Aurum mur-Herpes on the prepuce and vulva. Herpes accompanied by intolerable itching.
Bufo-Herpetic eruption after a cold.
Causticum-Burning vesicles under the prepuce, which become suppurating ulcers. Burning vesicles on the face which, when touched, exude a corrosive water, afterward they dry up to a scurf.
Cantharis-Large, burning painful blisters with erysipelatous inflammation of the parts. Burning, tearing ulcerative pains, worse on the right side. Urinary complications.
Clematis-Itching blisters on the lower lip. Gnawing itching not relieved by scratching. Worse during increasing, better during decreasing moon.
Graphites-Herpes in females with scanty menstruation; burning blisters on the lower side and tip of the tongue; dryness of the skin.
Hamamelis-Herpes on the nose. Profuse epistaxis.
Helleb. nig.-White vesicles on the lips; aphthae in the mouth; in scrofulous children.
Hepar-Herpes which tend to recur; herpes on the prepuce, exceedingly sensitive to the touch; small ulcers form around the large one; unhealthy suppurating skin, after mercurial poisoning.
Kali bich.-Herpes after taking cold; fluent coryza; all the secretions are a of stringy and ropy character.
Mercurius sol.-Herpes on the prepuce with a tendency to suppuration; ulcers on the glans; itching of the genitals.
Moschus-Herpes, with excessive burning, in hysterical subjects; menstruation too early and too profuse.
Natrum mur.-Herpes occurring during fevers; eruption on the lips and flexures of the joints; vesicles on the tongue; itching and pricking in the skin.
Petroleum.-Herpes on the perineum and genitals; itching worse in the open air.
Rhus tox.-Herpes upon the hairy parts with burning and stinging; itching worse after scratching; rheumatic pains with great weariness.
Sepia- Herpetic eruptions around the lips; herpes during pregnancy; circular form of epilepsy.
Sulphur-Herpes about the mouth and nose with itching and burning, aggravated by warmth. Hot palms and soles.
Sarsaparilla-Herpes on the prepuce; after abuse of mercury.
Upas-Herpetic eruption on the upper lip, on the left side.
ZOSTER
Zoster is an acute affection characterized by the development of one or more groups of large-sized vesicles. When there are several of these groups, it will be noticed that they are arranged along the course of one of the larger nerve-trunks whose filaments are distributed to the skin.
The most frequent and perhaps the most typical seat of the eruption is on the chest, where it may form a semigirdle corresponding to the area supplied by one of the intercostal nerves. Zoster, however, is by no means confined to the thoracic region, but may appear on the abdomen, the face, in connection with the trigeminal nerve, on the shoulders and arms, and on the thighs and legs.
The eruption may or may not be preceded by prodromal symptoms, which may partake of a mild febrile attack of one or two days’ duration, or, instead, of a more or less severe neuralgia, without fever; or neither of these phenomena may be present, the eruption itself being the first indication of the affection.
Each group or patch of vesicles may consist of from four or five to a dozen separate, non-confluent lesions situated upon a reddened, raised, and inflamed base. Occasionally the vesicles themselves may be absent, and nothing is to be seen except the circumscribed reddened patch. The several groups of vesicles constituting the typical eruption do not usually appear at the same time, but the patches may appear in succession, so that several days may elapse before all the lesions have developed.
The eruption having appeared, is accompanied with more or less pain of a neuralgic character, together with some soreness of parts if the vesicles rupture. As a rule, the lesions remain intact until after a week or so, when the fluid contents become absorbed, and the uplifted epidermis desquamates, leaving a reddened macule, or in some cases a small cicatrix, to mark the site of the lesion.
A striking peculiarity of zoster is the fact that it is strictly unilateral (with exceedingly rare exceptions). Cases of double zoster, in which both sides of the body have been involved at the same time, have been reported. Another feature of this affection is the extreme rarity or second attack, resembling in this respect the eruptive fevers.
