ANOMALIES 
OF - 
PERSPIRATION 
By }. H. Pooi.ey, M. ID., 
Lecturer on Surgery in the Columbus Medical College, 
COLUMBUS, OHIO. 
Reprinted from the Ohio Medical Recorder, Nov. 1880. 
Columbus, o. 
COTT & HANN, PRINTERS, 
iS8i. (Reprinted from the Ohio Medical Recorder for Nov:, 1880.) 
ANOMALIES OF 
PERSPIRATION. 
By J. H, Pooley, M.D., 
COLUMBUS, O., 
Lecturer on Surgery in the Columbus Medical College. 
In my last paper I had occasion to notice the excessive and some- 
times otherwise altered perspiration caused by injuries to the nerves* 
In this I propose to consider the various anomalies of that function un- 
connected with injury. And as the last paper was mainly taken up 
with cases from my own practice, so this will consist principally of 
those recorded by others. 
The various anomalies of the perspiratory function may be included 
under the following heads, viz.: Hyperidrosis ; Bromidrosis ; Chromi- 
drosis ; Hemidrosis ; Urinidrosis ; Phosphoridrosis ; Anidrosis: or, ex- 
cessive, odorous, colored, bloody, urinous, phosphorescent, and deficient 
sweat. 
I. Hyperidrosis. — Synonyms ; Idrosis, or Hydrosis ; Sudatoria ; 
Ephidrosis ; Polyidrosis; Hydropedesis ; Hypercrinia Sudorale; Ex- 
cessive Sweating. 2 
By these various terms is designated a condition or disease which 
consists essentially in excessive secretion from the sudoriparous glands, 
without any perceptible change in their structure. It may be general, 
but except when it occurs as a concomitant of certain well known dis- 
eases, such as phthisis or rheumatism, it is more commonly local, as of 
the hands, feet, &c., or partial, being confined to a portion only of the 
body, as one side, when it is called unilateral. The excessive secretion 
is in many cases strictly normal, different in no respect from healthy 
sweat. Sometimes it is abnormal, having a decidedly acid or alkaline 
reaction. In certain situations, as the feet, it is apt to be fetid ; it will 
then come under another division of the subject. Some of the subjects 
of this disorder seem to be otherwise in perfect health, but in the ma- 
jority of instances some concomitant disease is manifest, the most fre- 
quent complications being heart disease, malaria, and particularly some 
one of the so-called neuroses ; indeed it may be said that the weight of 
evidence is sufficient to induce us to regard the hyperidrosis itself as 
being in all cases essentially a neurosis of the sympathetic or vaso- 
motor system. It exhibits all grades of severity, from a slight increase 
to such an excess of secretion that it pours in streams from the sur- 
face ; it may be constant, but is more frequently more or less intermit- 
tent or paroxysmal, and may be increased or excited by various excite- 
ments or stimuli, both physical and mental. In some recorded cases 
the temperature of the affected part was markedly increased, in others 
it was lowered. Generally the annoyance to the patient is confined to 
the mere presence of the excessive moisture ; sometimes disagreeable or 
painful sensations are present, such as tingling, pricking, a feeling of 
bursting, &c.; the general health does not appear to be much affected; 
in one case there was metastatic transference of the phenomenon. 
The following case has recently come under my observation, and 
may be said to be the efficient cause of this paper, as it first drew my 
attention to the subject. 
H. S., aged twenty-one. A tall, slender, rather pale and delicate 
looking young man, consulted me for excessive and almost constant 
perspiration of the palms of his hands. He has been the subject of this 
curious affection for as long as he can remember ; when a boy at school 
his school-fellows used to make fun of him on account of it. His gen- 
eral health is moderately good, but only moderately so; he suffers at 
times from feelings of debility and exhaustion, and has a good deal of 
back ache; indeed, without any well defined ailment he is at times a 
type of what weare in the habit of designating as a nervous invalid. The 
local trouble as already indicated is not at all times equally severe ; as a 3 
rule it is worse when he is feeling poorly, and vice versa. When at its 
worst his hands are thoroughly wet with sweat which rapidly accum- 
ulates, and either runs off, or necessitates frequent wiping, and this 
when the rest of his body is free from perspiration ; indeed, his brow is 
generally free from sweat; he perspires rather freely in the axillae. 
Bough use of the hands, as in handling gardening tools, rather dimin- 
ishes the sweat, but using a delicate implement, like a pen, increases 
it. One singular feature of the case is that directing his attention to 
the subject, as by talking about it, examining his hand, &c., increases 
the secretion very remarkably. I prescribed ergot, but without any 
benefit. I am acquainted with a gentleman who is the subject of uni- 
lateral sweating of the head and face, to such an extent as to attract the 
attention of all his friends. I have never been consulted by him on 
the subject, but have understood that he had some form of heart trouble, 
either functional or organic, and some of his friends consider him to be 
quite hypochondriacal about his health. Another acquaintance of 
mine sweats from a small area or point about the middle of his chin, 
which he calls his sweat gland, and this takes place when there is no 
moisture on any other part of the body ; he is, and has been for many 
years, in delicate health from pulmonary disease. Let us turn now to 
some of the recorded cases. 
“The following singular example of partial sweating was communi- 
cated to the Medical and Physical Society of Bombay, by A. Duncan, 
Esq. A man was brought as a recruit to the 25th Regiment, Native 
Infantry, from the warlike .little territory of Sawant Warree. It was 
found on the slightest exertion that moisture oozed profusely from his 
hands and feet. He was a stout, able bodied, healthy looking man, 
such as it would be desirable to have an army composed of. The word 
attention being given, forthwith on clasping his hands, and that not 
very forcibly, the perspiration poured rather than dropped from them, 
the ground was also bedewed around the edges of his feet, and on 
changing his place, there were his foot prints in thorough wet. Being 
on a cow-dung floor, and desired to step about, every step was im- 
printed wet. His body remained unaffected. He stated that he had 
been all his life subject to this affection ; that he was able to work like 
his neighbors, but got fatigued rather soon ; that the various excretions, 
so far as he knew, were the same in quantity and kind as those of 
others ; that his appetite was similar also ; in short, no difference could 
be discovered between his usual state of health and that of others of 
good habit, except this singular flow of clear perspiration from the 
palms of his hands, his fingers and feet. 4 
“Mr. D. had no opportunity of watching the man, to know if all he 
had said as to his habit of body was entirely accurate ; he was evident- 
ly unfit for military service, as the grasping of a musket brought the 
perspiration streaming from his hands.”—India Journal of Med. and 
Phys. Science, January, 1837. 
In the following cases the affection seemed to own a malarial origin. 
Gaarder reports a case of hyperidrosis, affecting the right arm only, 
which was marked by a periodical remission. At night there would 
be a remission, in the forenoon was a tingling sensation in the limb, 
and in the afternoon the sweating was most marked. The treatment 
was quinine, in pill form, two grains every hour. On the third day 
after the commencement of the treatment, the hyperidrosis had ceased. 
St. Louis Clinical Record, p. 226, Dec., 1877. 
Dr. C. H. Lothrop, of Lyons, Iowa, in the Transactions of the Iowa 
State Medical Society for 1880, quotes from a letter of Dr. L. P. Yandell, 
in which, among other remarks on the subject of malaria, the writer 
says : “I have just cured a case of Polyidrosis of the hands and feet, in 
which the perspiration at 4 o’clock daily, and for many hours, dripped 
in quantities from the extremities, as water drips from your hand 
when you hold ice in it on a summer’s day.” 
The following case, also apparently of malarial origin, is very re- 
markable from the rise of temperature on the affected side. It is re- 
ported in the Virginia Medical Monthly for July, 1878, by Dr. Meri- 
wether Lewis, of Lenoir, Tenn.: “In the summer of 1877, Mr. Gran- 
ville Morton, aged thirty years, married, pame under treatment for in- 
termittent fever. While improving rapidly on appropriate treatment, 
he exposed himself improperly, and was taken with pneumonia of the 
right lung. The left lung, also, soon became affected—never so much, 
however, as the right. Six years before the patient had undergone a 
severe attack of the same disease, affecting chiefly, as at the present 
time, the right lung. The present attack passed through the usual 
stages, presenting the common physical signs of the disease in a very 
marked and beautiful manner, and by the twelfth day the stage of 
resolution was fairly established. He was cured of the pneumonia, but 
not, as the sequel shows, of chills. Eight days elapsed, and then the 
* everlasting chills,’ as he called them, returned. And now the strange 
phenomena of the case began to occur. The paroxysms, coming on 
between three and four o’clok P. M. on each alternate day, presented 
the usual symptoms of intermittent fever, with the exception that the 
sweating stage became longer and longer, until, finally, it lasted almost 
the entire night, and the perspiration was confined strictly to one side 5 
of his body—the right—and never passed beyond the median line. Be- 
coming as it were, true nocturnal perspirations in character, and ex- 
patient by their disproportionate severity, they were 
treated accordingly. In addition to regular doses of quinia,the patient 
received a special treatment for the prespiratory stage in the following 
prescription : 
R. Quinise sulphatis 3 ij 
Morphise sulphatis grs. vi 
Zinci sulphatis 3 i 
Ac. BUlph. aromat g i 
M. Twenty drops in water every four hours during the night. 
Under this treatment the chills soon ceased to occur, while the noc- 
turnal sweating continued to some extent for several nights. Gradual 
improvement, however, was merged into complete relief on the seventh 
night by the addition of sulphate of atropia to the prescription. From 
this time the patient’s health continued pretty fair for nearly a year, 
when he was again attacked by his old enemy, the chills. Unilateral 
perspiration again took place, but did not amount to hydrosis. Recov- 
ery rapidly took place under appropriate treatment, but still the pa- 
tient continued to perspire, when at all, on one side only, never exceed- 
ing the exact median line. I extract from my case-book the subjoined 
examination of the patient at the beginning of this attackMarch 
15t.h, 1878: Right side perspiring freely to the median line; left cold 
and dry. Temperature in the right axilla, 104° F.; in the left, 100£° F. 
Lungs; right, some dullness over upper lobe; sounds normal with the 
exception of slight mucous rales in the upper part; left, perfectly nor- 
mal. Heart normal in size and action. Some soreness of spine over 
the first and second lumbar vertebrae. Pulse 88; appetite moderate; 
bowels regular; kidneys normal; perspiration intensely acid; urine 
free from albumen ; phosphates and chlorides abundant. Another ex- 
amination made on the 10th of April, 1878, gave the following results : 
Chills have ceased, right side perspiring slightly; temperature in the 
right axilla 100° F., in the left 98£° F.; perspiration acid ; kidneys, and 
all his organs generally, in a pretty normal condition. Is actively en- 
gaged on his farm. 
“As perspiration tends powerfully to prevent, as well as to reduce, ex- 
cessive temperature, it is exceedingly strange that there should be a 
difference of 3£° F. in favor of the dry or unperspiring side. While the 
former attack of hydrosis was at its maximum last summer ( 1877 ), 
there was frequently a difference of two degrees F.; but this was never 
exceeded. At that time the perspiration was neutral.” 6 
In the above interesting case, the perspiration was either neutral or 
acid. I find one in which it is said to have been alkaline:—“ A man 
forty-five years of age, often affected with exhaustion, began in Decem- 
ber to perspire profusely every morning, rheumatic affections being at 
the same time very prevalent. The perspirations gradually increased, 
and so reduced the patient that at the end of January he was emaciated 
to a skeleton, and could not raise himself in bed without assistance. 
The perspiration, which was more profuse at night than during the 
day, exhibited a peculiar earthy smell; it restored to reddened litmus 
paper its original blue color, but contained no sugar. With all this, the 
patient was perfectly free from fever, and only felt a little chill when 
kept out of bed whilst it was being dried ; his appetite was very good ; 
thirst slight; urinary excretion increased, rather darker than usual, 
but neither exhibiting the presence of albumen, nor any precipitates, it 
was acid when first voided, soon after becoming ammoniacal; bowels 
regular. The thoracic and abdominal organs being all in a perfectly 
healthy state, the author considered the disease as idiopathic ephidrosis. 
Different remedies were employed, without apparent effect; and the 
disease, after a duration of nineteen weeks, as gradually disappeared as 
it had been developed. But even then the usual strength was so slow 
in returning that six months after the entire cessation of the perspira- 
tions, the patient could not perform his accustomed work. The forego- 
ing case is so far remarkable, that, at a time when acid was so decidedly 
prevalent in some of the secretory products, the pecspiration of the man 
not only did not have an acid reaction, but, on the contrary, colored the 
reddened litmus paper blue.” Dr. Philip, in Casper's Wochenschrift, 
quoted in the New York Journal of Medicine, Nov., 1844. 
Gaitman, in Centralblatt, 1876, No. 4, states that a tuberculous man, 
aged forty-four, had pain in the head and throat of the left side of the 
face and neck. By arduous labor a secretion of sweat was induced, and 
there was also reddening of the left half of the face, especially of the 
left ear, and the temperature in the left auditory canal was one-tenth 
of a degree higher than in the right side ; no trophic disturbance was 
visible, but the left eye was prominent and freely movable, and pre- 
sented a strong injection of the conjunctiva, and secreted tears at times 
easier than the right; the eye reacted normally to light. 
The following is a case of metastasis, or transference of the sweating 
from the feet to the hands. Hildebrandt reports, Deutsche Wochen- 
scrift, No. 20, the case of a soldier who dusted salicylic acid mingled 
with starch and talc on his feet seven times during three weeks to sup- 
press the abnormal perpiration. The latter ceased temporarily, but re- 7 
occurred during marching. The powder was reapplied a couple of 
times, after which the palms of the hands perspired freely, the water 
running in streams from them, while the feet scarcely perspired even 
during prolonged marching in very hot weather. The remaining por- 
tions of the body were at the same time quite dry. Hildebraudt also 
observed the same phenomena in another soldier who used this pow- 
der, though the perspiration of the feet did not cease entirely. The fol- 
lowing cases are reported by Prof. Bartholow : “ The first case is that 
of a cachectic individual, who had a tumor, aneurismal or malignant, 
at the base of the neck, which had grown upward from within the 
thorax. Not having had an opportunity of examining this morbid 
growth, I cannot pronounce as to its nature ; neither is the determina- 
tion of this point material to the inquiry. The facts of importance are, 
1st, the existence of a thoracic tumor on the right side of the thorax; 
2d, the occurrence of unilateral sweating on the right side of the head. 
The sweating, which was profuse, terminated abruptly at the median 
line. The pupil on the same side was contracted. No thermometric 
observations were made on the temperature of the affected side; but 
there was considerable redness of the lobe of the rightear, and a subjec- 
tive sensation of warmth in the affected parts. 
“Case II. A gentleman of Cincinnati, aged about fifty, in robust 
health. About a year ago he first observed that the right side of his 
head sweated very freely, while the left side was almost free from 
perspiration. This difference in the activity of the sudoriparous glands 
on the two sides became very marked indeed, so that he experienced 
great apprehension as to the result, although his general health con- 
tinued good. When he consulted me, I explored the thoracic organs 
very carefully, especially the heart and great vessels, but I was unable 
to discover a tumor or lesion of any kind. The pupils were equal in 
diameter on the two sides, and there was no apparent alteration of the 
circulation in the right eye. Mental emotion or active exercise caused 
the sweat to break out on the affected side, where it stood in enormous 
drops, almost no moisture being perceptible on the opposite side. A 
subjective sensation of heat preceded the outbreak of sweat, but I could 
not perceive that there was a real elevation of temperature. Neither 
the direct nor induction currents changed the condition of the parts. 
Sensation—of touch, of pain, of temperature—remained unaffeted over 
the whole sweating region. There was no apparent disturbance in the 
function of any organ. 
Case III. S. M., aged thirty-nine; nativity, Ireland ; occupation, 
laborer. Two years ago was attacked with a severe cold, since which 8 
time cough has been always troublesome. Has suffered once or twice 
from edema of the lower extremities. He was emaciated and feeble, 
with marked evidence of lung disease, but the peculiarities for which 
the case is reported, are the state of the left pupil and sweating of the 
left side, especially of the head. The left pupil is more contracted than 
the right, and does not respond so readily to the stimulus of light. 
When quiet there is a perceptible difference in the moisture of the 
right and left sides of the body. On taking active exercise the sweat 
stands in large drops on the left side of the face and head, the right 
being comparatively dry. The temperature of the right meatus audi- 
torius is found to be 99J° F., whilst the left is 99° F.; of the right axilla 
99° F., of the left 98f° F. After active exercise the temperature of the 
right meatus is 98£° F., and the left the same : of right axilla 98J° F., 
left 99° F.” 
Dr. H. C. Robbins, of Dement, 111., reports the following in the Bos- 
ton Medical and Surgical Journal, for July 9th, 1868: “ J. W., 
aged twenty-two, while in the army six years ago, contracted diarrhea, 
which confined him to the hospital for several weeks. Upon his recov- 
ery, he first noticed the phenomenon of profuse perspiration of the left 
side of his face, which condition still continues, nearly six years after 
it was first observed. His health is perfect in every other respect, and 
his mind is clear and strong, but every few minutes, winter or summer, 
is obliged to wipe the sweat from one side of his face. He is now a 
farmer, strong and energetic.” 
Prof. Ebstein, of Gottingen, in Virchow's Archives, reports the case 
of a man sixty years old Buffering from angina pectoris, in whom the 
attacks at certain times were accompanied by transpiration of the left 
side of the head and neck, and the left upper extremity. There was no 
redness of these parts, nor dilatation of the pupil of the same side. In 
the intervals between the attacks of angina pectoris, the sweating took 
place whenever the patient became fatigued from muscular exercise. 
At the autopsy of the patient, the cervical ganglia were examined with 
care, and presented nothing abnormal to the naked eye. On harden- 
ing small sections of the left ganglion in Muller’s fluid and absolute 
alcohol, round, dark-brown points could be distinguished, which under 
the microscope were recognized as vacuoles. These were lined by an 
endothelium, and contained blood globules; their form was usually 
round, seldom irregular, stellate; their continuity with dilated vessels 
could often be established, of which they constituted diverticula alter- 
nating with strictured points. The walls of these vacuoles were thick- 
ened, and contained, especially at their periphery, a large number of 9 
stellate nuclei. These ganglion-cells, which appeared empty, were 
markedly pigmented. Nothing was found in the ganglion of the right 
side. Ebstein is disposed to trace these alterations to the vascular ap- 
paratus of the great sympathetic. 
Frankie relates a very similar case (Centrolblatt, 1874, No. 52 ) of uni- 
lateral sweating in a man sixty years of age when he was attacked by 
difficulty of breathing, hypertrophy of the heart, and enlargement of 
one of the wings of the thyroid. He found on section of the body after 
death, in the lower cervical ganglion of the side affected, visible with 
the naked eye, objects of the size of a grain of sand, whidh presented, 
under the microscope, an endothelium, and were filled with blood cor- 
puscles. They were found in the continuity of the blood vessels, and 
formed varicose dilatations of the same. The ganglion-cells were 
strongly pigmented, but normal in size. These changes were found 
only on the side affected. By the increase of the blood, the ganglion 
fibres were compressed, and a paralysis of the sympathetic ensued. 
In an article on Neuroses of the Pneumogastric and Sympathetic 
Nerves, &c., by Dr. John J. Caldwell, of Baltimore, published in the 
Virginia Medical Monthly for October, 1878, there are several interest- 
ing cases of localized sweating related. He says : “ I have in my prac- 
tice a child who when nursing at the breast, sweats at the knees. Here 
the irritation of the nerves in the act of sucking is conveyed to the 
sweat centres which throw the sweat-glands in the skin at the knees 
into increased activity. Why the glands at the knee should be selected 
is not very clear.” Dr. Caldwell in the course of his article refers to 
the following additional cases of local or partial sweating:—“A lady, 
aged forty'five, suffered from migraine for many years, and especially 
at the menstrual periods. There was redness of the whole right side of 
the face, without previous blushing ; the temperature was considerably 
heightened ; the opening between the lids of the right eye narrowed ; 
the right bulbus oculi retracted ; the right pupil was narrowed, and the 
right side of the forehead and cheek moist. The pulse was sometimes 
greatly decreased in frequency, and pressure on the inner side of the 
right sterno-cleido-mastoid, as well as upon the spinous process of the 
seventh cervical and first dorsal, caused some sensibility. Very re- 
markable was the fact that during the hyperemia of the right side of 
the face, there was an increase of the capability of the sense of taste to 
all kinds of substances. This (the writer says,) was a case of paralytic 
form of the blood vessels, and was cured by the use of the constant cur- 
rent—kathode in the mastoid fossa, and the anode on the first dorsal 
vertebra.” 10 
“ In another case, a man forty years old, suffered neuralgia—some- 
times the right side, and sometimes the left side of the face was af- 
fected—both with paralytic and spastic form of hemicrania. The spas- 
tic form was accompanied with a great amount of saliva—about two 
pounds. Both cervical sympathetics were sensitive to pressure, and the 
right side of the face was disposed to sweat; sometimes the attacks 
were accompanied with gastralgia, and ecchymosis of the conjunctiva 
of the affected side.” The author further cites several instances where 
the sweating followed an irritation in a reflex manner. “ Thus Brown- 
Sequard in his own person finds that when he excites the nerves of 
taste, as by chocolate, in less than five minutes a very abundant secre- 
tion of sweat ensues on the lips, nose and forehead. (Journal de la 
Physiologie, Vol. 1.) Bartley describes a case where a little salt on the 
side of the tongue produced sweating of the cheek on the same side. 
Rouyer also details two cases where a similar sweating and redness of 
the region over the parotid took place on eating. Here, undoubtedly, 
the nerves of taste called the sweat-centres supplying nerves to the face 
into a reflex activity.” 
| ■ The following interesting case of unilateral sweating in connection 
with sciatica, is reported by Dr. Wm. Carson in the American Practi- 
tioner for February, 1876. The patient, a German, aged fifty-seven, 
was admitted to the Cincinnati Hospital Dec. 5th, 1874. He was suffer- 
ing from chronic sciatica on the left side, the details of the symptoms 
and treatment of which we omit. He had no other discoverable ail- 
ment except the unilateral sweating, the following details of which are 
given :—“ A short time after his admission our attention was attracted 
to the unilateral sweating of the left side of the face and head, of which 
the following are the principal facts. He had been conscious of it for 
many years ; had noticed that it was more marked after drinks, partic- 
ularly if they were warm, and that sometimes it was more profuse at 
the late hours of the night. Objectively, the sweating was limited by 
the median line of the face and head, the line of the spine of the 
scapula posteriorly, and the clavicle anteriorly. It was found more or 
less at every examination in a period of several weeks. The surface 
temperature was taken several times with a surface thermometer ; left 
temple, 96°, right temple, 97°; was sweating a little at the time: 
another time, the next day, left temple, 98£°, right temple, 99°. The 
next day the temperature was 99° on both sides of the face. There was 
not observed any difference within the mouth as to the two sides. 
Sometime after these notes, other observations were: Right cheek, 93°, 
left, 91£°; temples, both 90°; left hip, over glutei, 91$°, over right hip, 11 
89£°; right leg below the knee, on the outside, 91°, on the left, 90°.’’ It 
will be observed that the temperature of the sweating side over the af- 
fected region was lower than the other, though but slightly, whereas in 
some other cases, as we have seen, it has been found much higher on 
the sweating side. “ No difference in the mobility of the facial mus- 
cles of the two sides. No paralysis of muscles anywhere. Subjectively, 
there was no sense of heat or coldness about the head or face. Once he 
spoke of a numbness about the head. Often he spoke of having head- 
ache, which he did not localize, but which was accompanied with 
rheumatic pains about the body, ‘ pains in his bones,’ as he called 
them; has had cramps in his left foot at night, and while putting on 
his boot on the left foot the left hand has often felt so dry that he would 
moisten it to make it more comfortable.” He was treated with bella- 
donna and atropine, both locally and internally, but with no perma- 
nent benefit. The following cases are taken from an article “ On the 
Influence of Belladonna on Sweating,” in the London Practitioner tor 
August, 1872, by Sidney Binger, M. D. 
