AN ESSAY ON CUTANEOUS DISEASES, AND ALL IMPURITIES OF THE SKIN.
PROPOSING A SPECIFIC, AND, METHOD OF CURE.
BY JOHN GOWLAND, APOTHECARY TO HIS ROYAL HIGHNESS FREDERICK, LATE PRINCE OF WALES, THE PRINCESS DOWAGER OF WALES, AND ALSO TO HIS PRESENT MAJESTY.
LONDON: PRINTED FOR THE PROPRIETORS, NO. 55, LONG ACRE; AND SOLD BY MR. JOHNSON, ST. PAUL'S CHURCH-YARD, AND MR. MURRAY, IN FLEET-STREET.
[PRICE ONE SHILLING.]
(Entered at Stationers Hall.)
INTRODUCTION.
INNUMERABLE are the agents which disturb our health, and make us liable to a wonderful variety of disorders and diseases; and it has ever been the business of the good Physician to exert his application, study, and diligence, in proportion to their danger and malignancy—Physicians, I say, whose lives are occupied in destroying the existing causes of the different maladies to which we are subject, and of re-establishing the good order of the animal economy, are certainly the most noble portion of society, the most useful, and (as Cicero has expressed himself) "Who nearest approach the Divinity."
Cutaneous Eruptions, although an affection so very general, an affection, common to all ages, all constitutions, all cities and countries, have, from the enlightened, received little more than mere theoretical discussion; and thus, unhappily they are not even yet, advanced a long way in this branch of their art.
The only reason of their not having made progress in this part of the science, arises from an error, which, till lately, was universally adopted concerning the ORIGIN of these diseases.
Every one seemed sure that a vice did exist in the blood, which when carried to the surface of the body, produced the different morbific appearances: and each, as vainly endeavoured to determine the CHARACTER and QUALITIES of this imaginary vice; their labours were necessarily abortive, and, as will ever be the case where the criterion cannot be found, a variety of opinions necessarily arose.
From these erroneous and false principles they deduced their medical indications, or, in other terms, their method of cure; and these methods were not unique, but as numerous and as different, as had been their particular opinions: consequently, by pursuing the FALSE, the true means were neglected. This accounts for their backwardness and universal want of success in these complaints.
The case is now different; I say different, because in those latter times Physicians have known, that the diseases of the skin, are a local affection, produced by a depraved and altered secretion of the extreme arterial vessels, or, the cutaneous glands, which are in a PRETERNATURAL STATE: consequently, this knowledge has led them to [Page 5]attempt the cure, with topical, or external medicines. The effects have often corresponded with their expectation; but often also, their expectations have been frustrated, for want of a SPECIFIC REMEDY.
Experience only could bring forward this specific, which Physicians, by simple reasoning alone, never could discover.
As all new doctrines in medicine amount to an impeachment of, and directly militate against, the judgment and practice of the day in which they are proposed; they have therefore, not only men's prejudices to encounter, but also their pride; and frequently, nothing but the determination of the patients themselvs can make their adoption general: this was particularly instanced in the introduction of the Bark, Inoculation, &c. &c.
The situation of Mr. Gowland, as Apothecary to the Three Royal Households, was particularly favourable, and gave more frequent occasion to his experience in the complaints of which we are about to speak, than most others; and he laudably availed himself at an early stage of this doctrine, with that alertness, and observation, which eventually produced the specific in question.
He had observed the treatment employed on Miss Chudleigh, by the Physicians under whose care she was, and the inefficacy, with which it was [Page 6]attended; and although his Lotion was not administered, until their efforts had failed of success, its wonderful effects went beyond his own, or even his patient's hopes*. This fact alone, was not sufficient to canonize the Lotion and ensure to it the reputation of SPECIFIC: but a long use, a scrutinizing and judicious observation, was further necessary. The fact, however, being known, a great number of afflicted persons, the more readily concurred to try the remedy. This afforded him the opportunity of verifying and establishing, the vast power of his Lotion, and at the same time, was the most complete defence of his doctrine and his reputation, against the invidious attacks of those interested men of his time, whose practice it so directly militated against.
This happy discovery of Mr. Gowland's has been much more interesting, and more useful to mankind, than all the volumes written to this day upon Eruptions of the Skin, as they contain nothing but Theories, and have always been defective in the most essential part, namely, THE MANNER OF CURING, &c.
It is not enough to SPEAK well upon diseases; the thing more important is to RELIEVE them.
This recalls to my recollection, the history of those two Greek sculptors, who were called by the Senate, in order to learn from them, how they would execute a statue which might be allusive to an hero of Greece, and erect it to his glory. One of them made a long discourse, which showed him to have an exquisite taste, and proved, that he was completely master, at least of the theory of his art: as he finished, the opinion of the other was required; he answered in a few words, "I will DO what my colleague has SAID;" and he was chosen by the Senate, because they desired THE WORK, and not a dissertation upon the work.
I have no doubt that many Physicians have spoken with more elegance and eloquence, upon the impurities of the skin than Mr. Gowland has done—but Mr. Gowland RELIEVED HIS PATIENTS.
