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everywhere fine and delicate, is particularly so upon the eyelids and
the lips. 2d. The chorion of the trunk is posteriorly and all along the
back, of a thickness almost double that of its anterior part, where it
is nearly the same upon the neck, the chest and the abdomen. I
would except however that of the penis, the scrotum, the great labia
and the mammæ, in which its delicacy is greater than any where
else. 3d. In the superior extremities it is nearly uniform upon the
shoulders, the arm and the fore-arm; on the hand it increases a little
in thickness and more in the palm than on the back. 4th. This
thickness is generally much more evident on the thigh and the leg,
where there are more muscles, than on the arm or the fore-arm. On
the foot, it increases as on the hand, less in the dorsal than in the
plantar region, which is the thickest of all the parts of the dermoid
system; which is owing principally in the natural state to the
arrangement of its epidermis. We see from this, that though
everywhere continuous, the chorion is very different in its different
parts. The relation of its thickness with its functions is easily
perceived on the hand, the foot, the cranium, &c. Elsewhere we
cannot so well see the reason of these differences, which are
notwithstanding as constant.
Woman has a chorion generally less thick than that of man;
compared in all the regions, it exhibits in the two sexes a sensible
difference; on the mammæ especially, it is much more delicate in
woman. That of the great labia however is proportionally thicker
than that of the scrotum.
In order to understand perfectly the intimate structure of the
chorion, it is necessary to examine it at first on its internal surface,
after having carefully separated it from the fatty cellular texture, to
which this surface adheres more or less intimately. We see then that
it is differently arranged according to the regions.
1st. On the sole of the foot and the palm of the hand, we observe
an infinite number of white fibres, shining like aponeurotic fibres,
which are detached from this internal surface, form upon it a kind of
new layer, cross each other in all directions, leave between them,
especially towards the heel many spaces of different sizes, that are
filled with fat, separate more and more, and are finally lost in the
sub-cutaneous texture, nearly as the fibres of the brachial
aponeurosis insensibly disappear in the neighbouring cellular
texture. Hence why when we dissect the palmar and plantar
integuments, we experience the greatest difficulty in separating
them entirely from the cellular texture which is interlaced with these
fibres; hence why also these surfaces have not, on the parts which
they cover, the mobility which many others exhibit.
The density of the cellular texture contributes also something to
this arrangement which is essential to the functions of the foot and
the hand, which are designed to seize and grasp external bodies.
2d. The dermis of the superior and inferior extremities of the back,
of the neck, of the thorax, of the abdomen, of the face even and
consequently of almost all the body, is distinguished from the
preceding, because the fibres are much less distinct, and are not lost
in the cellular texture by being as it were confounded with it,
whence arises a remarkable laxity of the skin of these parts, and the
very great facility with which it is dissected; in a word because the
spaces between these fibres are much more narrow. These spaces
appear like an infinite number of holes irregularly placed at the side
of each other, containing most of them small fatty parcels of the
neighbouring texture, and exhibiting, when these small parcels have
been carefully removed, very evident vacuities. The fibres which
form them, are sufficiently near each other, to make you believe at
first view, that it is a surface pierced with an infinite number of
holes, that has been applied under the skin. On the contrary, on the
hand and the foot, towards the heel especially, it is a true net-work
the spaces of which are larger than the fibres that form them; this is
the reverse here. Be that as it may, these spaces in the internal
surface of the chorion are very favourable to the action of tannin
which penetrates the texture infinitely better from this side than
from the opposite, because it insinuates itself into these numerous
openings. I have had occasion to observe it in the human chorion
which I have had tanned for the purpose. Chaptal has observed that
the epidermis is a real obstacle to the action of tannin, and that on
this account scraping is a preliminary operation essential to tanning,
since it allows the skin to be penetrated on both sides; but even
when thus scraped, it receives the tannin much more easily on the
side of the flesh than on the opposite one.
3d. The chorion of the back of the hand and the foot, as well as
that of the forehead does not exhibit these numerous openings on
its internal surface; it is smooth and white, especially when it has
been macerated a little. It is precisely the same as that of the
scrotum, the prepuce and even the great labia. The texture of it is
more compact, no space is left in it, so that though more delicate
than that of the extremities and the trunk, it contains almost as
much substance. As to the chorion corresponding to the hair and the
beard, we see in it only the openings necessary for the passage of
the hairs, and which are wholly different from those of which I spoke
just now, which form real culs-de-sac, and do not pierce through the
chorion.
Hence the internal face of the dermoid chorion exhibits three very
distinct modifications. The first and last are seen to a small extent,
whilst the second is almost general, with some differences however
in the trunk, the extremities and the head. Besides, these
modifications do not suppose a diversity of nature, but only of
forms. Much separated and arranged in fibres in the first, the
dermoid texture is compact and condensed a little in the second,
and by this condensation renders the spaces less distinct. But there
is a means of seeing them everywhere very well, where there is the
least trace of them, and this is by maceration. This means also
shows the dermoid texture best. In fact, when the skin has remained
for some time in water, it softens, the fibres of its chorion separate,
and their interstices become more distinct; then we see that the
spaces exist not only on the internal surface, but that they extend
into its texture which appears to be truly like a sieve in its whole
thickness, so numerous are the spaces arising from the interlacing of
the fibres.
These spaces do not terminate in culs-de-sac towards the external
surface; they open upon this surface by many foramina which are
very evident in a skin that has been macerated for a month or two,
and which, in the ordinary state are almost imperceptible in some
subjects, and very visible in others. Besides, in order to see them it
is necessary to remove the epidermis; now as with the view of
producing this effect immediately we commonly employ the action of
boiling water or fire, the dermoid texture by this means acquires the
horny hardening, and they become much less apparent, whereas
