DERANGEMENTS 0* SECRETION IN THE SKIN 517 



glands occurs most frequently when the secretion of sweat has been 

 arrested for some time ; for instance, in the first weeks of typhus. 

 Sudamina, also called miliaria alba, have nothing in common with the 

 miliaria rubra, excepting that the source of both affections is in the 

 sudoriferous glands. Miliaria rubra has nothing to do with retention 

 of perspiration, but consists in an inflammation and exudation, induced 

 by excessive diaphoresis ; and for this reason we have classed miliaria 

 rubra under the eczematous affections. An eruption of sudamina has 

 no influence upon the course of the disease which it accompanies, and 

 is seen as often in critical sweats as in the profuse perspirations which 

 break out in unfavorable phases of a disease, and even in that stage 

 which immediately precedes dissolution. The profuse sweats of the 

 miliary fevers of the middle ages could hardly have been of a critical 

 character, as they appeared when the disease assumed a malignant 

 form; hence the miliary eruption was considered an unfavorable 

 sign. 



A partial hyperidrosis, confined to the palms of the hands, the soles 

 of the feet, to the armpits, and to the region of the genitals, is of far 

 more common occurrence than general hyperidrosis. The "sweaty 

 hands and feet," by which many people are troubled, are unnaturally 

 cool. The disgusting odor emitted by the perspiration of the feet and 

 armpits is not dependent upon the presence of ill-smelling ingredients 

 in the secretion, but upon putrefactive decomposition of the perspira- 

 tion, sebaceous matter and macerated epidermis of the skin. Hebra, 

 undoubtedly, goes too far in asserting that this offensive decomposition 

 only takes place in old shoes saturated with sweat, and that people 

 usually accused of having stinking feet really have stinking boots. 

 This offensive perspiration was formerly regarded as a wholesome ex- 

 cretion, to be encouraged and cherished ; and many complaints were 

 ascribed to its repression. Such views nowadays have been declared 

 altogether unfounded, upon the high authority of Hebra and others ; 

 and indeed, to say nothing of the fact that it is by no means easy to 

 check sweating of the feet, its arrest immediately before the outbreak 

 of a fit of illness is, in most cases, the result of the illness and not its 

 cause. But I think that it is saying too much to deny absolutely that 

 such suppression of perspiration may possibly now and then be the 

 caube of disease. There is no doubt that people are often made ill by 

 exposure to a degree of cold while perspiring, which would have done 

 them no harm had the skin not been moist with perspiration ; and it is 

 equally certain that diaphoresis artificially induced, often is of the ut- 

 most benefit in diseases caused by exposure to cold. Admitting the 

 correctness of these facts, it is not absurd to suppose that sometimes 

 the chilling of perspiring feet may induce disease, nor that the reestab- 



