Herpes

“ One winter nearly every case of pneumonia in Bellevue Hospital was accompanied by herpes labialis. When sweating exists and involves the entire body, it is very frequently accompanied by sudamina, which are either abundant or sparse, and seem to have a critical significance.
In children, while the surface of the body is hot and dry the extremities are cool. The pneumonic flush instead of having a mahogany tint assumes a bluish-white tint. Cyanosis of the extremities is more frequent than in adults, and herpes labialis more common. All the cutaneous symptoms are exaggerated in children. ”

“ Very much the best agent of this kind with which I am acquainted is the flexible collodion; in neuralgic herpes and erysipelas the effect of this application, conjoined with the [181] hypodermic injection of morphia (preferably in the immediate neighborhood) , is of the greatest possible service in mitigating the pain. In herpes it has this further special advantage, that it prevents the occurrence of sores after the vesicles fall, an accident which otherwise will sometimes happen, and which very much increases the severity and intractability of the consecutive neuralgic pain. ”

“ Vesiculation will serve to differentiate from erythema multiforme. The absence of neuralgic pain, the distribution, location, and arrangement of the vesicles, are sufficient to exclude herpes zoster. In pemphigus the size, distribution, arrangement, mode of formation, and course of the lesions are different from herpes iris.
The affection tends to spontaneous disappearance in the course of a week or two; nor does treatment seem to influence materially its course. The bowels should be opened with saline laxatives, and other symptoms treated on general principles. ”

“ In other cases, however, the fever is more prolonged, and the symptoms, although not differing in kind, are apt to be more severe than those above detailed. The pulse is often full, hard, and bounding; the headache throbbing or darting in character; the tendency to somnolence increases, or gives place to delirium; and the pyrexia is more marked. Frequently an eruption of herpes is observed upon the lips and upon other parts of the face, from which circumstance the disease is sometimes called herpetic fever. ”

“ The intolerance of light is so intense that the child cannot bear even a moderate degree, but persists in burying its face in its hands, or hiding from the light in some dark corner. But what strikes us so forcibly, and what really is so characteristic of the case, is the fact that the patient’s face is disfigured with patches of herpes,—a fact which makes us hopeful, as these cases are as a rule the most amenable to treatment. To cure the disease of the skin is to cure the disease of the eye in the most rapid and satisfactory manner. ”

“ Herpetic eruptions are very common in malarial attacks. According to Powell, in Assam the appearance of a patch of herpes somewhere about the body, usually the lips, is regarded as an infallible sign that the attack of fever is over for the time being. ”

“ In doubtful cases, an observation of several weeks will always suffice to distinguish it from eczema, erythema multiforme, herpes iris and pemphigus, diseases to which it at times bears strong resemblance.
Give the prognosis of dermatitis herpetiformis.
An opinion as to the outcome of the disease should be guarded. It is exceedingly rebellious to treatment, and relapses are the rule. Exceptionally the bullous and pustular varieties prove eventually fatal. The erythematous and vesicular varieties are the most favorable. ”

“ We may, nevertheless, always determine, provided we succeed at all, whether we are dealing with a disease that protects against vaccinal and variolous inoculation.
In the human subject we seldom meet with affections that counterfeit vaccinia, although, if we take only the lesion into consideration, there are certain contagious forms of herpes that may give rise to doubt, and possibly the same may be true of impetigo contagiosa. ”

“ To those which spread rapidly: of the rind of the sweet pomegranate, dr. vj; of litharge, dr. vj; of unwashed wool about a dead pine and burnt, dr. iij; of wax, dr. xij; of ceruse, dr. viij; of fissile alum, dr. j; add to wine and myrtle oil.
Commentary. The writers on phlegmon treat immediately afterwards of herpes and erysipelas. Fabricius ab Aquapendente, Dr. Bateman, and most of our modern authorities on this subject, are of opinion that the ignis sacer of Celsus and the other Latin authors was herpes. ”