Nor is this the only advantage enjoyed by him; it will appear, by this essay, that he was acquainted with the true causes of this disease.
The many reasons and proofs, which both demonstrate his knowledge, and the truth of the doctrine, have received additional weight, from having since appeared, in the works of the most enlightened Physicians of the present day, and which prove incontrovertibly, that the cutaneous affections are mere LOCAL affections.
It is to be lamented that medical works are [Page 8]chiefly confined to the readings of medical men; and of course, however indispensable and wholesome, the doctrine may be, are therefore never thoroughly disseminated, especially, when repugnant to the general consumption of medicine. How far that has been the case in what has formerly been written on this subject, is left to the discernment of the reader. This remark, however, may be made, that, the use of a Topical Remedy, in cutaneous diseases, must entirely supersede the use of internal medicine for these complaints; from its pleasantness, ease, and certainty of cure. Hence some opposition may be expected from the selfish as well as the ignorant: characters unhappily too common, even in this profession—characters, on whom the remark of CICERO should be reversed*.
In the course of this essay the term SECRETION is of necessity often used:—on a thorough knowledge, and indeed, intimate acquaintance with this term, and the exact meaning of it in its fullest extent, depends all the information the reader can gain; and in proportion to his acquaintance therewith, will be his information, and acquaintance with the subject.
By the term secretion people generally understand no more than certain secreted fluids, or matters; without considering AT ALL, the organs that produce them, or the power of those organs, to alter their properties, from a natural state, and according to the circumstances, impress them with new characters, and frequently characters of disease.
By the term SECRETION, physiologists understand a particular operation, performed by the extremities of arterial vessels, from which results a new animal product, or in other terms, a fluid which is furnished with new characters and properties, ("sui generis") and of their own distinct kind: for instance, the bile is elaborated in the liver, and is not in the blood, nor are its characters to be found in any other part of the human body. Again, the fat is not in the blood, [Page 10]but the arteries, which terminate in the cellular membrane, elaborate and compose it by a secret and inimitable combination of principles: the poison of vipers is not found in the mass of their fluids, (on the contrary they are very innocent) but it is created by particular organs endowed with that power.
The same observation applies to all the secretions, particularly that which takes place and is performed in the skin, or surface of the body, CALLED PERSPIRATION.
These operations are themselves very surprising and difficult to be understood, it is however, enough to know the effects, and these effects are, as has been observed, generally, of their own proper and natural kind.
Nor is this doctrine confined to animals alone, it is the same in greens, plants, and flowers themselves; their different colours, smell, taste, &c. are from a specific combination of parts, the consequence of different secretions.
Since then the EARTH, from which they have their nourishment, has not in itself, ALL the different principles, qualities, salts, and juices, which they themselves possess, so it is necessary to allow, that this combination, is the result of the vessels of those vegetables, adapted to an inherent power in them, the same as the secretions of animals: and if it is absurd to assert (as it certainly [Page 11]is) that these different products and matters exist READY PERFORMED in the earth; so it should be equally absurd to think that the different secreted fluids in animals exist READY PERFORMED, or that their characters, are in the BLOOD.
In the perusal of this little work, the intelligent reader, it is presumed, will find reasoning and fact founded on reflection and experiment, agreeing with the truest principles of the art, and not on simple speculation: nor is it doubted but the truth and candour of Mr. Gowland's Essay will entitle his Specific to that confidence which the experience of fifty years, and the testimony of thousands, in the first ranks of society, have proved it to deserve.
THAT the following Pages had been intended for Publication by Mr. GOWLAND in his life-time, is evident:— why it did not take place, we are at a loss to surmise. They were found among other MS. papers after his death, and have been submitted in that manuscript to a Gentleman, who, from his philanthropy and medical talents, is an ornament and a blessing to the Country in which he lives. The truth of the doctrine, he declared was such, and withal so little known, that he should regret extremely if it was withheld. This observation determined the present Proprietors of his specific, on its publication, and they conceive they are doing no more than their duty, to the public, and to themselves, in demonstrating also, that this remedy has not suffered any diminution, or lost any of its virtues, in its mission from the inventor's hand to their's; in proof of which, they here adduce the following general testimony:
CERTIFICATE OF THE EFFICACY OF THE GENUINE GOWLAND's LOTION, PREPARED BY ROBERT DICKINSON, UNDER THE INSPECTION OF HIS FATHER-IN-LAW, THOMAS VINCENT.
We whose names are hereunto subscribed, being well satisfied that the use of the Genuine Gowland's Lotion is calculated, and adequate to cure the most violent eruptions of the face, &c. and also to cleanse and clear the skin in general, We seel, as if promoting a general benefit, in permitting the Proprietors, to refer any person to us who may desire such satisfaction, and also, in authorising them thus publicly to use our names.
- A. CRUGER, son to the Member of Parliament for Bristol.
- THO. MAYER, of Queen-square, Westminster, and Malton, in Yorkshire.
- RICHARD BETHEL COX, Craig's-court, Charing-cross.
- THO. HOLLOWAY, Chancery-lane.