maceration not only does not produce horny hardening of the skin,
but it expands and dilates it, which renders these foramina very
evident. In some parts of the skin and in certain subjects, we might
then introduce the head of a pin into them; in others they are less
evident. These foramina never pierce the dermis perpendicularly, all
open obliquely to its surface; so that a perpendicular pressure tends
to close them and bring their parietes in contact. I cannot compare
their termination better than to that of the ureters in the bladder;
hence why the hairs which go through them are never perpendicular,
but oblique to the skin. We speak incorrectly when we say that the
hairs are planted obliquely; their insertion in the bulb is
perpendicular; it is in their passage through the chorion that they
change direction.
Besides, these foramina are not vessels, but mere communications
from the interior to the exterior through which pass the hairs, the
exhalants, the absorbents, the blood-vessels and the nerves which
go to the surface of the dermis; thus the subjacent spaces are only
cells in which are contained the vessels of the glands and of the
cellular texture. The dermoid texture should then be considered as a
real net-work, as a kind of cellular texture, the cells of which very
evident within, become less so on the exterior surface, with which all
communicate to transmit to it different organs. The chorion is then
the outline, the frame, if I may so say, of the cutaneous organ. It
serves to lodge in its spaces, all the other parts which enter into the
structure of this organ, and contributes to give them the form they
are to have, but is wholly foreign to them.
What is the nature of this texture, which enters especially into the
composition of the cutaneous chorion? I know not; but I think it has
much analogy with the texture of the fibrous system; the following
considerations support this analogy. 1st. On the heel, where the
dermoid texture has the fibrous form of the irregular ligaments, it
would be almost impossible to distinguish it from it, so uniform is the
external appearance; it has the same resistance and density; the
same sensation is experienced when it is cut with the bistoury. 2d.
The dermoid texture becomes yellow and transparent like the fibrous
by stewing. 3d. It melts gradually like it into gelatine. 4th. Like it,
except the tendons however, it strongly resists maceration. 5th.
Sometimes these two textures are identified; for example, the
annular ligaments of the wrist evidently send elongations to the
neighbouring dermoid texture. 6th. This texture can serve, like the
fibrous, for the insertion of muscles; we see it in the face, where
many of the fibres of the orbicularis of the lips and the eyelids, and
almost all those of the eyebrows, find real tendons in the fibres of
the dermoid texture. There is the same arrangement in the
cutaneous palmar muscles.
All these considerations evidently establish many relations
between the dermoid and fibrous textures. Yet they are far from
being the same. To be convinced of this it is sufficient to observe
how much their mode of sensibility differs, and how different also
are their diseases; it seems at first as if there was no analogy
between them in this double relation. Yet the line of demarcation is
by no means as great as it appears to be. In fact the acute
sensibility of the skin is not seated precisely in this white texture,
which is interwoven so as to leave between its meshes the spaces of
which we have spoken, and which we see especially on the surface
adhering to this organ. The experiment mentioned in the article on
the mucous system, and in which I irritated the cutaneous organ
from within outwards, evidently proves it. It is the surface on which
the papillæ are found that especially exhibits this vital property.
On the other hand morbid anatomy proves that the internal
surface of the dermis, in which are especially found the texture and
the spaces of which we have spoken, is entirely free from most
cutaneous eruptions. This is no doubt true as it respects the small
pox, the itch and many species of herpes; I have satisfied myself of
it as to the vaccine vesicles, the miliary eruption, &c. &c. It is certain
that in erysipelas, the external surface only of the chorion is
coloured by the blood which enters the exhalants; thus the slightest
pressure, causing the blood to flow back, produces a sudden
whiteness which soon disappears by the return of the blood into the
exhalants. It is this which forms the essential difference between
simple erysipelas and phlegmon, in which not only the external face
of the chorion, but its whole texture and the subjacent cellular one
are inflamed. In measles and scarlatina, the redness is also very
evidently superficial. These phenomena accord with those of
injections; for if they succeed at all in children, the skin of the face
and less frequently that of the other parts, becomes almost entirely
black. Now this blackness is much more evident on the external than
the internal surface of the skin, no doubt because more exhalants
are found in the first than in the second, which the arterial trunks
only traverse.
The preceding considerations evidently prove that the texture of
the internal surface of the chorion, and even that of its interior, have
a vital activity much less than that of the external surface; that this
texture is disconnected with all the great phenomena which take
place upon the skin, with those especially which relate to the
sensations and the circulation; that it is in the papillæ that the first
are seated and in the reticular body the second; and that it is almost
passive in nearly all the periods of activity of this double portion of
the dermis. Its functions, like those of the fibrous texture, suppose it
to be almost always in this passive state; they are only to defend the
body and to protect it from the action of external bodies. It is this
which forms our real covering; thus its properties are well adapted
to this use. Its resistance is extreme. It requires very considerable
weight to tear very narrow strips of chorion, when it is suspended
from them; drawn in various directions, these strips are broken also
with much difficulty.
Yet this resistance is much less than when tannin is combined with
the chorion. We know that when thus prepared, this portion of the
skin affords the strongest strings we have in the arts. I know but
two textures in the animal economy, which unite to such an extent
suppleness and resistance; these are this and the fibrous texture;
and this is a new character which approximates them. We have seen
that it requires a very considerable weight to break a tendon, a strip
of aponeurosis, or a ligament taken from a dead body. The muscular,
nervous, arterial, venous, cellular textures, &c. yield infinitely more
easily. If the dermoid texture had less extensibility, it might
advantageously supply the place of the tendons, the ligaments, &c.
in the structure of the body.
Since the chorion is foreign to almost all the sensitive and morbid
phenomena of the skin, let us inquire then in what part of the
dermis these phenomena are seated. These parts exist very
evidently on the external surface; now we find on this surface, 1st,
what is called the reticular body; 2d, the papillæ.