“ Numerous diseases of the skin are apt to occur during pregnancy; in addition to the well-known pigmentation of the face, the areola mammæ, and other parts, we may have herpes, eczema, or pruritus.
The serious aggravation which pregnancy is liable to induce in many disorders previously existent, is well known, and this exacerbation provides in some cases an indication for the induction of artificial abortion. ”

“ In the former case, where the mouths of the cutaneous lymphatics become torpid or quiescent, the fluid secreted on the skin ceases to be absorbed, and erodes the skin by its saline acrimony, and produces eruptions termed herpes, the discharge from which is as salt, as the tears, which are secreted too fast to be reabsorbed, as in grief, or when the puncta lacrymalia are obstructed, and which running down the cheek redden and inflame the skin.
When the mouths of the lymphatics, which open on the mucous membrane of the nostrils, become torpid, as on walking into the air in a frosty morning ”

“ It is an inflammatory disease of an herpetic character, the various lesions showing more or less tendency to group. In some of its forms it bears likeness to erythema multiforme and herpes iris, while in other cases it is allied to pemphigus. It varies greatly in the degree of development. The causes are varied, though in many cases they are neurotic in their nature; thus, the disease may follow shock to the nervous system. ”

“ The distinguishing feature of this group of cutaneous affections is the formation of bullæ, or blebs, which are defined as "eminences of the cuticle, containing a fluid."
Herpes is an inflammation of the skin in which the eruption appears in patches of a circular form. On the second day, minute, transparent vesicles appear and gradually develop, becoming opalescent. On the succeeding days, they shrink and produce reddish brown scabs, which soon become hard and fall off, leaving deep, purplish pits. ”

“ Pregnancy cannot be regarded as a cause of psoriasis. When that affection exists, however, it is usually aggravated. The elder Hebra24 in 1872 described a rare form of skin disease occurring in the course of pregnancy which he called herpes impetiginiformis, and of which he encountered five cases. Grouped vesicles upon inflamed bases appear about the genitalia, and subsequently diffuse themselves by successive crops over the body. Great prostration, rigors, and intense fever accompany the eruption. ”

“ It is to be distinguished from simple herpes by its location, number of groups, unilateral distribution, and absence of relapses. The prognosis is favorable, as the eruption usually disappears at the end of two or three weeks; severe cases, however, may last a month or more. When involving the eye, the possibility of its destroying the same, and even of a fatal result, is to be kept in mind. In elderly subjects the neuralgic symptoms are apt to prove persistent.
Treatment is mainly expectant. The disease is self-limited, and hence severe measures are to be avoided. ”

“ The general treatment should be of a tonic character. Iron—preferably the tincture of the chloride—and quinine in large doses are to be advised. A liberal diet of nourishing food, with a moderate amount of stimulants, is indicated in almost every case.
Herpes Simplex.
Herpes simplex is an acute, non-contagious, inflammatory disease, characterized by the formation of pinhead- to pea-sized vesicles arranged in groups and occurring for the most part about the face and genitalia. Malaise and pyrexia in severe cases may precede the eruption. ”

“ Observe the itch, herpes, cancer, venereal disease, &c. when they have ceased to be local affections, they spread themselves universally; they alternately attack different textures, according to the relation which they have with the organic sensibility of these textures. But it is almost always separately that they attack them; an organ is never as a whole influenced by them in all its parts. What do I say? If two of these diseases exist at the same time, one seizes upon one texture, the other upon a different one of the same organ. Thus the stomach, the intestines, the lungs, &c. ”

“ An artificial idiosyncrasy seems to be developed.
[193]
Single doses, or the use of moderate doses for a short time, has been found to produce erythema, eczema, papular, pustular, or macular eruptions; also urticaria and herpes zoster. In a few well-authenticated instances, eruptions, exactly resembling and in some cases mistaken for those of measles and scarlatina, have been produced. They passed through regular gradations, finishing with the typical desquamation of the disease simulated. Further use of the chloral again produced the same disturbances. ”

