The Book of Skin (review)

As a dermatologist and a student of the history of medicine and dermatology, I found this book most interesting. In fact, I had never thought of some of the connections with the skin that the author examines in detail, and I suspect that many other dermatologists would say the same.

The author, a professor of modern literature and theory at Birkbeck College in London, opens with a short essay beginning, "Like a tailor, I cut out these portions of cutaneous tissue into a suit of clothes. I adjusted the front, the back, the arms, the legs until it was a single sheath which could envelop me completely, head, feet, hands, and all. . . . Carefully disguised zip fastenings allowed me to slip into it easily" (p. 7).

Ten chapters follow to cover every aspect of the largest organ of the body: complexion, exposition, disfiguring, impression, stigmata, off-color, unction, aroma, itch, and light touch. Each chapter is developed with extensive discussions from both medical and nonscience literature. To discover so much material and weave it all into a book is a feat both remarkable and commendable.

Illustrative of the effort is the chapter on exposition. A scar, for example, can result from an accident or from surgical intervention. A child learns that a wound "results in a mark, of abrasion, contusion, inflammation, or incision" (p. 51). After a few weeks, the scar can abate or become permanent, as in the case of the hypertrophic scar or keloid. Connor points out that in the English language the skin is like the bones, for we say "the skin has been broken," while the French idiom, entamer la peau, does not suggest breaking through a hard surface (pp. 51-53).

In the chapter on disfiguring, he calls attention to the markings of prisoners and slaves at various times throughout history. In Victorian England, naval deserters were tattooed with a letter D. Few can forget Hester Prynne's "A" in Hawthorne's The Scarlet Letter. Tattooing, so much in vogue today, has been popular in various eras. This custom is prohibited in Judaism, yet endorsed by Paul in the New Testament. Dermographism, the property of the skin to show linear marks, is sometimes found in patients with atopic dermatitis and cannot necessarily be controlled with current medication.

Nevi, more commonly referred to as birthmarks or moles, have been the subject of much speculation. Daniel Turner, who wrote the first book in English on skin disease, perpetuated the idea in De Morbis Cutaneis (1714) that the mother could influence the appearance of nevi on her fetus through dreams and bad wishes. Moles have also been thought to portend astrological events, even being referred to as "fleshy or terrene stars."

The scholarship appears to be of a high order and the references appropriate. The book contains some excellent complementary photographs and illustrations. Although it is exhaustive in scope and will be a useful source for physician and laypeople, this book is not an easy read.