“Mrs. P., aged thirty, married, has all her life sweated freely, but much 
more on the left than on the right side of her body, the excess being 
most marked on the head and trunk, although the left arm and leg 
sweat more than the right. The line of demarcation on the face is 
sharply defined, equally dividing the head down the centre. The 
sweating on the left side is very profuse, running down the face and 
soaking her hair and even the bed-pillow. The sweating on the left 
side of the trunk is most marked, as low as the breast. Slight exercise, 
sleeping, or exposure to the heat of the fire or sun, especially the latter, 
greatly augments the sweating. It is markedly profuse when she is 
out of health. The sweating is unaccompanied by flushing, and does 
not excite any rash. She suffers from great coldness of the feet, but the 
right foot is decidedly the colder. She never feels the left hand 
warmer than the right. The left side of her tongue is always more 
coated than the right, and has been so as long as she can recollect. 
There are no bad teeth or other causes in the mouth to acount for this 
curious fact. She is rather deaf on the left side, and when young was 
very deaf of both ears, but much worse on the left side. Her pupils are 
equal, and her sight good in both eyes. She is very hysterical, and 
suffers often from globus hystericus, and from a sensation of heat and 
weight on top of the head, and palpitation on exertion or excitement. 
Her urine varies greatly in quantity, sometimes being scanty, at other 
times very abundant. Her bowels are generally confined, and she is 
troubled with a cankery taste in the morning. Her menses are very 12 
scanty and irregular, intermitting sometimes for six months. She does 
not blush more on one side of the face than the other: and when ex- 
cited her ears become both equally very red. The skin of the face pre- 
sents the same aspect on each side. The radial pulses appear to beat in 
all respects equally. Five months ago she was confined, and since 
then all her troubles have much increased. The left breast yields 
much less milk than the light, this being full and distended, while the 
left is flat and empty. Shortly before her visit to the hospital she was 
seized with neuralgia of the auriculo-temporal branch of the inferior 
division of the fifth nerve on the left side, the paroxysm being accom- 
panied by salivation of the left side of the mouth ; but previous to this 
neuralgic attack the secretion of saliva was no greater on one side of 
the mouth than on the other. During an attack of paiu the left side of 
the face sweated greatly. The application of a weak belladonna oint- 
ment to the left side of the face for five to ten minutes, three times 
daily, greatly reduced the sweating, and equalized that of the two sides. 
It moreover cured the neuralgia.” 
“ The author has met with cases of profuse local sweating over the 
loins, covering a surface rather larger than the hand, and exciting a 
copious eruption of eczema. Here the belladonna liniment checked 
the sweating, and the eczema at once disappeared.” 
“ In some cases of sweating the belladonna no doubt fails. Thus in 
one inveterate case, so far from affording relief, it increased the suffer, 
ings and sweating in the case of a man who for twenty-two years had 
been affected with an occasional eruption of the hands and feet, look- 
ing at times like eczema, but at other times putting on the appearance 
of lichen. In cold weather he is pretty well, unless he takes exercise 
or sits in a hot room; but in March, as the weather begins to get warm, 
the symptoms set in. His hands and feet swell and feel so tight as if 
they must burst. At the same time he sweats a good deal, but not 
while lying down ; but directly he rises, or even sits, the sweating be- 
gins. The sweating is much more abundant in his hands and feet, 
especially at the finger-tips and the thumb-balls; and at the tips of the 
ring and little fingers of the left hand it is especially marked. The 
sweat runs down in drops from the hands, and when he wipes the fin- 
ger tips he can see the sweat oozing from the pores of the skin. The 
outer part of his hands, corresponding to the fifth metacarpal bone, is 
also the seat of great sweating. At the tips of his fingers and the 
thumb-balls he suffers from severe pricking pain, which he likens to 
little insects biting their way out. He feels hot all over, and calls it 
heat in the blood. The attacks are accompanied by a good deal of itch- 13 
ing over his back. The skin of the hands about the nails becomes hard, 
cracks, and bleeds. A little rash similar to that described appears in 
the clefts of the fingers and over the back of the hand between the 
thumb and forefinger. In this patient’s case, as has been stated, bella- 
donna ointment applied to the hands greatly aggravated all his troubles 
and increased the sweating’” 
“ A middle-aged man, after much mental worry, suffered from exces- 
sive sweating of both cheeks while eating, especially hot meat or vine- 
gar ; the sweating ceased immediately after the meal. This man 
passed at times a profuse quantity of pale urine. Ten drops of tincture 
of belladonna taken three times a day completely checked the sweat- 
ing.” 
“A middle-aged man, a sufferer for several years from unilateral 
sweating of the right side of the face and neck, applied for relief from 
a pain in his side. He was found to be sweating very profusely from 
the right side of his face and neck, from exertion and the great heat of 
the weather. To relieve his pain the twelfth of a grain of morphia was 
subcutaneously injected, which appeared to increase the sweating, al- 
though it was difficult to be sure of this : while still sweating profusely, 
so that on wiping his face the sweat could be seen rapidly oozing from 
the skin, we injected 1-100 of a grain of atropia under the skin of his 
arm, and in about a minute the sweating entirely ceased, and his face 
remained quite dry, till his dismissal about three quarters of an hour 
after the experiment.” 
To these numerous cases of local and partial sweating I will add two 
of excessive general perspiration under unusual circumstances. 
*' A man twenty-five years of age, strong and healthy, was for many 
years from time to time the subject of abundant sweating, which came 
on at two or three o’clock in the morning, without any appreciable 
cause. The secretion was so abundant that the mattress on which he 
lay was completely soaked, and it was general over the whole body. 
Sulphate of quinia not having proved of any service, Vignard pre- 
scribed the following decoction : leaves of sage a handful, water half a 
pint. These are made to boil for about two minutes ; they are then 
left to get cool together; the fluid is strained and sweetened to the 
taste. It is taken in the evening. The sweating ceased from the first 
day of the use of the decoction, but reappeared with the suspension of 
the treatment.” Edinburgh Medical Journal, Nov., 1869. 
The following case is related by Dr. J. A. Lawrie, Surgeon to the 
Glasgow Royal Infirmary: “ The patient, aged about sixty, was sub- 
ject to biliary derangement. One of these attacks was brought on, 14 
April 28, 1849, by some bad porter, and on May 1st, he had severe pain 
around the umbilicus, followed by bilious vomiting. On the night of 
the 2d he slept comfortably till half past one A, M. of Sunday, when 
the most violent perspiration came on and remained unchecked till six 
A. M., and rendered all the bed clothes dripping wet as if they had 
been dipped in water. At ten A. M. severe rigors followed, then 
cramps in the limbs and intense pain in the abdomen, for which a large 
blister was applied; he was very weak and restless; pulse small and 
easily compressible, voice husky; choleric; hands bleached; cold 
perspiration, especially on the head ; countenance sunk ; intense thirst 
and desire for cold water; with great feeling of internal heat. These 
symptoms increased in importance and severity until Monday, when 
the pulse was almost imperceptible ; constant restlessness and tossing; 
no urine. In a word, he had all the symptoms of a patient about to 
rally from an acute attack of cholera. Brandy, cold water, and beef 
tea had been ordered, but he refused everything except cold water. 
From this time he began to rally, and was able on the next day (the 
4th ) to rise and shave himself. Symptoms of some importance, how- 
ever, continued on the 5th ; vomiting of a decidedly bilious character 
and a comatose state of the brain; 6th, the same condition of brain 
with severe vomiting and a copious vesicular eruption on the nose and 
lips. These symptoms became more mitigated, and at length the re- 
maining part of the case was that of a mild but tedious secondary 
fever, from which the patient did not recover until the 10th of June.” 
On this case, the reporter, among others, makes the following re- 
marks: “The points of interest in this case appear to be—1. The 
.amount of perspiration. I have never met with any case in which the 
same amount of fluid was discharged from the skin in the same brief 
period. 2. Its immediate effect. I have never before seen collapse pro- 
duced by perspiration. In this case it was complete, the patient being 
for sometime pulseless. It is worthy of remark, that the collapse was 
less sudden than in cases of acute cholera. It did not reach its acme 
till nearly twenty-four hours after the excessive perspiration had 
ceased. 3. I have asked myself, is this a sporacic example of the Sudor 
Anglicanus, sweating sickness, of the 15th and 16th centuries? And I 
am inclined to reply in the affirmative.” 
With regard to the cases thus collated, the following remarks are 
obvious, and suggest themselves at once. They are all associated with 
certain conditions: 1. With aneurismal or other thoracic tumors, 
angina pectoris, exophthalmic goitre, &c. 2. With certain neuroses, as 
neuralgia, hysteria, &c. 3. With malarial fever. 4. With no ascertain- 15 
able lesion or alteration in the function of any part, except the skin af- 
fected. This last class, however, is the smallest, and perhaps would grow 
smaller still could all the cases have been subjected to a more searching 
investigation. In all the first three groups we can easily imagine a 
connection with disturbance of the sympathetic nerve system, though 
we may not be able in the present state of our knowledge to point out 
its exact mechanism. While in some of the cases the direct influence 
of pressure from diseased organs seems plain enough ; and in two of the 
cases, where a post mortem examination of nerve ganglia was made, 
decided pathological abnormities were discovered of almost exactly 
similar character in the two instances. 
In the cases of unilateral sweating, we find the right side affected 
seven times, the left six times, while in a few cases the fact is not men- 
tioned, so that no inference can be drawn from this circumstance. 
In the treatment of this affectiou, various means, both local and gen- 
eral, have been recommended and tried with varying success, the chief 
of these we will now mention. Ringer, as we have seen, found bella- 
donna or atropine useful in the majority of instances, and curative in 
some, though he admits that in others it not only did no good, but was 
possitively hurtful. It is undoubtedly the most reliable as well as 
rational remedy we possess, and may be used locally in the form of 
tincture of belladonna, liniment, or ointment of belladonna, or solution 
of atropia. Internally, the most powerful mode of application would 
be undoubtedly hypodermic injections of atropia. This may be given 
in much larger doses than recommended by Ringer, who mentions 
1-100 of a grain ; twice this I should consider by no means a large dose, 
but the smaller one should be tried first, and if it succeeds, well; if not, 
it should be increased until effects, either curative or unpleasantly toxi- 
cal, are reached. 
Electricity has succeeded in at least one recorded case, but failed in 
others; it has not apparently been used very often, and certainly de- 
serves a further trial. Vignard, as we have seen, was successful with 
sage tea, and I myself believe that this homely domestic remedy is 
more worthy of confidence than the profession at large seem willing to 
concede. He states that its efficacy may be increased by the addition of 
alum or sulphuric acid, and from his experience we learn that the rem- 
edy should be persisted in for sometime after the cessation of the sweat- 
ing. Dr. Christman, it is stated, in the Wurtemb. Med. Corresp. Blatt, 
1869, No. 20, has seen in many cases of excessive perspiration, a diminu- 
tion of the cutaneous discharge ensue promptly upon the exhibition of 16 
ergot, eight to ten grams four times a day. I have tried it without any 
good effect. 
Various stimulating and astringent applications have been recom- 
mended, such as bathing with dilute alcohol, solutions of tannin, 
alum, &c. One writer is very enthusiastic over the liquor from tan- 
yard, though why this should be any better than a solution of tannin 
is not plain to me. 
Ringer and Bury have given (Practitioner, Dec., 1876, p. 401,) the re- 
sults of some interesting experiments on the effects of pilocarpine, used 
hypodermically, in cases of unilateral sweating. The first patient was 
a woman, aged forty-six, who had paraplegia ten years, and had been 
suffering from unilateral sweating of the leftside for nine years; the 
least exertion causing profuse perspiration. Six hypodermic injections 
of pilocarpine were given; each of the injections contained one-third 
of a grain of the alkaloid, except the last when one-half a grain was 
used. The first three injections and the fifth were introduced into the 
right arm, the fourth and sixth into the left arm. The first result of 
the injection in each case was a flushing of both sides of the face, and 
increased sweating, which gradually declined and ceased altogether in 
from fifteen to twenty-five minutes. The result of this case was that 
the patient was cured. This looks rather like homeopathic treatment. 
In the other patient, a cabman, who had right hemiplegia with uni- 
lateral sweating of the same side, the pilocarpine only effected a tem- 
porary abatement of the symptoms ; the sweating was finally controlled 
by atropia. It is hardly necessary for me to mention the mineral acids, 
oxide and sulphate of zinct-,&c., as they have been long before the pro- 
fession, and their general worthlessness is pretty well recognized. Of 
course every remediable disorder of the general system should receive 
proper attention, and every known or possible exciting cause be avoided 
as much as possible. 
Since writing the above, my friend Dr. Gilliam, of this city, has re- 
lated to me the following circumstance : Some years ago Dr. Bell, of 
Nelsonville, Ohio, had a patient who had been for a great sufferer 
with neuralgia of the face accompanied by unilateral sweating. The 
Doctor gave him stramonium in such large doses that severe toxic 
effects were produced; both physician and patient were seriously 
alarmed, the former so much so that he thought seriously of fleeing the 
town. But the event of the matter not only quieted their fears, but 
went beyond their best hopes, for the patient was completely cured of 
his neuralgia, and of his unilateral sweating as well. 
The “sweating sickness ” has been alluded to, and perhaps a passing 17 
notice of this extraordinary epidemic may not be out of place just 
here. This disease first made its appearance in England in the 
early autumn of 1485, and in its four subsequent visitations was 
confined mainly to that country, though in one of them it spread 
to some extent to Germany and the parts adjacent. Commencing as 
stated, by the end of the year it had spread over the whole of England, 
and caused the death of an unnumbered multitude of people; by the 
beginning of 1486 it had disappeared, not to occur again until 1506. 
This epidemic was less fatal than the first, mainly from the greater 
common sense exhibited in its management. It was confined to Eng- 
land, nowhere occasioning any great mortality. The third attack be- 
gan in April or May of 1517. On this occasion it was so violent and so 
rapid in its course, that it carried off many of those attacked in two or 
three hours, so that the first shivering fit was regarded as the announce- 
ment of certain death, and many who were in good health at noon 
were numbered among the dead at evening. The mortality is stated 
by all writers to have been very great, but the almost total absence of 
statistics in their accounts renders it impossible to reach even an 
approximation of its amount. The fourth, and most fatal, outbreak be*- 
gan in England during the latter part of May, 1528, and in the follow- 
ing year appeared in Germany, where it had at least one beneficial 
effect, if. as one writer states, it was the means of putting an end to the 
disputes between Luther and Zwingle concerning the eucharist, which 
were on the eve of kindling a religious war. This epidemic is spoken 
of by some historians under the expressive name of the great mortality. 
It spread to the Netherlands, to Denmark, Sweden, and Norway. 
Among the Continental people its fatality was much increased by their 
absurd treatment of the sick, who, it was believed, if they wished to 
escape death, must perspire for twenty-four hours without intermission. 
“ So they put the patients, whether they had the sweating sickness or 
not (for who had calmness enough to distinguish it?), instantly to 
bed, covered them with feather beds and furs, and whilst the stove was 
heated to the utmost, closed the doors and windows with the greatest 
care to prevent all access of cool air. In order, moreover, to prevent 
the sufferer, should he be somewhat impatient, from throwing off his 
hot load, some persons in health likewise lay upon him, and thus op- 
pressed him to such a degree that he could neither stir hand nor foot, 
and finally, in this rehearsal of hell, being bathed in an agonizing 
sweat, gave up the ghost, when, perhaps, if his too officious relatives 
had manifested a little discretion, he might have been saved without 
difficulty.” How much consideration was given in those times to the 18 
feelings of the sick we may judge from the following sentence from 
what, on the whole, must be called a very sensible pamphlet, published 
for popular distribution at this time: “Once for all the patient must not 
have his own way ; what he would have you do for him, that must not 
be done.” 
Full three and twenty years now elapsed, no trace of the sweating 
sickness showing itself anywhere, when the old enemy again, and for 
the last time, broke out in Shropshire, on the 15th of April, 1551, and 
lasted about half a year, namely from April 15th to September 30th. 
This was the epidemic witnessed by the celebrated Dr. Caius, and the 
occasion of his book which was entitled, “ A Boke, or Counseill against 
the disease commonly called the Sweate, or Sweatyng Sicknesse, made 
by Jhon Cains, Doctour in Phisicke. Very necessary for every per- 
son ne, and much requisite to be had in the handes of al sortes, for their 
better instruction, preparacion, and defence, against the soubdein com- 
yng, and fearful assaulting of the same disease. 1552.” 
His advice, such as it was, came too late, for the disease has never 
appeared, except possibly in rare sporadic instances, since 1551; nor 
Hoes his book, it may be fairly added, contribute anything to our 
knowledge on the subject. I cannot, however, resist the temptation of 
giving two short extracts from this quaint and exceedingly rare book. 
The first is a graphic description of the fatality of the pestilence on its 
first invasion. “ It immediately killed some in openyng their win- 
dowes, some in plaieng with children in their strete dores, some in one 
hour, many in two it destroyed, & at the longest, to them that merilye 
dined, it gave a sorrowful supper. As it found them so it toke them, 
some in sleape some in wake, some in mirthe some in care, some fast- 
ing & some ful, some busy and some idle, and in one house sometyme 
three sometyme five, sometyme seven sometyme eyght, sometyme more 
sometyme all, of the whyche, if the haulfe in every Towne escaped, it 
was thoughte great favour.” % And the following bit of advice is per- 
haps as applicable now as it ever was: “ Therfore seke you out a good 
phisicien, and knowen to have skille, and at the leaste be so good to 
your bodies, as you are to your hosen or shoes, for the wel making or 
mending wherof, I doubt not but you wil diligently searche out who is 
knowen to be the best hosier or shoemaker in the place where you 
dwelle; and flie the unlearned as a pestilence in a comune wealth.” 
This very extraordinary disease known as the Sweating Sickness, 
English Sickness, Sudor Anglicus, &c., seems to have been an epidemic 
ephemeral fever, with no very characteristic symptoms, except the 
enormous sweats. It bears some resemblance, in its short duration and 19 
frequent relapses, to our modem relapsing fever, but I think Niemeyer 
is manifestly in error in his effort to identify it with miliary fever, 
which I believe to be quite a different and distinct disease. The pro- 
dromata were ill defined, and uncharacteristic, consisting of chilliness, 
succeeded by some heat, pains in various parts of the body, particularly 
the back of the neck. “ But the sweating was peculiar and enormous ; 
in the course of a short time, and in many instances at the very com" 
mencement, the stinking sweat broke out in streams over the whole 
body. In others the sweating was longer delayed, while in the mean- 
time a slight rigor of the limbs existed ; it then broke out profusely. 
It was thick and of various colors, but in all cases of a very disagree- 
able odor, which, when it broke out again after any interruption to its 
flow, was still more penetrating ( odoris teterrimis ).” Some compared 
it to the smell of rotten straw or musty vinegar ; possibly the odor pro- 
ceeded from decomposition of the sweat which soaked the bedding. 
Some physicians attributed the disease to the decomposition of water 
in which hemp had been steeped. A more probable cause is to be 
found in the unutterably filthy habits of the people, and their entire 
ignorance of any relation between cleanliness and health, which pro- 
duced so many devastating pestilences during the middle ages. But 
why it should be renewed so many times at irregular intervals, and 
should at length entirely cease, are questions not so easy to answer. 
Three other epidemic diseases characterized by excessive perspiration 
remain to be briefly noticed. These are, first, the Morbus Cardiacus, 
cardiac disease of the ancients, which appeared for a period of 500 years, 
from 300 B. C. to 200 after Christ. It was described by Erasistratus 
Asclepiades, Areteus the Capadocian, Celius Aurelianus, Soranus, and 
others. The second is miliary fever, called also the Picardy Sweat, &c., 
which has often prevailed, not only in Picardy, but also in other parts 
of Europe, for more than a hundred years, and even at the present 
time exists in some places as an endemic disease. It is characterized, 
in addition to the profuse sweating, by a miliary or sudaminous erup- 
tion. Suffice it to say of it that more than 125 epidemics have been 
noticed or described. Lastly, the following localized epidemic, or the 
Rottingen Sweat as it is called, is unique in the history of medicine 
“ In November, 1802, a very hot and dry summer had been succeeded 
by incessant rains. Thick fogs spread over the country, and enveloped 
such places in central Germany as were inaccessible to ventilation. 
Amongst others, the small Franconian town of Rottingen, situated on 
the river Tauber, and surrounded by mountains. Scarcely had a few 
weeks elapsed, when unexpectedly, towards the 25th of November, an 20 
extremely fatal disease broke out in the town, which was without ex- 
ample in the memory of its inhabitants, and totally unknown to the 
physicians of the country.” “ Strong, vigorous young men were sud- 
denly seized with unspeakable dread ; the heart became agitated and 
beat violently against the ribs, a profuse, sour, ill smelling perspiration 
broke out over the whole body, and at the same time they experienced 
a lacerating pain in the nape of the neck, as if violent rheumatic fever 
had taken possession of the tendonous tissues. This pain ceased some- 
times very quickly, and if it then shifted to the chest, the distressing 
palpitation of the heart recommenced ; a spasmodic trembling of the 
whole body ensued, the sufferers fainted, their limbs became rigid, and 
thus they breathed their last. In most cases all this occurred within 
four and twenty hours.” I do not find it anywhere stated how many 
perished from this visitation, but infer from the tone of the report that 
the mortality was considerable, but panic would be easily excited in 
such a small and isolated community. At first it is said they were en- 
tirely without medical advice, and the people greatly aggravated the 
disease by their injudicious sudorific treatment, many being literally 
stewed to death. Government physicians were sent to them, under 
whose skillful care the sickness rapidly abated. 
The disease was confined entirely to Rottingen, and did not make its 
appearance anywhere beyond the gates of this little town. On the 5th 
of December, clear, frosty weather set in ; from that time no new cases 
occurred, and all traces of this Rottingen sweating fever, which was 
never either preceded or followed by miliary fever in any part of Fran- 
conia, have from that time disappeared. 
A malignant form of hydrosis which appears to correspond with the 
sweating sickness of the sixteenth century, has occasionally made its 
appearance in sporadic,cases, particularly, it would seem from reports 
made to the Academie de Medicine, in France. But after all a fair as 
well as rigid criticism of these cases would lead us to the conclusion 
that they are but aberrant forms of well-known diseases, characterized, 
and somewhat confused as to diagnosis, by the occurrence of extraor- 
dinary perspirations. They have been seen associated with inflamma- 
tion of the stomach and intestines; inflammation of the lungs; in- 
flammation of the cerebro spinal axis. They have occasionally proved 
fatal in twenty-four or forty-eight hours, or the disease has run on for 
two or three weeks. These cases were observed by M. Marrotte, in the 
Hotel Dieu, at Paris, at the close of an epidemic of typhus or typhoid 
fever which raged in that city in 1842, 
Now we know that both at the beginning and the end of epidemics 21 
of various diseases, cases are apt to assume quite puzzling and un- 
wonted forms; and hence we cannot think it very wonderful that at 
the close of a fever epidemic some cases should occur in which the nor- 
mal symptoms of the particular disease should be wanting, dislocated 
as to order of appearance, and complicated with those of a new and un- 
usual character, such as profuse perspiration. Nor can we admit that 
this forms a sufficient ground for identification of them with the pecu- 
liar and well-marked “ sweating sickness.” 
IT. Anidrosis.—Having considered those cases which are character- 
ized by excess of the perspiratory secretion, we come naturally to speak 
next of those in which it is deficient. This condition is known as ani- 
drosis, and is a functional disorder of the sweat glands, consisting in a 
diminished or insufficient secretion of sweat, either general or partial, 
or local. 
