Crocker speaks of defervescence being associated in some cases with the her petic outbreak.
The disease runs its course in about four days, terminating in recovery.
The course of the disease and its oc currence in endemics points to an infec tious origin. Cases have been traced to sewer-gas and faulty hygiene.
[Epidemics have been reported by Savage (Lancet, Jan. 20, '83) and Seaton (Clin. Soc. Trans., vol. xix, p. 26, 'S6). WILLIAM FRANCIS ROBINSON.] Diagnosis.—Herpes facialis is to be dis tinguished from ECZEMA by the larger size and greater stability of the vesicles, by their peculiar grouping, the insignificant sensations accompanying the disease, and the rapidity with which the disorder runs its course. There is no weeping, as in eczema, and no successive new forma tion of vesicles upon the same sites. The resemblance of herpes, when the lesions have broken and crusts have formed, to IMPETIGO is sometimes marked. But in impetigo the crusts have been preceded by a single vesicle, bleb, or pustule. In stead of a group of vesicles, the patches of disease are not distributed in the line of any cutaneous nerve, but are scattered irregularly over the surface, and typical lesions can usually be found upon the hands and also upon the trunk. There is often a history of contagion. Care must be exercised in not confounding herpetic lesions of the mouth with the mucous patches of syphilis. Many pa tients, frightened by the knowledge of their exposure to syphilitic infection, point to their frequently recurring can ker spots as indubitable proof that they possess the disease. Mort decisive evi dence in the form of scars, alopecia, gummata, or the peculiar eruptions of syphilis must be searched for and found before confirmation of the subject's fears should be given. Veterans of syphilis are sometimes subject to her petic troubles of the mouth that give rise to much mental distress on the part of the patient, but which are not in any wise related to the precedent hies.
Herpes occurs at all stages of pneu monia, and is dependent rather upon the peculiar liability of the subject to herpes than upon the nature of the case.
nosis is better in cases in which the eruption occurs. Talamon (Rif. Med., Mar. 20. '95).
Buccal herpes must be differentiated from mucous patches. Buccal herpes is much more painful and much more liable to become fissured. It has from the out set a marked milky tint, and long pre sents in the centre of its polycyclic bor der a whitish circle, which is the last vestige of the broken-clown or ruptured reside. The microcyclic contour has a positive value. The specific treatment is injurious. Fournier (Revue Internat. de Sled. et Chin, June 25, '96).
Herpes simplex can be distinguished from herpes zoster by the bilateral dis tribution of its lesions, the presence of fever, and the lack of nerve-pain.
Herpes Facialis (fever-blisters).
Etiology.—Herpes facialis is a com mon, though not necessary, accompani ment of many fevers and of catarrhal disorders of the nose, throat, bronchial passages, and lungs. The popular desig nation "cold sore" is indicative of the frequency with which the complaint occurs in simple coryza. Typhoid and intermittent fevers frequently give rise to it. Herpes simplex is very apt to occur in pneumonia not only upon the face, but upon the genitals and at times in other localities upon the body. At one time it was believed to occur regu larly at the crisis in all cases of sthenic pneumonia in which a favorable out come was likely to occur. Such auspi cious prognosis, however, can no longer be maintained.
Disturbances of the digestive tract, especially in children, are prone to pro duce herpes of the lips. Indigestion, gastritis, gastric ulcer, and enteritis in adults are frequently associated with this form of herpes. It is not unusual in malaria, but is said to be rare in re lapsing fever. Herpes of the nose and lips often co-exists with tonsillitis and bronchitis.
Some persons are so extremely sus ceptible to the disease that merely brushing the face or the lips with a feather will induce it. Many women are affected at each menstrual epoch with labial herpes.