Of the Reticular Body.

Most authors have considered the reticular body as a kind of layer

applied to the external face of the skin between the chorion and the
epidermis, pierced with an infinite number of openings through
which the papillæ pass. I do not know how we can demonstrate this
layer, which escapes according to the opinion of most of them, when
the epidermis is detached. In order to see it I have employed a great
many means, but no one has succeeded. 1st. Such is the adhesion
of the epidermis to the skin, that in a sound state we can hardly
separate them without injuring one or the other. Yet with the
greatest precaution we see nothing mucous on the chorion when it
is laid bare. 2d. A portion of skin cut longitudinally, especially from
the foot where the epidermis is very thick, allows us to see very
distinctly on the divided edge the boundaries of this and of the
chorion; now nothing escapes from about the line which separates
them. 3d. In ebullition in which the epidermis has been removed,
nothing remains upon the internal surface, nor upon the chorion.
4th. Maceration and putrefaction, the latter especially, produce upon
the chorion a kind of glutinous layer the instant the epidermis is
removed. But this layer is entirely the product of decomposition.
Nothing similar is met with in the ordinary state.
I believe, from all these considerations, that there is not a
substance deposited by the vessels upon the surface of the chorion,
extravasated, stagnant upon this surface, and representing there a
layer in the sense in which Malpighi understood it. I believe that we
ought to understand by the reticular body, a net-work of extremely
fine vessels, whose trunks already very delicate, after having passed
through the numerous pores with which the chorion is perforated,
come and ramify upon its surface, and contain different kinds of
fluids.
The existence of this vascular net-work is placed beyond a doubt
by fine injections which change the colour of the skin entirely
externally, without altering it much within. This is, as I have
observed, the principal seat of the numerous eruptions most of
which are really foreign to the cutaneous chorion.
We may then consider the reticular body as a general capillary
system, surrounding the cutaneous organ, and forming with the
papillæ a layer between the chorion and the epidermis. This system
contains in most men, only white fluids. In negroes, these fluids are
black. They have an intermediate tinge in the tawny nations. We
know how much the shades vary in the human race. Hence the
colouring of the skin resembles nearly that of the hairs, which
evidently depends upon the substance existing in their capillary
tubes; it is analogous to that of the marks at birth, that are
commonly called nævi materni, and in which we never see a layer of
fluids extravasated between the epidermis and the chorion.
Moreover, I think we know but little as yet concerning this
substance, which fills a part of the external capillary system. It does
not circulate in it, but appears to remain there till another replaces
it. When we examine the skin of a negro, we see a black teint, and
that is all. In maceration I have observed that this teint is sometimes
removed with the epidermis, and that it sometimes remains adhering
to the chorion. It is very evidently foreign to both, since both have
the same colour in whites as in blacks. It is never reproduced, after
it has been removed; for cicatrices are white in all people.
Is there in white people a white substance which, remaining in the
external capillary system, corresponds to that of negroes, or does
the colour of their skin depend only upon the epidermis and chorion?
I have been tempted to believe that they also have a colouring
substance, since the long-continued action of a powerful sun
evidently blackens them. This circumstance has even made me
believe that whiteness is natural to all men, and that there was but
one primitive race which has degenerated according to different
climates.
But in order to be convinced of the diversity of races, it is
sufficient to observe, 1st, that the teint of the skin is but one of the
characters which distinguish each race, and that many others are
always united to it. The nature and form of the hair, the thickness of
the lips and the nose, the width of the forehead, the degree of
inclination of the facial angle, the whole appearance of the face, &c.
are constant attributes which indicate a general modification in the
organization, and not merely a difference of the dermoid system. 2d.
White people become tawny in hot countries; but they never acquire
the teint of the people of the country. 3d. Removed to cold countries
in early age, or even born in them, the blacks always remain so;
their shade hardly changes at all from generation to generation. 4th.
Colour by no means follows temperature exactly; we see many
varieties in the shades of people who live under the same degree of
latitude, &c.
Every thing proves then that the colour of the skin is but an
insulated attribute of the different human races, though it is that
which is most striking to our senses, and that we should not attach
to it a greater importance than to many others which are drawn
from the stature, which is oftentimes very small, as in the
Laplanders, from the broad and flat face, as in the Chinese, from the
dimensions of the chest, of the pelvis, the extremities, &c. It is from
the differences of the whole, and not from those of an insulated
part, that the lines of demarcation should be made which separate
the races. The European face and forms are in general the type with
which we compare the exterior of the other nations. The ugliness or
beauty of the human races are, in our way of considering it,
measured by the distance which separates these races from ours.
Such is in fact the force of habit with us, that we rarely judge in an
absolute manner, and that every object which is much removed from
those to which we are accustomed, is disagreeable to us and
sometimes even disgusting.
Besides, the colouring matter of the cutaneous reticular body is
more interesting to the naturalist than to the physician. What should
particularly arrest the attention of the latter is the portion of the
capillary system exterior to the skin in which the fluids circulate. In
fact, besides the portion which is the seat of colour, there is
evidently another that the white fluids constantly pervade, in which
they are moved with more or less rapidity, and in which they
continually succeed each other. It is from this portion that the
exhalant pores arise which furnish the sweat; it is this vascular net-
work which is the seat of erysipelas and of all the cutaneous
eruptions that are foreign to the chorion.
The blood does not penetrate it in an ordinary state, but a
thousand causes can at every instant fill it with this fluid. Rub the
skin briskly, and it reddens in a moment. If an irritant is applied to it,
whether it acts mechanically like nettles, the appendices of which
penetrate the epidermis, or exerts a chemical action, like the
frictions with ammonia, or the action of fire when a portion of skin is
held too near it, instantly the sensibility of this vascular net-work is
raised; it invites into it the blood which it formerly repelled; every
part of a surface reddens in proportion to the irritation. If passion
acts powerfully upon the cheeks, immediately a sudden redness is
evident in them. All rubefacients exhibit moreover a proof of the
great tendency which the sensibility of the superficial capillary
system of the dermis has to place itself, if it be ever so little excited,
in relation with the blood which in the ordinary state is foreign to it.