Duhring, in his work on Diseases of the Skin, speaks of it as follows : 
“ It is the opposite of hyperidrosis. It occurs in the] course of certain 
chronic diseases of the skin, and is particularly noticeable in icthyosis ; 
the same condition may be observed in patches of eczema, psoriasis, 
and in elephantiasis Grecorum.” I may add also, from my own ob- 
servation, elephantiasis Arabum. “It may also exist as the result of a 
congenital deficiency of the sweat glandular apparatus, in which case 
the person perspires very slightly, and perhaps sensibly only under a 
high temperature. There are other cases in which the individual 
ceases at times to sweat. In these instances the health is more or less 
impaired, and serious symptoms often arise, especially during the warm 
weather. It is at this season that such cases are apt to come under ob- 
servation. Occurring as an independent disorder, it is rare. I recall 
meeting, two summers ago, the case of a man—a blacksmith—who 
suddenly, during the hot weather, ceased sweating. He was, when I 
saw him, several weeks after the trouble first manifested itself, unable 
to pursue his occupation, and complained greatly of indisposition, head- 
ache, and other symptoms of distress.” Mason Good says, Study of 
Medicine: “ It is affirmed by some writers that there are persons who 
never perspire. This demauds ample proof; for experience teaches us 
that all warm blooded animals either perspire by the skin, or have 
some vicarious evacuation that supplies its place, as in the case of the 
dog kind, in which an increased discharge of saliva seems to answer 
the purpose; though in violent agony, I have known a Newfoundland 
dog thrown into a sweat that has drenched the whole of his thick and 
wavy hair.” 22 
Broussais asserts that fear and other violent passions have been 
known temporarily to arrest perspiration completely, though they gen- 
erally have quite the opposite effect. 
Wilson remarks, that, “ diminution of perspiratory secretion from 
arrest of function of the sudoriparous glands has hitherto been ob- 
served ouly in relation with febrile diseases.” An observation which 
is obviously inaccurate, and which is scarcely in accord with other re- 
marks which he makes, for he says further: “It is probable, however, 
that the perspiratory secretion, like that of other secerning glands, 
may be diminished and checked as a consequence of inflammatory dis- 
order of the sudoriparous glands, independently of the rest of the or- 
ganism,” The dryness of skin which we occasionally meet with in 
some individuals bears no reference to the sudoriparous system, but is 
dependent on the absence of secretion of the sebiparous glands. In the 
Philosophical Transactions (Abridgment, Vol. 3), is recorded the case 
of a “ gentleman near Leyden, who, being much addicted to the study 
of astronomy, and spending very many nights in star-gazing, had, by 
the nocturnal wet and cold temper of the air, in such manner ob- 
structed the pores of his skin, that little or nothing exhaled from his 
body ; which appeared hence, because that the shirt he had worn five 
or six weeks was then as white as if he had worn the same but one 
day.” 
Wilson relates the following case, quite amusing in some of its de- 
tails, where this affection followed upon its opposite, or an attack of 
hydrosis : “An eminent actor told me the following anecdote of him- 
self. When a young man, starring in America, he had one night, in 
the summer time, been playing a tragedy, in which he was violently 
heated, and had scarcely time to cool, when he was obliged to come on 
the stage again as Sir Archy MacSarcasm, in Macklin’s comedy of 
Love h la Mode. The make up for this character required that he 
should convert his features, by means of paint, into those of an old 
man. In the course of the play he was struck by perceiving himself 
the ‘cynosure of neighboring eyes,’ particularly those in the front rows 
of the pit, and concluding that it must be the excellence of his acting 
which was attracting so much attention, felt highly flattered, and ex- 
erted himself to the utmost. From time to time, however, he was 
startled at the bursts of laughter and applause falling in the wrong 
places, and was thoroughly puzzled at the unusual sensation he was 
creating. On retiring to his dressing room, after making his best and 
most grateful bow to an hilarious audience, the mystery was ex- 
plained ; it was not his brilliant acting alone which had brought down 23 
such noisy honors on his head, but the drollery of his face, one half of 
which was washed clean of its wrinkles by partial perspiration, and 
displayed the juvenile features of twenty; while the other half exhib- 
ited the care worn lines and withered seams of eighty. In his case, 
while one half the face was affected in this peculiar manner, and the 
other half was dry, his chest was acted on in a precisely opposite way, 
the perspiratory side being reversed. At a later period of his life the 
perspiratory action ceased over the entire body, and, as a consequence, 
he suffered bitterly in his health.” 
Niemeyer in his Practice, American edition, Vol. 2, p. 474, has the 
following remarks ; “ We have already mentioned that a diminution of 
the cutaneous secretions may form one of the Symptoms of senile mar- 
asmus. In other instances, as has already been mentioned, it depends 
upon derangement of innervation ; in others, again, it is due to disease 
of the skin, psoriasis or to icthyosis, while, finally, cases exist of ani- 
drosis, and now and then even anidrosis of half the body, the causes of 
which are quite unknown.” 
On the subject of the deleterious effects of mere suppression of the 
perspiration in man, the following editorial remarks in the Lancet for 
July 7th, 1877, are so appropriate and interesting that I need hardly 
apologize for quoting them in extenso: “The opinion that the sup- 
pression of the functions of the skin produces on man profoundly dele- 
terious effects is as old as the time of Galen, and is a belief almost uni- 
versally held. It has of late years received remarkable countenance 
from the experiments upon animals in which the covering of a large 
part of the skin with an impermeable coating of varnish is followed by 
systemic disturbances ending almost invariably in death. 
“It has been assumed that we are justified in applying the conclu- 
sions thus obtained to man, by certain effects which are known some- 
times to follow the destruction of a large part of the skin by a burn, 
and by the well-known instance of the unintentional experiment per- 
formed on an Italian boy, by gilding him to play a part in some theatri- 
cal performances, with the result of causing his death in a few hours. 
These facts have seemed to lend color to the influence on the functions 
of the skin which sudden chills, according to popular pathology, have 
been supposed to produce, and by which they are believed to cause 
their deleterious effect. But a consideration of what we know of the 
functions of the skin renders it difficult to understand the mechanism 
by which suppression of these functions, such as an impermeable coat- 
ing produces, can cause such grave consequences. The perspiration is 
now known to consist almost entirely of water, and there is reason to 24 
believe that no product escapes with it which could not be easily re- 
moved by another channel; and the chain of reasoning that the simple 
suppression of the cutaneous functions in man is followed by conse- 
quences analogous to those which result in animals, presents the grave 
defect that it is unsupported by any careful and purposed observations. 
The investigations of Senator, however, furnish us with some very im- 
portant and unexpected information, and if not numerous enough to be 
absolutely conclusive, they are of a most significant and suggestive 
character. Some of them were made four years ago, and other more 
recent observations are described in the current number of Virchow’s 
Archives. 
“The experiments were suggested both by a desire to ascertain how 
far the results obtained on animals were applicable to man, and further 
by a consideration of certain facts which show that the functions of the 
skin can be interfered with to a considerable degree, without prejudi- 
cial results. Senator points out that inunction of the skin, and the 
application of plasters to large portions, are constantly adopted with- 
out any ill effects referable to the interference with its function, and 
occasionally no special results can be traced from an extensive burn, 
comparable to that which would result from the varnishing of a cor- 
responding area of the skin of an animal. Frequently the whole skin 
is so changed by disease—psoriasis, icthyosis, &c.—that its functions 
must be gravely interfered with, and yet no ill result follows. 
“ In his experiments on pyrexia, Senator varnished areas of the 
body, and noted the relation between the area covered and the body 
weight, and the effect on the temperature. He made his observations 
especially on persons with an abnormally high temperature, in the 
hope of finding a therapeutical indication for the practice. The skin 
was rendered impermeable by sticking plaster, thick ointment, flexile 
collodion, and a solution of gutta percha in chloroform. Finding that 
no prejudicial effects resulted from varnishing a moderate area of the 
skin, he became bolder and covered the abdomen, or thorax and back 
in addition to one extremity. He concluded that no ill effects could 
be attributed to the rendering impermeable an area of the skin equiva- 
lent to one half the body area, which certainly could not have been 
thus treated in animals without producing grave symptoms. On two 
grounds, however, the validity of these conclusions is open to objection. 
In the first place, these observations were made on patients suffering 
from fever, especially typhoid fever, and it is not certain that the same 
results would be obtained with healthy men. In the second place, the 
knowledge that the effect of an application to the skin is marked in 25 
inverse proportion to the size of the animal suggests the idea that in 
man the area of the skin covered may not, after all, have been suffi- 
cient to produce those effects which occur when a similar proportional 
area in a smaller animal is coated. For these reasons Senator has made 
three other observations. All the varnishes used in animals cannot be 
employed in the case of man, for obvious reasons, so the extremities of 
three apyrexial individuals were well covered with adhesive plaster, 
and the backs with flexile collodion. Where, through movement, the 
plaster might be loosened it was additionally secured by collodion. 
Such a covering would certainly cause the death of an animal if main- 
tained for several days. Collodion, however, has not been commonly 
employed in varnishing warm-blooded animals, and therefore Senator 
made some special experiments, and found that it was equally effective 
upon them as the varnish commonly employed. A third observation 
was made by coating the skin with tar, which he ascertained caused in 
the animal the same effect as varnish. The results of these experi- 
ments on man compared with those on animals, were entirely negative. 
None of the striking consequences, manifested by animals where 
only one half of the surface of the body has been covered with varnish, 
were to be detected in man. There was no sign of the depression of tem- 
perature, muscular weakness, dyspnea, spasm, paralysis, albuminuria, 
diarrhea, serous effusion, which animals manifest. In one case there 
was some nausea and vomiting, but it subsided before the removal of 
the application. In one case there was a slight irritation of the blad- 
der, but this was attributed to the absorption of turpentine from the 
plaster. One case presented an increase in the quantity of urine. In 
the case in which the surface was smeared with tar, there was a slight 
indication of the absorption of carbolic acid; and a very slight fall in 
the temperature in one case, Senator ascribes to the exposure of the 
body and the evaporation of the ether employed in the varnishing. 
“ The conclusion which he draws is that the suppression of the func- 
tion of the skin has not the same effect on man as on animals. To this 
conclusion, however, the case of the ‘ gilded boy ’ seems at first sight to 
be opposed. Senator points out that the opposition is rather apparent 
than real, for it cannot be admitted that the death of the lad resulted 
from the same mechanism as that which causes the death of varnished 
animals, since the boy died the same night, and animals always live 
for several days, even when manifesting the greatest susceptibility to 
the procedure. He suggests the details of the case render it far more 
probable that the boy’s death resulted from the absorption of some 
poison employed in the gilding, and that the comparison with the var- 
nished animals is misleading. 26 
“Dr. Senator’s facts and conclusions are doubtless of great impor- 
tance and value, but they leave certain elements of the problem unde- 
termined, which further observation only can solve. It is probable 
that varnished animals die, not only from a toxic influence of the un- 
excreted sweat, an influence which some experiments of Rohrig sub- 
stantiate, but from the rapid loss of heat consequent on dilatation of 
surface vessels, and the rapid conduction of heat from them by the var- 
nished skin. This is an element in the eflect from which man is free, 
since the patients experimented on were covered with bed clothes or 
wearing apparel, and the loss of heat from this cause would be pre- 
vented. But this does not account fpr all the discrepancy between the 
effects on animals and on man, since prevention of loss of heat does 
not always prevent the deleterious effects upon animals of the varnish, 
and there must be, as Senator suggests, an essential difference between 
the relation of the two organisms to the functions of the skin.” 
We may furthermore remark that in some skin affections, as prurigo 
and icthyosis, where the eruption is almost if not quite universal, and in 
which the disease ordinarily lasts for the life time of the individual, we 
do not find that the suppression of perspiration is followed by those 
deleterious effects which might theoretically be apprehended. Hebra, 
who considers the affection purely from a dermatological standpoint, 
ignores its existence altogether except as a symptom, or concomitant 
phenomenon, of the extensive and well-marked dermatoses. But we 
have sufficient evidence that anidrosis may and does exist without any 
lesion whatever of the skin, though it is unquestionably a very rare 
affection. And when so existing it does give rise to symptoms of gen- 
eral discomfort and ill health, or at least is accompanied by such symp- 
toms, though they are not ordinarily of any great severity. 
Treatment.—The treatment of this disease, aside from the correction 
of co-existing symptoms and the cure of accompanying skin affections, 
resolves itself into such measures as will be likely to restore the defi- 
cient secretion. And here we have very little in the way of recorded 
experience to guide us. Hot, or warm baths, with accompanying fric- 
tions, should be tried. Vapor or hot air baths, as the so-called Turkish 
and Russian baths, may be tried in succession. If these fail, cold baths 
with thorough friction afterwards would be proper, if there were no 
contra-indications in the case. Exercise, even somewhat violent, may 
be resorted to. Various sudorific drugs, such as the stimulating diapho- 
retics, and above all jaborandi, or its alkaloid pilocarpine should be 
carefully but thoroughly tried if other means failed; it might be used 
in conjunction with some of the forms of bathing already alluded to. 27 
In conclusion, I refer to the fact mentioned by Dr. S. Weir Mitchell 
and others, that local anidrosis has occasionally been observed as the 
result of gunshot and other injuries to the nerve trunks. 
III. Bromidrosis. — Synonyms; Osmidrosis; Ephidrosis Olens; 
Odorous Sweat; Stinking Sweat. Bromidrosis, strictly speaking, 
means stinking sweat, or that possessing an unpleasant and offensive 
odor; osmidrosis, sweat of any unusual odor, sometimes agreeable. 
But inasmuch as this distinction is but seldom observed, but all forms 
of unusual odor of the perspiration, whether unpleasant or otherwise, 
are generally spoken of as bromidrosis, and as this is the term most 
commonly in use, we shall so employ it. Where the perspiration has 
a strong smell, it is also as a rule excessive in quantity, so that the 
term epidrosis oleus, is really perhaps more proper than any of the 
others, but probably because of its being a compound epithet it is 
scarcely ever employed. The affection may be general or local, bromi- 
drosis unversalis, or bromidrosis localis ; the latter being much the more 
common, especially that form of it which affects the feet, bromidrosis 
pedis. 
In treating both of bromidrosis and chromidrosis, we have to remark 
that, inasmuch as two sets of glandular bodies exist together in the 
skin, the sudoriparious and the sebiparous, and pour out their secretion 
side by side, the cutaneous transpiration, especially when it becomes 
visible in the form of sweat, is really a compound secretion. Nor is it 
possible, even when it is desired to do so for purposes of examination, 
to separate these two secretions from one another. This mixed secre- 
tion from the glands of the skin is known as the materia perspiratoria ; 
and it is the opinion of some that, in the two affections named, it owes 
its peculiarities of odor and color mainly if not entirely to the sebipa- 
rous glands alone. But that the secretion of the sudoriparous glands 
may not only participate in giving to the sweat an abnormal odor, but 
be the main or only source of it, is proved by the singular cases alluded 
to by Mitchell in his work on injuries to the nerves, in which in addi- 
tion to local hyperidrosis specially of the palms of the hands, very 
marked and penetrating odors were given off, and this notwithstanding 
the perpetual use of water by the patients. Chromidrosis will be more 
particularly spoken of in the next section. With these few preliminary 
remarks, we will proceed to treat of bromidrosis, and first of the gen- 
eral form. 
That the exhalations from the bodies of certain persons, are distinctly 
odorous, often disagreeably so, and this when the individuals are per- 28 
fectly healthy and cleanly, is a fact that must be within the cognizance 
of all. This fact of difference in the odor of the person is more strongly 
marked when we notice the various races of mankind, as the well- 
known but indescribable odor of the negro abundantly testifies. It can 
scarcely be doubted that this distinction, which to our imperfect sense 
of smell seems only occasional, is in fact universal, that every individ- 
ual has his own distinctive odor or smell; by this means the dog is en- 
abled with his acute sense to single out the traces of his master in the 
most crowded thoroughfare. This acuteness of smell is not necessarily 
accompanied by any refinement of the sense, according to our notions 
on the subject, for this same dog will plunge his marvelous nose into 
the most loathsome and revolting mass of carrion with the greatest ap- 
parent enjoyment. It is said that the men of savage tribes and na- 
tions will also readily distinguish friends from foes by the smell, and 
this at very considerable distances; and a boy born deaf and dumb, 
whose history is related by Dugald Stewart, presented the same power. 
But however interesting these facts may be, they do not concern us now, 
but only those cases in which the cutaneous transudation is accom- 
panied by a marked and peculiar odor. The sweat of a man is said to 
smell more acrid than that of a woman. Though the odor of the per- 
spiration, when perceptible, is usually unpleasant, it has been known 
to give forth an agreeable aroma, which has been compared to the per- 
fume of violets, roses, and musk. In the memoirs of the Queen of 
Navarre, we read that Catherine de Medici was a perfect nosegay; and 
Cujacius, and Lord Herbert of Cherbury, were equally distinguished by 
the suavity of their trauspiration. De Monteaux has noticed a very 
rank and fetid odor from the perspiration of the whole body. Musk, 
perhaps the most universally diffused odor among the lower animals, 
and by no means infrequent in plants, has been but rarely noticed in 
man. The following are in addition some of the distinct odors that 
have been spoken of by authors, viz., sulphureous, sour, aliaceous, and 
• the odor of feces. The odor of perspiration, particularly when it con- 
tains an excess of acetic or butyric acid, is often intensified by its re- 
tention on the surface of the body, and probable partial decomposition, 
when it has not been unaptly compared to that of musty or rotten 
straw. Rayer relates the following case: “ I had a woman under my 
care in theHopital de la CharitS affected with chronic peritonitis, and 
who sometime before her death, exhaled a very decided odor of musk ; 
the pupil who called my attention to this circumstance had observed 
the smell for several days while dressing a blister, but thought it owing 
to a bag of musk put purposely into the bed to overcome other bad 29 
smells. The woman, however, assured us that she had no description 
of perfumery about her, and I satisfied myself that her linen, which 
was frequently changed, was not impregnated with any perfume be- 
fore being delivered to her from the laundry of the hospital. The odor 
of musk, the existence of which was fully ascertained by myself and 
several physicians, and which was very perceptible on the arms and 
other regions of the body, did not become more powerful from rubbing. 
After continuing for about eight days the smell became fainter, and 
nearly vanished the evening before the patient’s death.” Speranza re- 
lates a similar case. Schmidt has inserted in the Ephemerides Natures, 
Curiosorum, the account of a journey-man saddler, three and twenty 
years of age, of rather robust constitution, whose hands exhaled a 
smell of sulphur sc* powerful and penetrating as very soon to infect 
any room in which he happened to be. Wilson says, “ I was once con 
suited by a valet de chambre, who could never keep a place, in conse- 
quence of the unpleasant odor he left behind him in the rooms which 
he had been occupied in cleaning. There have been instances of in- 
dividuals who, to obtain their discharge or immunity from military 
service, have simulated these offensive perspirations, by rubbing their 
axillae with dippel oil, asafetida, a piece of much decayed cheese, 
putrid fish, &c.” The odor in these cases has sometimes been likened 
to that of a goat, odor hircinus, and in some unfortunate instances has 
been so powerful, penetrating and offensive as to banish the individual 
from all society. 
Certain diseases are said by several authors to give rise to peculiar 
and distinctive odors of the perspiration. And one would think, to 
read the confident statements made by some writers, that nothing 
could be easier than to diagnosticate many ailments by this simple and 
unerring means. But many of these statements are exceedingly fanci- 
ful, and must be received with a large grain of allowance. Beside, the 
whole nomenclature of odors is entirely comparative, and probably no 
two observers would agree in the application of these various designa- 
tions. And moreover the sense of smell is so differently developed, 
and as far as I can'judge so little susceptible of cultivation, that its in- 
dications cannot be regarded as worthy of very implicit confidence. 
One who has what is called a sharp nose, is very apt to be unduly con- 
fident in his conclusions from his exceptional power, and announce 
them far too authoritatively and dogmatically. Thus the sweat of per- 
sons with the itch is said to have a mouldy odor, while that of syphi- 
litic patients is said to smell sweet. The sweat of rheumatic and gouty 
persons has an acid smell, while in putrid fever and scurvy it has a 30 
putrid smell; in jaundice it is said to resemble musk in its smell. In 
Stark’s General Pathology, p. 1126, we find it stated that the odor of 
the sweat in scrofula resembles that of sour beer, while in intermittent 
fever it smells like fresh baked brown bread. Heim, of Berlin, main- 
tains that each of the exanthemata possesses a specific smell, and that 
he could detect it so constantly and with such precision as to be in the 
enviable position of being able by means of this odor, to distinguish 
these diseases from one another. Thus it is asserted that patients 
effected with morbilli exhale an odor like that of recently plucked 
feathers; that in scarlatina the smell resembles that of new bread; 
in small pox, that of a menagerie; in miliary fever, that of decompos- 
ing straw. But the organ of smell must surely be extraordinarily acute 
to be able to detect these odors ; and in any case ttfey have no claim to 
be termed characteristic, for the substances with which they are com- 
pared by no means possess a smell so decided as to prevent the possi- 
bility of confounding them with many others. As we have already 
seen the odor of the perspiration in the sweating sickness was very 
offensive. 
Murchison, in his great work on the Continued Fevers of Great 
Britain, p. 138, says, under the head of typhus fever: “ A peculiar re- 
pulsive odor i3 given off from the body of most typhous patients, after 
the first week. This smell was noted three centuries ago by Salius 
Diversus, and has been alluded to by almost every subsequent writer. 
Lind compared it to the odor of rotten straw, or to the disagreeable 
affecting scent from a person laboring under the confluent small pox. 
Gerhard spoke of it as pungent, ammoniacal and offensive. Barrallier 
likened it to the odor of rotten straw, or that given off by deer, or by 
certain reptiles, or by rubbing the leaves of rue between the fingers. 
By other observers it has been more aptly compared to the smell of 
mice, but perhaps it is more correct to speak of it as sui generis. The 
nurses in the Loudon Fever Hospital are quite familiar with the 
typhus-odor, and I have known them to distingush typhus by it 
alone.” The same writer, p. 346, quotes the following from Kelly’s re- 
port of Relapsing Fever at Mullingar in 1847: “ Its smell was peculiar, 
not fetid or heavy, but somewhat like burning straw, with a musty 
odor: and, strange to say, there was not a single pauper in the work- 
house, with whom 1 had any intercourse, that did not evolve a similar 
odor when heated, even by the slightest exertion.” 
I have myself several times known patients suffering from suppres- 
sion of urine whose skin exhaled a strong and unmistakable urinous 
smell, about this there could be no fancy or mistake. Sensible odors 31 
are also, it is said, imparted to the perspiration by various articles of 
diet. An alliaceous sweat is perceived from eating garlic, a leguminous 
( whatever that may mean ) from peas; an acid from acids; a fetid 
from animal food only; and a rancid sweat from fat foods, as is ob- 
served in Greenland. Hecker states in his history of the epidemics of 
the middle ages, that an exclusive diet of fish gives rise to offensive 
perspiration. 
The administration of certain drugs is followed by their peculiar 
odor in the perspiration ; this is particularly the case with sulphur, 
asafetida, and musk. It must certainly have been perceptible enough 
in the following example of a celebrated Mohamedan, which is re- 
corded in Ockley's History of the Saracens, p. 478: “Abdallah’s 
mother gave him just before his last battle a draught with a pound of 
musk in it to increase his courage. It is said his head was cut off, and 
his body hung up, and for several days after they smelled the perfume 
of the musk he had drunk.” Workers in mercury, and those engaged 
in other metallurgical pursuits, are said to acquire occasionally an 
offensive perspiration. Further, I may remark with regard to the ap- 
pearance of various drugs in the perspiration, that Landerer has ob- 
served in his own person that afer taking large doses of quinine, the 
sweat assumed the bitter taste of the drug. The following substances en- 
ter into and have been detected in the sweat: sulphur, mercury, iodine, 
iodide of potassium, asafetida, garlic, saffron, olive oil, rhubarb, indi- 
go, prussian blue, and copper. ( Stark’s General Pathology, p. 1127.) 