“ Dr. Little wiped a streak of custard from his mustache with his dinner napkin.
“It is my hour of relaxation. Haven’t you heard the tale of the two bishops who played leap-frog at the end of a church conference. But, to be serious, what are the symptoms?”
“She seems rather feverish and has a sore throat. I noticed something that looked like herpes on her lip.” ”

“ Membranous pharyngitis, or herpes of the pharynx, is one of the infrequent phenomena of a not uncommon sore throat, which exhibits at first a collection of small vesicles the size of millet-seeds or larger, isolated here and there or clustered in groups on the palate and uvula, less frequently on the tonsils. Herpes of the mouth and lips sometimes coexists. These vesicles are surrounded by inflammatory areolæ. ”

“ As the attack advances the pulse gradually or rapidly rises above the normal rate, and sometimes becomes very frequent, and the skin, although it grows warmer, does not often acquire the temperature observed in idiopathic fevers or sustain it as they do. In many cases eruptions appear upon the skin. During some epidemics the only one observed is herpes labialis; in others the eruption resembles roseola, measles, or the mulberry rash of typhus, or from the first it consists of petechiæ, vibices, or extensive ecchymoses. ”

“ Engin and others, where scarlatina, erysipelas, herpes, and other cutaneous eruptions, were treated on hydropathic principles, and seemingly with success. Hæmorrhages of various kinds, from nose, lungs, bowels, &c. are subjected to this treatment, as well as a host of chronic maladies, including constipation, hæmorrhoids, amenorrhœa, chlorosis, liver complaints, jaundice, gout, rheumatism, melancholia, hypochondriasis, hysteria, epilepsy, tic douloureux, gastrodynia, scrofula, rickets, &c. ”

“ I preserved a great part of the skin of a man who died at the Hôtel Dieu, and his epidermis, which was treble the thickness from his birth and even in the womb of his mother, that it is in the ordinary state, had been subject during his life to a continual desquamation which made the whole of it appear as if covered with herpes, though nothing similar to this affection existed upon the dermis, which was perfectly sound. ”

“ From the age of puberty to the end of life, the tendency of herpes to be complicated with neuralgia becomes progressively stronger. The course of events varies much in different cases, however. In adult and later life the symptoms usually commence with a more or less violent attack of neuralgic pain, which is succeeded, and generally, though not always, displaced by the herpetic eruption. ”

“ In the herpes zoster, zona or “shingles” the eruption occurs in the course of one or more cutaneous nerves, often on one side of the trunk, but it may be on the face, limbs or other parts. It may occur at any age, but is probably more frequently met with in elderly people. The appearance of the eruption is usually preceded by severe stinging neuralgic pains for several days, and, not only during the continuance of the herpetic spots, but long after they have dried up and disappeared, these pains sometimes continue and give rise to great suffering. The disease seldom recurs. ”

“ In herpes progenitalis cleanliness is of great importance. Liquor gutta-perchæ, a paste composed of equal parts of mucilage of acacia, glycerin, and oxide of zinc, lotions of sulphate of zinc, a few grains to the ounce, and of ammonia-water, may be prescribed. A saturated solution of boric acid and a dressing of borated absorbent cotton are likewise useful, while in some cases dusting the parts with calomel will prove beneficial. Where the affection recurs, if the prepuce is long, circumcision may afford future immunity. ”

“ An inflamed and irritable state of the spinal ganglia, nerve tract, or peripheral branches is directly responsible for the eruption, and this state may be due to atmospheric changes, cold, nerve-injuries and similar influences. The view has also been advanced that the disease is of specific and infectious character.
Give the chief diagnostic features of herpes zoster.
The prodromic neuralgic pain, the appearance of grouped vesicles upon inflammatory bases following the course of a nerve tract, and the limitation of the eruption to one side of the body. ”