By Jonathan Reinarz and Kevin Siena (eds)

Illnesses affecting the surface have tended to impress a reaction of specific horror in society. With visible and infrequently repellant outward symptoms of illness, they have been usually looked as if it would be hugely contagious, in addition to synonymous with immorality. Such connotations can have stemmed from the tell-tale buboes of syphilis, however the social stigma of disfigurement is anything that also exists this present day. This selection of essays makes use of case experiences to chart the clinical heritage of dermis from the eighteenth to the 20th century.

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The side effects of opium were well known – vomiting, constipation, depressed respiration – and Pott makes reference to the need to keep increasing the dose as the patient developed tolerance. Pott also lectured repeatedly on the age-old problem of surgeons causing pain unnecessarily just to be seen to be doing something, for example in the cases of children who were unable to pass faeces due to an imperforate anus. This was a congenital problem that Pott frequently encountered; he instructed students to resist making any kind of opening in the skin: I know of nothing surgery can do for it – I mention this to you on your Guard, & to enable you to resist a Proposition often made in this State of things; the People belonging to the Child will say, the Child is certainly dying, give it the Chance of Life by pushing in your Knife or Trocar … I never would do what must give pain … even if you should happen to thrust the Instrument within it, it can only afford a temporary Relief, the child has no Rectum … & therefore it could answer no end, & I have seen a trocar pushed up as high as possible to please the Parents, from which a Gush of Urine has flowed & no feces & the infant has soon died, I wont say from [what] but with a wounded bladder …60 We have no evidence that Mr Peters ever gave James Channon any opium, and he never mentions the use of an anodyne, the early modern medical term for a Drain, Blister, Bleed 27 moderate painkiller.

37 The old Surgeons were terribly afraid of opening large abscesses – Hence Mr. 38 To demonstrate he was unafraid of operating on large infected abscesses, Abernethy described the case of a woman with a two-foot circumference swelling on the inside of the knee. Over four years it had grown from the size of an egg into an enormous and debilitating soft tumour. Bedridden for two years, the woman was hospitalized at her family’s plea when the swelling: ulcerated, sloughed, and left a cavity of the size of a pint-bason.

Kirkland stated that such information came from making incisions in the wound over several days. Incising the skin when bubbles first form produces a discharge of blood; however, if incision is made when the skin inflates, one gets a large discharge of wind and frothy matter. Later, if one pierces the skin, the blood will be black and the muscles putrid. Finally, the skin becomes livid and putrid. The rotting of wounds thus progressed from the inside to the outside of the skin. Kirkland argued that hospitals hastened and aggravated this series of events for three reasons.

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A Medical History of Skin: Scratching the Surface by Jonathan Reinarz and Kevin Siena (eds)

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