Local bromidrosis is, however, much the most common form of the 
affection, indeed is very frequently met with, particularly in the form 
of bromidrosis pedis. The regions of the body which most commonly 
give rise to offensive perspirations are the axillae, the perineum and 
genito-aual region generally, and the feet, especially the inner or con- 
tiguous surfaces of the toes. In all these situations the peculiar odor 
arises no doubt from other sources than the perspiration itself, al- 
though it is to be observed that when the odor is specially marked, the 
perspiration is also in excess. In each of these situations the secretion 
of the skin has naturally a disagreeable smell, of which even the worst 
cases of bromidrosis there developed are probably only an exaggeration ; 
this arises in the first two situations from peculiar glandular apparatus, 
in the third from another altogether special cause. In the axillae there 
exist large glandular bodies, which bear a general resemblance in 
their structure to the sweat glands, but have been termed by some 
ceruminous glands, from their being still more like those which are 
found in the external auditory meatus, and secrete the cerumen. The 32 
true character of these organs is doubtful, it being still a matter of dis- 
pute whether they should be reckoned among the sebaceous or rather 
among the sudoriparous glands. The genito-anal region in both sexes 
is abundantly supplied with a somewhat peculiar and truly odoriferous 
glandular apparatus. 
The cause of the offensive hyperidrosis which so often effects the 
feet, I believe to be entirely different, and to arise simply from the 
peculiar treatment to which they are subjected by the fashion of 
modern dress. I refer to their being habitually and for a large part of 
the time in nearly air tight boots and shoes, a circumstance that ob- 
tains in no other part of the body. We find here none of the glandu- 
lar peculiarities pertaining to the regions we have just examined, and 
we do find, what we seldom if ever notice elsewhere, that the epi- 
dermis has a most decided tendency to become thickened and sodden 
when the sweat is at all free, and its superficial layers pass rapidly into 
a peculiar form of decomposition. All this points very strongly to the 
conclusion that the maceration of the epidermis, by the impervious 
character of our foot gear, the high temperature thus maintained, and 
the decomposition thus produced, are, I will not say the only, but the 
main factors in the case. Men, and according to my observations those 
especially who wear boots rather than shoes, are much more liable to 
this affection than women. Moreover, I never heard of any one who 
constantly went barefoot, who suffered from stinking feet. Hebra at- 
tributed the affection very largely to the constant wearing of the same 
boots or shoes, and their consequent saturation with decomposing 
sweat: though there is much truth in this idea, he carried it too far. 
Of course dirty socks, and other absolute uncleanliness, will greatly 
aggravate, if they do not cause, the trouble. Dr. Longwortb, of Cin- 
cinnati, gives in the Clinic, for October 30th, 1875, the results of some 
experiments made by him to test the truth of the commonly accepted 
opinion that the ill odor in this affection is due to the decomposition of 
the elements of perspiration. Horny epidermis was removed from 
different parts of the cadaver, including the soles’of the feet, soaked in 
ether three or four hours, and washed thoroughly in water. It was 
then entirely odorless. Being placed in test tubes with just enough 
water to cover it, and kept at a temperature of 90° F., the specimens 
from the various parts behaved differently. Those from the chest and 
abdomen preserved their transparency, and did not swell up for several 
days ; the fluid, however, became turbid, and had a fetid odor resem- 
bling that of bromidrosis. Those from the soles began to swell up 
within an hour or ,two, and after twenty-four hours gave out an odor 33 
absolutely identical with that under discussion. Dr. Longworth con- 
cludes, therefore, that the odor of the affection is due to the macera- 
tion and decomposition of the horny epidermis. In this he is, without 
doubt, mainly right, but that the materials present in the sweat, added 
to some unknown personal peculiarities of the individual, have some 
influence is not to be denied. The odor of this affection has always 
seemed to me to resemble more than anything else some kinds of 
strong cheese, and the worst cases I have known were strongly sug- 
gestive of Limburger. In addition to the smell, the maceration some- 
times goes to such an extent as to produce superficial denudation and 
even absolute ulceration, expecially between the toes ; and patients are 
often rendered absolutely unable to walk from this cause. Although, 
as we have seen, often associated with abnormal conditions, bromidro- 
sis never seems of itself to be a cause of disease; neither is there any 
ground for the fear once very commonly entertained that its suppres- 
sion or cure was liable to result in serious internal mischief. All such 
fears may nowadays be dismissed as purely chimerical. 
Treatment.—We will speak of this under three heads : first, the treat- 
ment of bromidrosis universalis; second, of bromidrosis localis; and 
third, of bromidrosis pedis. The treatment of general bromidrosis con- 
sists both of that which is constitutional or addressed to the system at 
large, and that which may be called local, addressed to the skin. On the 
first of these heads J. L. Milton, of London, in a little book on the 
modern treatment of some of the diseases of the skin, published in 
1865, has the following remarks : “ Rank perspiration is such an offen- 
sive affection that every possible care should be taken to get rid of it as 
soon as possible. Some persons give off, and are yet not aware of it, 
a most offensive effluvium. Cleanliness, inside and outside,fis always 
necessary. It has been well observed that there are many people who 
would be shocked at the idea of having a dirty skin, and who yet 
never think how dirty the inside is, or how much depends on their 
own exertions for keeping it clean. The great highway of life is left to 
purify itself. Arsenic has always appeared to me to be the most effec- 
tual remedy. Purgatives given two or three times a week and tonics 
often do a great deal of good, but in an obstinate case I know of no 
remedy to be compared with arsenic. The Turkish bath should be 
used once a week ; where it cannot be procured a hot bath should be 
substituted.” We may perhaps see in this efficacy of arsenic a reason 
to believe that this affection, as well as hyperidrosis and anidrosis, is 
after all virtually a nervous disease, particularly when we recall the 
fact that all three of these complaints have at times resulted from in- 34 
jury to nerves, and when we remember that herpes, a somewhat allied 
disease, is now generally regarded as one of the neuroses. Thus we are 
supplied with another illustration of the fact that to master even one of 
the least corners of medical science we must take broad general views, 
and cultivate—what is almost becoming obsolete in the multitude of 
specialties—the general science of medickie. 
After bathing in this disease, if the moisture be excessive the surface 
may be dusted, after well drying, with rice powder, starch, lycopo- 
dium, or some similar substance. If any smell linger after this, free 
use may be made of chloride of zinc or permanganate of potash. Sali- 
cylic acid, either as a powder or as a lotion in solution with borax, 
might be useful. It is obvious that the common disinfectants which 
substitute one bad smell for another, are not applicable here. Lotions 
containing alcohol and astringents are to be recommended; alcohol 
alone may often be used with marked benefit. The following prescrip- 
tion Duhring says will be found of value : R. Acidi tannici, 3 j ; Al- 
coholis, § viij. M. S.—Use as a lotion. Various other astrigents may 
also be employed, such as sulphate of zinc and alum, also salt baths. 
Frequent washing of the parts with dilute ammonia water has been 
well spoken of; acetic acid, diluted, will also be found useful in check- 
ing the mild forms of the disorder. Washing with the so-called juni- 
per tar soap, has also been well spoken of. 
In offensive sweating of the axillse and genital regions, including the 
perineum and genito crural fold, the same plans of treatment will be 
found applicable. Here, however, the drying and disinfectant powders 
may be more freely and successfully used ; a combination of salicylic 
acid and powdered soap stone may be thoroughly dusted over the parts 
after thorough washing and drying. One writer in case of stinking 
armpits speaks of cutting off the hairs, or, what he says is better, pull- 
ing them out, but this seems unnecessarily severe, and I should judge 
not so infallible as to compensate for its severity. Dr. Bull writes to the 
Lancet, May 8th, 1880, that in a case of bromidrosis of the axillae, where 
mineral acids, German mineral waters, and Fowler’s solution, together 
with the local application of carbolic acid in glycerine, extract of bella- 
donna, tannin dissolved in spirits of wine, tincture of iodine, and un- 
guentum diachyli, had been employed in vain, inunctions of ten per 
of mercury used nightly after washing the armpits with 
alcohol caused the excessive sweating to disappear and the offensive 
odor with it. 
The most common, annoying, and intractable form of the disease is, 
however, still to be considered, viz., bromidrosis pedis. Even if we had 35 
no experience, we might infer the obstinate nature of this affection 
from the multitude of remedies that have been proposed for it. One of 
the older writers, Dr. Durr, has the following remarks in Hufeland1 s 
Journal, Vol 9, No. 8.; he says that “ he has observed two cases, in 
which after the cessation of the fluxus meusium, which had appeared 
rather disorderly and in long spaces of time, a very strong sudor 
pedum ensued, combined with a most disagreeable smell, which went 
away by degrees, as soon as the fluxus mensium was re-established ; 
but instead of it an acrimony of the stomach was brought on, which 
could by no remedies be subdued. Dr. Durr is in general of opinion 
that in the investigation of chronical diseases of the head and stomach, 
that circumstance, viz., sudor pedum, is not sufficiently regarded. He 
relates a case where, after a customary sudor pedum had been expelled 
by bathing the warm perspiring feet in cold water, the four back teeth 
of the right side of the maxilla inferior fell out without any other per- 
ceptible cause, and without much pain, and an efflux of a puriform 
matter was occasioned, which lasted a long series of years, till the 
death of the patient.” 
The good doctor’s reasoning is strictly of the post hoc ergo propter hoc 
kind; but, his observations are curious and I give them for what 
they are worth. However, we have quoted two cases from Hildebrandt, 
in a previous section, in which repression of perspiration of the feet 
was followed by profuse hyperidrosis of the hands, so that we cannot 
utterly deny some constitutional influence in bromidrosis pedis, strictly 
local as the affection generally seems to be. But still we need never 
hesitate to cure this disagreeable affection for fear of bad consequences 
ensuing; Hebra states that he has never known anything of the kind 
to happen during a very large experience extending over twenty years, 
and intimates that the idea has been fostered mainly by those who 
could not cure the disease and sought a screen for their incompetence. 
In treating this disease let us, first bearing in mind the opinion of the 
distinguished dermatologist just referred to, insist that the patient 
shall leave off wearing any boots, shoes or slippers, previously in use, 
and change his socks or stockings at least every day, and bathe and 
thoroughly dry his feet twice in every twenty-four hours.. This, to- 
gether with the use of some of the astringent lotions or drying powders 
already referred to, will no doubt suffice for many of the milder cases if 
thoroughly carried out for a sufficient length of time. In addition to 
this, many other remedies have been suggested of which I will men- 
tion a few. Dr. Rumbold, of St. Louis, recommends bathing the feet 
in warm water for fifteen minutes just before going to bed. The water 36 
should be kept as warm as can be borne, by the addition at intervals of 
boiling hot water. After the feet are dried and thoroughly rubbed 
with a coarse towel, an ointment composed of salicylic acid and bro- 
mide of potassium, each five grains to the ounce of vaseline, should be 
applied with considerable friction, and the feet should be covered with 
a pair of cotton stockings well warmed. According to the Revue de 
Therapeutique, an immediate remedy is found in washing the feet with 
a solution of chloral, one part to a hundred, and keeping them enveloped 
in compresses wetted with the same solution. Ortega recommends the 
same treatment. Dr. Burdon claims to have attained satisfactory re- 
sults by the employment of a solution of permanganate of potash, com- 
mencing with three parts in a thousand. Dr. Gaffard, in the Edin- 
burgh Medical Journal, Jan., 1860, recommends a mixture of red oxide 
of lead, 15 grains, and about one ounce of solution of subacetate of lead 
as an application, with which the feet are to be bathed every day. 
Tincture and ointment of belladonna have also been recommended. 
Dr. Berthold recommends a method which he says is efficacious, and 
which is less troublesome than that of bathing with solutions. It con- 
sists in powdering the interior of the patient’s socks with a powder 
composed of one part of salicylic acid and five of starch. This is, too, 
an excellent mode of treating the local sweating which in fat persons 
takes place between the scrotum and the thighs, and which if not 
arrested is apt to lead to a troublesome eczema. 
Kuester employs the following; Salicylic acid, 3 ij ; powdered soap- 
stone, § ss ; starch, 3 ijss ; soap, 3 j. The feet having been thoroughly 
washed and dried, the powder is dusted over them and between the 
toes, and some of it is put in the stockings. After two or three appli- 
cations the bad odor disappeared ; the secretion of sweat was considera- 
bly diminished in quantity ; and in a short time the perspiration 
ceased entirely, and the result was a permanent cure. In a correspon- 
dence with the Deutsche Zeitscheift fue Practische Medicin, in which 
journal the above appeared, Dr. Page speaks very highly of the grati- 
fying success he has had with the following powder, viz. 
R. Acid, salicylici grs. x 
Acid, tannici grs. xv 
Talc, preparat # 
Pulv. iris florent aa § ss. M. 
The daily application of this powder between and under the toes, and 
in the stockings or socks, stopped the maceration of the skin, and fetid 
odor attending it, and reduced the excretion of sweat to the normal 
standard. 37 
Dr. F. C. Ainsworth, Assistant Surgeon U. S. A., in the Medical Re- 
cord, for October 2d, 1880, lauds most highly the following powder: 
R. Pulv. alum, exsiccat., iij ; acid, salicylici, 3 iss-iij. M. It is de- 
sirable that the alum should be very thoroughly burned and reduced to 
an impalpable powder. This he says, when used in the same way we 
have already directed for other powders, is equally efficient as Hebra’s 
celebrated plan, which we shall describe further on, and much less 
troublesome. 
Panarolus, an old writer, remarking that perspiration of the feet doth 
very much torment people, continues, “ for which I can tell them a 
speedy remedy ; namely, if they put some powder of myrtle into their 
linen socks ; but let them have a care they fall not into worse disease 
by the cure of this, as I have often seen ; for this excretion preserves 
from many diseases, and should rather be promoted than any way 
checked.” 
Foot baths of brine or of a strong solution of alum have succeeded in 
some cases. The following ointment is much esteemed by Wilson, 
namely; equal parts of tar ointment and sulphur ointment, to be spread 
upon clothes and applied with a bandage. Finally, when all other 
methods fail, Hebra says, “recourse may be bad to the following pro- 
ceedure, which will invariably be attended with success. A certain 
quantity of the simple diachylon plaster (Emp. Plumbi, Emp. Ly- 
thargyri) is to be melted over a gentle fire, and an equal weight of lin- 
seed oil is then to be incorporated with it, the product being stirred 
till a homogeneous mass is produced, sufficiently adhesive not to crum- 
ble readily to pieces. This is then spread over a piece of linen measur- 
ing about a square foot. The foot of the patient being well washed and 
thoroughly dried, is now to be wrapped in the dressing thus prepared. 
Pledgets of linen, on which the same ointment has been spread, are also 
to be introduced into the space between each pair of toes, to prevent 
their touching one another, and care must be taken that the foot is 
completely covered, and that the dressing is accurately in contact with 
the skin. When this has been done, an ordinary sock or stocking may 
be put on the foot, and outside this a new shoe, which should be light, 
and should not cover the dorsum of the foot. After twelve hours the 
dressing is to be removed; the foot is then not to be washed, but must 
be rubbed with a dry cloth, or some dry and absorbent powder may be 
applied to it. The dressing is then to be renewed in the same way as 
before, and its application is afterward to be repeated twice a day. This 
proceedure must be continued for from eight to twelve days, according 38 
to the severity of the ease. Duiing this time, however, the patient 
need not keep his room, but may go on with his business as usual. At 
the end of this period the dressings and pledgets are to be removed, the 
foot is to be again rubbed with some pulverulent substance, and the 
patient may then be allowed to wear his ordinary shoes and stockings. 
In the course of a few days it will be found that a brownish-yellow 
layer of cuticle, about half a line thick, is beginning to peel off from all 
those parts of the skin which were before affected with the disease, and 
that a healthy, clean, white surface of epidermis is exposed as this sub- 
stance separates. When this layer of cuticle has become completely 
detached, the foot may for the first time be washed, but it will still for 
some time be advisable to dust some pulverulent substance into the 
stocking, or to rub it into the skin of the foot. After the lapse of a 
fortnight or three weeks from the first application of the dressing, the 
hyperidrosis will generally have disappeared, and the cure will last for 
a year or longer, or may even be permanent. In quite exceptional 
cases, however, it will be found that a single course of this treatment is 
not sufficient to effect the complete removal of the complaint. The 
whole proceedure’must then be gone through a second time; but this 
will certainly, and without exception, bring about a cure. I have prac- 
ticed this mode of treatment for more than twenty years, and in many 
hundred cases.” 
Notwithstanding Prof. Hebra’s strong declarations of its infallibility, 
I am afraid this plan is too troublesome to be adopted except in the 
most severe and rebellious, and otherwise hopeless cases. 
Dr. Gay, of this city, informs me that when he was at the Hot 
Springs in Arkansas, he saw there what was called the “corn hole,” 
being one of the hot wells for which the region is celebrated, in which 
numerous persons were in the habit of soaking their feet for many 
hours every day, until their corns were thoroughly macerated, and 
could easily be pulled out by the roots. He was told that it also cured 
sweaty feet, which he found on inquiry to be the fact, and since his re- 
turn home he has cured this affection in many instances, by simply 
directing the feet to be soaked for hours every day in water as hot as 
can be borne. 
Dr. Nash, also of Columbus, tells me that on the recommendation of 
Dr. E. B. Stevens, of Cincinnati, he has tried with good results the ap- 
plication of a strong, almost caustic, solution of silver nitrate; but 
there are obvious objections to this plan which I need not mention. 
Dr. Klitzinski, in the Echo Medicate, quoted in Braithwaite's Retro- 
spect, part 40, p. 151, speaking of Chloihydric acid, says: “A portion 39 
of the skin wet with this liquid perspires in the same time and under 
the same circumstances 27 to 30 per cent, more carbonic acid, and, 
what is remarkable, 7 to 12 per cent, less water, than the same portion 
not wet.” The author concludes, among other things: “ It diminishes 
the uncomfortable sweating of the hands and feet, and causes them to 
cease entirely, after a long continued use of it. It does not injure the 
skin in any way if properly used ; on the contrary it softens it, and 
can be regarded as a real cosmetic. When employed it should contain 
neither iron nor chlorine. It is used as concentrated as the patient can 
bear it without feeling a burning sensation, and after thirty to sixty 
seconds, the wet part is washed first with pure water, then with soap 
and water.” 
M. Stanislas Martin, Bulletin de Therapeutique, Tome 65, p. 143, says : 
“ The diffusion of the abominable odor in this complaint may be effec- 
tually prevented by placing a sole containing a layer of powdered char- 
coal between the foot and the stocking, or between the latter and the 
shoe. A paste composed of forty parts of powdered charcoal, forty of 
water, and fifteen of gum should be thickly spread over a piece of felt- 
ing paper, flannel felt, &c., stretched over a board or pasteboard. The 
paste is then covered with another piece of paper, which is to be 
smoothed with the hand so as to remove all asperities. The whole is 
submitted to compression during an hour, after which the water is to 
be allowed to evaporate. When quite dry, the sole may be cut out of 
the required size. Being so cheaply made these soles can be changed 
once or twice a day if required.” 
Dr. George Thin, in an article in the British Medical Journal, Sept. 
18th, 1880, says: “ It has been pointed out by Hebra that the evil smell 
is not in the sweat itself, but in the coverings of the feet; a fact which 
it is easy to verify. The patient who has afforded me the opportunity 
of investigating the cause of the smell is a young woman, aged twenty- 
two, who has suffered from evil smelling feet with soreness of the heels 
for several years. Her hands are usually moist, or even wet, but are 
always odorless. The smell from the feet is not constant, disappearing 
in dry, bracing weather, and reappearing when the weather is moist 
and depressing. The experiment I made was to subject the soles of the 
stockings and boots to the action of an antiseptic solution. The success 
was complete, the odor being entirely banished. The antiseptic pre- 
cautions being soon neglected, the smell returned, and I took the op- 
portunity of investigating its causes more minutely. The sole of the 
stocking, a few hours after it was put on, was found to be quite wet; 
and a stocking, if worn for a whole day, was so extremely offensive 40 
that, when held close to the nostrils, its over-powering fetor was com- 
parable to that of putrid blood. The inside of the boot was equally wet 
and offensive; but at the very time that the stocking and boot smelt so 
strongly, the heel itself, exuding moisture profusely, had no disagree- 
able odor. The sole of the heel was reddened and tender, and macer- 
ated round the edge, like a washerwoman’s palm. The reaction of the 
moisture in the stocking and in the sole of the boot was alkaline, that 
of the moisture exuding from the skin of the sole of the heel faintly 
alkaline, while that of the perspiration of other parts of the body was 
acid. The fluid in the sole of the stocking was found to be teeming 
with bateriaforms, the nature and development of which I have care- 
fully investigated. The treatment in this case is as simple as it has 
been effective. The stockings are changed twice daily, and the stock- 
ing feet are placed some hours in a jar containing a saturated solution of 
boracic acid. They are then dried, and are fit for wear again if it be 
desired. The boracic acid effectually destroys the smell. But to kill 
the bacteria in the stocking is not enough. The leather in the bottom 
of the boot is wet and sodden, and smells as vilely as the stocking. 
This difficulty is got over by the use of cork soles. I directed 
my patient to get half a dozen, which she finds sufficient. A pair must 
only be worn one day unchanged ; at night they are placed in the bo- 
racic jar, and put aside the next day to dry. If these directions be ac- 
curately carried out, the evil smell is perfectly destroyed. The boracic 
acid solution is an excellent application to the painful skin in these 
cases. When the tender skin of the soles is washed with it, a sensation 
of coolness follows the feeling of heat and tension which are the usual 
accompaniments of the eczematous condition associated with the smell, 
and the skin becomes harder and loses its abnormal redness. The bac- 
teric fluid would seem to act as a direct irritant to the skin. My pa- 
tient assures me that, if she wears the stockings which have been dried 
without being disinfected, irritation is speedily felt; and that the cork 
soles, if worn a second day without having been purified, act in a simi- 
lar way.” 
This is a most interesting contribution to our subject, but surely the 
doctor builds too great an edifice on the foundation of a single case. 
Another correspondent writes to the British Medical Journal a plan 
for curing this nauseous malady:—“ A plan I always adopt, and have 
always found successful in a few days (say from seven to fourteen). 
The feet are washed well over night, and are then enveloped in about 
a couple of folds of linen dipped in equal parts of hot water and the fol- 
lowing : 41 
“R. Zinci sulph 3 i 
Glycerin 
Ac. carbolic aa 3 ij 
Aquam, ad 3 viij. M. 
“ The linen is tied on by a couple of pieces of tape, and the patient goes 
to bed, keeping the feet out at the bottom. This is done night after 
night, with improvement at once, and the cure in the time first stated. 
I have known one case in which the disease recurred in two or three 
months, but quickly yielded to a repetition of the treatment.” 
Mr. Edgar A. Browne, M. R. C. S., in a paper in the Liverpool Medi- 
cal and Surgical Reports, October, 1870, says that the patients affected 
with bromidrosis pedis ‘‘are usually of the lymphatic type; the ner- 
vous system poorly toned, and apt to break down under stress; skin 
pale, sallow, or muddy—generally thick, loose, tender to external im- 
pressions, and liable to acne, eczema, and other diseases of a low type. 
Sex does not appear to have any influence.” These observatiens have 
not been borne out by my own, nor are they confirmed by other 
writers, they seem either to be purely fanciful, or derived from a 
limited and peculiar experience ; and moreover do not accord with his 
other remarks, to the effect that the smell depends solely on retention of 
the secretion in the socks. He recommends washing the feet in cold 
water, and says that, “ hot does harm,” which again is contrary to the 
experience of others; he has not added anything to the subject, and is 
in the main a mere echo of Hebra. 
IV. Chromidrosis.— Synonyms; Ephidrosis disc®lor ; Chromocrinie 
Cutande; Dyschromatoderma; Colored Sweat. 
Chromidrosis is a very rare disease, though perhaps if we exclude of- 
fensive feet and axillse, not more so than osmidrosis. In this affection 
the excretion of sweat is usually excessive and possesses positive color. 
