Part 37

At birth, though it is in contact with a fluid that is new to it, it does not undergo a great alteration; which proves that the air has little or no agency in its formation. It becomes thicker as we advance in age, and follows, in this respect, nearly the same proportions as the skin. Beyond the twenty-sixth or thirtieth year it increases no more. I have often raised up in many places the epidermis of an old person; it has not appeared to me to differ much from that of the adult; it is a little more subject to scale off and it is a little thicker. In some miserable objects which come to hospitals, there is often vermin in cracks of the epidermis, whose layers are afterwards separated by them and in which they live; so that I have seen the epidermis in this way conceal thousands of little animals, which were evidently found between the layers of this membrane, and which were not upon the reticular body and the papillæ. It is the only means that has shown to me the lamellated structure of the epidermis, in any other place than on the foot and the hand, in which I have never seen vermin.

The cracks of the epidermis in old age appear to arise from its dryness owing to the want of exhalation; it is that which renders the skin so rough and harsh. What contributes to it also is, that as it has many inequalities on account of its numerous folds, frictions being more felt in these prominent places, make the epidermis scale off; thus in the adult the same cause renders it scaly on a tubercular skin, whilst a skin that is smooth and well distended with fat, undergoes every kind of friction without desquamation.

ARTICLE SECOND.

INTERNAL EPIDERMIS.

All authors have admitted the epidermis of the mucous membranes. It appears that most have believed that it is only this portion of the skin which descends into the cavities to line them. Haller in particular is of this opinion. But the slightest inspection is sufficient to show, that here as upon the skin, it forms only a superficial layer over the papillary body and the chorion. Boiling water which detaches it from the palate, the tongue and the pharynx even, enables us to see the two other layers.

I. Epidermis of the origin of the Mucous Surfaces.

The epidermis is very distinct upon all the origins of the mucous system, upon the glans, the entrance of the anus, the urethra, the nasal fossæ, the mouth, &c. It is demonstrated in these places by the excoriations that take place there, upon the lips especially, by dissection with a very fine lancet, by the action of boiling water, maceration, putrefaction and even epispastics, as is proved by the fact that the ancients employed this method to make the edges of a hare-lip raw. The delicacy of this epidermis is much greater than on the skin; and as it is more in the interior this delicacy increases. It is to this circumstance that must be attributed the ease with which different remarkable modifications are produced through this membrane, when in galvanic processes, we arm with zinc the surface of the tongue and with another metal the mucous surface of the conjunctiva, the pituitary membrane, the surface of the rectum, the gums, &c. and bring in mediate or immediate contact these different metals.

The mucous epidermis is quickly reproduced when it has been removed. Destitute of every kind of animal and organic sensibility, it is in this respect, destined like the skin, to defend the very sensitive papillary body that is subjacent to it. It is to its presence upon the mucous membranes, that should be in part attributed the faculty they have of being exposed to the air, and even to the contact of external bodies, without exfoliating or inflaming as in preternatural anus, prolapsus of the rectum, &c.; whilst the serous membranes cannot bear this contact with impunity.

Besides, the nature of the mucous epidermis is the same as that of the cutaneous. Submitted to the action of the same agents, it gives the same results. The excrescences formed on its surface are also analogous, though much more rare. It becomes callous by pressure. Chopart relates the case of a shepherd, whose urethra became so, from frequently introducing a small stick to procure pleasure. We know the density that this covering has in the stomach of the gallinaceous animals, and in certain cases in which the mucous membranes come out of the body as in prolapsus of the rectum, the vagina, the womb, &c. Sometimes in those cases the pressure of the clothes produces in this epidermis a thickness evidently greater than what is natural to it; it is this which then makes these membranes lose in part the bright red that characterizes them in the interior.

II. Epidermis of the deep seated mucous surfaces.

The epidermis gradually becomes more delicate, and is soon almost insensible, on the internal mucous membranes. 1st. In the stomach, the intestines, the bladder, the gall-bladder, the vesiculæ seminales, in all the excretories, &c. the most delicate instrument cannot raise it up. 2d. In the maceration and ebullition of the mucous system of these parts, I have never seen the epidermis raised up on its surface. 3d. I have drawn out of the abdomen of a dog a portion of intestine; its mucous coat has been laid bare by an incision, and I have applied an epispastic to it; more redness was seen upon the free surface of this coat, but no pellicle was raised up from it. 4th. We do not see in preternatural anuses, complicated with inversion, excoriations analogous to those of which the surface of the lips, that of the glans, &c. are the seat. 5th. I have already had frequent occasion to open bodies affected with acute or chronic catarrhs of the intestines, the stomach, the bladder, &c.; now I have never seen the epidermis separated by inflammation, as happens after erysipelas, phlegmon, &c. upon the cutaneous organ. 6th. We do not see upon the deep seated mucous surfaces those exfoliations, desquamations, &c. so frequent upon this after many affections.

