General Anatomy, Applied to Physiology and Medicine, Vol. 3 (of 3)

by Xavier Bichat

I. Forms, Relations with the Dermis, &c.

We see upon the epidermis the same wrinkles as upon the skin, because being exactly contiguous, both wrinkle at the same time. Different pores open on its surface after having passed through it. Some transmit the hairs; these are the most apparent; others give passage to the exhalants. We do not see these in the natural state, because their course is oblique, and they open between two small layers, which, being in contact with each other when we do not sweat, conceal their termination. 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. It is only in the soles of the feet and the palms of the hands that we cannot make this observation, which is owing to the thickness in those parts. It is impossible to distinguish in these pores the absorbent orifices from those of the exhalants, even when mercury enters the first by friction.

The internal surface of the epidermis adheres very closely to the skin. The means of union are at first the exhalants, the absorbents and the hairs, which in passing through the first, adhere to it more or less, and thus fix it to the second, from which they arise. By separating the epidermis by maceration, which is the most proper means, we see on its internal surface many small elongations of greater or less length, and which, when examined attentively, appear to be nothing but the broken extremities of exhalants and absorbents. In fact these little elongations which are easily raised up, and which then appear like small ends of thread when they are of some size, but which exhibit only inequalities when they are left very short, have all of them an oblique course, and terminate in the pores which, we have said, pass through the epidermis to go to its surface. Their existence is sufficient, at the first inspection and without the aid of a microscope, to enable us to distinguish the internal from the external face of this membrane. The spaces that separate them are more or less large. About these spaces, the adhesions are less. It is at this place that the small epidermoid vesicles are formed with which the skin is covered when plunged into boiling water. The depressed interstices, which separate these vesicles, are the places where the exhalants are and which have prevented the epidermis from being raised up. When ebullition is long continued, they are detached also.

We cannot doubt then that all these vascular elongations serve powerfully to unite the epidermis to the chorion. How is the adhesion formed in their interstices? I know not; but it exists, though it is less evident. The cellular texture, as I have said, appears to take no part in it.

Every one knows that many causes destroy the adhesions of the epidermis, and raise it up. These causes are, 1st, every severe inflammation, whatever may be its species. We know that after erysipelas, phlegmon, biles, and cutaneous eruptions of different natures, the epidermis is always detached; there is then no fluid that raises it up. The exhalants cannot furnish it, as they are full of blood; it is dry when detached. 2d. Various cutaneous eruptions, which have not an inflammatory character, as herpes, &c. also detach the epidermis at the place where they are. It most commonly comes off then in the form of dry scales; hence no doubt the idea of some authors who have attributed to it a scaly structure, which neither observation nor experiment upon the epidermis in the natural state have proved. This pealing off in scales is owing to the same cause precisely as the formation of vesicles which take place the instant after the skin has been plunged into boiling water, viz. to the greater adhesion of the exhalant vessels which go to the epidermoid pores. Observe in fact that it is always in the space between these pores that the scales are produced, which do not exist in nature, but which arise only from the manner in which the membrane is raised up. For example, when herpetic eruptions take place on the chin, the pores through which the hairs pass are not detached; it is only the epidermis in the space between these pores; now as these are very near together, these scales are extremely small; they are almost like dust. 3d. Whenever the epidermis is raised up by cutaneous inequalities, the least friction detaches it from these inequalities. Hence why, after strong dry frictions, a rough skin becomes scaly, whilst a smooth one experiences no alteration; it is this even, which in the external appearance, contributes much to the ugliness of the one and the beauty of the other. 4th. After idiopathic fevers, and even many affections of the internal viscera, the skin which has felt the sympathetic influence of the disease, becomes the seat of an alteration which without having any external sign, is sufficient to break the union of it with the epidermis, which is everywhere raised up. 5th. We know that the action of a blister, which draws a large quantity of serum to the external surface of the chorion, breaks off the exhalants which go from it to the epidermis; so that this serum is effused under it and forms a more or less considerable sac. The water does not escape through the open pores, because their oblique course through the epidermis makes their parietes, when brought in contact with each other by the pressure of the water, form an obstacle to it. It is for the same reason, that though these pores may be very evident, as I have said, in a separate portion of epidermis when examined against the light, this portion will support mercury, without giving passage to its particles. 6th. Most of the preceding means, which produce their effect only by an alteration of the vital forces, have no effect in raising the epidermis in the dead body. Putrefaction, maceration and ebullition are those by which it is effected. All act by breaking the elongations which extend from the dermis to the epidermis, though the mechanism of this rupture is not exactly known.

