“Black sweat” was the complaint of a twenty-nine-year-old woman. For ten long years she had suffered from black droplets appearing all over her face whenever she became excited, tense, or overheated. She had seen numerous doctors who had no explanation and no cure. Indeed, many had doubted her story, because her skin appeared perfectly normal at the time of her office visit. The burst of black droplets would appear when she was dancing, and her partner would wipe them away, remarking, “you've got soot on your face.”

Of far more concern than such embarrassment to this young woman was her mounting anxiety. Could the “black sweat” be a sign of black cancer? Was it a sign of the black plague? Yet, she seemed in perfect health. But neither she, nor anyone she knew, had knowledge of such an ominous secretion. Her doctors could provide no reassurance, because her problem was not in their textbooks of medicine. She was truly an “orphan patient.”

When we first saw her, we were equally puzzled. We had only her history. Her skin was perfectly normal. There were no black spots. Could she be hallucinating? Could it be a form of the bloody sweat described as a stigmatization as in the case of Saint Therese Neumann? Could it be of hysterical origin? Or could it be a case of deception?

We had little to go on in the first visit.