Vesicatories depend upon the same principle. Their first effect is to
fill with blood the cutaneous capillary system, where they are
applied, to produce in it a sudden erysipelas, and then to occasion a
copious serous exhalation under the raised epidermis. They effect in
a few hours what most cases of erysipelas do in many days; for we
know that most of them terminate by vesicles which are raised
above the skin. In burning, carried sufficiently far to be more than a
rubefacient, and yet not so as to produce the horny hardening, there
is also a sudden increase of exhalation under the raised epidermis.
In general the production of every cutaneous bladder is always
preceded by an inflammation of the external surface of the skin. This
phenomenon is not exclusively confined to this system. We have
seen the serous, as soon as it is laid bare and irritated considerably,
redden in a short time by the passage of the blood into its
exhalants; which constitutes an inflammation to which often
succeeds a copious exhalation of milky or other kind of serum. This
exhalation does not remain upon the surface, and does not form
vesicles there, because it has no epidermis; this is the only
difference between these phenomena, which at first view do not
appear to be the same in the serous and cutaneous systems.
It is not only the irritation of the cutaneous organ which makes
the blood pass into the external capillary system. Whenever the
heart is powerfully excited and it accelerates the course of this fluid,
it always tends to go into it; this is what is evidently seen, 1st, after
violent running; 2d, in the hot period of a paroxysm of fever.
Upon this subject I will make a remark which appears to me to be
very important; it is that the capillary system of the face is, more
than that of all the other parts of the skin, exposed to be thus
penetrated with blood. 1st. This is evident in the two cases of which
I have just spoken, and in which the action of the heart is increased.
2d. In the passions, the skin remains the same in the other parts,
whilst that of the face suddenly becomes pale or red. 3d. We know
that physicians frequently examine the state of the facial capillary
system, which is almost always affected by the state of the internal
viscera, and is full of blood or empty, according as it is
sympathetically influenced. 4th. In various kinds of asphyxia, in
those especially produced by submersion, by the vapour of charcoal,
by strangulation, &c. the face is uniformly of a violet colour from the
passage of the black blood into its external capillary system, into
which it is brought by the arteries. Oftentimes the neck and the
upper part of the chest are also livid; but there is never a
discoloration of the inferior parts. 5th. In many diseases, in which
death takes place by a kind of asphyxia, because the lungs are the
first interrupted, the dead bodies have a violet-coloured and swollen
face; this may be easily observed by all who frequent dissecting
rooms. There are a hundred subjects in which the head has this
lividity, to one in which it is observed in the inferior parts. 6th. Most
cases of apoplexy produce the same lividity of the face.
To what is this extreme susceptibility of the facial capillary system
to admit the blood owing? Three things, I think, principally
contribute to it. 1st. The course is already opened to this fluid, since
the redness of the cheeks necessarily supposes its presence in them,
it only increases in quantity; whereas when another part of the
dermoid surface becomes red, all the blood which enters it is almost
accidental. 2d. The anatomical arrangement of the capillary system
is more favourable to this passage there than elsewhere; for it
appears that the communications of this system with the arteries of
the chorion are more free. What proves this is, that in injections the
face is coloured with great ease. There is undoubtedly no anatomist
who has not been struck with this phenomenon, especially in
children, in whom if the coarse injections of our dissecting rooms
succeed at all, the face becomes wholly black, whilst the fluid
penetrates but very little into the other parts of the cutaneous
system. 3d. It appears that there is a greater sensibility in the face;
in fact the same irritant brings blood there, which does not make it
flow to any other place. For example, a blow equal to a box on the
ear does not redden the skin of the arm, whilst it suddenly inflames
the cheeks.
The blood disappears from the facial capillary system as it enters
it; in an instant the passions will successively produce there the
bright red of a paroxysm of fever, the whiteness of syncope and all
the intermediate shades. It is even the extreme ease with which this
fluid penetrates this system, that renders the face well adapted to
serve as a kind of picture, which the passions paint by turns with a
thousand shades, that are effaced, altered, modified and return
again according to the state of the mind.
I would observe upon this subject that the passions have in the
face three means of expression; 1st, the capillary system, a means
wholly involuntary, and which often betrays what we wish to
conceal; 2d, the muscular motion, which, by contracting or
expanding the features, expresses the melancholy or gay emotions,
and to which belongs as effects, the various wrinkles of which we
have spoken; 3d, the state of the eye, an organ, which, as Buffon
has remarked, not only receives the sensations, but also expresses
the passions. The two last means are to a certain extent voluntary;
we can at least disguise them; whereas we cannot deceive by the
first. The actor imitates anger, joy, &c. because we can give these
passions by contracting the eye-brows, by dilating the face in
laughing, &c. But it is the rouge of the actress that imitates modest
chastity; it is by removing this rouge that she imitates the paleness
of fear, horror, &c.
 I will add another essential observation in respect to the facial
capillary system; it is that it appears that its tendency to receive
blood, disposes it to become the more frequent seat of many
affections. We know, 1st, that erysipelas is much more frequent in
this than in other parts; 2d, that the variolous pustules are
remarkably conspicuous here; 3d, that many eruptions are more
abundant here than elsewhere.
From all that we have just said, it is evident that it is necessary to
distinguish two portions in the capillary system exterior to the
chorion. 1st. One is constantly filled with the colouring substance of
the skin, a substance which appears to be stagnant like that of the
hair of the head, and that of the hair of the body, which is subjected
only to the slow and insensible motion of composition and
decomposition and which never exhibits that sudden increase or
diminution of which we have just spoken. 2d. The second is
constantly pervaded by many fluids which continually succeed each
other there, and which constantly escape by transpiration, and which
are replaced by the blood, that insinuates itself into this portion of
the capillary system. These two portions are entirely independent,
and have probably no kind of communication.
It appears that at the instant of death there remains a certain
quantity of the white fluids in the second portion of the exterior
capillary system; the following experiment, which I have frequently
made, proves it; by plunging a portion of skin into boiling water, and
leaving it there an instant, the epidermis is raised up, not as a whole
as in a blister, but in an infinite number of small vesicles which are
formed suddenly on its surface, and which contain a serous fluid,
that escapes as soon as we open these vesicles.