The following are the hues that have been observed; (a) Viridis, of a 
green tinge (Sauvages, Borelli, Cent. 2, obs 56, Ac.); (b) Nigra, of a 
black tinge ( Sauvages, Joel. Langelot, Collectanea Academica, 3. 255); 
(c) Cerulea, of a blue tinge (Sauvages, Winder, Collect. Acad., 3. 263, 
Ac.); (ef) Rubra, of a red color (Sauvages, Bartholin.); (e) Flava, of a 
yellow color; (f) Fusca, of various shades of brown. Sometimes special 
names are given to these different forms, as cyanidrosis, melanidrosis, 
Ac. Of the various colors, yellow is the most rarely met with, except 
when it occurs as a complication of jaundice of which we shall speak 
further on ; the next rarest is the green, unless it occur from copper 
poisoning of which we shall have some interesting cases to relate. 42 
The commonest hues presented by this chameleon disease are black, 
brown, and blue, the blue being generally of a dull dark shade, often 
so dark as to be rather what may be called a blue black ; sometimes, 
however, it is a real azure hue. The coloring matter in these three 
forms is probably identical, being most likely indican, which is, as it 
normally exists, colorless, and occurs pathologically in human urine. 
The indican is believed to be secreted by the sweat glands in a colorless 
state, and to be acted upon by the air so as to be oxidized blue, or 
brown, or blackish, as the case may be. In one case which Scherer 
examined, the patient had been taking a large quantity of iron, and 
Scherer found the blue color to be due to protosulphate of iion. It may 
be proper to remark just here that in the cases of blue pus, blue milk, 
and blue bile and urine, which have been reported from time to time, 
some salt of iron, generally the prussiate, has been found to constitute 
the coloring matter. The red coloring matter of the urine, uroerth- 
rin, has been found in perspiration by Landerer; a blue coloring mat- 
ter allied to cyanin has been found in the [sweat. As already ob- 
served, the coloring matter of bile, and various salts of copper, may be 
present, and impart to the cutaneous transpiration their peculiar hue; 
whether any other coloring principles besides those I have mentioned 
have been found in this secretion, I do not know. 
As in bromidrosis it is necessary to bear in mind that in this disease 
we have to do with the totality of the secretions from the skin—the 
materia perspiratoria—and some authors have insisted that the so- 
called colored is in most cases more truly a colored sebum, of the 
nature of that in stearrhea or seborrhea nigricans, more or less diluted 
it may be with the true perspiratory fluid. No doubt this is some- 
times the case, but we have the testimony of respectable authors that 
it may be observed as an oozing of sweat, more or less profuse, coming 
directly from the opening of the ducts and possessing the properties of 
normal sweat plus the peculiar coloring matter. The disease occurs 
most commonly in women, and is much more frequent in unmarried 
than in married women. It is usually, but by no means always, en- 
countered in connection with uterine disorders of one kind or other ; 
and particularly in that mysterious condition known as hysteria. It 
has often been simulated, and this possibility should always be borne 
in mind in investigating a case of this kind, and every precaution 
taken lest we be made the victims not only, but the agent also of ridic- 
ulous or interested deception. In this proneness to attack the nervous 
and hysterical we find another of those links which we have been 43 
tracing all through our general subject, connecting the anomalies of 
perspiration with the sympathetic or vaso-motor nerve system. 
The amount of secretion in chromidrosis may be very slight, or ex- 
cessive in quantity. As a rule the flow is not constant, but appears 
suddenly, remains for a short time, and then disappears again. It may 
come and go in this manner for a period of weeks or months. It is 
frequently brought on by excitement, emotion, or passion; fright is 
often mentioned as a cause, although it may appear without any excit- 
ing cause. 
As far as I know it is never universal; various regions may be at- 
tacked, but it has been noticed most frequently upon the face, chest, 
abdomen, arms, hauds, and feet; the lower eyelids and cheeks seem 
to be its most favorite seat. 
Dr. Bleifuss ( Wurtemburg, Med. Correspondenz Blatt, 1835, No. 26) 
has seen blue sweat from the foot of a patient with disease of the ab- 
domen. Michel has likewise observed it in an hysterical woman and 
in a hypochondriacal man; it was most marked on the right side of 
the body. Billard (Froriep., Notizen, 32) observed a blue sweat on the 
upper part of the body of a girl, and Conradi reports blue perspiration 
of one half of the scrotum. 
It has long been known that in certain rare cases of jaundice the 
perspiration, particulary in the axillary regions, is deeply tinged with 
bile. Wood says, Practice of Medicine, Vol. 2, p. 515; “All the other 
secretions are occasionally more or less tinged with bile, especially the 
perspiration which often stains yellow a towel rubbed upon the skin.” 
Flint, Practice, p. 547, says: “The perspiration contains the coloring 
principles of bile, and the body linen may be stained yellow, especially 
from the abundant cutaneous secretion in the axilla.” Roberts, Prac- 
tice of Medicine, p. 657, says: “ Evidence of the presence of bile is often 
afforded by the sweat, milk, saliva, and tears.” Niemeyer says, “ bile 
pigment constantly occurs in the sweat also, so that the linen is colored 
yellow, particularly at those parts where the patients sweat much. 
The milk of nursing women has also been found colored yellow.” 
Murchison, Clinical Lectures on Diseases of the Liver, remarks: “The 
cutaneous glands usually eliminate the pigment, and sometimes in such 
quantity as to stain the linen yellow, but the amount discharged in 
this way is small when compared with that which escapes through the 
kidneys.” Frericbs, in his classical work on Diseases of the Liver, 
says : “ Next to the kidneys, the sweat glands take the most prominent 
partin the excretion of bile pigment. Not unfrequently the secretion 
of the axillae, and of other parts of the skin remarkable for their secre- 44 
ting properties, colors the whole linen distinctly yellow.” Chomel 
was acquainted with this symptom, and Cheyne observed a patient who 
first became cognizant of his complaint from noticing his towel become 
yellow upon wiping his face. Andral describes a case in which the 
sweat colored the linen yellow, and the urine contained the coloring 
matter of the bile, although the skin and conjunctivse exhibited no 
jaundiced tint. Finally, under this head, Dr. J. Wickham Legg, in a 
recently published work on Diseases of the Liver, &c., states that this 
symptom was known to Galen, though it is only said by him, how- 
ever, that the sweat is bitter. A similar Xanthidrosis, according to 
Dr. Geo. B. Wood, Practice, Vol. 1, p. 515, is observed in yellow fever; 
he says: ” All the other secretions are occasionally tinged with [bile, 
especially the perspiration, which often stains yellow a towel rubbed 
upon the skin.” Other writers concur in the same statement. 
Having mentioned the appearance of colored sweat as one of the 
symptoms of poisoning by copper, I will now proceed to cite some of the 
cases in which it has been observed. Dr. Clapton ( Medical Times and 
Gazette, Vol. 1, 18C8, p. 658 ) has put on record a number of cases of cop- 
per poisoning occurring amongst the out-patienls of St. Thomas’ Hos- 
pital, London. In these cases the copper had been taken into the sys- 
tem with the food, or by work people in the course of their accustomed 
occupations. One was a sailor, who had been compelled, during the 
whole time of a long voyage, to drink lemon juice, which was kept in 
a copper tank. Another was a young woman, an artificial flower 
maker, who was in the habit of inhaling the dust of verdigris and 
Scheele’s green, which she used in her business. A third case, a cop- 
persmith in an engineer’s factory, led to the discovery that all the per- 
sons working in a particular shop, fifteen in number, were similarly 
affected. The general symptoms induced by the copper, which were 
of a chronic character, were : vertigo, gastrodynia, flatulence, dyspnea, 
frequent vomiting, wasting of the body, coppery taste, lassitude, and 
indisposition to exertion ; the tongue moist and flabby, and pulse hard 
and full. In all there was a green tinge of the edge of the gums ex- 
tending half way up the tooth. The perspiration of these people had 
a bluish tinge. “I examined the flannel waistcoats of several and 
found them deeply stained, especially under the arms. One of the 
men stated that, even after a hot bath on Saturday night, the white 
shirt next day, if in hot weather, would be quickly discolored. I 
noticed, too, that the wooden handles of all the hammers were stained 
green from the perspiration of the hands. Even with the greatest 
care it is impossible to prevent the inhalation of copper particles or 45 
fumes. The dust of the shop, when viewed in a bright ray of light, 
can be distinctly seen to be charged with bright metallic particles. 
Water, too, kept in any vessel in the room for a short time can be 
shown by tests to be charged with copper. The fumes given off during 
the process of strongly heating the copper for the purpose of joining 
appear to be most injurious.” 
In a case of green perspiration recorded by M. Pritchard, of Leaming- 
ton (London Medical Gazette, Vol. 2, p. 211, 1833) the cause was ascer- 
tained to be the accidental exhibition of copper with the food, the food 
having been prepared in a copper vessel plated willi u, from which a 
portion of the tin had been rubbed away. The subject of the affection 
was a young lady of fourteen, who “ had for some months evinced much 
general debility.’' She was then “ seized with an attack of rheumatic 
fever, which yielded to remedies slowly and unsatisfatorily. After 
some days, during which the perspiration was considerable, my atten- 
tion was called to a collection of light green perspiration between the 
toes, and underneath the nails of the young lady’s feet, whilst the 
same appearance was observable in a fainter degree on the upper, but 
more especially the under surface of the foot.” 
So far we have only mentioned instances in which the sweat was dis- 
colored by the elimination of coloring matter derived from well-known 
poisons taken into the system, or retained in the blood ; let us now 
turn to those cases which come more properly under the head of true 
or idiopathic chromidrosis, though even here we shall almost invari- 
ably find some concomitant pathological condition. I have stated 
already that the disease is a very rare one, in confirmation of which I 
offer the following quotations, from those who have had the largest 
opportunity for observation, and whose authority in such a matter is 
both undisputed and indisputable. Erasmus Wilson says, “I have 
never seen a case deserving of being considered as one of chromidrosis.” 
The following is absolutely all that Hebra has on the subject, in his 
work on diseases of the skin. I quote the section entire as it is very 
short. “No instance of this affection having come under my observa- 
tion, I can only quote the description of it given by other writers. 
Thus Eayer states that cases occur in which the sweat is of different 
colors—green, black, blue, or yellow,—but he confesses that he himself 
has seen none of these varieties. Fuchs says that cases have been ob- 
served in which, sometimes over the whole body, sometimes at partic- 
ular spots, the cutaneous secretion has been yellow, green, blue, brown, or 
black. Besides staining the linen, the perspiration dried on the skin of 
the persons thus affected into a colored powder, which, however, could 46 
easily be scratched off, the heathy skin beneath being then exposed. 
Erasmus Wilson also admits that he has seen no instance of this affec- 
tion.” 
I am myself aquainted with a middle-aged man, whose axillary 
sweat is distinctly and deeply colored, leaving a stain on his under- 
clothing over the region indicated as laige as the Bpread hand, which 
is of a deep fuscous orange color; and a few years ago I knew an elderly 
lady the perspiration over several regions of whose body stained her 
clothing of a dark brown, and was a source of deep mortification to 
her. Both of these persons are, as far as I know, in good health, and 
neat and cleanly in their personal habits. 
In regard to red perspiration in the axilla, a number of communica- 
tions have appeared in the Medical Record during the year. The first 
is in the number for May 15th, 1880, in the department headed Progress 
of Medical Science, p. 540, as follows:—“ At a meeting of the Swedish 
Medical Society, Prof. Alex Key reported the case of a colleague who 
had for sometime noticed that the hairs in his axillae adhered together, 
and that this was occasioned by a sticky substance covering the hairs. 
The perspiration from the axillae stained the shirt red, but occasioned no 
other inconvenience. On close examination, Key found the hairs 
roughened and sticking together, and many of them were covered with 
a yellowish coating resembling honey. The latter was situated on the 
free ends of the hairs and formed partly isolated or confluent intumes- 
cences, partly rosary, chain-like globules, or a coherent mass surround- 
ing the hair. There were no changes in the skin. The microscopic 
examination showed that this condition depended on a peculiar fun- 
gous vegetation which by transmitted light had an amber-yellow 
color. At its commencement the vegetation appeared as a small, thin, 
glistening lamella, of a pale yellow hue, which soon formed small glob- 
ular elevations of homogeneous appearance in the main, but with 
numerous imbedded small glittering spores. The flakes seemed to lie in 
part on the surface of the hair, in part and predominantly the vegeta- 
tion pressed in between the outer layers of the epidermic plates of the 
hair, giving the latter a roughened appearance. Again and again the 
vegetation could be followed as far as the medulla of the hair. No 
mycelium was discovered. No mention of a similar case could be found 
in special literature.” In the next week’s issue of the same journal 
(May 22d, p. 580) is a short communication from Dr. W. A. Dayton, 131 
W. 125th St., as follows: “Sir:—The extract in your last Issue entitled 
‘Red Perspiration of the Axillae,’ brought to mind several cases which 
I have seen within the past two years. In each instance the patients 47 
were afflicted with pediculi pubis, and the axillae were inhabited. The 
hairs in the armpits were invariably matted together with the ‘ honey ’ 
secretion, and microscopic examination revealed what might, in truth, 
be called 1 glittering spores.’ At first I concluded that the honey secre- 
tion was a sebaceous matter, but now am quite sure it bears some re- 
lation to the nutrition of the ovi, as in the case of spiders’ eggs. As for 
treatment, a little soap and water will prevent, or a little blue ointment 
will cure, any case where there is red perspiration of the axillae.” This 
writer’s short communication involves a most unwarrantable assump- 
tion, and, take it all together, I am rather surprised it should have 
found a place in any scientific journal. The following appears in the 
Record for July 10th, 1880; it is rather ambiguous in its import, if not 
rash in its assertions. It is from Dr. W. C. Moore, of Eldora, Iowa, 
who says:—“ The cases of this condition are very common. Few, if 
any, fleshy people are exempt, although it is not by any means con- 
fined to this class. The axilla is seldom inhabited without the hairs 
of the pubis being similarly affected. Its chief cause is lack of cleanli- 
ness, and the trouble is easily cured by means of mercurial ointment, 
compound zinc ointment, or carbolic soap and water.” Finally, in the 
issue of October 30th, 1880, Dr. H., of Savannah, Georgia, writes p. 
502 :—“I noticed in a recent issue of the Record a short article on Red 
Perspiration of the Axillae, in which are the words, ‘the perspiration 
from the axillae stained the shirt red, but occasioned no other incon- 
venience.’ As I am subject to this red perspiration of the axillae, and 
suffer no other inconvenience whatever, I can corroborate the above 
statement. The description of the state of the hairs in the article re- 
ferred to, corresponds exactly to the condition of mine. But a strange 
feature in my case is that although I always perspire a great deal every 
summer, saturating my undershirt at least once daily since the first of 
June, as well as I can remember, it is only occasionally that my shirt is 
stained red at the axillae ; and I think that this is more likely to occur if 
I take an unusual amount of exercise, such as a long walk out of town, 
or rowing. In the Record of May 22d, p. 580, is another article on the 
same subject, by Dr. W. A. Dayton, in which he says:—‘In each in- 
stance the patients were afflicted with pediculi pubis, and the axillae 
were inhabited.’ Now, on this point I think the doctor is entirely mis- 
taken, and as far as my own case is concerned I know he is mistaken, 
as I never yet had to support a family of pediculi pubis, and I have 
been subject to the red perspiration of the axillae for several years. 
Another fact which induces me to believe that Dr. Dayton is mistaken 
in regard to the cause of this affection is that in my case I have never 48 
known this red perspiration to occur except in summer, while I am in- 
clined to think that in this climate (perhaps also in others,) the pediculi 
pubis will affect persons in winter as well as in summer. Although I 
have while hunting been perfectly covered with perspiration in the 
middle of winter, yet I have never noticed a red stain or the peculiar 
condition of the hairs at that season. As to the treatment, I have not 
as yet given it a thought, but I find that a liberal and daily application 
of soap, for week3 continued, has not removed that peculiar condition 
of the hairs ; and from the fact that I have been in the habit of using 
soap and water liberally and daily winter as well as summer, I know 
that their use has not prevented the affection in my case, but it has 
prevented, the hairs in the armpits from being invariably matted to- 
gether with the honey-like secretion. If this affection was produced 
by a sticky substance covering the hairs, this substance would impart 
its stickiness to the perspiration, and through it to the fabric of the 
shirt, but I have not found this to be the case. Although I have not 
made a microscopical examination of the hairs thus affected, I am in- 
clined to think with Dr. Key, that the affection is due to a peculiar 
fungous vegetation.” 
We cannot accept the conclusions of any of these writers, at least 
only in a few and exceptional cases. The Swedish Professor’s fungus 
needs to be seen and examined by others; indeed, his description of it 
supplies serious doubts as to its being a fungus at all. Dr. Dayton’s 
inference, whatever may have been its value in the particular cases he 
saw, it is absurd to apply to others. In this connection it is well to re- 
member that the axillary sebaceous glands are so peculiar, that some 
have called them ceruminous, and I may repeat that Lauderer has 
found the red coloring matter of the urine (uroerythrin) in the axillary 
sweat of a fever patient, so that the explanation of this red axillary 
perspiration may not be such a simple matter after all. 
Delthil {La France Medicale, March 24th, 1877, p. 186) reports a case 
of chromidrosis occurring in a girl sixteen and a half years old. 
Around both orbits and various parts of the body were discolorations of 
a blackish blue hue, which stained the clothing and were evidently the 
product of a natural secretion. The appearance of this secretion was 
intermittent and did not correspond with the catamenial epoch. A 
peculiar phenomenon presented itself, viz., the falling off of the nails, 
all those of the right foot were already gone, while those of both hands 
and other foot were tender and appeared as if about to fall off. The pa- 
tient menstruated regularly, and was in good health with the exception 
of a slight nasal catarrh. Some spots of purpura were to be seen at 49 
times. The gums were painful, bled easily, and were spongy. The girl 
had had urticaria and measles, but she presented, more especially, 
some of the phenomena of hystero-epilepsy in which the crisis some- 
times lasted for two days. These crises were accompanied by a pecu- 
liar form of hyperesthesia, so that the hairs appeared as rigid as those 
of an electrified animal, and the simple touching of the hair follicles 
provoked an erethism with hystero-epileptiform convulsions. In con- 
clusion, Delthil asks if ebromidrosis is a true morbid entity, if the phe- 
nomena described have not an analogy to scorbutus, ergotism, and dif- 
ferent other affections characterized by an alteration in the function of 
the vaso-motor nervous system. 
I quote the following from Braithwaite's Retrospect, Part 13, p. 308:— 
“In the last Volume of the Medico Chirurgical Transactions (Vol. 28, 
p. 611), Mr. Teevan has recorded a wonderful case : the patient, a girl 
fifteen years of age, was the subject of this remarkable discoloration. It 
was first observed in January, 1845, on the left under eyelid and inter- 
nal angle of the eye. It was at first of a brown color, but soon became 
black, and spread over the forehead and eyelids of both eyes. The 
black secretion thus formed could be washed oft, and was sufficient to 
discolor a iarge quantity of water; when it was being secreted, there 
was a burning heat in the parts, and so decided was this that she could 
tell within a quarter of an hour when the blackness would show itself. 
It invariably commenced in the same situation, and spread as noticed 
above. Mr. Teevan states that he has no knowledge of the physiologi- 
cal cause of the disease ; the secretion he considers analogous to mela- 
nosis. There is no other case of a similar description on record.” 
There is room here for just the ghost of a suspicion that Mr. Teevan 
may have been imposed on, and surely he is a little hasty in saying 
there is no similar case on record. 
Among recent wriiers on this curious and rare disorder, may be men- 
tioned Dr. G. Camuset, in Le Mouvement Medicate, 1870, p. 419. Ac- 
cording to Camuset, the affection is almost always observed in women, 
and manifests itself by a slate-black discoloration of the skin in various 
regions, chiefly the lower eyelids. Sometimes it extends to the middle 
of the cheek, and to the upper lids, symmetrically on both sides. It 
has been observed on the chest and elsewhere in localities where the 
sweat glands are abundant. The exudation is composed of an amor- 
phous, blackish substance, of strong coloring powers, like soot. Under 
the microscope the fragments look like bits of dried varnish. This 
material is derived from the glomeruli of the sudoriparous glands : it 
has nothing in common with the pigment of the rete Malpighi. The 50 
color of the material varies in intensity in different cases, and accord- 
ing to the condition of the individual. It is worse at the menstrual 
period. The affection may last from a few months to several years, 
with occasional intermissions and remissions. It leaves the lower eye- 
lids last of all the localities attacked. Young women are most usually 
the subjects of chromidrosis. Treatment is to be directed against the 
general debility accompanying the affection. Dr. Camuset gives notes 
of the case of a young girl of feeble health, who presented the eruption 
in its typical form. She was cured by the use of tonics, &c. It is suffi- 
ciently obvious that this author writes of only one form of chromidro- 
sis, and from a very partial and imperfect knowledge of the affection. 
The following case is reported by Dr. C. D. Purdon, of Belfast: “Bar- 
bara Murphy, aged 40, mother of two children, inmate of an infirmary 
at Belfast. I?or twenty years she has been the subject of various affec- 
tions, mainly of a rheumatic character, with heart complications, 
anasarca, and hydrothorax. About the time of the report these troubles 
which had been much better returned with such severity as to threaten 
her life. When at the worst, a miliary eruption appeared on the 
trunk, greatest in the epigastric region, from which a clear serous dis- 
charge flowed in such quantities as literally to wet the bed ; there was 
a great moisture on the legs, which had blisters on them in place of the 
miliary eruption; this was attended with the greatest relief, and the 
breathing became almost free. The discharge continued for some days, 
after which it ceased, and symptoms of dyspnea returned with great 
severity for fourteen days, when after having a sense of prickling over 
the whole body for twelve hours, the eruption again appeared, attended 
with the discharge, and causing the same relief. In this state of alter- 
nate relapse and recovery she had been for the last two months, the 
duration of the paroxysms being either eight or fourteen days. But 
the most curious point in the case is, that the serous discharge has 
changed very much in character for the last four or five attacks, being 
alternately nearly blue and straw colored or yellow, almost like pure 
bile. When the blue discharge appears she is aware of its advent by a 
mouldy smell, and a prickly sensation which precedes it invariably for 
twelve hours ; the yellow is not attended by either of these. The blue 
always appears along the posterior part of the chest; the yellow gener- 
ally proceeds from the abdomen and back of the neck, and rarely from 
the back; the blue never has appeared on the abdomen ; the two colors 
have been produced from different parts at the same time. The dis- 
charge from the extremities has never been colored. In place of cata- 
menia there is a discharge of reddish green color. As to treatment 51 
every remedy has been tried without relief to any of the symptoms, 
either of the rheumatic or cardiac affections. The yellow color is toler- 
ably permanent, the blue, however, fades; she has not taken any 
iodine for some years, and at present uses only opiates 
and saline draughts.” Dublin Quart. Jour. Med. Sci., quoted in the 
Medical Examiner, Jan., 1840, p. 67. In this extraordinary case it 
seems highly probable that, notwithstanding the concomitant appear- 
ance of certain eruptions, the cutaneous discharge was mainly perspira- 
tory in character. 
The following are some further cases and authorities on this curious 
and interesting subject. Oases have been recorded by Billard, in the 
Archives Generates de Medicin, see Cyanopathie Cutan6e; Neligan, 
Dublin Quarterly Journal, 1855; Barensprung, Le Roy de Mericourt, 
who has a Memoire sur la Ohromidrose on Chromocrinie 
Cutanee; Gintrac, Lecat, Gallot, Bousquet, Banks, Lyons, Macken, 
Gilbert, Robin, Kollman. Dr. Foote, in the Dublin Quarterly Journal, 
1868, in a good paper on chromidrosis, has given the particulars of 
thirty-eight cases. Other writers are, Fernery, Historeede VAcademie 
des Sciences, 1701; Fontenelle, sur les Suems bleues, Journal de 
Chemie-Medicale, Vol. 1, p. 330. Maker, of Kirchberg, Gaz. des Hopi- 
taux, 1859, quoted in CanstatVs Jahrbuch, Vol. 3, p. 322; and many 
more. 