- PETER CRAWFORD, York House, Albemarl-street.
- JAMES BAILY, York House, Albemarl-street.
- JAMES FOZARD, Park-lane,
- ALEX. WEATHERLEY, Crown-and-scepter-court, St. James's. street.
- FRANCIS UNDERWOOD, No. 228, High Holborn.
A letter from Mrs. Jane Fountain, of High-street, Maryle-bone, has in it also this very remarkable passage:
‘"I have recommended the Lotion for upwards of thirty years to all my female acquaintance, as a general cleanser and clearer of the skin, and have as constantly received the thanks of those who have used it."’
Mrs. Patterson Anstruther, of Ely House, Fifeshire, and sister-in-law to the Member of Parliament, has savoured the Proprietors with this very expressive declaration:
‘"I have found it [...] a great cleanser, and clearer of the skin, though at first it occasioned rather an alarming scurf. A. P. W. ANSTRUTHER."’
The respectability of those testimonies is such as must supersede the necessity of all further remark.
PRELIMINARY OBSERVATIONS.
AMONG the Chronical Diseases, the Eruption of the Skin is one affection, the most common, and, at the same time the least dangerous: it is not preceded by any causes, capable of inducing a disorder in the animal economy, and those who are thus afflicted always enjoy the best state of health. This excludes the idea of that humoral vice, to which some Physicians, ascribe every disorder, when the cause thereof is unknown to them. Some learned English Physicians, however, of the present day, have taken away the veil to this species of imposture, and have brought to light the vacuum that did exist in the hypothesis of humours; and yet, notwithstanding their efforts, the same prejudices nevertheless exist, and indeed, are almost general, from their works having been chiefly confined to the reading of medical men. The humourists have never been able to support their opinion beyond the most simple conjecture, the strongest of which is, that the work of Chylification and Sanguification, or of Chyle and Blood, is often ill performed, [Page 14]and consequently the fluids remove more or less from their natural state. One might answer these gentlemen, that if the aliments are not all converted into chyle, the lymphatics or lacteal vessels of the intestines do not absorb the remainder, and that they refuse admission to all matters which have either an acid or alkaline quality; that is, these vessels have a power of attracting what is proper for them, and of repelling what is not: thus their mouths become shut the instant their outer extremities are approached by these substances, and except to some violent medicines, open only to what is neutralised and fit for nutrition. In order to demonstrate this, we need but observe, that there are always matters in the intestinal canal, which are naturally in a corrupted state, namely the residium of the chylification or excrements, and which, are refused upon the same principle.
There is also in the intestines a quantity of gaz really mixed with the aliments and chyle; but this is never absorbed by the lymphatics in the pure state of gaz; I say never, because if it should happen, immediate death would be the certain consequence of such absorption: in fact, when this gaz, or ethereal fluid are injected into the cellular of the skin, or into the vessels of any animal, the most dreadful disorders ensue, and, in general, death itself. This has been demonstrated by the experiments of the Abbe Vassalli. And, [Page 15]as to the sanguification, it is demonstrated, that the atmosphere makes this admirable process,—changes and converts the fluids into animal substances, and renders them proper for nutrition: it is for this reason, that in individuals who have a bad temperament or constitution, the blood is as good, as in the most robust, and healthy. This fine and precious observation, is made by Dr. Ballonius, the Hyppocrates of France.
There are also positive vital powers, in the life of the animal, which prevent the degeneration of humours, as is demonstrated by experiments and facts; from which it results, that the circulating fluids, though they are not refreshed by new aliments, preserve themselves innocent. V. Haller Physiolog:—Tit de fame et Siti, &c. And lastly, many organs exist in the animal body, which continually purge and purify the mass of blood, if by any accident heterogeneous matter should intermix therewith: but without stopping any longer on this question, I return to my subject.
I have said that the Cutaneous Eruptions do not originate by any acrimony of the fluids: their proximate cause is an altered secretion, which takes place in the skin.
That the perspiration be a secretion, sui generis, is a fact which wants no proof, and it would be ridiculous to doubt, and question, upon any physiological [Page 16]point so evident as this is. That every secretion is liable to be changed, and more or less altered, by a variety of circumstances, there are many instances. Individuals who are seasick, often bring up a great quantity of bile, which is black and corrosive, and is very far from being in a natural state. It also happens frequently that children when cutting their teeth have very fetid Diarrhoea, from the stimulus of the gums communicating with the intestines. It is an observation of Sydenham, that hysterical women sometimes vomit bilious and depraved matters, which did not exist before the paroxism in the stomach nor in the bowels, but which had been separated during the paroxism itself.