From all these considerations it would appear, that the epidermis does not exist upon the deep seated mucous surfaces, and the great quantity of mucous juices constantly poured out by the subjacent glands, supplies its place in defending the papillæ and the chorion from the impression of substances heterogeneous to the economy, contained in the internal cavities. Yet there is a circumstance that would seem to demonstrate the existence of the epidermis upon the deep seated mucous surfaces; it is the separation of preternatural membranes, which are often detached from these surfaces, and which may be considered as a kind of epidermoid exfoliation. Many authors give examples of these membranes formed either upon the bladder and voided by the urethra, or upon the stomach and œsophagus and thrown up by vomiting, or upon the intestines and expelled with the alvine evacuations; Haller has collected many cases. Dr. Montaigu informed me that he saw a membrane vomited up, which formed a sac without a rent, exactly analogous to that of the stomach whose internal surface it lined. Desault saw a sac almost analogous to the bladder, voided by a patient who was affected with retention of urine.

I confess that I have made no observation on this point, so that I cannot say what is the nature of these membranes. But authors in general agree in attributing to them a soft and pulpy nature, which does not appear to me to accord with that of the epidermis. I have many times seen at the Hôtel Dieu white membranes detached from the œsophagus after poisoning with the nitric acid. But these membranes are evidently the superficial portion of the mucous organ, which is disorganized, and thrown off by suppuration which takes place below. It is thus that cutaneous eschars fall off in the form of membranes from large burns; in this way the osseous layers are formed in necrosis, which are only the superficies of the bone that dies and is detached in a lamellated form.

From this, the existence of the epidermis of the deep seated mucous surfaces appears to me to be very uncertain, and cannot be admitted till a new examination, which will, I think, prove rather against than in favour of its existence. What is the place in which the epidermis terminates that lines the origin of the mucous surfaces, or if it exists everywhere, where does it begin to become no longer apparent from the action of our different reagents? We cannot, I think, determine with precision; it diminishes in an insensible manner, and is lost as it were by degrees.

ARTICLE THIRD.

OF THE NAILS.

All the fingers have at their extremity, on the outer side or that of extension, hard, transparent and elastic layers, of the nature of the horns of many animals, and which are called nails.

I. Forms, Extent, Relations, &c.

The nails of man differ from those of most other animals, in their breadth and want of thickness. The first makes them better adapted to support the extremity of the fingers, which is broader than in most animals for the perfection of touch; the second renders them less fit to serve for defence or as a means of aggression.

Most people cut their nails even with their fingers, so that the length of these bodies which is seen is not what is natural to them. When allowed to grow, they lengthen and turn over on the side of flexion, and cover entirely the lower end of the fingers. This growth has a certain limit which the nail cannot pass, and which it attains when it exhibits at its extremity a cutting and sharp edge. As long as this edge has the appearance of having a part cut off, the nail continues to grow.

We usually think that the habit of cutting our nails is a thing of mere decorum. But if we reflect a little upon society and the numerous arts to which it gives rise, upon the perfection, delicacy, precision and rapidity of the motions which the fingers are often forced to execute, upon the necessity of approximating them, crossing them in a thousand different ways, &c. we shall soon see that this habit is almost inevitably the result of the social state, and what appears to us the effect of fashion is that of necessity. The sense of touch in man in a natural state is coarse and obscure; it is only necessary that he should seize objects destined for his nourishment, his defence, his aggressions, &c. that he should climb especially and attach himself to trees to keep himself upon them; now his nails are for this purpose of great use. What he loses in this respect in society, he seems to gain by the precision and extent which are added to his touch, and by the faculty which the fingers acquire of distinguishing the most delicate tangible qualities. In the first state, his hands are of great assistance to him in locomotion. In the second, they contribute hardly at all to this use, and they gain in the partial motions of their fingers what they lose in their motions as a whole, which become of less urgent necessity.

The nail has three distinct parts in the natural state; one posterior, concealed on both sides by the integuments; another middle, free only on one side, and the third anterior, without adhesion at either side.

The posterior portion of the nail is nearly a sixth part of its extent. Its convex surface adheres very intimately to the epidermis, which goes in the following manner to fix it. After having covered over the portion of the finger corresponding with flexion, it is reflected upon the concave edge where the skin terminates and where the nail begins to become external; it commonly forms all around this edge a kind of small string that is very distinct and has a small groove in the top of it, and which is evidently composed entirely of epidermis, since we can cut the whole of it without giving any pain, and which is afterwards easily reproduced. After having formed this string, which is in the form of a parabola, the epidermis is again reflected, passes between the skin and the nail, and is glued, if we may so say, to the concave surface of the latter, without being intermixed with it; for we can remove it with ease by scraping with a scalpel. So that the dermis which covers the superior portion is really between two layers of epidermis. After having thus fixed the nail, and having arrived at its posterior edge, the epidermis is continued and identified as it were with this edge, whose evident delicacy and softness approximate it in nature to this membranous layer. Hence it follows that without the adhesion of the epidermis to the nail, there would be between them, a kind of cul-de-sac. Some authors have thought that the extensor tendon is extended as far; but it is easy to see that it does not go beyond the tubercle which terminates behind the phalanx. The nail does not reach this tubercle, there is a space of three lines between them. The concave surface of the posterior portion of the nail corresponds with the same substance as the middle portion.

