Pathologic Physiology. Mechanisms of Disease

Abstract

so well as Kuno has dominated research in human perspiration. The structure, mechanisms, distribution, variation, and function of units of the sweating apparatus are explained and illustrated with comprehensive skill. He describes the two remark¬ able phases of acclimatization—first the change which makes sweating begin more promptly on exposure to heat along with the increased volume of sweat which accompanies the rapidly gained cardiovascular thermal adaptation, and then a slower salt-saving change mediated by the adrenal cortex—which constitute the two adaptations. Perhaps months or years later gradually a sweat-conserving process may become established, at least in tropical countries. Then less sweat is produced for a given heat stimulus. This is important, since sweat which cannot evaporate has its cooling function largely wasted. The exhaustion of sweating mecha¬ nisms, acutely in heat stroke, more gradually in a state resembling cumulative fatigue, which was first established during World War II, is ably discussed. It may cheer those who resist the mental repose prevalent in devotees of the all-encompassing systems to know that Kuno has not needed to invoke the terms or -concepts of stress. The explanation for the uneven intensity of sweating on the palm as being the result of repeated pressure is inaccurate if the photograph is correct, since at least at the distal part of the palm sweating is most intense between and not at the exact site of the normal pressure points. Most sweating actually occurs on the palms in areas where palmar erythema presents its most intense redness. If Kuno himself wrote the book he has better mastery of medical English than most per¬