At the outset a slight tinLrling or burn ing is felt in the part about to be at tacked. Redness and swelling rapidly follow, and upon this base a cluster of tiny vesicles soon appears. Usually an areola surrounds the group. The groups vary in number from one to a half-dozen or more, and in size from the surface of a split pea to a silver twenty-five-cent piece. They are round, oval, or irregular in outline, and may be closely set or widely separated. The vesicles are from pin-head to a kernel of wheat or larger in size and number three to a dozen or more in each group. They are fairly firm to the touch and do not readily rupture. Most authors describe a preceding papular stage. This is exceedingly hard to demonstrate, and, if it does exist, is of very short duration. With care in the examination, fluid may be found in the lesions at the moment of their inception.
At the outset each vesicle is filled with clear, transparent serum. This gradually grows turbid, until by the end of the second or third day, if the lesion be not sooner ruptured, the liquid as sumes a milky condition, and examina tion under the microscope shows an abundance of pus-cells and degenerated epithelium. Where closely set the cles may coalesce, forming a flat-topped bleb.
Unless interfered with, the vesicles run their course in from four to ten days, the process then being completed by the formation of a crust which des iccates and falls, leaving a brownish, pigmented spot. This pigmentation gradually disappears without forming a scar or other relic of the disease.
If the vesicle, as usually happens, is broken by picking, rubbing, or scratch ing, an excoriation results, which, if it does not become infected, is shortly cov ered with a crust, and the disease then runs its usual course and terminates in the ordinary way. Such crusts are dry and firmly attached. When the excori ations become infected with pus-cocci or are treated with strong caustics, grave ulcers are apt to supervene and disfigur ing scars remain.
Haemorrhage into the vesicle (black herpes) and gangrene sometimes com plicate the process.
Subjective sensations are usually slight. The unsightliness of the:dis ease causes the patient more distress than does the pain of the disorder. The tickling, burning, or pricking sensations occurring at the outset may continue for a day or two and then subside, no further distress being experienced. Sometimes, though rarely, more or less itching is complained of, and even pain is occasionally felt.
Herpes of the mouth and throat (canker spots) presents a somewhat dif ferent appearance. Owing to the moist,
warm condition of the parts the vesi cles cannot develop as such. A round or oval patch, slightly elevated, and cov ered with a whitish, sodden exudate, is first formed. These spots may be situ ated upon the upper or under surface of the tongue, the border of the gums, the inner wall of the cheek, the palate, or the tonsil.
Case of chronic recurrent herpes of the oral cavity seen in a man of 38, healthy until his eighteenth year, when, after an attack of typhoid fever, in 1874, the herpetic trouble began to show itself,— at first upon the lips and along the gums, later on the tongue. The erup tion lasted from eight days to four weeks. In 1333 and 1339 for nearly a year the patient was free from herpes. After this, however, the attacks recom menced with greater frequency, some times immediately following one an other. The patient complained of diffi culty of breathing through the nose during the attacks. No general symp toms accompanied the attacks; the pharynx and larynx remained free. Sal ivation was a marked symptom from time to time, and the mucous membrane of the cheeks was attacked.
The immediate cause of the affection seemed to be some involvement of the trigeminus. Flatan (Dent. med. NVoch., May 28, '91).
The most frequent site of herpes of the larynx is upon the posterior face of the epiglottis, and in the neighborhood of the arytenoids.
It is characterized anatomically by the evolution in these regions of her petic vesicles surrounded by an inflam matory zone, and clinically by the symp toms peculiar to herpetic fever, and also by painful dysphonia, rawness of voice, occasionally aphonia, sometimes dysp ncea.
Its invasion is abrupt, its course rapid, prognosis favorable, and cure complete. Relapses sometimes occur.
Rarely it is accompanied by phenom ena. analogous to those of croup. Brin dell (Rev. de Laryn., xvi, p. 233, '95).
Herpes of the mouth, while not al ways severe, usually occasions consider able distress.
A condition that is known as "her petic fever" is occasionally met with. The disease usually occurs in endemics and is characterized by languor, ing, and chilly sensations, followed by a rigor and then a sudden attack of fever. The fever may run as high as 104°; the tongue is moist and heavily coated; the throat is sore, and the glands of the neck enlarged. Restlessness and delirium are exhibited at night. On the second day the vesicles appear and are usually confined to the face.