Papillæ.

We call by this name those small eminences that arise from the
external surface of the chorion, and which, piercing the capillary net-
work of which we have just spoken, become by their extremities
contiguous to the epidermis. These eminences are very evident in
the palm of the hand and the sole of the foot, where they are
regularly arranged, in the form of small curved striæ in different
directions. We see them through the epidermis, notwithstanding its
thickness in these places. But they are seen especially when this has
been in any way removed, as by maceration, ebullition, &c. If we cut
longitudinally a portion of the chorion of the foot, with its epidermis
adhering to it, we see between them along the divided edge, a line
in the form of a curved thread, which arises from these small
eminences placed at the side of each other.
In some other parts of the skin, we distinguish the papillæ in a
very evident manner; but in a great number, the epidermis being
removed, we see only a surface, slightly uneven from some small
eminences, especially towards the orifices through which the hairs
and the vessels pass, but we do not discover those regularly
arranged eminences, the papillæ properly so called.
We must not mistake for them the numerous and very evident
prominences, which render the skin of some subjects extremely
rough. These prominences are formed by small cellular, vascular or
nervous bunches, by sebaceous glands, &c. which are found near
the small openings by which the chorion opens under the epidermis,
and usually transmits the hairs. These bunches, lodged in the small
oblique canals which are terminated by these openings, raise the
external side of them and thus form this prominence. The following
very curious experiment proves this arrangement; when the skin is
macerated for two or three months, or even less, on the one hand
these little bunches in which there is almost always a little fat, are
changed into that white, thick, unctuous matter, analogous to
spermaceti, into which fat kept a long time in water is always
converted; and on the other, the foramina enlarging, as we have
seen, and the skin changing into a kind of pulp, we can easily
remove it all around these little prominences, and see that they are
continued with the fat which fills the meshes of the subjacent
chorion, and which is also changed into a hard matter.
 Injections have evidently proved to me that there were vessels in
these cellular bunches, and I have been convinced of it for some
time past by the dissection of some subjects that died of scurvy, in
whom the spots commenced by very small ecchymoses, similar as it
were to flea-bites, and which occupied these little eminences. The
petechiæ of adynamic fevers have a different appearance; but they
belong also to an extravasation of blood in the cellular texture,
occupying the small pores which open on the exterior of the chorion
to transmit the vessels, the hairs, &c. The more prominent these
eminences are, of which we have spoken, the more uneven is the
skin. In general they are more frequent on the extremities and on
the back, than on the anterior part of the trunk. In the extremities
there are more of them in the direction of extension, than in that of
flexion.
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. Where it is
very thick, as in the palm of the hand and the sole of the foot, it
cannot be raised, and these small cutaneous tubercles are never
seen. In the face where many vessels pass from within outwards, by
the little pores of which we have spoken, we meet with hardly any
more of them. The papillæ scattered among these eminences, are in
general very slightly apparent in the places where they exist.
All anatomists attribute to these last a nervous structure; they
regard them as the termination of all the nerves that go to the skin,
and which, according to them, are expanded to form these, after
having first left their external covering. Some even say that they
have traced filaments even into the papillæ; I confess that I have
never been able to do it. In the ordinary state, the density of the
chorion and the extreme delicacy of the filaments, are evidently an
obstacle to it. In the state of long continued maceration, in which
the chorion becomes pulpy and in which we might consequently
trace these filaments, were it ever possible, it cannot be done. I do
not however deny the texture attributed to the papillæ. The acute
sensibility of the skin seems even to suppose it; but it is only
analogy and not demonstration, which establishes this anatomical
fact; indeed all the other senses, whose organs are so sensible, have
the portion of them which receives the impression of bodies
continuous with a nerve.

Action of different bodies upon the Dermoid Texture.

In most of the other textures, we have only considered this action

in the dead body, because during life, these textures always
removed from external bodies, cannot be influenced by them. Here
we can regard it in a double relation, since the skin is incessantly in
contact with almost all the bodies of nature.

Action of Light.

Light evidently acts upon the dermis. Removed from its influence,
men are blanched, if we may so say, like plants. Compare the
inhabitant of a city, who is never exposed to the influence of the
sun, with the peasant who constantly is, and you will see the
difference. It appears that it is the light and not the heat which
produces the effect of which I have already spoken; for individuals
who live in a warm temperature, but removed from the solar light,
become white like those of cold countries. Thus we know that some
men who keep their chambers always very hot, are whiter than
others who, living in a less hot atmosphere, are constantly exposed
to the sun. We might remain forever in a bath of a temperature
equal to the warmest seasons, and the skin would not blacken.
Apartments for study which are warmed with stoves, and in which
men remain as long as the labourer at his plough, are as warm as
the atmosphere of summer, and yet the skin of those who occupy
them never becomes darker. Besides an irresistible proof is that the
clothing which does not prevent the action of caloric upon the skin,
and which offers a barrier to the rays of light only, prevents the
cutaneous colouring that takes place upon the parts which the light
immediately strikes, as upon the hands, the face, &c.
I do not speak of the solar influence upon the vital forces of the
skin, as in cases in which sun-strokes produce erysipelas, or as when
light is employed medicinally to recall the life of a part; but it is only
in relation to the dermoid texture that I consider its action.