In the same women, as well as in the hypochondriacal, when afflicted by their maladies, a very copious quantity of urine is instantaneously separated, and it is as limpid and clear, as spring water. This secretion is the sure, or as Physicians say, the pathognomonicon sign of this disorder. Sometimes fear alone will suddenly arrest the menstrua; sometimes anger will provoke an hemorrhage of the uterus. Grief and sorrow constantly occasion a greater secretion of bile, and this fluid is sometimes so acrid as to produce convulsions, or the more dreadful effects of melancholy, or pains in the intestines, or colick; and if it be by any accident absorbed [Page 17]and brought into circulation, excites some serious or fatal disorders. The secretion of the milk, by violent pathemata, or passions of the mind, has been on several occasions stopped, and it often happens that its qualities are changed and vitiated: in the last case the child is violently purged, or affected with convulsion-fits, and other indispositions and disorders. In a word, every organ, which nature has destined to perform any secretion, is subjected to the influence of the nerves, and as a certain consequence receives and partakes of all the affections of this system.
Now nothing is more certain, than that those organs, which are supplied with the greatest share of sensibility, and which have a more intimate connection (let me say) with the nervous system, will suffer more than other parts in exact proportion to the closeness of that connection. I will now ask what part in the animal body, has so much connection with, or dependence on the nerves, as the skin? Certainly none. It is from the innumerable quantity of nerves which are interspersed throughout, and actually terminate in the skin*, that this dependence and connection exists, and thus it is that the anxieties, emotions, and troubles of the mind,—the morbific state of the viscera, the tooth-ach, a bad digestion, and a hundred [Page 18]other CAUSES, are capable of influencing the transpiration, and thereby materially affecting the health of the skin; besides, that the action of the atmosphere must be calculated, and considered, as one of the most obvious, and powerful agents.
The causes last spoken of, do not always act; for instance, they do not act when the tone of the Cutaneous vessels is above the irritability of the muscular fibre; and sometimes, although an impression be made upon those vessels, nevertheless no eruption takes place, because in this case, the other secretions are augmented, in the same proportion, as the cutaneous secretion is diminished: This is especially observable in cold weather*. Hyppocrates says—Cutis densitas ventris laxitas. It is not only by the belly that this compensation of secretion is executed, but the Reins are also another Canal, by which the superfluous fluids are commonly evacuated.
Persons of an irritable temper, a great mobility, a fine a delicate skin, and a disposition to the cutaneous eruptions, suffer very much from the humidity and vicissitudes of the air, and every kind of irritation. The animal powers in such individuals are very often insufficient to prevent the disorders in question.
One reflection ought here to be made; it is, [Page 19]that a great number of persons are ignorant of the cause of their complaint, although it really exists in themselves; but where the causes are so extremely numerous, it cannot be expected I should enumerate them all: yet in order to be understood, I shall instance a few facts, and at the same time observe, that the effects frequently remain, when the primary cause has ceased.
There are many women, who, in certain delicate circumstances, are frequently troubled with efflorescences, pimples, &c. in their faces, hands, legs, &c. but who, not perceiving any sensible unusual trouble, or inconvenience, do not immediately think of the stimulus that exists in the internal organs, and are therefore far from conceiving it to be the cause of the present cutaneous affection.
A great eater, who vigorously executes all the functions of life, and is perfectly well, never suspects that his stomach is stimulated by the farrago of aliments, with which it is continually assailed; but seeing the surface of his body covered with eruptions, is disposed to attribute them to any cause rather than the true one. But there is a variety of stimulus, of which our internal organs are sensible, that we do not perceive; thus, we have no sense of the stimulus excited by the blood circulating in the heart, nor of that which the juices of the stomach occasion [Page 20]in its nervous membrane, and which the bile and other juices, occasion in the intestines, &c. &c.
If these different stimulus, and many others, I do not speak of, are increased, and become violent, then not only the proper organ where the specific fluids are separated and collected, but other parts, are, by sympathy, sensible thereof, without any knowledge or consciousness of the mind. It is from effects that a knowledge of the wonderful laws of the animal economy is obtained; and in order to prevent mankind's being any longer mistaken, as to the real sources of cutaneous eruptions, I have endeavoured to explain them the more fully, that they may be the better understood.
I have said, that the sensibility and mobility of the arterial vessels are so very great*, that they sympathize, extremely, with all the nervous system, but, particularly with the stomach, the intestines, and the womb, &c. and also, of the peculiar influence, which, the passions of the mind, affecting the nerves, have upon the skin; nor, must we forget what is still greater, the action of the atmosphere, to which the face, particularly, is always exposed. Since then, there are so many [Page 21]agents to disturb the functions of the skin, it is not extraordinary to see the surface of the body, and particularly the face, so often affected with lumps, blotches, pimples, efflorescence, herpeys, &c. &c.—indeed, it would be more extraordinary if it was otherwise.
The action of stimulus, directed now to one part, and now to another, gives occasion to partial eruption, and the character of this eruption differs, according to the nature of the stimulus, its duration, and, of the sensibility of the person affected.
These appearances, sometimes, resemble scorbutic spots, and the practitioner, not well instructed, often confounds the one with the other, but without reason; because the real symptoms of scurvy, never attend the affections we are speaking of.
It is truly important to determine the true cause of this disorder, for, from hence, one ought to deduce the medical indications; and I have endeavoured, in my little work, to fix this point, assisted by reason, experience, and authority.