This middle portion is bare on its convex surface, which is smooth, whitish behind where this colour forms a kind of half moon, reddish in the greater part of its extent, a colour which is foreign to it and which it derives from the subjacent texture. Upon the sides, the skin covers this surface a little, and terminates afterwards by continuing the concave and free edge of which we have spoken. The epidermis forms also in this place a small string which is continued on each side with that pointed out above; then it unites to the nail and adheres to its lateral edges with which it is identified. The concave surface of this middle portion is fixed in front by the epidermis, which, after having covered the extremity of the fingers, and having arrived at the place where the nail ceases to be free, is separated from the dermis, and adheres to the whole length of the nail in a curved line; then by mixing with it, it seems to form its internal lamina. The dermis on the contrary is continued on the convexity of the last phalanx, has there a remarkable consistence, a reddish appearance, and a texture like pulp and wholly different from what is observed elsewhere; more vessels run through it; there is no distinct space in it, and no elongation goes from it to the surface of the nail of which the epidermis forms a part. We do not see on this surface, as on those of the other parts of the epidermis, those threads, which are the remains of the broken exhalants and of which we have spoken; thus the sweat never passes through the nail. There is neither any oily oozing upon its surface; whence it follows that water is not formed into little drops on the exterior of its horny laminæ. Hence the nail is evidently insulated from all the other organs except the epidermis, with which it is continued on its concave face and especially on its posterior and lateral edges. Thus observe that when collections of pus or other affections have broken this continuity behind or on the sides, the whole of the nail, though unaffected in the middle falls off.

The free or anterior portion of the nail is of a length which it is difficult to determine. I have never seen it allowed to take its natural growth. I have only observed that if it is permitted to grow to a considerable size, we see evidently that it has a greater thickness than the posterior and middle portion. In general, the thickness, resistance and hardness of the nail increase in a gradual manner from the posterior to the anterior part; we shall now examine to what this is owing.

II. Organization; Properties, &c.

In order to observe the organization of the nails advantageously, it is necessary to take those that are very distinct, as those of the great toe, the thumb, &c. We then see evidently that a single lamina occupies the whole of their convex surface. Behind, this lamina exists alone; hence the extreme thickness of the nails at this place. But as we examine towards the front, we see new laminæ successively added to it, on the concave surface; so that the nail becomes successively thicker. These laminæ can be easily raised up layer by layer. The most anterior are the shortest. They often exhibit upon the concave surface of the nail an infinite number of very evident small striæ, all longitudinal and parallel, and which make us attribute to it a fibrous texture. At other times this arrangement is less evident.

What is the nature of the laminæ which form the nails? I believe that they are almost precisely the same as the epidermis. What proves it is, 1st, that the most superficial is evidently continued with it by its edges; there is no intermediate agent between them. 2d. I have already observed that the nails are detached, and then regenerated exactly like the epidermis. They have two modes of increase; one in length, when we cut their extremities; the other in thickness, when we detach only a lamina, which is soon formed again. When the whole of the nail comes off, all the portion of the dermis which covers the back of the last phalanx, contributes at the same time to form it anew by its external surface. 3d. There is the same obscurity in the vitality of the nails as in that of the epidermis. No trace of animal sensibility is discoverable in them. The excruciating pain that is experienced when they are pulled out arises solely from the sensibility of the subjacent pulpy texture; it is from the same cause as in pulling out the hair. There is no organic sensibility, no internal circulation and consequently no heat inherent in the texture of the nails; thus the horns of animals are nearly of the same degree of temperature as the atmosphere, whilst some external productions with evident vital forces, though raised up like horns, have a temperature equal to that of the body. Such are the combs of the cock of our country, and those which are more striking of the cock-turkey. Compare these excrescences with those on the feet of these animals, which are horny, and the difference of temperature is evident. 4th. The nails give out when burning a disagreeable odour, analogous to that of the epidermis under the same circumstances; they exhibit then the same phenomena. Their combustion is supported, like that of the epidermis, by an oil of which they contain a great quantity. 5th. If maceration and stewing do not produce upon the nails that want of consistence, that kind of brittleness, if I may so express myself, which they produce upon the epidermis, it appears to be owing only to their greater solidity. 6th. The action of the nitric, sulphuric acids, &c. has exhibited to me nearly the same phenomena as upon the epidermis.