Tilbury Fox remarks with good judgement:—“ In all cases of chrom- 
idrosis it is the first duty of the physician to see that he is not being 
cajoled.” Indeed, as might be expected from the class of patients in 
whom the phenomenon has been most frequently observed, it has fre- 
quently been made the subject of attempted, and no doubt also of suc- 
cessful deception. And when we remember the consummate and un- 
tiring cunning of these hysterical women, we need not wonder that it 
should sometimes baffle even professional skill and sagacity. Billard 
and Neligan regard the disease as altogether a simulation, and in a case 
referred to by Duchenne, a woman avowed that she had painted her 
face during a period of twenty years to simulate the disease. I take 
pleasure also in referring to an excellent paper by James Startin, Esq., 
F. R. C. S.,‘in the British Medical Journal, Jan. 8th, 1870, on “ Feigned 
or Hysterical Diseases of the Skin.” One of his cases was that of a 
young hysterical female in the middle ranks of life, who spoiled a large 
amount of linen in consequence of a profuse perspiration of a dark or 
black color; this, says he, “I found to be a solution of soot in milk or 
tea, which opinion was confirmed by my esteemed friend, M. Jonathan 
Hutchinson, whom I asked to put a portion of the linen under the 
microscope.” 52 
Treatment.—Of the treatment of this disease there is, indeed, very 
little to be said. It resolves itself almost entirely into the treatment of 
concomitant or accompanying conditions. In the yellow sweat of 
jaundice, we have to treat the jaundice, or rather the condition of 
which it is a symptom. For the green sweat of metallic poisoning, 
the sine qua non is the removal of the cause, and subsequently such 
means as will favor the elimination of the poison and the restoration of 
the patient’s bodily functions and powers. In the cases which are 
associated with uterine and hysterical symptoms in the female, and 
hypochondria in the male, the indication is plain enough, but often ex- 
ceedingly difficult of accomplishment. And when we consider the 
capricious and chronic character of the ailments, our hopes for speedy 
cure cannot be very sanguine. It would be a mere waste of time to 
enumerate individual remedies, as they must be adapted to the pecu- 
liarities of each case, and nobody, as far as I am aware, has ever sug- 
gested anything as having a specific virtue in chromidrosis. 
Perhaps, in addition to the general remedies here suggested, warm 
water and soap, or some alkaline or detergent wash like borax, with 
the subsequent use of some of the stimulating and astringent lotions 
spoken of under the head of hyperidrosis, might be of value. 
V. Hematidrosis.—Synonyms: Hemidrosis; Diapedesis; Derm? 
themorrhois; Ephidrosis Cruenta; Sudor Sanguineosa; Sudor Cru n- 
ta; Bloody Sweat. 
This rare affection, which has always excited in a high degree the 
interest and attention of medical observers, consists essentially of a 
hemorrhage from the unbroken surface of the skin. But inasmuch as 
this hemorrhage takes place from the network of capillaries which sur- 
rounds the sudoriparous glandule and makes its appearance through the 
aperture of the sweat duct, it is not inappropriately after all spoken of 
as bloody sweat, and its various synonyms which stand at the head of 
this section. The discharge is generally intermittent, or at least re- 
mittent, and paroxysmal in its nature, the intervals varying from a 
few hours to months. Sometimes it is pure blood, which coagulates in 
crusts or gouts upon the surface, sometimes it is so intermixed with 
serum or the perspiratory fluid as to be merely a more or less deeply 
colored bloody liquid. Its amount varies extremely ; it may make its 
appearance over the whole or nearly the whole of the cutaneous sur- 
face, but more commonly it is confined to some selected regions, gen- 
erally those in which the integument is thin and delicate. It most fre- 53 
quently appears as a more or less copious and continued oozing from 
the surface, which when wiped away, rapidly or slowly reappears from 
numerous minute or indistinguishable points, but it has been seen to 
spring up in a distinct jet from the surface. It is often associated with 
eruptions upon the surface of an erythematous or vesicular character, 
but quite as often there is nothing of the kind. Every age, and both 
sexes have furnished examples of it, though it is most common in fe- 
males, and especially nervous and hysterical women who are affected 
with some menstrual irregularity. It sometimes appears to be vicari- 
ous of the menstrual function. Bloody sweat may be produced by 
overwhelming mental emotions, and marks the acme of such perturbing 
passions as terror, anguish, despair, &c. In these cases and some others 
it appears to be the result of a purely nervous impression. While in 
others, as in malarial fevers, of which it has been known to form a 
complication, the immediate cause is of a somewhat different nature. 
While in some cases it has been associated with scurvy, purpura, and 
other blood dyscrasise, this has not generally been the case. It has 
been simulated, chiefly by enthusiastic and dishonest pietists. Ex- 
amples of the affection may be found extending throughout the whole 
range of medical literature, as well modern as ancient, and from a col- 
lection of these we shall probably be best able to study it, and bring 
4nto view its numerous and varying phases. And if it should be claimed 
tht t it is a matter of very little practical importance, at least no one 
can doubt its interest. 
Case 1. The eminent French historian, De Thou, mentions the case 
of an Italian officer who commanded at Monte-Maro, a fortress of Pied- 
mont, during the warfare in 1552 between Henry II. of France and the 
Emperor Charles V. This officer, having been treacherously seized by 
order of the hostile general, and threatened with public execution unless 
he surrendered the place, was so agitated at the prospect of an igno- 
minious death, that he sweated blood from every part of his body. 
Case 2. The same writer relates a similar occurrence in the person 
of a young Florentine at Rome, unjustly put to death by order of Pope 
Sixtus Y. in the beginning of his reign, and concludes the narrative as 
follows: “When the youth was led forth to execution, he excited the 
commiseration of many, and through excess of grief, was observed to 
shed bloody tears, and to discharge blood instead of sweat from his 
whole body ; a circumstance which many regard as a certain proof that 
Nature condemned the severity of a sentence so cruelly hastened, and 
invoked vengeance against the magistrate himself, as therein guilty 
of murder.” 54 
Case 3. Among several other examples given in the Ephemerides, 
of bloody tears and bloody sweat occasioned by extreme fear, more 
especially the fear of death, may be mentioned that of “ a young boy 
who, having taken part in a crime for which two of his elder brothers 
were hanged, was exposed to public view under the gallows on which 
they were executed, and was thereupon observed to sweat blood from 
his whole body.” 
In Millingen’s Curiosities of Medical Experience we have the follow- 
ing account of this disorder, with illustrative cases. “ But of all the 
maladies that affect cutaneous transpiration, diapedesis, or sweating of 
blood, is the most singular; so much so, indeed, that its existence has 
been doubted, although several well authenticated cases are on record, 
both in the ancient and modern annals of medicine. It is mentioned 
by Theophrastus and Aristotle, who says, some have sweat a bloody 
sweat, and again, some through an ill habit of body have sweat a 
bloody excrement. And Diodorus Siculus says of the Indian serpents, 
that if any one be bitten by them, he is tormented with excessive 
pains, and seized with a bloody sweat. Galen observes: Contingere 
interdum, poros ex multo aut fervido spiritu adeo dilitari, ut etiam exeat 
sanguis per eos fiatque sudor sanguineus. While Lucan thus describes 
it: 
‘Sic omnia membra 
Emisere simul rutilum pro sanguine virus. 
Sanguis erant lacrymse; quacumque foramina novit 
Humor, ab his largus manat cruor ; ora redundant, 
Et patulse nares; sudor rubet; omnia plenis 
Membra fluunt venis; totum est pro vulnere corpus. ’ 
The detestable Charles IX. of France sunk under this disorder, thus 
described by Mezeray (Historie de France, Vol. 3, d. 306): ‘La nature 
fit d’ etranges efforts pendant les deux dernieres semaines de la Vie de 
a Roi. II s’agitait et se remuciet sans cesse; le sang leei rejalliait par 
les pores et par tous les conduits de son corps. Apres avoir long-terns 
suffert, il tomba dans une extreme faibleur et rendit l’ame.’ The 
same historian relates the case of a governor of a town taken by storm, 
who was condemed to die, but was seized with a profuse sweating of 
blood the moment he beheld the scaffold. Lombard mentions a general 
who was affected in a similar manner on losing a battle. The same 
writer tells us of a nun who was so terrified when falling into the 
hands of a ruthless banditti that blood oozed from every pore.” 
(Bchenck, apparently referring to this same case, says that she died 
of hemorrhage in the sight of her assailants.) “Henry ab Heer re- 55 
cords the case of a man who not only labored under diapedesis, but 
small worms accompanied the bloody secretion.” (Probably vermicu- 
lar coagula formed in the sudoriparous ducts.) “In the memoirs of the 
Society of Arts of Haarslem, we read of the case of a sailor who, falling 
down during a storm, was raised from the deck streaming with blood. 
At first it was supposed that he had been wounded, but on close exam- 
ination, the blood was found to flow from the surface of the body. 
Fabricius de Hilden mentions a case that came under the observa- 
tion of his friend Sporlinus, a physician of Bale; the patient was a 
child twelve years of age, who never drank anything but water; hav- 
ing gone out into the fields to bring home his father’s flocks, he stopped 
upon the road, and contrary to habit, drank freely of white wine. He 
shortly after was seized with fever. His gums first began to bleed, and 
soon after a hemorrhage brook out from every part of the integuments, 
and from the nose. On the eighth day of the malady he was in a state 
of extreme debility, and the body was covered with livid and purple 
spots, while every part from whence the blood had exuded was stopped 
with clots. A case is also related of a widow forty-five years of age, 
who had lost her only son. She one day fancied that she beheld his 
apparition beseeching her to relieve him from purgatory by her prayers, 
and by fasting every Friday. The follow Friday, in the month of 
August, a perspiration tinged with blood broke out. For five succes- 
sive Fridays the same phenomenon appeared, when a confirmed diape- 
desis appeared. The blood escaped from the upper part of the body, 
the back of the head, the temples, the eyes, nose, the breast, and the 
tips of the fingers. The disorder disappeared spontaneously on Friday, 
the 8th of March the following year. This affection was evidently 
occasioned by superstitious fears; and this appears the more probable 
from the periodicity of the attacks. The first invasion of the disease 
might have been purely accidental; but the regularity of its subse- 
quent appearance on the stated day of the vision may be attributed to 
the influence of apprehension. Bartholinus mentions cases of bloody 
sweat taking place during vehement terror and the agonies of torture. 
“The case of Catherine Merlin, of Chamburg, is well authenticated, 
and worthy of being recorded. She received a kick from a bullock in 
the epigastric region, that was followed by vomiting of blood ; this dis- 
charge having been suddenly stopped by her medical attendants, the 
blood made its way through various parts of the pores of her body, every 
limb being effected in turn. The sanguineous discharge was invaria- 
bly preceded by a prickly and itching sensation ; frequently this itch- 
exudation proceeded from the scalp. The discharge usually occurred 56 
twice in the twenty-four hours ; and on pressing the skin, the flow of 
blood could be accelerated and increased. 
“Dr. Fournier relates the case of a magistrate who was attacked with 
diapedesis after any excitement, whether of a pleasurable or a painful 
nature.” 
The following explanation of the phenomenon, which Milligen gives, 
is probably nearly as good as any that we can offer at the present day. 
“It is probable that this strange disorder arises from a violent com- 
motion of the nervous system, turning the streams of blood out of their 
natural course, and forcing the red particles into the cutaneous excre- 
tories. A mere relaxation of the fibres could not produce so powerful a 
revulsion. It may also arise in cases of extreme debility in connection 
with a thinner condition of the blood.” 
Cases 14 and 15. In his Commentaries on the Four Gospels, Maldo- 
nato refers to a robust and healthy man at Paris who, on hearing sen- 
tence of death passed on him, was covered with a bloody sweat. Zac- 
chias mentions a young man who was similarly affected on being con- 
demned to the flames. 
Case 16. The following case is quoted in the Medico Ghirurgical Re- 
view, from the French Transactions Medicale for November, 1830. “A 
young woman, aged twenty-one years, irregular in menstruation, and 
of indolent habits, and obstinate temper, had been much irritated by 
some reflections made by her parents on account of her abjuring the 
Protestant religion. She left her paternal roof, and after wandering 
about for some time, took up her residence in a hospital. She was then 
suffering violent attacks of hysteria, attended with general convulsions, 
and exquisite sensibility in the pubic and hypogastric regions. After 
paroxysms of hysteria, which sometimes lasted twenty-four or thirty- 
six hours, this female fell into a kind of ecstasy, in which she lay with 
her eyes fixed, sensibility and motion suspended. Sometimes she 
muttered a prayer, but the most remarkable phenomenon was an ex- 
udation of blood from the cheeks and the epigastrium, in the form of 
perspiration. The blood exuded in drops, and tinged the linen. The 
cutaneous surface appeared injected in those parts whence the blood 
escaped, being red, and showing a net work of arborescent vessels. 
This bloody perspiration took place whenever the hysteric paroxysm 
lasted a considerable time. This state continued for three months, and 
ultimately gave way, it is said, to local bleeding, together with strong 
revulsive measures. 
Case 17. J. C. Schilling relates the case of a boy, twelve years of age, 
who was relieved from a severe comatose and convulsive disorder by a 
bloody sweat, which broke out August 2d, 1747. 57 
I take the following note on this subject from Dr. Schneider in Cas- 
per’s Wochenschrift, 1849. “It has often been a question whether, 
under any circumstances, blood is ever mixed with the fluid of perspira- 
tion in human beings. Dr. Schneider remarks that he has several 
times observed the phenomenon. He mentions having been once 
summoned to a heathy man, fifty years of age, who, for a period of 
twelve months in succession, had travelled on foot, during the journey 
he had perspired much in his feet; and, on examining them at the end 
of it, they were found covered as high as the ankles with a sangui- 
neous perspiration, which had also soaked into and stained his stock- 
ings. In another case of a healthy young man, Dr. 8. mentions hav- 
ing noticed that, after violent exercise, the perspiration beneath the 
arms was of a bright red color; and he quotes a similar case from 
Hoflman. In proof that the perspiration over the whole body may 
also be of a sanguineous character, he mentions one case in which it 
had been observed in a delicate man after copulation, and then quotes 
the following still more remarkable case from Paulini: While surgeon 
on board a vessel, a violent storm arose, and threatened immediate 
destruction to all. One of the sailors, a Dane, thirty years of age, of 
fair complexion and light hair, was so terrified that he fell speechless 
on the deck. On going to him, Paulini observed large drops of perspira- 
tion of a bright red color on his face. At first he imagined the blood 
came from the nose, or that the man had injured himself by falling; 
but on wiping off the red drops from his face he was astonished to see 
fresh ones start up in their place. The colored perspiration oozed out 
from different parts of the forehead, cheeks and chin ; but was not con- 
fined to these parts, for, on opening his dress, he found it formed on 
the neck and chest. On wiping and carefully examining the skin, he 
distinctly observed the red fluid exuding from the orifices of the sudo- 
riparous ducts. So deeply stained was the fluid, that on taking hold of 
the handkerchief with which it was wiped off, the fingers were made 
quite bloody. As the bloody perspiration ceased, the man’s speech re- 
turned ; and when the storm passed over he recovered, and remained 
quite well during the rest of the voyage.” 
Erasmus Wilson, in his work on Diseases of the Skin, mentions two 
cases which had come under his own observation, and refers to three 
others, he says: 
Cases 22 and 23. “I once saw a young lady, in whom a discharge of 
this nature took place every fortnight from four circular spots, each 
about the size of a half crown, and situated symmetrically on the face, 
one being on each cheek, one on the forehead, and one on the chin: 58 
And more recently I have seen another young lady of highly nervous 
temperament, whose face would become in a few hours covered with 
blotches of blood without any lesion of the surface. When I sponged 
away the blood the skin looked congested and erythematous.” 
Cases 24, 25, and 26. A young woman of eighteen suffered a loss of 
blood from her ears, a little after at the points of her fingers, and then 
at her toes; presently after, at the umbilicus and corner of her eyes; 
several times by sweat; and at length it burst out from the middle of 
her breast; afterwards in the foot, where the saphena vein is pricked 
in bleeding; then at both palms and back of her hands. Two days 
after it flowed from the chin, and in the night time from the tip of her 
tongue, and all this in a fortnight’s time. Whenever it flowed from 
her breast or other parts like sweat, there was no vestige of an orifice 
to be seen. 
M. Du Gard has recorded the case of a child three months pld, that 
was taken with a bleeding at the nose and ears, and in the hinder part 
of the head, which lasted for tnree days, and afterwards the nose and 
ears ceased bleeding, but still the blood-like sweat came from the head. 
Three days before the death of the child, which happened the sixth 
day after it began to bleed, the blood came more violently from its 
head, and streamed out to some distance. It also bled on the shoulders 
and at the waist. It also bled for three days at the toes, at the bend of 
its arms, at the joints of the fingers, and at the fingers’ ends. 
Voigtel also has noticed an instance of sanguineous perspiration. 
Mason Good remarks, that ephidrosis cruenta, which he defines as 
cutaneous perspiration intermixed with blood, has taken place oc- 
casionally during coition ; sometimes during vehement terror, and not 
unfrequently during the agony of hanging or the torture. It is said 
also in some instances to have occurred in new-born infants, probably 
from the additional force given to the circulation, in consequence of 
a full inflation of the lungs, accompanied with violent crying. 
Case 27. The following case is recorded by Dr. J. Parrott, in the 
Gazette Hebdomadaire for 1859. “Madame X. was born in 1832. The 
father expired from a nervous affection, but her mother enjoyed good 
health. At the age of seven months the patient received some wounds 
on several fingers of the right hand, which wounds cicatrized only 
after a lapse of two years. In her sixth year she suffered, without any 
apparent cause, from convulsions, with loss of consciousness, two or 
three times a month; afterwards the scars would bleed, without any 
cause, and without pain. One morning bloody tears appeared after a 
fit of anger, and since then bloody perspirations were occasionally ob- 59 
served on the knees, thighs, the chest and the lower eyelids. With 
the appearance of the menses, at the age of twelve, these manifesta- 
tions decreased for a time in frequency, but soon returned with greater 
vehemence. The face became often quite suddenly covered with blood. 
These bloody sweats always followed physical emotions, and were ac- 
companied with nervous disturbances, a loss of sensibility and mobili- 
ty. The patient was married at twenty-five. The convulsions grew 
more frequent at first, disappeared during gestation, but returned after 
delivery, with a hemorrhage. During the year 1858 Mrs. X. felt much 
better, until she got sick in consequence of sitting up at night with her 
child. On the first of April she was attacked by a swoou and convul- 
sions, the face appeared covered with blood, and heavy pains through 
the abdomen, thighs, and head distressed her. Dr. Parrott, being 
called, found very frequent convulsions, with bloody perspirations on 
different parts of the body. Spanish-fly plasters to the most painful 
parts, inhalation of chloroform and large doses of opium gave some re- 
lief, and on the 20th day of May the patient was allowed to go to the 
country. She returned in five days. The menses made their appear- 
ance several days beyond the regular time. May 25th, at 4 P. M., the 
patient was attacked by pains in the sides, breasts, the hypochondriac 
and epigastric regions ; in a short time a bloody perspiration on all 
these parts followed, with epileptic fits; on the front part of the head 
there was a regular circlet of blood drops, and blood also exuded from 
below the cilia on the lower eyelids. Neither before nor after the ex- 
udation did the skin present any abnormal appearance. Relief was 
afforded by large doses of morphine ; the monthly discharge established 
itself and ended the trouble. September 28th, pain and bloody sweat 
over right side of the face, with epileptic fits; no menstrual discharge. 
On the 18th of November, headache, convulsions, blood all over the 
face. The next day ejection by the mouth of about two spoonfuls of 
arterial blood, with heavy pains and bloody perspiration in the epigas- 
tric region. January 25th, again disturbed menstruation, epileptic fits, 
pains, bloodj7 sweats; the next day almost mania, every paroxysm 
terminating with vomiting, spasm of the glottis, and somnolence; the 
pains and exudation of blood continuing. Towards evening regular 
flow of the menses, cessation of all other symptoms. Two days after- 
wards, the menses becoming disturbed, hematemesis, tetanic convul- 
sions and bloody perspiration set in again. Between the paroxysms 
this patient appeared perfectly healthy and her intellect unimpaired; 
she presented nothing of the mental depression so common in epi- 
leptics.” 60 
In connection with this case, Dr. Parrott cites five other observations 
of a similar character. Friederich Hoffman, Opera Omnia, Geneva, 
1748, noticed blood sweating following the suppression of fluor albus in 
a hysterical patient; Boerhave, Comment in Aphorismi, Paris, 1765, 
saw a similar secretion in a girl also suffering from hysterical com- 
plaints ; Caizergues, Annales Clinique de Montpelier, 1814, observed 
sanguineous sweats in a woman of thirty years, and Chauford in a girl 
of twenty-one; finally Prof. Magnus Huss refers, Archives Generale, 
1857, to a girl twenty-three old as being a bleeder; but Parrott consid- 
ered this case as belonging to hematidrosis. In Boerhave’s case only 
the right side of the body was affected, in Dr. Huss’s patient the left 
side. In an article on this subject in the Cincinnati Lancet and Ob- 
server for July, 1861, from which the above cases were taken, the 
author, Dr. C. A. Hartmann, remarks:—“Sometimes there are no pre- 
monitory symptoms ; at others a great excitement precedes the exuda- 
tion. The paroxysms are either irregular, depending only on the 
nervous derangement, or they manifest a periodic type. Their dura- 
tion varies from a few hours to several days. Females are particularly 
subject to hematidrosis, but the disease appears to be limited to the 
years of youth. Among the predisposing causes are enumerated the 
irritable temperament, angry disposition, mental exertion, sitting up 
during the night, moral impressions.” These observations, good 
enough as far as they go, are evidently founded on a very partial sur- 
vey of the subject, and cover only a part of this strange and many 
sided disorder. 
Case 33. The following remarkable case is related by Hebra, in his 
work on Diseases of the Skin. “The patient was a young man, strong 
and well nourished, who was attackad repeatedly by hemorrhage from 
the surface of the lower limbs. This generally occurred during the 
night, so that he first became aware that the bleeding had taken place 
by finding the sheets stained with spots of blood when he awoke. I 
once, however, saw blood flow from the uninjured back of the hand of 
this patient while he was sitting near me at table. The blood formed 
a jet, which would about correspond in size to the duct of a sweat gland. 
This jet had also a somewhat spiral form and rose about 1mm. above the 
surface of the skin.” 
Case 34. A. Franque, iu the Wurz. Med. Zeit., 1863, No. 4, p. 73, re- 
cords a case of hemorrhagic sweat occurring in a hysterical female 
aged 45, whose catamenia were regular. The bleeding ensued three 
times after long continued severe convulsions, produced by mental 
emotions. On the fourth occasion Franque himself was present. The 61 
patient suffered for some days previously the most violent prickiDg 
pains along the vertebral column, in the left ear, the forehead and the 
left arm. After the convulsion had lasted an hour there broke out all 
over the whole body a copious sweat, which appeared red at the parts 
which had been the seat of pain, and derived its color from actual 
blood containing red globules. The convulsions and the pains now 
gradually ceased. As the skin appeared unbroken, Franque presumes 
that the hemorrhage took place from the sweat glands. 