In order then, to demonstrate the severe consequences which obtain, by a wrong and false principle, we need but reflect upon the ordinary method of humourists in the case in question; they always begin by purging and bleeding, and [Page 22]so prepare the body to the use of remedies, which they call sweeteners and balsamicks.
This plan is as infamous as their theory, as it serves merely to weaken more and more the constitution, and, from hence, the cutaneous affections take a greater extent, and its character becomes more hurtful, severe, and uneasy. Experience so fatal ought to teach them to renounce a practice which is always useless, and frequently dangerous.
Another remark must be made on the method of humorists; it is, that they attempt to cure in the same manner all the unhappy persons which fall into their hands, however various may have been the cause. If in their opinion an acrimony does exist, it cannot be the same in all individuals; nay, it must extremely differ from one another from their tempers, constitution, age, customs, and passions, and, to be corrected, its nature should be known, &c. It is another argument of the absurdity of the treatment employed by the humorists, and is also, equally a proof, that they have not an idea, nor just nor false, of the acrimony which they undertake, and pretend to destroy, and, that they exercise the art blindly.
The good practitioners, instead of occupying themselves, to correct an imaginary vice of the blood, direct their thoughts to the skin, as there is the focus and seat of the disorder.
The qualities of the eruption are not always the same, nay, they differ materially, not only in different subjects, but also in the same individual; for a person may have spots, herpeys, blotches, &c. &c. all at the same time, which could not happen if the vice was in the blood, for then they would be all of the same species of eruption, which is not here necessary, as it proceeds from an altered secretion, and this secretion is not every where the same, but changes in different parts in the same body, because every part, nay, every point of the body, is furnished with ITS OWN sensibility, and as the physiologists say, "Sua fruntur vita."
It might seem contradictory and paradoxical, that we should propose one remedy as the specific in all these cases; but it is not so, for we are NOT intending by THIS remedy to attack the bad qualities of the matters which occasion the local disorder, because we know not their intrinsic nature; there is another way for us to take that is more short, easy, and at the same time sure; it is to alter the action of the vessels which prepare it improperly,— IT IS TO CHANGE THE CUTANEOUS SECRETION, by applying to the vessels themselves. The small arteries which filtrate the perspirable matter, are affected with spasm; I say, with spasm, for I see that the remote causes of the eruption act upon the skin [Page 24]as stimulants; and I observe, that, if the stimulus be momentary, the eruptions almost always disappear spontaneously, with swiftness and facility. When the stimulus has been of long continuation, the spasm continues though the stimulus has subsided, and EXISTS NO MORE.
From the foregoing reflections, it is easy to perceive, that the principal indication in the cutaneous affections is TO RESOLVE THE SPASM, from which the preternatural secretion depends, and to give a bland tone to the cutaneous vessels.
The Lotion produces this effect, by calming the spasmodic contraction, and restoring the tone of the excretories, and the cutaneous vessels.
It often happens, that in the first moments, the use of the Lotion increases the eruption, because the action of the skin becomes more easy and natural: this symptom, besides being demonstrative and satisfactory, announces always a very quick recovery.
Generally the recovery is not rapid, but comes on slowly, and in proportion as the vessels approach their former state, and usual manner of acting.
THE ANATOMY OF THE SKIN.
ITS IMPURITIES, AND THE CAUSES THEREOF.
NATURE has been no less bountiful and attentive to the structure of the external covering, than to the more noble parts of our frame; it is no less remarkable for its general use, than for its beauty; it is composed of two parts, viz. the epidermis, or scarf-skin, which is the external, and the cutis, or true skin, which is underneath: the first is inorganic; the other is, what anatomists call highly organized, being made up of arteries, veins, and nerves, and exquisitely formed to convey to the mind, the various impressions we receive, which impressions, we call feeling.
It is beset with many small glands, for separating the perspirable matter, and with others also, which furnish a different and a more mucilaginous fluid, contained in a fine reticular, or network substance, between the outward and inward skins, to sheath the nerves from injury, and regulate the sense of feeling, which would, without such protection, be too exquisite. The internal surface becomes insensibly of a less firm texture, and at length degenerates into the cellular membrane; a great number of arteries, and still greater number of veins, extend themselves within its substance; the lymphatics distributed upon it, are also very numerous, as well as the nerves, the extremities of which evade the observation of the most discerning anatomists.
The scarf, or outward skin, is a very fine transparent membrane, in the composition of which, neither vessels or fibres are observable; it is, in itself, not endued with a sense of feeling,—easily separated from the parts beneath,—is renewable when it peels off, or is destroyed by any accident; —it is pierced by an infinite number of pores, which afford a passage to the hairs, and in which, terminate, the lymphatics and excretory ducts of the sebaceous glands; it is preserved soft and supple, by the mucus secretion below it, and by the perspirable matter opening on it, through those innumerable pores. It is generally imagined by anatomists, that, this membrane is formed by the condensation of a fluid, furnished by the extremities of the capillary arteries.
