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.)
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![and, with more qualification, by M. Rayer himself. Plumbe, while he admits the value of the anatomy and physiology of the skin as a guide, lays stress on the etiology of the diseases of this tegument, in con- nection, especially, with constitutional conditions of the system, which originate or modify them. Even if we should fail to establish a suc- cessful classification from these premises, it is all important that we should continually bear them in mind, in proceeding to the treatment of cutaneous diseases; for in this way alone shall we be saved from the empiricism which, up to the present day, is still prevalent when this subject is brought up. Plumbe's criticism, as conveyed in the follow- ing words, is too well founded:—A classification of the external and ever-changing forms of the accumulated secretion of disease on the surface—one day a pimple, the next a vesicle, on the third a scab or crust, the fourth a falling scale, the fifth a red spot! This might have served the purpose at the time, for want of a better; but to pronounce it a better classification than one founded, whether with solid foundation or not, by its originators, on etiology, or the causes, external and internal, of the cutaneous disease, would be manifestly absurd. And again:—Purpura or scurvy stands foremost among these. Its different states, in different and not unfrequently in the same person, may, at uncertain periods, be found putting on the mask of pimple, vesicle, pustule, scab, or scale; blue flat discolora- tions; large vesicles, half filled with bloody serum, and others, smaller in dimensions, of a yellow, transparent colour. Again, it may show itself in the form of what is commonly called thrush, either in the infant or adult. It may appear in the form of erythema nodorum, which is a scorbutic inflammation of the integuments, ending in a partial effusion of serum and blood into the cellular structure. Erythema andrupia are the pustular forms of it, ending in scabs. [P. 44, op. cit. Am. Ed.] But, whatever differences may exist between the modified artificial arrangement of M. Rayer, and the alleged natural one of Mr. Wilson, or between them and the mixed one of Mr. Plumbe, there is among these writers a general agreement respecting the organic condi- tion of the skin, in most of the forms of eruption which we commonly speak of as constituting its diseases. Inflammation is the primary and chief pathological change, that on which the phenomena that more immediately strike the eye depend. According to the division of the cutaneous system affected, and in degree to the duration of the affec- tion, will be the physiognomy of skin diseases. M. Rayer, in his table, (p. 21,) includes the larger number of diseases of the skin, under the head of inflammatory affections distributed according to tlie number and form of their elementary lesions; and of these, the larger number, or nine classes, have only a single elementary form. Peculiar states of the skin, not referable to inflammation, are com- paratively few. He enumerates some, again, as morbid states of the secreting function, and, under another head, introduces neu- roses of the skin. His fifth chapter is faulty structure or unusual states of one or other of the elements of the skin; and the sixth is degenerations. In a second division, he places alterations of the dependencies of the skin, such as diseases of the sebaceous and piliferous follicles. Recurring to the original proposition, we find a vast majority of cutaneous diseases, viz., exanthemata, bulla, vesicular, pustules, furun- cidi, gangrenes, papulee, squamae and tubercula, recognized as depend- ing on inflammation of a single elementary form, and syphilis, ambus- tio and pernio, having several elementary forms inflamed. Mr. Wilson, also, while he refers the larger number of cutaneous diseases to the dermis, regards the organic changes constituting them as depending on inflammation, in its several varieties of congestive, effusive, suppurative, depurative, squamous, or from parasitic animal- cules. Mr. Plumbe, although he does not lay down thus broadly inflam- mation as the sole pathological basis of diseases of the skin, is hardly less explicit, when introducing their several divisions to his readers; as when he speaks of some of these diseases being marked by chronic inflammation of the vessels secreting the cuticle, others characterized by active inflammation, with or without constitutional debility or derangement of any kind. The general division of diseases of the skin into those of an acute and febrile, and those of a chronic and apyretic character, is gene- rally admitted; but we much fear that too broad a contrast is supposed to exist between the two, to the oblivion, if not actual denial, of the chronic class being also inflammatory, and of their having, like the acute, their periods of incubation, attack and decline. Few of the diseases of the skin, if carefully watched from their early in- ception, would be found wanting in these stages; and the chiet difference between the two divisions will, on careful analysis, be found to consist in this, that the acute and febrile, after having run a definite course, terminate either in health or death—putting aside, for the moment, complications which do not essentially belong to them ; while the slow, or chronic, go through a similar course, but with a termi- nation only temporary and incomplete ; so that, after a period, the cuta- neous irritation and congestion, or other organic changes are renewed, either in the same or at another region, and go through a series of stages like the first. It is this partial suspension and renewal, more or less complete, according to the hygienic system pursued by the patient, that give reputation, for a season, to a particular remedy or plan of treatment, and tantalizes the sufferer with the prospect of a cure, which, in a short time, is shown to be fallacious. Until we get the measure of these alternations of relief and exasperation, and of the constitutional state and changes accompanying them, we cannot pro- mise ourselves to make any great advances in the rational therapeu- tics of cutaneous diseases. In the acute febrile diseases of the skin, and particularly in the exanthemata, or eruptive fevers proper, the mucous membranes suffer often as much as the dermoid texture. Their being primarily affected, has been already adverted to. In the case of the skin, however, the inflammation is generally diffuse, and extends over the entire surface ; whereas the mucous membranes are but partially affected, or, at any rate, suffer most in particular regions, as the fauces in scarlatina and small-pox, the air-passages in measles, &c, at any rate, at the begin- ning or first stage of the disease; while, towards its decline, the lower bowels may become the seat of secondary irritation, or phlo- gosis, manifested by diarrhoea, or the kidneys be the organs thus secondarily affected, giving rise to albuminaria and anasarca. He who does not continually carry in his mind this connection in function as well as in disease, between the two great divisions of the general tegumentary system, will have very limited views of the pathology of febrile cutaneous diseases, and be not a little embarrassed ia arriving at a rational treatment. In a more advanced part of the present volume, the reader will find a parallel between the diseases of the skin and those of the mucous membranes, which might have been introduced with advan- tage, by the author, at a much earlier period. If we except, says M. Rayer, par 1282, the white wheals of urticaria and the patches of roseola, we find in the mucous membranes almost the whole of the varieties in form and appearance, presented by the exanthema- tous inflammations of the skin. As to the brown, gray, or slate- like discolorations presented by the mucous membranes, in conse- quence of their inflammation, we observe very similar tints following chronic inflammatory affections of the skin. M. Rayer then proceeds to describe the various forms of eruption on mucous membranes, such as exanthemata, bullae, vesiculae, &c, similar to those seen on the skin. Mr. Wilson very properly places rubeola, scarlatina, variola, varicella, vaccinia, under the head of inflammation of the dermis and mucous membranes, with constitutional symptoms of a specific kind. It is now eighteen years since the editor, in his Syllabus of a Course of Lectures on the Institutes of Medicine and Medical Jurisprudence, printed for the use of his class, (at the Philadelphia Medical Institute) enumerated variola, varicella, ru- beola, scarlatina, erysipelas, urticaria, and herpes, as a class desig- nated as Diseases affecting the cutaneous and mucous systems simultaneously, or cutaneo-mucous diseases. To this conclusion he was the more determinately led by the results of extensive clini- cal experience in epidemic small-pox, measles and scarlatina. It is not meant that the treatment of the exanthemata should be described here, in anticipation of the time when it will come up in regular order. One remark, however, of practical importance may be made, viz., that independently of the varieties in their intensity and progress, depending on differences in individual constitution, we meet with great modifications during different epidemic seasons, requiring corresponding changes in treatment; so that scarlatina, for instance,](https://iiif.wellcomecollection.org/image/b21149495_0059.jp2/full/800%2C/0/default.jpg)