Case 35. The following is a part of a clinical lecture, delivered at 
St. Mary’s Hospital, by Dr. Thomas King Chambers, and published in 
the Lancet for March 2d, 1861, p. 207. The patient is described as short 
and stout, twenty-seven years old. She has suffered much from head- 
ache and dyspepsia. She has only menstruated twice, and that in con- 
sequence of the application of leeches to the uterus ; and at or immedi- 
ately after the last period (three and a half years since ) the peculiar 
symptoms from which she suffered first appeared. She feels first a 
peculiar soreness and tenderness of an isolated spot, which enables her 
to predict that in the course of a few hours an eruption is going to com- 
mence. The first appearance of this is an erythematous blush, some- 
times slightly raised above the surrounding surface, but not so much 
as in erysipelas. After an uncertain time, seldom more than a few 
hours, there may be detected a scattered crop of fine vesicles, like suda- 
mina, mixed with a fine serous dew, uncovered by any pellicle. This 
never lasts long enough to form colorless drops, for quickly it becomes 
blood stained, and then little points of blood are seen oozing out, some- 
times so slowly as to dry and form a scab, sometimes collecting into 
great thick gouts, and trickling in a ghastly way down her face. The 
eruption runs through its stages quickest when she is in bed, and 
especially during sleep. Suspecting from the strangeness of this story 
that there was some collusion, I had the bed watched, and the nurse 
saw the blush come, and the blood ooze out in the manner described, 
while the patient was fast asleep. If rubbed, washed with water, or 
otherwise interfered with, the bleeding is much increased and pro- 
longed ; but if left alone to dry in a scab, it stops in a week o» ten days, 
usually, however, to be succeeded, before it is quite recovered, by a simi- 
lar eruption in another place. Sometimes, at irregular periods, there 
was an interval of a week or a fortnight; sometimes the cutaneous 
phenomena were replaced by bleeding from the nose, sometimes by 
vomiting of blood, but never by hemorrhage from either lungs or 
bowels. These symptoms continued nine months, and were relieved 
by anticipating the eruption of blood with leeches applied to the spot 62 
where it was expected. The discharge became serous, then was like 
little blisters, and Anally ceased, when her health was reestablished by 
the sea air of Margate. She continued well until last September, when 
she was admitted here as a mild case of erysipelas of the face. It really 
looked exactly like erysipelas; but it puzzled us a good deal when it be- 
gan to bleed, and has continued to puzzle us ever since, as regards its 
nomenclature, pathology, and treatment. She was seldom seen free 
from cutaneous hemorrhage from that period till four weeks ago, but it 
has varied a good deal in violence. During this attack, the face has 
not been the only part affected. When she lies down much in the day, 
that, indeed, is almost always the locality where it has appeared ; but 
when she is about, the legs and thighs have exhibited like appear- 
ances ; both forearms, too, and once the chest, were attacked. The loss 
of blood, however, was less than on the brow. Examined under the 
microscope, the Auid exuding from the skin contained blood discs in a 
natural state—blood discs with roughened edges and shrunken, much 
granular matter, dark fatty looking specks, and scales of epidermis. It 
did not coagulate into rolls. Blood drawn from a prick in the Anger 
looked perfectly natural, and coagulated into rolls, leaving the usual 
number of pale globules free. She has twice thrown up from the stom- 
ach about half a pint of dark brownish-purple sanguineous Auid, and I 
have occasionally seen her pocket handkerchief stained with blood re- 
ported to have come from the nose. She states that she has been hys- 
terical for the last year, and has had occasional paroxysms of crying 
and low spirits during her residence here, but with that exception 
there are no visible disorders of the bodily functions. The action of 
the bowels is free, the urine pale and sufficiently copious, the appetite 
small, especially for meat. But in spite of the little she eats, the con- 
stant loss of blood by the disease, and a persistence in a very lowering 
treatment, she has got very fat—pale, it is true, and Aabby, but decid- 
edly fat,—and not weaker in muscular power than on admission. In 
the last month, during which her ailment has been declining, she has 
been less hysterical, and had somewhat more appetite. She tells me 
that a sin*ilar increase of Aesh occurred during her last illness, three 
years ago. There is no leucorrhea, and examination per vaginam fails 
to detect anything abnormal in the parts that can be explored with 
the Anger. She complains of pain and becomes hysterical during the 
process. The lungs and heart appear quite healthy. 
“This appears to me a case of cutaneous hemorrhage, or, in homely 
Saxon, ‘bloody sweat,’ vicarious to suppressed menstruation. Some 
physicians have fancifully attributed to suppressed menstruation every 63 
kind of increased secretion or congestion which accompanies the de- 
rangement of uterine functions, and the female public are still more 
disposed to endorse this imaginative pathology. I am far from agree- 
ing with them, and would restrict the explanation to those cases where 
a flow of blood from a distant part not organically diseased follows 
(follows, not precedes) a defective condition of the catamenia, and 
where this flow of blood is a relief to the previous symptoms, and not 
weakening to the patient. The most frequent forms under which this 
vicarious menstruation occurs, are hematemesis, epistaxis, hemoptysis, 
and hemorrhoidal flux, instances of which you may fairly expect to 
see in the hospital during pupilage; but it is a chance if any of us see 
again a case where the discharge occurs through the external skin, and 
it behooves us therefore to seize the opportunity of taking note of the 
phenomena. My opinion of its rarity is formed on the difficulty I have 
experienced in finding records in authors who v/rite on allied subjects. 
I suppose since the invention of printing very few examples of so 
strange a thing can have escaped being put into type; yet Haller, in 
his exhaustive work, can only cite eighteen from the industrious col- 
lectors of physiological curiosities during a century and a half. After 
him, Van Swieten, Commentaries on Boerhave Sec., 1286, quotes a case 
from Boerhave’s MS. remains, of a young girl who from her twelfth 
year menstruated through an eruption of pustules in various parts of 
the surface, which pustules after the menstruation, entirely disap- 
peared. Pinel, in his Nosographie Philosophique in 1802, repeats 
Haller’s collection, but evidently cannot then cap the cases with any 
later ones at all to our purpose. In Hufeland’s Journal de Practischen 
Ascarkuude, there is mentioned a woman who menstruated through 
of an abscess at the navel at her proper periods for two years; and a 
girl is said to have told a Mr. Gutgesell, that her menses always ap- 
peared through a red spot over her knee. In the Archives Generale de 
Medicine, 1829, t. 19, pp. 212 and 236, are two cases recorded, one of a 
young lady, who, after ten years suppression, menstruated for three 
years through a vesicular eruption in one finger; a second of a prosti- 
tute, in whom the discharge occurred through spots of the size of a 
five franc piece, which appeared from time to time one after another 
on the breast, in the axilla, on the back, the buttocks, and the epigas- 
trium. This is called by the term I have used, ‘bloody sweat,’ and the 
description accords closely with that of our patient, especially in the 
eruption being less periodical, and more continuous than happens in 
most vicarious menstruations. The uterus also was healthy, for she 
became pregnant and bore a child. In 1836 I find a rather fuller ac- 64 
count of a case related in Schmidt’s Jahrbucher, by Heusinger. The 
woman had diseased ovaries and recto-vesico-vaginal fistulze, and 
though sometimes the catamenia appeared at the proper place, they 
were generally arrested there, and appeared in a variety of parts of the 
external skin. The most common part was, as with our patient here, 
the face. She had suffered five years, and been in several hospitals. 
Heusinger says that she was so hysterical that she would have made a 
capital subject for mesmerism; whether he means that he suspected 
her of imposture I cannot say. M. l’Heritier, in his Traite Complet des 
Maladies de la Femme, Paris, 1838, cannot add any case from his own 
knowledge, but he quotes one recorded by M. Gardien, as reported by 
M. Brule, of a young girl with suppressed catamenia, who had period- 
ically monthly hemorrhages from vesicles on the legs for six months, 
from an eruption on the left arm for a year, through a sore on the 
thumb for six months, by the upper eyelid for two years. This last was 
preceded by erysipelas, as was also an eruption of the same nature by 
the navel. She had also hematemesis and other vicarious hemorrhages 
not to the present purpose. Curiously enough, this identical case is 
again repeated by M. Briere de Boismont, and said to be quoted from 
Pinel’s Medicine Practique, but I cannot find it in that author’s works 
at all. It is doubtless our old friend of l’Heritier, who also again turns 
up in Meisner’s Diseases of Women, and there gets made into two per- 
sons by having her history quoted separately from each author. The 
last named learned and valuable work adds no instances from contem- 
porary observation of menstruation by the healthy skin ; and I believe 
the same may be said of more recent authors. The chatty Meigs 
and the judicious West do not seem to have seen it. The literature of 
the subject is scanty simply because the number of patients is scanty; 
and I cannot say that I have learned anything new from books which 
this one case had not already taught, though they have given me the 
satisfaction of agreeing in almost all points of doubt. With their h Jp, 
and the case before us, I think the following conclusions may be 
arrived at:— 
“1. Cutaneous menstruation occurs in robust and healthy looking 
rather than anemic persons. It appears, in fact, to be a plethora. 
“2. It may occur without any detectable disease of the parts of gen- 
eration ; instance this girl, the prostitute mentioned in the Archives, 
who had a child, and Mr. Gutgesell’s case who was going to be married. 
“4. The catamenia are not necessarily entirely diverted from their 
usual channel. 
“5. Periodical cutaneous hemorrhage is not necessarily connected 65 
with the catamenia at all. Thus Van Swieten quotes from Beneventus 
the case of a man, who once a month sweated a great quantity of blood 
from the healthy skin of his right flank. It is not always periodical. 
“8. Cutaneous menstruation usually appears in the shape of a slightly 
swelled erythema, painful and tender, on which vesicles form; the 
vesicles quickly burst, and there is poured forth a sero-sanguinolent ex- 
udation, which then becomes bloody, and continues to exude like a 
bloody sweat for various times, from four days to a fortnight. No scar 
is left, but the skin is slightly discolored for sometime afterwards in the 
parts affected. 
“10. Bloodletting is the most efficacious treatment; and it is most 
efficacious in the form in which it is known to produce its most power- 
ful physiological effect—namely, in small repeated doses, and as close 
as possible to the seat of action—that is, on the spots affected. The 
measure of the good effect of the bloodletting is the relief experienced 
by the patient without loss of strength. No other remedies are as yet 
known to be of any advantage.” 
Case 44. The following case is taken from a volume of Lectures on 
Clinical Medicine by Dr. McCall Anderson, published in 1877. <l On 
the 5th of May, 1866, at the recommendation of Dr. J. Lindsay Mason, 
of Ayr, I was consulted with regard to a young lady, who, although 
fifteen years of age, had the appearance of being a couple of years 
older. I am indebted to Dr. Mason’s description of her case for many of 
the details which follow. Menstruation because fully established at 
the early age of eight, and continued regularly until she was eleven 
years old, when it ceased entirely. At the age of thirteen it reappeared, 
and continued normal until the middle of February, 1865, when it 
again became irregular, and about this time Mr. Holdern, of Ayr, was 
requested to see her on account of a large abrasion of the cuticle in the 
middle of the right cheek, suppurating in the centre, and inclining to 
bleed toward the circumference. This sore was exceedingly obstinate, 
refusing to yield to the constitutional and local treatment resorted to. 
In the summer of this year she went to England, the sore being un- 
healed, and the menstruation very irregular. The cutaneous manifesta- 
tions seem to have subsided in the mont'h of October, coincident with 
which she began to menstruate regularly each month, the discharge on 
each occasion being profuse, and lasting about six days. In March, 
1866, Dr. Mason was requested to see her aga n, owing to a fresh out- 
break of the eruption; and from this time onwards until I saw her in 
May the menstruation was very irregular, that is to say, she menstru- 
ated for one day every week for four weeks, the discharge being, how* 66 
ever, very scanty, after which a fortnight elapsed before the next men- 
strual flow, and then the weekly discharges reappeared again for 
another four weeks, and so on. The only parts of the skin implicated 
from first to last were the face, arms, front of the chest, and legs. 
“When I saw her I was struck by the arrangement of the round 
patches of eruption which were left in the sites of the hemorrhagic at- 
tacks. One was on the brow, another on the chin, and one on each 
cheek. On the front of each arm also there were four in a row, two on 
each upper arm, and two on each forearm. When the chest was the 
seat of the eruption, the patches also occurred in a row in front of the 
sternum. It will thus be observed that the symmetry of the patches 
was wonderfully perfect, pointing very conclusively to the constitu- 
tional origin of the complaint. The patches were oval or rounded; 
some of them resembled erythema, while others were covered with 
crusts due to the dessication of serum, blood, or pus, and resembled 
eczema. One of the most marked peculiarities of the hemorrhage was 
the suddenness of its invasion. She sometimes exclaimed, ‘Oh, I feel 
another place on my face again,’ and immediately the hemorrhage set 
in. One day, when Dr. Mason was dressing a patch of eruption on 
her face, she suddenly called out, ‘Oh, I feel a place on my arm.’ He 
at once turned up her sleeve, and sure enough a large oval patch, fully 
two inches in length and one in breadth, was detected on the left fore- 
arm. Each outbreak was accompanied by a burning pain, and for 
some time after the development of a patch, especially when they were 
on her arms, the part was very sore, but never itchy. An oval or 
round red ring, varying from the size of a shilling to that of a crown, 
formed almost instantaneously, and the redness quickly spread in- 
wards over the enclosed skin. As soon as seen, the patches appetred 
as if the cuticle had melted away, and the surface was quite wet. Some- 
times the exudation was like water at first, and changed into blood; at 
other times, and especially on the face, the patches were at once 
covered with a complete dew of blood. The hemorrhage did not, how- 
ever, consist merely of the dew of blood ; that was only the outset; it 
was actual bleeding as from a cut, the blood sometimes streaming down 
the face or other parts attacked. Sometimes, instead of blood, there 
was only a serous discharge, ending in suppuration. Those patches 
which bled most healed soonest; but before they healed (which gener- 
ally took place within five or six days) both suppuration and hemor- 
rhage often occurred in the same place. In exceptional instances the 
parts did not heal for four weeks. This was especially observed on the 
chin. No trace of the previous eruption was left after it healed up, ex- 67 
cept on the right cheek, where suppuration was free and prolonged, and 
where a slight cicatrix was left, although not sufficient to cause de- 
formity. At first she had not the slightest warning that an outbreak 
was at hand, but at the later periods of her illness Dr. Mason ‘observed 
her lean her head upon her hands, and wear an almost anxious look ; 
and on questioning her she said she felt rather giddy, and in a quarter 
of an hour, or less, another place would break out.’ There was rarely 
more than one attack each day, although sometimes the hemorrhage 
occurred from two separate portions of skin simultaneously. It is very 
curious to note, too, that the outbreak generally occurred at the same 
hour each day—namely, at 11 A. M.; but it did not seem to be under 
the influence of mental or bodily excitement, or to be induced by tak- 
ing food or stimulants. Occasionally it occurred in the afternoon, and 
sometimes a day passed without an attack. 
“While still suffering from this complaint, she had a severe attack of 
whooping cough, which seemed greatly to aggravate the patches on 
her face, causing them to bleed freely. At this time also she had fre- 
quent and copious epistaxis, generally after a fit of coughing or retch- 
ing, and this somewhat relieved the parts attacked. This young lady 
was a rather excitable person, but her general health was good, and the 
bloody discharge was not sufficiently profuse to weaken her. 
“The treatment which was adopted was the maintenance of free 
action of the bowels with aloes and iron pills, especially when there 
was any menstrual flow, at which times she sat for about an hour in a 
hot mustard hip bath, and had a few leeches applied to the insides of 
the thighs. Locally, when the hemorrhages occurred, the parts were 
bathed with cold water, and afterwards dusted with powder of oxide of 
zinc. Dr. Mason also combined with this the administration of 
Fowler’s solution, which she had been getting before I saw her, and 
which, at all events, did no harm; although I was rather opposed to it 
on theoretical grounds, as being apt to produce congestion of the skin, 
and to favor the outbreaks. Within a fortnight of the commencement 
of the treatment directed against the disorder of menstruation, there 
was manifest improvement, and Dr. Mason reported that by the be- 
ginning of June the cutaneous manifestations had quite disappeared, 
and no traces of them were left, except the slight scar previously re- 
ferred to, and slight redness of the previously affected parts if she got 
overheated or excited. About this time, however, she had on one oc- 
casion a slight discharge of blood from the eyes. Her menstruation, 
although considerably improved, was not well established. On the 
27th of October, 1866, Dr. Mason reported that she remained ‘quite free 68 
from her old and troublesome complaint,’ and that her menstruation 
was pretty regular, though not quite up to the mark ; and on the 19th 
of May, 1867, he reported, ‘The young lady is now quite well, and has 
been so since I wrote you last.’ ” 
At the conclusion of his narrative of this case Dr. Anderson goes over 
pretty much the same ground we have already traversed, giving no 
new case, and adding nothing material to the subject. He mentions 
Chambers’ case at some length, most of those referred to by that writer, 
and draws a similar series of conclusions from his survey of the subject. 
An exceedingly interesting case was reported by Dr. Hart in the 
Richmond and Louisville Medical Journal, January, 1875, p. 98, which I 
have not been able to obtain. 
Case 46. The most recent case that I have found is the following 
from an informal Report of the Proceedings of the King William 
County, Virginia, Medical Association, by Geo. Wm. Pollard, M. D., 
and published in the Virginia Medical Monthly for Jan., 1880, p. 816. 
“Among a number of interesting cases reported at the last meeting of 
the King William County Medical Association, was one by Dr. R. G. 
Hill, of bloody sweat, the subject being a boy four years of age, sufler- 
ing from malarial fever. During each sweating stage, blood oozed 
from the face and neck. Febrifuges, followed by quinine, afforded re- 
lief ; but two months later he was taken with hemorrhage from the 
alimentary canal. This condition was accompanied with both vomit- 
ing and purging of blood, from which he died. No autopsy.” 
One at least of the lower animals, the hippopotamus, sweats blood, 
when brought to this country and kept in a state of confinement, as I 
myself have witnessed; the instance thus seen occurred during hot 
weather in late summer. 
As already stated, sweating of blood has been simulated by religious 
enthusiasts, the following interesting example of which is taken from 
Hebra. “More than ten years ago there lived in a village not far from 
Vienna a woman who was said to take neither food nor drink, and 
who asserted that every Friday, between the hours of ten a. m. and 
noon, hemorrhage occurred spontaneously from her skin at various 
points, but especially from her face, feet, and hands. The parts were, 
in fact, said to be the same from which blood flowed during the cruci- 
fixion of our Lord. Now, as this occurrence created a great sensation in 
the neighborhood, and attracted numerous pilgrims from all parts of 
the country, the authorities found themselves compelled to make a 
thorough investigation of the matter. Dr. Haller, a physician who 
held a high position in the General Hospital at Vienna, was sent to the 69 
spot, with the necessary staff of police, in time to place the woman 
under surveillance on a Thursday, and to bring her before the Friday 
to Vienna. Here she was placed in a room, so that she could be watched 
uninterruptedly, night and day, by medical men The Friday came, 
and the woman did not bleed. She, however, took nothing that day 
nor till the evening of Saturday, when, tormented by hunger, she asked 
for food, and ate a considerable quantity. From this time she took 
nourishment regularly, and the hemorrhage never recurred. The case 
just related is probably similar to not a few others, which are recorded 
in the history of spontaneous hemorrhages (under the name of stig- 
mata), but which were never brought into the clear light of scientific 
investigation, so as to be examined without prejudice and — ex- 
plained.” These impostors, the so called stigmata, still make their ap- 
pearance from time to time in Catholic countries, as may appear from 
a recent publication, which bears the following extended title-page: 
“Letter from the Earl of Shrewsburg to Ambrose Lisle Phillips, Esq., 
descriptive of the Estatica of Caldasa and the Addolorato of Capsiana ; 
being a second edition revised and enlarged ; to which is added the 
Relation of Three Successive Visits to the Estatica of Monte Sansavino 
in May, 1842. First American, from the last revised London edition ; 
with Additional Letters now first published; bringing the Narrative 
down to 1842. ‘It is Honorable to Reveal and Confess the Works of 
God.’—Tobias, xii., 7. New York, 1843.” In this publication fifty 
similar cases are adduced, which are said to have leceived the attesta- 
tion of the church. Of those with which the book itself is concerned, 
one is said to eat nothing but a little fruit; of another it is asserted:— 
“Indeed, she may be truly said to subsist upon air ; for on the fifteenth 
of August next it will be eight years complete since she ate, drank, or 
slept]'1'1 Where is Hr. Tanner after this? It is a noteworthy fact that 
these cases were all those of noor peasant girls, in secluded, out-of-the- 
way hamlets, amongst a rustic and ignorant population : they were 
plainly hysterical and cataleptic; visited by nundreds of wondering, 
half adoring spectators, who were ready to fall down and worship them. 
We have here everything that could stimulate and aid deception ; 
everything but the “clear light of scientific investigation,” to which 
Hebra’s case was subjected. 
With regard to the so-called bloody sweat of our Saviour, such an 
undoubted article of faith to many, aud so familiar to our ears in the 
pathetic invocation of the Episcopal Church, “by thine agony and 
bloody sweat,” the celebrated Hr. Mead makes the following observa- 
tions in his Medica Sacra: “Saint Luke relates of Christ himself that 70 
when he was in an agony by the fervency of his prayers, his sweat was 
like drops of blood falling down on the ground. This passage is gener- 
ally understood as if the Saviour of mankind had sweated real blood. 
But the text book does not say so much. The sweat was only hosei 
thromboi aimatos, as it wiere, or like drops of blood ; that is the drops of 
sweat were so large, thick and viscid, that they trickled to the ground 
like drops of blood. Thus were the words understood by Justin 
Martyr, Theophylactus, and Enthymius.” Among modern commen- 
tators, some agree with Whitby, who says, “I own that these words do 
not certainly signify that the matter of this sweat was blood, but only 
that it was like to blood, being in such large drops.” But the majority 
hold with Alford, that it was a veritable bloody sweat. Adam Clarke 
contends that the passage must be interpreted according as the em- 
phasis of the passage is made to rest on thromboi, or aimatos, and un- 
hesitatingly declares for the latter. Perhaps it would be better not to 
add anything to the judicious aud non-committal remarks of Dr. Mead, 
but still I will hazard the following considerations. It is difficult to 
understand why, if Luke, a clear writer and said to be a physician, 
wished to state the fact of a bloody sweat he could not have done so in 
plain straightforward language, with no ambiguity about it. If he 
was, as it is said, a physician, the simile of dropping blood, not an un- 
natural one in any case, for profuse sweat, would be all the more 
natural and likely to be used. In the gloom of the garden the 
color would not be noticed, though the profuseness of the sweat as 
its falling proved might; furthermore, if it had been blood it would 
have left stains, if not crusts or coagula behind it, and excited still fur- 
ther notice and remark. From all these considerations I think we 
have reason enough to conclude that this bloody sweat exists only in 
the affectionate and pious fancy of the church ; derived during the 
darker ages when men would rather believe than examine, and left 
undisturbed even to these times when, alas ! men would, as a rule, 
rather examine than believe. 
Treatment—The cases of hematidrosis detailed in this section have 
said for me all there is to say on the subject of treatment. This is ob- 
viously never directed against the condition itself, but to the general 
condition of which it is a symptom or concomitant. Malaria, purpura, 
and scorbutic or other cachectic conditions need their well known 
remedies. Where the complaint is a symptom of suppressed or irregu- 
lar menstruation, to this function and the nervous system attention 
must be mainly directed, and what little experience there is on the 
subject se6ms to show that judicious bloodletting is more to be relied 
on than the tonic treatment now so fashionable for everything. 71 
Since writing this section I have seen a newspaper account of a boy 
aged fourteen years, in Chicago, who has, it is said, been sweating 
blood at intervals for seven years. The hemorrhage in his case is pre- 
ceded by an erythematous eruption; he has also hemorrhage from 
various mucous surfaces. No doubt a more detailed and reliable ac- 
count will make its appearance in the medical journals in due time. 
VI. Oalactidrosis.—Synonyms: Galactorrhea erronea; Sudorlac- 
teus; Milchschweiss. 
This is the heading of a section in Hebra’s work on Diseases of the 
Skin, which reminds me of a celebrated chapter in a certain history of 
Iceland, entitled “The Snakes of Iceland,” the contents of which are 
as follows: “There are no snakes in Iceland.” I am not without a 
fear that the reader of this will visit the same criticism upon me, be it 
so, I will write what I have to write nevertheless, quoting first the 
section from Hebra to which I have referred. 