Under the true skin, and over the muscles, Nature has placed another covering, called the membrana cellularis, or cellular membrane; between this membrane and the true skin, lie a number of small glands, called sebaceous glands: these glands have one or more excretory ducts, every where opening on the surface of the skin, through which is transmitted the fluid the glands secrete, to lubricate the skin, and keep it lax, and a very important office they do perform. Other glands separate a fatty matter of the skin, of the nature of suet, and these are found, in those parts of the body, which are most exposed to the action of the air; in other parts it does not contain any.
The skin is capable of being distended, and of contracting itself to a surprising degree; it has a variety of uses; but we shall confine ourselves to that one only, which is most particularly interesting to our subject, namely, the secretion of the matter of perspiration. I must not here be understood as speaking of a fluid floating in, and circulating with the blood, but, of a fluid which the vessels and glands themselves prepare and elaborate, upon which, they impress characters of a greater, or lesser, degree of malignity, according [Page 27]to the degree of stimulus with which they are oppressed. This matter, in its natural state, is only a watery fluid, but when by any exciting cause, its quantity is increased, its nature is changed, and it immediately appears to contain a saline principle, along with a certain quantity of inflammable air.
In acute diseases, convulsions, and epilepsy, its alterations are frequently very remarkable, so that its smell becomes disgusting and intolerable. From numberless other causes, it frequently happens, that this secretion is wonderfully changed, so that the matter furnished by it, adheres to, and corrodes the skin, and forms a chronic cutaneous disease.
This last subject, is meant to be investigated in this Treatise.
OF CUTANEOUS ERUPTIONS.
THE appearance, of cutaneous eruptions, varies considerably, either on account of the different sensibility of the persons affected, or, of the different character of the secreted fluid.
Sometimes they present themselves, as a red efflorescence, under which a white powder is formed, which, after some time, falls off, and leaves the skin apparently healthy; the efflorescence, however, again makes its appearance, and again goes off in the same way. These alterations continue for life, unless cured by a topical remedy.
At other times, there are very small pustules or pimples, like millet-seed, filled with a transparent water, which when shed, condenses and forms crusts or scabs; these detach themselves, but the skin underneath being inflamed, pours [Page 28]out fresh matter, which undergoes the same change as the first.
Sometimes, likewise, there are pustules, containing serum, which at first is white, then becomes yellow, excudes, and is converted into crusts; at other times the disease puts on the appearance and symptoms of the itch. What is called black worms frequently appear on the nose, the chin, the cheek bones, &c. this is the sebaceous matter of the glands, obstructed and lodging in the ducts, which when squeezed out, have the appearance of worms; the blackness at the outward extremity is dirt, too much insinuated to wash off; and the reason they infest these parts particularly, is owing to the ducts being larger on those extremities than in other parts.
And lastly, in other instances, there is only a redness in the skin, or spots, which prove extremely troublesome, from the itching which attends them. Sensations of pricking and itching almost constantly attend diseases of this nature, and it scarcely ever happens, that they go off of themselves.
That these diseases of the skin, are, in general, simply local affections, was an opinion entertained by Dr. Cullen, one of the most enlightened Physicians of the present age; and from the numerous remote causes, it evidently appears, that a DEPRAVED SECRETION, in the cutaneous capillary arteries, and the vicious elaborated matter, by the cutaneous glands, are the proximate cause of the disease.
I. This acrid and corrosive matter, could not exist in the mass of blood, without exciting grievous disorders in the animal economy; but, as the latter does not exist, there is not any reason for supposing the existence of the former.
II. Those persons who are subject to eruption, generally enjoy good health, and execute their functions without inconvenience.
III. Those who have a bad constitution, and in whom one might, with some appearance of probability, suppose an acrimony existing in their fluids, are least of all subject to eruptions. They are never met with in cases of chlorosis and cachexy.
IV. The eruption is generally confined to some one particular part; as to the nose, the cheeks, the breast, or the extremities, but almost, always, to the face alone.
If it were true, that the arteries received from the blood, the matter which occasioned the eruption, and that they discharge it upon the surface of the body, why do they not discharge it in equal proportion upon every part of it? Would it not be absurd to suppose, that the artery A, or the artery B alone, should have a power of selecting, every thing viciated, from the general mass, whilst all the other vessels of the system receive their blood from the same source?
V. Cutaneous disorders, are not peculiar to any particular class of individuals, but attack all without distinction.
Thus, we meet with them alike, in the voluptuary, and the ascetic; in those who are little sensible to the allurements of wine, or the still softer ones of love; in those who do not work, as in those who do: in a word, the disease attacks persons of all temperaments, characters, and passions. This, precludes every suspicion of a specific acrimony of the humours, as it could not be found in the midst of circumstances so opposite to each other.
VI. And lastly, if there really existed a disease in the fluids, some advantage might be derived from the use of those means, which Physicians have characterised under the titles of edulcorants, refrigerants, balsamic and antisceptic medicines; but, on the contrary, experience has unfortunately shewn, that instead of the patients receiving benefit from their employment, the disease is uniformly exasperated, and [Page 30]becomes worse and worse: for confirmation of this fact I have only to appeal to the tribunal of those who have been the victims of their credulity. The skin is therefore the source of the eruption.