The neuralgia which precedes or accompanies zoster may exhibit any degree of severity, and may indeed persist for an indefinite period after all symptoms of cutaneous irritation have disappeared. Instead of neuralgia, a more or less intense pruritus may be present, confined to the affected region, and persist for a long time.
As a rule, zoster is an affection of little gravity-that is, in persons who when attacked are in ordinary health. In those, however, who are aged or feeble, the prognosis is not always so favorable, as the vesicles may be followed by more or less severe ulceration. When the eruption appears on the head, and especially in connection with the branches of the trigeminus that are distributed to the eye ulceration of the cornea, and even destruction of the sight, may ensue.
Etiology-It has been very clearly demonstrated that the majority, if not all cases, of zoster appear in connection with irritation or inflammation of the ganglia attached to the roots of the sensitive nerves; but what sets up this primary irritation is not always clear. Zoster has been known to appear, after exposure to cold, in connection with pleurisy, after traumatisms, and after the internal administration of arsenic. Quite recently bacilli are said to have been found in the inflamed ganglia, but how they got there does not appear very clearly.
M.Fere reports four cases of herpes zoster, which occurred nearly contemporaneously among his 150 epileptic patients at the Bicetre. The first was a young man of nineteen, who had had a few violent epileptic attacks without any unilateral symptoms. The herpes was confined to the left side of the thorax and the left side of the face, and along with it he had some spasms of the left side of the face, and along with it he had some spasms of the left corner of the mouth, illusory impressions of persons approaching him from the left side, and some contractions and sluggishness of the left pupil.
The left side of the tongue also was much more thickly furred than the right. The temperature ran up to 107 degree F. at first, but all the morbid symptoms gradually subsided in a week. In the three other cases, in middle-aged men, the most prominent symptom was severe pain, with tenderness on pressure, down the spinal column. M.Fere is led to conclude from these and similar observations that the most probable cause of the herpetic eruption is a slight epidemic cerebro-spinal meningitis, which may be widespread, but perhaps only of sufficient irritative power to cause th herpes at the root of one or two nerves. Such a pathological condition would not be surprising in infectious diseases, for in them some forms of meningitis are not rare.
Zoster may follow influenza; Dr.Finzi reports a case in a girl of fifteen, who after recovering from severe attack of influenza, was seized with neuralgic pain, accompanied with a pricking and burning sensation shooting from the back around the right side. On being seen five days after, a chain of herpetic vesicles was found extending along the seventh intercostal space, the lymphatic glands in the axilla being swollen and tender, and pressure along the course of the seventh intercostal nerve, making the patient scream with pain. In from eight to ten days the vesicles disappeared, the whole duration of the symptoms having been about a fortnight.
Another case is reported of a case of zoster corresponding to the eighth intercostal nerve of the right side in a girl of eighteen, in whom the disease appeared at the beginning of an attack of influenza and lasted a mouth.
The writer had a case occurring in a girl of twelve corresponding to the eighth intercostal nerve of the left side, in which the eruption made its appearance three days after the beginning of an attack of influenza of severe form, and the eruption lasted two weeks.
Treatment-The chief indications are to preserve the integrity of the vesicles until their contents are absorbed, and to give relief to the neuralgic pain. We may attempt to carry out the first by the application of several coats of flexible collodion, or traumaticin, or we may brush the lesions over with oil, and then cover them freely with some indifferent dusting- powder. The neuralgia is to be treated exactly in the same way as if it were not accompanied with the vesicular lesions.
Zoster of the mucous membranes is not an infrequent affection. Three cases are reported in which the region supplied by the trigeminus was affected. In one of the cases the vesicles were located upon the mucous membrane of the left cheek; in the second case upon the conjunctiva of the right eye; and in the third case on the left half of the tongue.
The galvanic current, from four to eight cells of a battery of ordinary strength, has been found very beneficial if the pain is sharp, when applied from fifteen to twenty minutes daily. The principal internal remedies and their indications are as follows.