II. Organization, Composition, &c.

Authors have made many conjectures upon the structure of the epidermis, which it would be useless to relate here. I shall only speak of what accurate observation demonstrates. Its thickness is in general very uniform in all the parts. It has not appeared to me to be increased or diminished, according to the varieties of thickness of the skin on the back, the abdomen, the extremities, &c. It is only on the soles of the feet, the palms of the hands and the corresponding face of the fingers, that this thickness becomes greater. It is even so great in these places, that there is no proportion between them and the other parts of the body as it respects this membrane; it is especially towards the heel that it exhibits this character. This excessive thickness appears to be owing to different layers which are applied upon each other, and which seem to be superadded to the layer of the ordinary epidermis; but there is also a real difference, though but little known, in the organization; for example, when the epidermis has been removed from these parts by maceration, we cannot see, as in the others, those small appendices or inequalities regularly scattered over it, and which are the remains of the broken exhalants. In these places these vessels are torn smoother on the internal surface of the epidermis, on which are seen only the traces of the wrinkles of which we have spoken.

I attribute to this excessive thickness of the epidermis of the soles of the feet and the palms of the hands, the difficulty and oftentimes impossibility of making blisters act in these places, on which I have often applied them there, because I thought that the sensibility being greater, they would produce more effect in some diseases. The failure of my attempts has compelled me to renounce them.

This thickness takes from the epidermis the transparency it has in the other parts; it is whitish and opake even on the hand and the foot. Thus the epidermis which, in negroes not being coloured, allows the blackness of the subjacent reticular texture to be seen, conceals in part this blackness in these places. I have observed however, by means of maceration, that the less deep colour of the soles of the feet and the palms of the hands depends also in this race upon this, that the reticular texture is really less coloured. We might say that every thing relates to animal sensibility in this region, the capillary net-work of which appears to be less, and in which all the phenomena that are derived from organic sensibility are much less active.

In examining in this relation the hand and foot of a negro, I have been led to make upon the colour of the reticular body some other experiments, which form a short digression. 1st. By plunging into boiling water a piece of the dermis taken from any part it becomes twice as black, almost immediately; which is probably owing to this, that the fibres in approximating by the horny hardening, bring together the colouring particles, whence arises a deeper black. This phenomenon is very striking, when the piece plunged into the water is compared with one that has not been. 2d. Maceration for a month or two, sometimes removes the epidermis without the reticular body, the seat of colour, and sometimes detaches the whole together. 3d. Being immersed for some days in cold water produces no sensible effect. 4th. Long continued stewing hardly changes at all this colour, after the deep tinge that has been suddenly given to it. Only by scraping with a scalpel the external surface of the skin which is then reduced to a kind of gelatinous pulp, we easily detach the coloured reticular body from it, which however always remains adherent to a small portion of the chorion. 5th. Sulphuric acid, which reduces the skin like all the other organs to a kind of pulpy state, also enables us to remove this coloured portion easily, which is detached in separate pieces, but the shade of which is hardly altered at all. 6th. Nitric acid, though very much weakened, does not facilitate so much the removal of this coloured portion. It yellows the internal surface of the skin and the epidermis; but it has appeared to me to produce but very little effect upon the blackness of the reticular body. 7th. A portion of the skin of a negro, immersed for twenty-four hours in a solution of caustic potash, has not appeared to me to have undergone any alteration in its colour. I have made the same observation when I used a weaker solution. 8th. Putrefaction detaches the coloured portion of the skin, sometimes with the epidermis, sometimes alone, but it does not alter its colour. I have not employed other agents to ascertain the nature of this colour of the skin of negroes. Let us return to the epidermis, which we have for a moment lost sight of.