, semitransparent membrane observed in health, but becomes broken, thickened, opaque and divided into numerous scales. Of the various modes in which this secretion may be deranged, and of the varieties in cuticular disease to which it may give rise, too little is known to speak with precision of their individual forms. But it may be considered as certain, that every morbid state of the outer surface of the corion gives rise to certain unnatural conditions of the cuticle, and that every anormal state of the cuticle depends originally on a morbid state of the cuticular or secreting surface of the corion. In genera], this morbid state consists in some degree of inflammation, or at least it is attended with some degree of this process, though in the chronic form. In some instances, this chronic inflammation is obviously the immediate cause of the derangement of secretion ; but in other instances, the disordered secretion continues after the inflam- mation subsides. The former is observed in the Greek leprosy {lepra), and the scaly tetter (psoriasis), in both of which the forma- tion of the morbid opaque scales is preceded and attended by a red inflamed state of the corion taking place in minute spots. It is less obvious in dandiiff (pityriasis), in which the surface of the corion, though dry, harsh and rough, is not particularly red or vascular, and which, therefore, appears to exemplify the latter statement. The fish-skin eruption (ichthyosis), is in general so chronic that it is diffi- cult to say whether it is or is not attended with any degree of the inflammatory process; but when its commencement can be traced, it is generally possible to recognize marks of inflammation of the outer surface of the corion. e. Cutaneous inflammation originally affecting the outer surface of the corion, circumscribed, definite or punctuate, producing effusion of fluid, first pellucid, afterwards slightly opaque, with elevation of cuticle, ivith or without further affection of the corial tissue. Inflammation may be developed in many minute points of the corion simultaneously, and, continuing limited to these points without spreading, may terminate in each in the formation of a pellucid fluid, afterwards becoming more or less opaque. These may either be confined to the outer surface of the corion, without affecting its sub- stance, or, beginning originally at the surface, may thence affect its substance. The individual points appear first like a common rash, with general redness of the skin, sometimes like pimples or minute ele- vations, with a good deal of redness surrounding them. After some hours, a white pearly point appears at their summits, while the sur- rounding redness diminishes in breadth, so as to form a mere circle or hoop (areola), which, if minutely examined, is found to consist of a zone of vessels, circumscribing the inflammatory process, and forming in their centre the fluid which gives the elevation the white appearance. After 12, 20 or 30 hours more, according to circum- stances, the white pearly appearance extends, assumes a tint of yellow, and is depressed on the summit, indicating the advancement of the process of circumscribed inflammation. In the course of two 13 or three days, there is detached a thin crust or scab, which consists of the cuticle of the part with the dried fluid adhering to it. Minute elevations of this description haA^e been termed vesicles (vesicuhr), and the contained fluid lymph by Dr. Willan. The fluid thus dis- tinguished is not the same as the coagulable lymph of J. Hunter. It is nevertheless sero-albuminous, and appears to be quite similar to that which is secreted in the first stage of suppuration. The process by which it is secreted is confined to the vascular surface of the corion, and is not attended by ulceration of that surface in millet-rash, shingles (herpes), and the red-fret or mercurial eruption (eczema). In chicken-pox it is sometimes attended by ulceration of the corial sur- face, sometimes not. In the other two forms of vesicular inflammation, though the process commences at the surface of the corion, it finally affects the substance of that membrane. In the limpet-shell vesicle (rupia), inflammation of the punctuate or circumscribed character commences in one or more points of the outer surface of the corion, and causes the secretion of a thin clear fluid, which first elevates the cuticle into a broad flat vesicle, and soon becoming opaque, oozes through the broken cuticle, and is hardened into thin, superficial, but in general, laminated scabs. These vesicles are surrounded by a red, hard and painful margin or base, indicating slow inflammation of the corial tissue. The progress of this form of cutaneous inflammation, demonstrates clearly and satisfactorily the gradual transition of the morbid action from the surface to the substance of the corion. The inflammation, confined at first to a small spot by the usual zone or areola, causes merely sero-albuminous secretion, and consequent elevation of the cuticle. If at this time the cuticle be removed accidentally or inten- tionally, the subjacent surface of the corion is intensely red, soft or velvety and pulpy, elevated and extremely tender, while the sur- rounding ring or hoop of skin is hard, and equally elevated and red. From the softened inner portion the secretion of sero-albuminous fluid, generally of a reddish tint, continues ; and the surface itself begins to become rough, and to loose its velvet aspect. This indi- cates incipient ulceration, which proceeds to affect the substance of the corion, until it is either much or wholly destroyed, generally in the form of an inverted cone; while the place of the destroyed skin is supplied by the sero-albuminous secretion, which hardens as it is formed, and seems thus to sink deeper and deeper into the skin. In the meanwhile the surrounding portion of the skin is much indurated and inflamed, and seems to form a hard ring in the skin; and the whole process is attended with extreme pain, searing heat, and con- stitutional distress. These phenomena are most distinctly seen in the rupia prominens and escharotica, and in a variety of the eruption, which I have witnessed in the persons of those who have been affected with the constitutional symptoms of syphilis, and who have for this been subjected to repeated courses of mercury (rupia cacheclica). Cow-pox (vaccinia), whether in the teat of the cow, or the skin of the human subject, consists in local inflammation of the outer surface of the corion, which, by causing the secretion of a thin semi- transparent fluid, elevates the cuticle into a vesicle. At the same time, the surrounding skin is red, sore and hard (areola); and the inflammatory process denoted by these signs causes suppuration of the corion, with some destruction of its substance, or what is termed ulceration. If the thin fluid secreted by the vaccine vesicle either in the teat of the cow, or in the skin of the human subject, be taken before it has become opaque or puriform, and applied to the surface of the human corion exposed by scratching, slight incision, or suitable abrasion of the cuticle, it is followed by local inflammation of the same characters as those of the original sore or vesicle, from which the morbid fluid is taken. The vaccine inflammation is naturally divided into two stages. During the progress of the local inflammation, some disorder of the constitution fakes place generally about the seventh or eighth day, in the form of loss of appetite or sickness, slight thirst and heat, and dryness of the skin. The pulse is almost never affected. The vaccine vesicle may also produce sundry cutaneous inflammations, very transitory, and of a secondary nature. Of these the vaccine rose-rash (roseola vaccina) is the most important and frequent.](https://iiif.wellcomecollection.org/image/b21149495_0053.jp2/full/800%2C/0/default.jpg)