“Under these names there are described, especially in the older 
works, certain diseases of lying-in-women, said to be caused by a metas- 
tasis of the milk, sometimes to one of the internal organs, sometimes to 
the skin. 80 long as the puerperal diseases of the uterus, ovaries, &c., 
were not known, all maladies arising after childbirth were referred to a 
“metastasis” of the milk. In the last century Van Swieten, Levret, 
Selle, and others gave minute descriptions of affections of various 
organs supposed to be produced by retrocession of this secretion. But 
now that pathological anatomists are familiar with the morbid changes 
which occur in the puerperal state, and that chemistry and the micro- 
scope have made clear the composition of the milk, no one any longer 
fancies that this secretion is liable to metastasis, and that he sees it exud- 
ing from the swollen axillary glands of a woman recently confined 
(Siebold), or from her nose after violent sneezing ( Fleischmann, Hufe- 
land’s Journal, 1836, part 6). Puerperal affections are at the present 
day regarded as pathological processes arising from a special cause, but 
not as differing in any essential respect from inflammatory and sup- 
purative diseases produced by other conditions. As a further proof 
that there is no such thing as a metastasis of the milk to the skin, I 
may state that no one of the many physicians who have attended in 
the lying-in hospital of Vienna (in which there are, on an average, 
8,000 births annually) has ever seen milk exude from the skin, 
although epidemics of puerperal fever have carried off many victims. 
Nor again, have any of the physicians engaged in our school of path- 
ological anatomy (who find material for their world renowned labors in 
thousands of post-mortem examinations) ever found occasion to dem- 72 
onstrate a metastasia of the milk in the dead body. I think, therefore, 
that I am justified in expressing the doubt whether any diseases have 
ever arisen from this cause, and in regarding galactidrosis as an affec 
tion altogether mythical.” 
The writer in the Eucyclographie des Sciences Medical, Bruxelles, 
1845, says“ Are there milky sweats ? This question is not yet 
answered ; though many authors formally deny their existence, never- 
theless it is well known that in icterus the elements of the biliary 
secretion are found in the liquid exhaled from the skin. Why may it 
not happen that milk may appear during the fever of those newly 
delivered? It would be interesting to verify this analogy. I have 
spoken of urinary sweats observed in recent times in subjects affected 
with retention of urine, and to-day all doubts have been removed by 
many observers; according to them the odor characterizing the affec- 
tion of which we speak comes from the arrest of the excretion of urine. 
This is extremely fetid, and rapidly infects the clothing of the patient, 
and gives to the whole body the odor in question. According to these 
authors the sweat contains the elements of the urine reabsorbed as the 
result of their prolonged sojourn in the bladder. I repeat this is an 
interesting question to verify.” 
The following case of a man who had a Vesicular Eruption on the 
Abdomen, which discharged at times great quantities of a chylous 
fluid, was reported to the British Medical Association, August, 1870, by 
Wm. Roberts, M. D , of Manchester. The patient was a dogger, aged 
forty-five. Two and a half years previously he suffered for six months 
from a succession of abscesses in various parts of the body. One of 
these was situated in the hypogastric region, and about the site of 
this—after it had healed—there arose an eruption of vesicles which 
gradually extended over nearly the whole of the lower half of the skin 
of the abdomen. These vesicles at first contained a serous fluid, but 
afterwards this assumed a milky appearance. Some of the vesicles 
were as large as peas ; others as small as pins’ heads. Sometimes the 
eruption was quite dry for days and weeks ; but some half a dozen of 
the largest vesicles often discharged immense quantities of milky fluid. 
This fluid coagulated spontaneously; it contained albumen and finely 
divided fat; also cells resembling the pale blood corpuscles. This erup- 
tion remaiued—sometimes dry and sometimes discharging—without 
much change for a period of two years. No local appliance or internal 
remedy availed anything. The patient finally became tuberculous and 
died. The skin of the abdomen was removed after death, and it was 
found that the disease was situated in the cutis vera and the subjacent 73 
connective tissue; the altered part appeared to consist of a network of 
short channels or lacunae, lined with spheroidal gland cells. These 
communicated with each other and with their vesicular expansions on 
the surface. This man passed chylous urine on two occasions, but no 
anatomical changes could be discovered in the urinary passages. The 
lymphatic glands in the groin and the lymphatic vessels were un- 
affected, and the lacteal system had no connection whatever with the 
eruption. Reference was made to the cases of Dr. Buchanan and Dr. 
Carter, and the bearing of the case on chylous urine pointed out. 
In an interesting work on Occlusion and Dilatation of Lymph Chan- 
nels, by Samuel C. Busey, M. D., of Washington, D. C., published in 
1878, we find several instances of a milky exudation, though not from 
perfectly healthy skin nor from the sweat ducts. In one case, in 
which there was enlargement of the left labium in a woman aged 
thirty, it is related : “ On the forenoon following her admission the 
discharge reappeared, and it was seen that the labium became more 
tense, and that at several places, without visible lesion of the skin, 
minute milky drops exuded, which after being enlarged rolled off1. 
The dried remains of these drops formed a yellowish-white scab.” The 
reporter of this case, Prof. W. Petters, of Prague, says. “ In maDy dis- 
charges looked upon as milk secretion by the older physicians, there 
may have been a mistake of lymph for milk. Thus, the milk sweat 
observed by Dr. Storch in a woman aged thirty, parturient for the fifth 
time, which continued for eleven days, and was accompanied by 
milky lochia, was very likely only a lymphorrhagia.” This is no doubt 
the origin of galactidro3is, which has then after all a foundation in 
facts, only the facts were ill-observed, and not properly understood. 
VII. Urinidrosis.—Synonyms : Uridrosis; Sudor urinosus ; Ephi- 
drosis arenosis; Ephidrosis sabura; Harnschweis; Urinous Sweat; 
Sandy Sweat. 
Curious cases are recorded of a sandy sweat, in which the evapora- 
tion of the watery elements of the perspiration leaves a crystalline or 
amorphous deposit upon the skin. Bartholinus, Schunig, and Mollen- 
brock, among the older physicians, have related several cases of the 
kind. This condition is generally associated with suppression of the 
renal secretion, and the solid matter deposited upon the skin has been 
found to be more or less rich in urea or uric salts, thus showing a true 
vicarious relation between the kidneys and the perspiratory emunc- 
tories; it is then a true urinidrosis. But it is also possible, as intimated 
by Mason Good, that solid particles, the residuum of evaporated sweat, 74 
may be deposited upon the skin from other causes, he remarks, “ at 
times the more solid particles of the materials employed in handicraft 
trades are absorbed by the lungs, and thrown forth upon the surface. 
Among glass blowers, from the large quantity of sea salt that enters 
into their manufacture, the sweat is sometimes so highly impregnated 
that the salt they employ and imbibe by the skin and lungs has been 
seen to collect in crystals upon their faces.” That this may often take 
place is no doubt true, and reasonable enough, and yet we should re- 
member, that these saline particles in a state of fine division are dis- 
seminated through the atmosphere in which they work, and the ap- 
pearance referred to may be in part at least due merely to their settling 
upon the surface. 
Murchison, in his work on the continued fevers of Great Britain, has 
the following, p. 138. “ Convalescence (in typhus fever) is sometimes 
ushered in by moderate perspiration, while death is often preceded by 
copious sweats, giving a sodden appearance to the skin. The secreted 
fluid has an acid reaction, but in two severe cases I have found it alka- 
line. In several cases, for the most part fatal, I have found that, on 
evaporation, it left a white efflorescence upon the eyelids and face con- 
sisting of oval shaped and stellate crystals, composed of a free acid, 
fatty matter, and a large proportion of chlorides. Barrallier makes a 
similar observation.” 
Of true urinidrosis Hebra gives the following account. “This name 
is given to an affection in which, while the renal secretion is defective, 
the perspiration possesses a urinous smell. This character may either 
belong to the sweat generally or only to that which.is formed at cer- 
tain parts of the cutaneous surface. The older writers, Salmuth, Haes- 
bart, Marcus Donatus, Arnold, and others, record cases in which, the 
urine being dpficientin consequence of disease of the kidneys, the skin 
took up the function of these organs and became covered with an 
abundant urinous perspiration. Even by the thorough investigations 
of the chemists and physiologists Lehmann, Schottin, Schlorsberger, 
Liebig, Scherer, and Wohler, it has not yet been proved to demonstra- 
tion whether or no urea exists, as such, in the blood. Most writers are, 
however, of opinion that this is the case, and that the kidneys are 
merely excretors of this substance. Urea has, indeed, been often 
shown to be present in the circulating fluid ; and the fact that attempts 
to detect it have sometimes failed by no means justifies the conclusion 
that this substance is formed elsewhere, and not in the blood, from the 
decomposition of nitrogenized substances. Such being the case, it is 
anything but unreasonable to suppose that when the secretion of urine 75 
by the kidneys is interfered with the different solid tissues will be 
traversed by blood overloaded with urea, and, therefore, that this sub- 
stance will be present in the sweat, as well as in the other fluids. 
Those who have made direct experiments in reference to this point 
have, however, very rarely succeeded in detecting urea in the perspira- 
tion, and certain chemists, among wrhom is Lehmann, even maintain 
that this has never yet been done. But the investigations of Schottin, 
Drasche, Freitz, Hirschsprung, and others, have furnished positive 
proofs that, under certain conditions, urea may be discovered in the 
cutaneous secretion. I may quote, especially, the observations made 
during the year 1855, when the cholera was raging in Vienna, by 
Drasche. In certain severe cases of that disease this physician ob- 
served, on the surface of the scalp and face, a scaly deposit, resembling 
fine white meal. On examining this substance he found it to contain 
crystals of oxalate of urea, of which the nature was determined both by 
their form and by their chemical reactions. It must be admitted, how- 
ever, that such an alteration of the cutaneous secretion is exceedingly 
rare; and it has still to be shown which of the glands of the skin were 
concerned in the excretion of the urea. The crystals were, however, 
found by Drasche at those parts where the sebaceous glands are most 
abundant and of the largest size, and their presence was associated 
with the formation of sebum in excessive quantity. These facts are, of 
course, rather in favor of the supposition that the urea was, in these 
cases, excreted not by the sudoriparous, but by the sebaceous glands.” 
I have already stated in a previous part of this dissertation that I 
have observed the sweat to have a strong and well marked urinous 
odor in cases of suppression of urine, I will now cite some further 
authorities on this subject. 
“ When the urine has been suppressed in this way, it has occasion- 
ally escaped from some other p rt of the body; I saw a case where it 
passed from the skin—particularly of the palms of the hand. Others 
have passed it in the form of perspiration. There can be no doubt of 
the truth of these cases.”—Elliotson’s Practice, Amer. ed., p. 975. 
“Fourcroy first detected urea in perspiration, and observation subse- 
quently confirmed by Landerer and others. That the skin can under 
certain circumstances excrete urea, is proved by the interesting fact 
that this substance sometimes occurs as a bluish powdery material on 
the body of those who have died of cholera.”—Draper’s Physiology, 
p. 240 Dr. Alfred B. Garrod says, “Uric acid has also been found in 
the cutaneous excretion of gouty patients in the form of a white pow- 
der, consisting of crystalized urate of soda.” Simon says in his Ani- 76 
mal Chemistry, “ Uric acid is stated to have been found in the sweat 
of arthritic persons. Wolff found that the sweat which bad hardened 
on the forehead into a solid white substance, in a patient with stone 
in the bladder, contained uric acid. Urate of soda is likewise stated to 
have been found in the sweat of persons suffering from gout or stone.” 
Niemeyer says : “ In a few instances of suppression of urine, trust- 
worthy observers have discovered crystals of urea upon the skin.” Dr. 
Robert Hooper remarks: *l Thus, dropsy is sometimes carried off by 
perspiration, and the bad effects of the suppression of urine are occa- 
sionally obviated by a copious sweat of an urinous smell.” 
Boerhaave relates the following case: ‘‘A gentleman, from close 
attention to business, neglected to pass his urine ; at length he lost the 
power of expelling it, and it was consequently drawn off by the cathe- 
ter. On the third day after, the catheter being passed as usual, the 
bladder was found empty. On the fourteenth day he died. The 
symptoms on the sixth day were inaptitute for conversation, sleepiness, 
overpowering but unrestful, offensive breath and perspiration, quickened 
pulse, convulsion, lethargy, and death.” 
Dr. Johnstone, in the London Medical Commentaries, Vol. 5, men- 
tions a case of suppression in which “ for some days before death, the 
skin was all over as white as if it had been powdered. The white dust 
on being gathered was found to have the taste of crude salammoniac; ” 
and a very rational explanation of this occurrence is offered, that the 
secretion of urine being prevented, the ammoniacal salts were deter- 
mined to the skin in such quantity as to crystalize as the sweat evapo- 
rated. According to Schottin, in such cases this urea is found in pus 
and milk, and the sweat may contain so much of it as to form a crust 
upon the skin. 
More recently, in the Deutsche Archives fur Klinische Medicin, Dr. 
Deiniger published the case of a boy, five years of age, who suffered 
from anuria renalis for a whole week, and on whose skin urea was dis- 
covered. Five cases of this kind have been recorded by Jurgensen and 
Leube; but the issue was fatal in all, whereas Dr. Deininger’s patient 
recovered. 
Treatment.—The treatment in these cases consists mainly in an 
attempt to restore the suspended function of the kidnies by appropriate 
measures, which should of course include, as the chief, removal of the 
cause of obstruction, if this can be done. Meanwhile, the vicarious 
action of the skin should not be interfered with, but rather encouraged, 
and perhaps supplemented by the action of hydragogue cathartics. 
Of course in so grave a condition the prognosis must be in the highest 77 
degree discouraging, and the longer the obstruction to renal function 
continues, be it what it may, the more hopeless does the patient’s con- 
dition become. 
VIII. Phosphoridrosis, or Phosphorescent Sweat. 
Of all the anomalies of perspiration this is the most curious, and the 
rarest. Indeed, so uncommon are any phosphorescent phenomena in 
the Jiving human body, that I shall include in this section all the 
notices of the condition which I have been able to find, of whatever 
character, and take them all together they are still very few. 
Bartholin gives an account of a lady in Italy, whom he designates as 
mulier splendens, whose body shone with phosphoric radiations when 
slightly rubbed with a piece of dry linen.—Phipson on Phosphores- 
cence, p. 162. 
“ In the annals of medicine there exist well established facts of the 
appearance of flames upon the bodies of persons .affected with certain 
diseases. A phosphorescent perspiration of the feet has been spoken 
of, and it is curious to observe the analogy between the odor of the 
phosphorescent substance of the glow-worm and the sweat of the feet. 
All these cases of phosphorescence remain unexplained.”—Matteucei, 
Physical Phenomena of Living Beings, p. 184. 
“The subject of the following case was a male infant sixteen months 
old. The child bad suffered from teething, and had been casually seen 
by Dr. H. McCormack, of Belfast. An emetic was administered, and at# 
irritating linimeut rubbed on the breast. The nurse in raising the 
child in bed at night, observed a phosphorescent light about the hips, 
both before and after the candle had been lighted. The legs were also 
observed to be luminous for a short time. From what Dr. McCormack 
could learn, the appearance very much resembled that produced by 
phosphorized oil, but none of this had been employed. The phenome- 
non occurred only once. The mother had, however, observed that on 
one occasion a spark had flown to her hand from the infant’s body. 
Cases of human phosphorescence in the living body are rare, and the 
fact recorded by Dr. McCormack is therefore interesting.”—London 
Medical Gazette. 
I And the following in the Cincinnati Lancet and Observer for May, 
1877, p. 504, which I give together with some additional particulars on 
the same subject in the Boston Medical and Surgical Journal for 
December 6th, 1877. Prof. Fargioni presented a paper to the Medico 
Physical Society of Florence on the phosphorescence of marine ani- 
mals, and after it Prof. Panceri mentioned the case of a Neapolitan 78 
physician who had eaten of fish and afterwards experienced malaise 
and nausea and presented the phenomenon of a luminious sweat. The 
physician related his case to Prof. Panceri while he was making some 
observations upon a phosphorescent fish, the pesce bandiera, fowid in 
the waters of Naples. Prof. Panceri did not hesitate to attribute the 
phosphorescence of his Neapolitan confrere to the elimination of the 
fatty matter of the fish ; for he found by experimenting that patients, 
after eating the fat of Mediterranean fishes known to be phosphorescent, 
excreted a perspiration which was luminous in the dark. Hereupon 
another academician, Dr. Borgiotti, mentioned having seen phosphor- 
escent sweat in a patient affected with miliaria, and this condition had 
alarmed the family of the patient in no slight degree and considerably 
astonished his physician, who, although he did not share their super- 
stitions, was at a loss to explain the phenomena. But one of his col. 
leagues, to whom he related the case, informed him that this condition 
had already been recorded in the history of miliaria. Recent investi- 
gations of Dr. E. Pfluger with phosphorescent fish show that the phe- 
nomenon never occurs while the fish is absolutely fresh. When tte 
animal is preserved in a cool cellar, immersed in a three per cent, solu- 
tion of common salt, the phosphorescence begins on the second even- 
ing about the cavities of the eyes, and slowly spreads over the whole 
surface, increasing daily until decomposition sets in, when it gradually 
ceases. It occurs only on surfaces exposed to the air. A fresh water 
fish was cut in two pieces, and these were placed in separate vessels in 
salt water. In one of them water from a vessel containing a phosphor- 
escent sea fish was sprinkled. This after two or three days became 
phosphorescent, the other half remained absolutely dark. The matter 
scraped from the luminous surfaces, a whitish mucus, was found to 
contain numerous forms of schizomycetes. The phosphorescence is very 
faint, and can be perceived only by retinae made sensitive by darkness. 
It has been detected in the urine as well as in the sweat, and seems, 
therefore, to depend upon the oxygenation of the living forms. 
This question of evolution of light from the body is exceedingly inter' 
eating from the fact that it lias so often received superstitious in- 
terpretation. The aureola about the head of the saints has really been 
authentically observed in advanced cases of phthisis. It is of course 
nothing else than the ignis fatuus, corpse light in cemeteries, Ac., that 
is a phenomenon of phosphorescence. In 1842, Sir Herbert Marsh, of 
Dublin, wrote a paper on the Evolution of Light, from the living 
human subject, containing many interesting cases. This paper I have 
not been able to obtain, but a resume of it is given in Carpenter’s Physi- 
ology, from which I quote what follows. 79 
“ Dr. W. Stokes narrates the case of a patient who was under his ob- 
servation, some years since, in the old Meath Hospital, having been 
admitted on account of an enormous cancer in her breast, which was 
in an advanced stage of ulceration, the edges being irregular and 
everted; every part of the base and edges of this cavity was strongly 
phosphorescent, the light being sufficient to enable the figures on a 
watch dial to be distinguished within a few inches; and here also it 
appeared that the luminosity was due to a particular exudation from 
the exposed surface. Three cases are recorded by Sir H. Marsh, in 
which an evolution of light took place from the living body, without 
any such obvious source of decomposition; all the subjects of these 
cases, however, were in the last stage of phthisis; and it can scarcely 
be doubted that here, as in other disease of exhaustion, incipient disin- 
tegration was taking place during the latter periods of life. The light 
in each case is described as playing around the face, but not as directly 
proceeding from the surface ; $md in one of these instances, which was 
recorded by Dr. D. Donovan, not only was the luminous appearance 
perceptible over the head of the patient’s bed, but luminous vapors 
passed in streams through the apartment. It can scarcely be doubted 
that it was here the breath which contained the luminous compound, 
more especially as it was observed in one of the cases to have a very 
peculiar smell; and the probability that the luminosity was due to 
the presence of phosphorus in process of slow oxidation, is greatly 
increased by the fact, that the injection of phosphoretted oil into the 
blood vessels gives rise to a similar appearance. In repeating this 
experiment, Sir H. Marsh states that when half an ounce of olive oil? 
holding two grains of phosphorus in solution, was injected into the 
crural vein of a dog, a dense white vapor began to issue from the nos- 
trils even before the syringe was completely emptied, which became 
faintly luminous on the removal of the lights ; and the injection being 
repeated with the same quantity, the expiration immediately became 
beautifully luminous, resembling jets of pale colored flame pouring 
from the nostrils of the animal. And the luminosity which has been 
occasionally observed in the urine, may fairly be imputed to an increase 
in the quantity of unoxidized phosphorus which it seems normally to 
contain ; its liberation taking place at a more rapid rate than its con- 
version into phosphoric acid, either through excessive secretion, or 
impeded respiration. In Casper’s Wochenschrift, 1849, No. 15, a case 
has been put on record in which the urine and semen of a patient who 
was under treatment for impotence and spermatorrhea, and who was 
employing phosphorus as a remedy both internally and externally, 80 
were observed to be luminous. A case has been recorded by Raster in 
which the body linen was rendered luminous by the perspiration after 
any violent exercise; and here, too, the cause may be presumed to have 
been the same. On the whole, then, we may conclude the occasional 
evolution of light from the human subject to be the consequence of the 
production of a phosphorescent compound at the expense of the disin- 
tegrating tissues, or its introduction from without; which compound 
passes off through one of the ordinary channels of excretion.” 
In addition to the anomalies of perspiration which we have already 
noticed, there are a few isolated statements with regard to peculiarities 
of this secretion, which may fittingly receive a passing notice at the 
conclusion of this treatise. As for instance, Mayer, Die Elementar- 
organization des Seelenorgans, p. 12, remarks that some are said to 
have the power to perspire at will. 
Many writers of good repute, such as Ledel, Frommann, Lanzoni, 
Paulini, Helwick, and Speranza, are quoted by Joseph Frank, ( Haut- 
krankheiten, iii Theil, p. 312, Leipzig, 1843) as having asserted that 
they have seen sweat formed after death. Of course no such thing as 
genuine perspiration has taken place under these circumstances; the 
sweating referred to can only be that deposit of moisture which is re- 
ferred to by the common people when they say a pitcher or goblet 
sweats, &c., in short, the condensation of the watery vapor always 
present in the atmosphere—or dew. If these writers had lived in our 
day, when it is so common to place dead bodies upon ice, they might 
have witnessed this phenomenon as often as they pleased. 
Among the abnormal constituents observed in the sweat in addition 
to those already noticed in this paper, I may mention the following: 
Albumen—has been observed by Anselmino in a critical sweat, 
which broke out in large quantity one evening over the whole body in 
a case of febris rheumatica, with severe pains in the joints; on the 
following day it had disappeared. Stark asserts that albumen may be 
found in the sweat in gastric, putrid, and hectic diseases, and also on 
the approach of death, in consequence of the abnormal solution of the 
solid constituents. Simon says he failed in detecting any certain indi- 
cations of albumen in sweat collected ( by means of linen washed with 
distilled water) from the breast of a person in the colliquative stage of 
tubercular phthisis. W. Leube (Virchow’s Archives ) has investigated 
this question, and after careful experiment has detected albumen in 
the secretion of the skin in four cases. Three of the cases were suffer- 
ing from chronic disease, one with old anchylosis, one with roseola 81 
syphilitica, and one with sciatica. The fourth case was that of a hospital 
nurse. In all the cases it was necessary to collect at least 300 c.c.m. 
before proceeding to test for albumen. This quantity filtered and con- 
centrated, responded in each case to proper tests. The patient with 
traumatic anchylosis showed a larger percentage of albumen, both 
relative and absolute, than either of the other cases. The woman with 
sciatica (aged 51) showed only traces of albumen. The hospital nurse 
gave a secretion responding readily to the albumen tests. The urine in 
each case was free from albumen. The concentrated secretion on 
being treated with carbonic acid gas and acetic acid does not become 
opaque; it contains, therefore, neither para globulin nor kali albumen, 
but consists chiefly of serum albumen. 
In all the cases the secretion was obtained by packing in woolen 
blankets after subjecting the patients to a hot bath, the sweating was 
therefore forced and abnormal, and the question whether albumen is a 
constant ingredient of the perspiration under ordinary circumstances is 
still an open one, to be decided by future investigations. (1870.) 
Fat—is stated to occur in colliquative hectic sweats. 
Sugar—has been detected in the sweat in cases of diabetes, by several 
good chemists. 
Mercury.—The bichloride taken by the mouth has been recognized 
in the urine two hours, and in the salivation four hours, after its inges- 
tion ; still later it is found in the sweat, and in the milk of nursing 
women. Bumstead and Taylor on Venereal, p. 804. The Ohio Medical Recorder, 
A Monthly Journal of Rational Medicines. 
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