Action of Caloric.

The action of caloric upon the skin exhibits very different

phenomena, according to the degree of it that it is applied.
1st. A warm atmosphere expands the dermoid texture, increases
its action, and makes most of the fluids which form the residue of
nutrition and digestion, pass off by the exhalants.
2d. When contracted by cold, this texture refuses to admit those
fluids, which then go off principally by the urine.
3d. The insensible change from one to the other of these two
states, does not disturb the functions. When this change is sudden,
there are almost always alterations in different organs, because the
fluids destined to pass out, cannot vary their direction as rapidly
towards this or that organ, as the cutaneous excitement produced
by the sudden changes from heat to cold.
4th. The skin resists a temperature much greater than that of the
body; it opposes an insurmountable barrier to the external caloric,
which tends to an equilibrium in animate as well as inanimate
bodies. Thus whilst these last are penetrated with this fluid in a
medium warmer than themselves, and soon acquire the temperature
of this medium, living bodies remain at the same degree, how much
greater soever the surrounding heat may be to their own. The
curious experiments of the English physicians have placed this truth,
as it respects man, beyond a doubt. It is unnecessary to give the
detail of these well known experiments, in which the mercury was
seen to descend in the thermometer, when the bulb was placed in
the mouth and in which the skin became covered, in a heated room,
with the aqueous vapours of the air, which the greater cold of the
body condensed upon its surface. A slight attention to animals with
cold blood, living in warm climates, proves the same thing. I will
make one remarkable observation upon this point, it is, that most
reptiles, whose temperature is much less than that of the mammalia
and of birds, and who consequently are brought much nearer than
them to the temperature of winter, cannot however support it. They
become torpid and sleep in subterraneous places, the heat of which
remains nearly uniform like that of cellars, and do not awake till the
milder temperature of spring stimulates them.
5th. The skin, in very cold climates, seems to be on the other
hand an obstacle which prevents the internal caloric from suddenly
escaping and thus placing the body in equilibrium with the
surrounding medium. This is evident in countries near the pole.
Upon this subject an observation the reverse of the preceding can be
made; it is that the cetaceous animals inhabit seas the temperature
of which is most unlike their own. Whales are sought for especially
in the latitudes of Greenland, Spitzbergen, &c. Why do fishes with
warm blood delight in the frozen seas, whilst the amphibious animals
with cold blood prefer the burning heat of the sun? I know not.
Let us observe that most of the internal organs when exposed in
solutions of continuity, have not the faculty of preserving as well as
the skin, a degree of independent temperature. They become cold or
hot sooner than it as long as they remain healthy. The intestine
brought out of the abdomen in the operation for hernia, a muscle
laid bare, &c. &c. exhibit this phenomenon; thus in order to give
them this faculty of having an independent temperature, nature
inflames them, and they thus constantly preserve their heat,
whatever may be that of the surrounding medium. The mucous
surfaces next to the skin resist the surrounding temperature the
most, as is seen in prolapsus of the rectum, in inversion of the anus,
&c. This difference among the different systems is probably owing to
that of their structure.
6th. When the action of caloric is carried to a very considerable
extent, it begins to act upon the skin, and its effects are the more
evident in proportion as it is the more intense. 1st. The slightest of
these effects is to produce an evident redness, a kind of erysipelas;
the caloric then acts like a simple rubefacient. 2d. The second is to
redden the skin and then to produce vesicles on it. 3d. In the third
there is a real horny hardening, a crisping of the fibres of the
chorion which contract, like those of all the animal textures exposed
to too strong a degree of heat. 4th. In the fourth and last effect, the
dermoid texture is burnt, blackened and reduced to mere carbon.
These different degrees of burning arise only from different degrees
of caloric. I would observe that in the two first effects, this fluid acts
upon the vital forces, and that these two effects cannot
consequently take place except during life. The two last are exerted
only upon the texture of the organ; thus they take place after death
precisely as before. Cooks often employ the horny hardness, to give
to the skin a hardness and brittleness necessary in some kinds of
cooking.
7th. Cold carried to a great degree acts also upon the cutaneous
organ, and produces different effects, according to its intensity. The
first of these effects is very analogous to the first effect of a slight
degree of caloric. It consists of a kind of local inflammation. The tip
of the nose, the ears and the fingers, the cheeks, &c. become red
from a slight degree of cold. I have not accurately observed the
other effects between this and the last, which consists in a sudden
privation of life. But there is this difference between the gangrene
that then takes place, and that produced by a high degree of caloric,
that the blackness is sudden in this last, whereas it takes place only
as a consequence in the other. Observe in fact that there is in
gangrene two things which physicians do not sufficiently distinguish,
1st, the mortification of the part; 2d, its putrefaction. The
mortification is always antecedent; it is produced by a thousand
different causes; sometimes by the ligature of an artery, as in
aneurism; sometimes by that of a nerve; often by violent
inflammation; sometimes by a contusion, attrition, a bruise, &c.
Whenever a part is dead in the midst of those which live, whatever
may be the cause of its death, it becomes putrid precisely like a
dead body, every part of which life has left. Putrefaction takes place
then even sooner, because on the one hand the natural heat of the
body, and on the other the moisture of the surrounding parts, favour
it remarkably. This putrefaction varies according to the state in which
the part was at the instant of death. If much blood infiltrated it, as
when inflammation destroys life, it quickly becomes putrid, blackens
immediately and allows a fetid sanies to escape; this putrefaction is
called moist. If there is but little blood in the part at the instant of
death, its putrefaction is less sudden; it first putrifies, then blackens,
and allows but little sanies to escape; this is the dry gangrene. Thus
in a dead body, if one part is much loaded with blood, as the head of
those that have died of apoplexy, its putrefaction is much more rapid
and moist than that of the parts in which this fluid is less abundant.
In the gangrene which succeeds mortification produced by cold,
there is often dryness of the part, because there was but little blood
in it at death. How little many physicians know of the progress of
nature in the employment of antiseptics, which they apply in the
living economy, as upon flesh without life. Antiseptics are applied for
one of two purposes, either to prevent the death of the part, or its
putrefaction. 1st. If it is with the first intention, antiseptics should be
varied. By untying the artery of a limb of an animal that has been
tied, you will perform an antiseptic operation. Bleeding and emollient
applications which lessen the violence of inflammation in a
phlegmon, are antiseptics. A tonic as wine and all stimulants which
excite the vital forces in a part in which they are languid after a
bruise, are antiseptics. This word is then extremely improper when it
is applied to medicines designed to prevent the mortification of the
parts. Antiseptics are employed to prevent a dead part in the midst
of living ones becoming putrid; some effect is obtained; thus by
sprinkling cinchona, muriate of soda, or any neutral salt, by
moistening a limb, a portion of skin, the extremity of the nose, &c.
which is dead from any cause, the putrefaction will be arrested, as in
a dead body upon which the same means are employed. But what
will be the result of it? a little less fetor in the surrounding parts and
less danger of their receiving the influence of the emanations of the
dead part; but it is always necessary that this should come off;
antiseptics will never bring it to life. Hence it is evident that these
means should be considered in two points of view entirely different.
The first prevent mortification, and vary remarkably though they are
designed to effect the same object; thus our means of curing
retention of urine are very variable, oftentimes opposite, according
to the cause which tends to produce this retention. The others
prevent putrefaction, without restoring the parts to life; now these
are uniformly the same, whatever may have been the cause of the
local death.

