OBTURATOR HERNIA.—This is a rare variety of hernia, which protrudes through the obturator foramen between obturator externus and pectinous, push ing before it the obturator fascia. The femoral artery and vein pass externally and in front of it, the adductor longus forming the opposite wall. The obtura tor artery and vein may lie to the inner or outer side of the hernia, especially near the neck: anatomical features which should be borne in mind when operative feature, in addition to the usual signs of strangulated femoral hernia.
Taxis is sometimes successful, espe cially if the thigh is flexed, adducted, and rotated inward. The muscles and tis sues around the hernia are thus relaxed. If this fails, herniotomy should be per formed, the nature of the vascular supply and the fact that the constriction is at the neck of the sac—which should be incised by cutting downward — being borne in mind.
HERPES.—Gr., 4)7t(,), to creep.
Definition.—Herpes simplex is an acute, non-contagious, benign disease of the skin, usually dependent upon a neu ritis of the nerves supplying the part, and characterized by an eruption of vesicles in groups upon an inflamed, oedematous base.
Herpes simplex may attack any part of the body-surface, but the malady shows a decided preference for two lo calities. These parts are the facial and genital regions. Because of the usual distinct restrictions of the disease to one or the other of these sites, and the diversity in symptoms that is liable to be manifested, two varieties of the dis order have been distinguished, and to each has been given a separate title. They are called herpes facialis and her pes genitalis. While essentially the same in nature, the specific causes apt to pro duce them, the dissimilarity of their manifestations, and the various diseases with which they are likely to be con founded, make their individual descrip tion a matter of necessity.
Herpes simplex appears but rarely in other situations upon the body and still less likely is it to occur in a generalized form. When such does happen, the term "herpes generalis" is applicable.
[Our etiological and pathological knowledge of the affection is still too limited to enable us to demonstrate with absolute certainty that there is always a preceding or accompanying neurosis, but evidence enough is at hand to war rant our accepting this statement as the truth. The almost constant distribution
of the lesions in the course of certain nerves points definitely to such a con clusion. WILLIAM FRANCIS ROBINSON.] Symptoms.—Herpes facialis may oc cur upon any part of the face or fore head.
Case of herpes affecting simultane ously the ophthalmic and the auriculo temporal nerve,. Vesicles appeared in the area supplied by the left frontal nerve, groups being present over the eyebrow, near the median line, close to the hair, and near the temple. The eye lids were reddened and swelled. Later, vesicles developed upon the left tym panic membrane. Bonnier (.Dour. of Laryn., June, '93).
Two instances of herpes oplithalmicus associated with paralysis of the ocular muscles observed. The first case oc curred in a man aged 5S years, the third and fourth, sixth, and first divisions of the fifth nerves being involved. In the second case (a man 79 years of age) there was complete ophthahnoplegia externa, proptosis, and a glaucomatous condition of the eye, with hypiemia. The first case was benefited by iodide of potassium. Silcock (Clinical Jour., Aug. S, '94).
The vermilion border of the lips, also of the nose, upper lip, cheeks, and auricles are favorite sites for its appear ance. The mucous membranes of the mouth and throat are often implicated. So, too, the disorder may attack the cornea.
Case of stubborn. recurrent, herpetie disease of the conjunctiva and cornea, in conjunction with menstrual disturb ance of the menopause, cited. The dis ease took the form of a small loss of corneal tissue, with fatty, uneven edges, and resembled a phlyetenule in appear ance. Rs summit had undergone ulcer ation. The eruption differed from that which is characteristic of herpctic dis ease by its disposition and appearance. Stuelp (Arehiv f. Ophth. [Criife]. B. 40, II. 2, '94).