M. Lorry, a very ingenious French Physician, who has written a very voluminous work upon cutaneous diseases, adduces many instances of persons, who the instant after having eaten of certain kinds of aliment, or taken certain liquids, had the face, or some other part of the body covered with pimples, which disappeared as soon as the irritation of the stomach had subsided.
Eruptions, also, frequently appear, in a very remarkable short time after drinking cold liquors, particularly cyder, when heated; this is one eruption which often finally becomes a real chronical cutaneous disease.
Riverious Hoffman, and all eminent practitioners, have remarked, that, the saburra of the alimentary canal, frequently occasions erysipelatous affections, which go off as soon as the saburra is evacuated.
Pechlin, quotes examples, of instantaneous eruptions, produced by violent emotions of the mind, and the history of medicine teems with similar examples.
A woman, Hyppocrates tells us, had, during pregnancy, an exanthematous affection of the face, which went off immediately after delivery.
There are many women, as M. Lory has observed, who in certain delicate circumstances, have eruptions which last as long as their cause continues to exist, and no longer.
From these observations, it is evident, that the skin has a consent or sympathy with every part of the nervous system, —that every impression, whether physical or moral, may easily become an indirect stimulus to the skin, and, that this stimulus is capable of altering its functions in such a way, as to give rise to a secretion of an acrid matter, and consequent eruption.
Since we are here in possession of causes which explain, in the most satisfactory manner, the origin of cutaneous diseases, it is by no means necessary to seek for another in the blood, and gratuitously suppose the existence of an universal acrimony.
The term acrimony, is, in its application, extremely analogous, to the occult qualities so much in use, among the ancients; that is to say, a term void of sense, a term, to which Physicians only associate false and arbitrary ideas.
The acrimony which is generally accused, is that of the scurvy.
It is commonly the want of sound fresh animal food, with the want of vegetables, which gives rise to the scurvy; but, in London, neither of these is wanting: we are provided with excellent fermented malt liquors, as beer and porter, with brandy, rum, and other spirits, and foreign wines, which may all be considered as so many antiscorbutics*. We are not in the neighbourhood of marshes; salted or smoak-dryed flesh or fish do not constitute any considerable part of our food, neither do we drink putrid or stagnated water, which give the disposition to scurvy. In a word, however it may have suited the interest of regulars or irregulars to insist upon it, our mode of living, and our situation, are by no means, favourable to its production.
Scurvy is preceded or accompanied by symptoms, which are never met with in the cutaneous affections of which we are speaking. In fact, the scurvy begins by a spontaneous weakness, or sense of weight in the whole body, pain in the muscles, inability to walk, a difficult and laborious respiration. The colour of the face of scorbutic patients, is pale and sallow, the mouth exhales a fetid smell, the gums become red, painful, and flabby, and liable to bleed upon the slightest pressure, the teeth fall out, flying pains are felt in [Page 32]different parts of the body, bleedings come on, and lastly, (and not till then) ulcerations make their appearance, particularly in the legs, and the skin becomes covered with an itchy eruption, pustules, and crusts.
The matter which produces the eruption is so acrid as to corrode the skin, and its smell is highly disgusting and alkaline. This short sketch evinces the enormous difference, which obtains between simple affections of the skin, and the real scurvy.
Those who confound them together, either are unacquainted with the causes, and nature of these diseases, or they abuse the confidence which the world, without sufficient examination, may repose upon their talents or integrity.
Having laid down these principles, which are supported both by reasoning and facts, I may advance, without running a risk of being accused of temerity, that, cutaneous affections, being a local disease, require a local treatment.
(NOTE.) The single authority of Mr. Gowland upon this point, may not, perhaps, be of sufficient weight to carry along with it conviction and persuasion, but, the world, surely, will not refuse to accord its confidence to that of men of science. The Proprietors, therefore, take the liberty of adducing the authority, of one of the most respectable surgeons, this, or any other country can boast of, and, whose works are known in every part of Europe; we mean the Professor Bell, of the University of Edinburgh.
"It was" says he, "till lately believed, that eruptive diseases of this nature (herpetic) could never appear but in consequence of some general morbid affection of the system, and, accordingly, a great variety of internal remedies have been recommended, by almost every author who has written upon the subject. It has even been commonly considered, as an unsafe and dangerous practice, to attempt the cure of [Page 33]such eruptions in any other way, than by correcting the fluids which at first were supposed to have produced them: it is somewhat singular, however, that the opinion should have remained so long uncontroverted by regular practitioners; as, from the writings of many old authors it appears, that complaints of this kind were constantly and easily cured, as they still are, by every itinerant, with local external application only.
"This, we should imagine, ought, very soon, to have overturned the general notion, which prevailed with respect to the nature of those disorders, and which seemed, all along, to have no other foundation than antiquity for its support. Modern practitioners, however, not being shackled by such authority, have, in many instances, ventured to dispute, and boldly to deviate from, the opinions of their predecessors, and the improvements which have universally resulted from such a free spirit of enquiry, have never yet given them reason to repent their having done so.
"This, in no instance, has been more remarkable, nor attended with better effects, than in the treatment of cutaneous disorders, which, from having been very perplexed, and intricate, will soon, it is hoped, become a very simple, and easy part of the practitioner's employment.
