Attention called to the great infre quency with which herpes zoster affects two widely-separated regions. Case ob served of a middle-aged man who pre sented the lesions of the disease on the left side of the thorax, on the inner as pect of the left arm, and on the left side of the forehead. Bradshaw (Lancet, Oct. 13, '94).
Notwithstanding the common opinion as to the strict delimitation of the vesi cles of zoster over a determined nerve territory, the writer finds in a large number of subjects vesicles disseminated over the entire tegumentary surface. These resides resemble those proper to zona, and, if their evolution is studied, it is found that they belong properly to the zoster, and are not pustules of self inoculation. Jeanselme and Leredde (Gaz. Hebd. de Med. et de Chin, July 28, '98).
Fingers are by no means an uncom mon situation for herpes zoster. It has been observed in women who have to wash dirty linen or bandages from sup purating wounds, and also among hos pital nurses. It is due, in every instance, to a direct infection of the finger. A large flat blister first attracts the pa tient's attention. There is a slight amount of redness, but no oedema. It usually affects the metacarpal or middle phalanges. F. Guermonprez and A. Platel (Jour. des Malad. Cut. et Syph., Dee., '09).
In so-called double zoster the girdle, Or zone, about the body is complete. This form of the disease is exceedingly rare and is very apt to be productive of great distress. The belief, however, in the fatality once accorded it has not been shown to be founded in fact.
The pain is the chief symptom of an noyance complained of. At times there may be more or less of itching and burn ing sensations, but these are not apt to occasion marked distress. The pain usually persists throughout the course of the eruption and subsides as the ves icles disappear, but it may endure for an indefinite period after all trace of the skin trouble has vanished. Weeks, months, and even years, with complete shattering of the nervous system, have been recorded of such continuance. Age has a decided influence upon the charac ter of the pain. In children it is ordi narily mild, while in the aged it is apt to be extreme in its severity.
Case of a child suffering from reflex epileptic convulsions, which supervened upon an eruption of herpes zoster occur ring in the distribution of the superior superficial branches of the cervical plexus, the left side of the head, neck, shoulder, and upper part of the thorax affection of vasomotor nerves, the vaso dilators being irritated, and looks on the herpes as an intense angioneurotic dis turbance which may be associated with diseases of the motor or sensory, spinal or cerebral, nerves.
In most eases the disease results from causes acting on the body iu general, though trauma and cold may assist. It
is possible that infection or autointoxi cation plays a part. Ebstein (Virchow's Archiv, B. 130, H. 3, '95).
Typical case of herpes zoster, affecting the entire right side of the neck and face, corresponding with the lower re gion of the cervical plexus, observed in a man 75 years old. After tell days of acute suffering total paralysis of the right facial nerve suddenly set in. The pain and the paralysis gradually dimin ished, and finally disappeared after from two to three weeks' treatment by the galvanic current. Olaf Friel' (Norsk Mag. f. Liigevidenskab., p. 112a,'90).
being affected. With the disappearance of the eruption the convulsions ceased. Byron (N. Y. Med. Jour., Jan. 10, '91).
The pain is more decided when the head is attacked than in the regions of the trunk or limbs. In rare instances complete anmsthesia of the part follows or anaesthesia dolorosa may supervene. Motor as well as sensory disturbances exhibited in local paralyses may occur.
Case of an old woman who, while suf fering from a subacute attack of rheu matism, developed neuralgia of the right side of the neck and face with an erup tion of herpes zoster. The eruption fol lowed the course of the superficial cervi cal plexus and the facial nerve. After a few days a complete Bell palsy occurred. In the course of four months, under treatment, the palsy disappeared. H. A. Spencer (Lancet, June 9, '94).
Case of herpes zoster with facial paralysis and another with sensory dis turbances. The writer agrees, with Recklinghausen, that there is a primary 3— Combination of herpes zoster and facial paralysis very rare. Ebstein was able to collate but eleven cases. The author has found seven others, and adds the following of his own: a woman, aged 20 years, no nervous disease in family. Trouble began the day after sitting in a draught, with a drawing sensation in right side of face, slight tenderness over right eyebrow, followed by pain radiating from neck to back of head and on right side. On the third day a total right-sided facial paralysis. Four days later a vesicular eruption on the lower half of the right ear and in the auditory canal, on the right half of the tongue, uvula, and palate. The paralysis was very marked, with complete reaction of degeneration. The tongue protruded straight; touch and taste Un impaired. Sensation of face intact. No tenderness at points of exit of the fifth and seventh nerves. No cerebral symp toms. So far as the author knows, this is the fourth case in which the paralysis preceded the herpes. The phe nomena in this case maybe explained as follows: The trigeminal branches were involved; the lingual herpes was caused by continuation of the inflammation from the facial to the chorda tympani and affected only its trophic fibres. Eichhorst (Centralb. f. innere Med., No. 18, '97).