Action of the Air.

The air acts incessantly upon the cutaneous organ. In the ordinary
state, it constantly removes from its surface the sweat that is
exhaled from it. Fourcroy, who has paid particular attention to the
solution of the transpired fluid by the surrounding air, appears to me
to have allowed too much influence to this solution upon
transpiration. In fact there are two very distinct things in this
function; 1st, the action of the exhalants which throw out the fluid;
2d, the action of the air which dissolves and evaporates it. Now the
first of these is wholly independent of the other. Whether the fluid is
dissolved or not, more is still furnished by the exhalants. If the
solution does not take place, the fluid accumulates upon the skin,
which remains moist; but this moisture does not obstruct the
exhalant pores and prevent new moisture from being added to it. A
comparison will render this very evident. In the natural state, the
serous fluids are constantly exhaled and absorbed; the absorbents
perform for them the functions of the air which dissolves the sweat;
now, though these vessels cease to act, as in dropsies, the exhalants
continue their action; there arises only a serous collection, which,
though applied to the orifices of the exhalants, does not prevent
them from pouring out more serum. The bladder in vain contains
urine which presses upon the opening of the ureters, these ducts do
not pour less into it. Though the mucous juices become stagnant on
their respective surfaces, new juices are however poured upon these
surfaces. So though the skin remains moist from the want of solution
of the transpiration, more transpiration is nevertheless exhaled.
Solution is a physical phenomenon wholly foreign to the vital
phenomenon of exhalation. We transpire in a bath as well as in the
air; only the fluid which arises from it is mixed with the water,
instead of being reduced to vapour.
The moisture of the skin is owing to two causes wholly foreign to
each other; 1st, to the increase of the fluid furnished by the
cutaneous exhalants; now the action of these exhalants may be
increased from three causes. First, every thing which accelerates the
motion of the heart, as running, the paroxysm of acute fevers, &c.
drives to the skin, as it is commonly expressed. In the second place,
every thing which tends to relax and expand the cutaneous organ by
a direct action exerted upon it by the surrounding bodies, increases
also the action of these exhalants, as in the great heat of summer,
as in a bath and after coming out, as in a heated room, &c. In the
third place, the action of the skin is in many cases, sympathetically
increased. Here may be classed the sweats of phthisis of which the
lungs are the source; those of fear, which depend upon a sudden
affection of an epigastric organ; those of many acute diseases, &c.
Now in all these cases, however active the solution by the air may
be, the skin will be constantly moist, because there is thrown out
upon it more fluid than the air can dissolve. Thus in catarrhs of the
lungs, in which more mucous juices are thrown into the bronchia
than the air can remove, it is absolutely necessary that there should
be cough and expectoration to carry off the remainder.
 2d. There are cases in which the moisture of the skin arises from
the solution not being sufficient. This is what takes place in the
moisture of the bed in which the air is not changed, in damp
weather, &c. There is not then more fluid exhaled; but the ordinary
fluid becomes evident, because it is not dissolved. It is under this
point of view that we must consider the action of the air upon the
cutaneous organ which transpires. It carries off nothing in this
organ; it has no real action upon it; it takes only what its vessels
throw off. Solution is merely accessory, it is always subsequent to
exhalation, and has no relation with it. In the same day, in which the
temperature has remained the same, the skin is often dry, moist,
humid and even wet with sweat. If the air acts upon transpiration, it
is by contracting or relaxing the exhalants, and not by dissolving
what they throw out. If the skin formed a sac without an opening,
like the serous surfaces, transpiration would go on though it was
removed from the contact of the air, the same as if in contact with it.
Why in fact should not that take place there, which does upon these
surfaces?
If we consider the action of the air upon the skin of the dead
body, we see that it produces two different effects, according to the
state of the body. If the air penetrates the skin on all sides, it dries
it, and it then acquires a sort of transparency, like the fibrous
organs, unless a large quantity of blood had been accumulated in it
at the moment of death, in which case it becomes black or of a deep
brown. Thus dried, 1st, it is firm and resisting, but can be bent in
various directions without breaking, as is the case with many
textures thus dried, as the cartilaginous, the muscular, &c. &c. 2d. It
is much less easily altered than most of the other textures in a dried
state. 3d. It absorbs moisture less easily than them, though however
when immersed for a long time in water, it finally resumes nearly its
original colour and loses its transparency. 4th. It does not exhale a
very disagreeable odour, like many of the other textures. Hence why
the skins of animals, merely dried, are used in many of the arts; why
some barbarous people make use of them for clothing, &c. The
aponeuroses, and the mucous, serous and fibrous membranes could
not be thus employed. It is to this also that must be attributed the
little alteration that takes place in the exterior of mummies, which
would never last for ages, if clothed with a fleshy or serous covering.
When the skin is left upon the dead body, or exposed to a moist
air, it becomes putrid instead of drying. Then it takes at first a dull
colour, then a green and finally a black one. It exhales a very great
fetor, swells and thickens, because the gases which are disengaged
there fill the cellular texture in its little spaces. A mucous covering is
spread upon its external surface, which is deprived of its epidermis.
Nothing similar to this covering is seen on the internal surface.
Finally, when all the fluids it contains are evaporated, there remains
a black residuum, very different from that which is left after
combustion.