"Instead of the tedious, and debilitating courses of medicines, which patients went through formerly, and which, perhaps, they are still too frequently obliged to undergo, it is now found, that the greatest number of these complaints, are more certainly, and speedily removed, by the use of local remedies merely, than they ever were by a contrary course."
BELL, on the Theory and Management of Ulcers.
Sect. ix, page 336.*
Bell became convinced, by long experience, that the external application of medicaments, rarely disappoint the expectations of the Physician and Patient. He enumerates several of those employed, as well by him as others, and observes, that the principle dependence, is to be placed upon those which are of an astringent and drying quality.
I have been able to discover a remedy which I may with the greatest propriety stile "the Specific for Cutaneous Diseases;" it has a great advantage over those which have generally been employed, namely, that so far from possessing any the slightest repellant quality, it is the very reverse, and acts in a mode diametrically opposite thereto. Its operation confists in taking off the spasm of the extremities of the capillary arteries, removing the inflammation where it exists, and gradually bringing back the excretorious vessels to the discharge of their natural functions.
Some days after its employment, the inflammation disappears, and consequently the transudation; after which, the skin resumes its natural state and complection. If there are any pustules, they become in the first place less troublesome, which shew that the lymph they contain has lost somewhat of its malignant properties.
Lastly, they disappear altogether, and never appear again in any part of the body, except some new cause arises, or that the natural texture of the skin should be inadequate to resist the power of the external air, in which case its application should be sometimes repeated.
In those cases, which, actually owe their rise to some specific virus, as the scrofulus, venereal, &c. even though the morbific cause be destroyed, the local disease of the skin is incapable of curing itself. Vessels which have been in the habit of making, a depraved secretion, do not of themselves, change this disposition, although the mass of [Page 35]blood and the constitution be in a healthy and natural state. Van Swieten, when speaking of venereal ulcers, has made this observation: Here the necessity of a topical treatment becomes particularly evident; that is, the application, of a remedy, to the part affected. Thus, the Lotion is productive of the greatest advantage, even in scrofulus, and scorbutic cases.
We have said, that there are sebaceous glands in the skin, the excretory ducts of which, throw out a suetty matter, and that there is likewise a great number of excretory vessels, which are, a continuation of the capillary arteries.
These ducts and vessels, are frequently, constricted by sudden cold, so, that the matter which ought to be exhaled, is pent up, and if not evacuated by the intestines or kidneys, it forms tubercles, or hard knots, and small vissicles, as has been observed, by the celebrated Ludwig.
The face, is the most common seat of the eruption of which we are speaking, on account of its being exposed more than any other part of the body, to the action of the air. Eruptions will sometimes frequently remain, after the cause has ceased; for, nature is not always equal, by its own power, of reestablishing these minute organs in their natural functions; in consequence of which, the skin remains disfigured, not only by a partial redness, but by scabious irregularities on its surface, and even by matter contained in pustules, and by crusts, which arise from the condensation of the lymph, escaping from the vesicles.
If this affection be unfortunately neglected on its first appearance, it soon overleaps its first limits, extends its sphere of action, and every day gives additional force to its malignity. This disease, commits horrid ravages on those persons whose general system is in a state of debility.
The female sex, the endearing bond of society, when once attacked by these disorders, suffer more from them than men, on account of their skin being possessed of a far greater degree of delicacy and sensibility.
How distressing must it not be to a fine woman, to the perfecting of whose face nature has lavished all her power, to find the beauteous fabric spotted and discoloured with disgusting pimples, which destroy the effect of all her charms? It is in this case, that the imagination, whose influence on the softer sex is so very extensive, takes the lead, exasperates the disease, and renders it a thousand times more obstinate: and yet I can assure my readers, from long and assiduous observation, drawn from the experience of many years, that these impurities, arising from obstructed perspiration, are the easiest of all others to overcome. The vessels, when once freed from the matter contained in them, and which has become foreign and vitiated by stagnation, readily resume the tone and energy necessary for cutaneous secretion.
The Lotion, constantly produces this effect; it washes and cleanses the surface, and, by penetrating within the small, obstructed vessels, dissolves the condensed fluids contained in them, and facilitates their expuision.
When this is executed, the skin resumes its natural state, becomes smooth and polished, and, exhibits that brilliancy of tint which depends upon the free circulation of the fluids in the cutaneous arteries, and, the continual afflux of those, furnished by the different glands and vessels, which are found in the skin.
In addressing my reflections to the public, I have advanced, that simple cutaneous diseases, are local affections only, and I have given proofs of the truth of this assertion; I have said, that, the mode of treating them, ought to be local; and, both authority, facts, and reasoning, have confirmed what I have advanced.
I have asserted, that my Lotion, is a Specific for these Eruptions; and I appeal to those who have experienced its efficacy, after they had been disappointed by internal means: [Page 37]thus, the goodness and infallibility of my Specific, is a sufficient answer to, and compleatly confutes the invidious attacks that have been made against me, for its introduction.