Action of Water.

This action during life, is relative either to the substances that are
deposited on the surface of the skin, or to the cutaneous texture
itself.
The sweat deposits incessantly upon the epidermis many
substances, the principal of which are taken away by the air, but
many being slightly soluble in it, as the salts for example, remain on
its surface, and adhere to it when not removed by friction. Mixed
with the unctuous fluid which oozes out upon this surface, and with
the different foreign particles that the air deposits there as
everywhere else, these substances form upon the skin a deposit
which cannot, like the transpiration, be carried off by solution. Now
water removes all this deposit; hence why the use of baths is truly
natural. All quadrupeds bathe themselves. All birds frequently plunge
into the water; I do not speak of those for whom this fluid is as it
were the element. It is a law imposed upon all species of animals
whose skin throws out a considerable quantity of fluid. All the
human races hitherto observed frequently plunge into brooks, rivers,
or lakes, along which they take up their abode. The countries that
are well watered are those which animals prefer. They avoid those
where this fluid is wanting, or in which it is only sufficient for their
drink. We oppose nature in every thing in society. In our own,
numerous classes hardly ever use a bath; thus you must seek
especially in these classes for cutaneous diseases. We have seen
that the mucous juices, remaining too long upon their surfaces,
irritate and stimulate them and cause there various affections. Is it
astonishing that the residuum of the cutaneous exhalation which the
air does not remove, should occasion various alterations upon the
skin? In summer, baths are more necessary, because as many
excretions are taking place by the skin, more substances are
deposited there. In winter, in which every thing passes off by the
urine, the cutaneous surface becomes less dirty, and has less need
of being cleansed. After severe diseases, in which there has been
copious cutaneous evacuations, one or two baths terminate the
treatment advantageously. Let us consider water then as acting as
accessory to the air upon the skin, as removing from its surface
substances which the first cannot dissolve, substances, which
varying remarkably like those that compose the urine, have
presented the transpiratory fluids to chemists, sometimes as
alkaline, sometimes as acid, oftentimes as containing salts,
sometimes charged with odoriferous substances, &c. Water is the
general vehicle; when it is evaporated, it leaves the substances that
are not volatilized like it. It is on this account that dry frictions are
also advantageous; they clean the exterior of the body.
As to the action of the bath upon the cutaneous texture, we know
but little of it during life. They say in medicine that it softens, relaxes
and unbends this texture; this is vague language to which no precise
meaning is attached, and which is no doubt borrowed from the
relaxation which the skin of dead bodies undergoes, or even tanned
leather, when exposed to water. A bath acts upon the vital forces of
the skin, raises or diminishes them, as I shall say; but it leaves its
texture in the same state; it is only that of the epidermis which it
alters, as we shall see.
 Macerated in water of a moderate degree of temperature, in that
of cellars for example which does not vary, the human skin softens,
swells but little, becomes evidently whiter, and remains for a long
time without experiencing any other alteration than that of a
putrefaction infinitely less than that of the muscular, glandular,
mucous textures, &c. subjected to the same experiment. This
putrefaction, which removes the epidermis, appears to be much
greater on the side nearest to this membrane; at the end of two or
three months the skin loses but little of its consistence. It does not
become pulpy as the tendons and muscles in this length of time
when macerated; it does not become a fetid pulp till the end of
three or four months. I have preserved some of it for eight months,
which has still its primitive form, but which feels liquid under the
fingers when pressed a little. In the half putrid state, the skin still
preserves the faculty of crisping from the action of caloric; it moves
about when placed on burning coals, or when plunged into boiling
water. When once reduced to a really putrid state it loses this
property.
Exposed to ebullition, the dermoid texture when well separated
from the cellular, furnishes less scum than the muscular, the
glandular and the mucous; it resembles in this respect the tendons,
no doubt because being almost wholly gelatinous, it contains but
little albumen. In the horny hardening that takes place a little before
ebullition commences, it twists and then always becomes convex on
the side of the epidermis, and concave on the opposite side; and for
this reason; the fibres of the chorion in contracting by the horny
hardening, are pressed against each other; all the spaces which exist
between them are effaced; now, as these spaces are very large in
the second direction, the dermoid texture necessarily becomes more
contracted there, whilst in the first, the spaces hardly existing at all,
every thing being almost solid, the fibres have less space to
contract, they remain longer, and the surface continues larger. In the
natural state the cavity of these spaces, being filled with cellular
texture, increases the extent of the internal surface; this space then
disappearing, this surface becomes contracted.
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