Five cases of acute pyrexia occurring between the second and fifth dVs after confinement or abortion, is each of which the febrile attack terminated by an eruption of facial (usually labial) herpes. In each case the attack was ushered in by rigors; the pyrexia was severe, rising to 103° to 104° F., and in each case, after the appearance of the herpes, the patients rapidly recovered. Attention called to the disquieting nature of these symptoms and their lia bility to be confounded with those of grave septic infection; when strict antiseptic precautions have been taken in the conduct of labor or abortion, and no local condition can be found to ac count for the subsequent rigor or py rexia, it may be well to remember that the explanation of these phenomena may sometimes be found in the occurrence of the herpetic disorder described. Lu taud (Jour. de Sled. de Paris, July 12, '96).
Toothache as well as dental instru mentation is known to produce the trouble.
Herpes facialis may be due to irrita tion of the trifacial nerve reflexed from some dental affection. George Carpenter (Pediatrics, May 1, '06).
Blows upon the head, exposure of the face to alternate hot and cold blasts, or the application of irritating medica ments to the parts, are fruitful sources of the disorder. Many cases are thought to arise without appreciable cause, and are spoken of as idiopathic, but it is doubtful if such is ever strictly the truth. A careful analysis would, in all likelihood, reveal in each instance the existence of some irritating factor capable of producing the affection.
Pathology.—Owing to the benign nature of the disease, opportunities for studying its pathology are rare, and our knowledge is correspondingly lim ited.
[To Unna, of Hamburg, is due much that we know. His observations were confined to the study of tissue taken from three living subjects affected with herpes genitalia, and one corpse dead of a febrile disease in which facial herpes was present. WILLIA]t FRANCIS Ron INsox.] Unna found that the process origi nated in the upper layer of the rete mucosum and was a true coagulation necrosis. The cells affected were much enlarged and the cell-contents were greatly changed. The nucleus had dis appeared and the protoplasm could not be stained. This was due to the satura tion of the cell by fibrinogenous sub stance from the fluid surrounding the cell-body. The cell retained its normal shape and the prickles remained in tact. Beneath the zone of necrotic tis sue a layer of flattened and thinned prickle-cells was found that still re tained its normal features and the cells their capacity for staining, thus indi cating that the elevation of the whole epithelium was a secondary, and not a primary, occurrence. Deeper down in
the rete were cells in a necrotic condi tion. In most of these the nucleus had disappeared, leaving only a cavity, while in some cell-substance had been com pletely dissolved in the fluid of the blis ter. The heads of many papillie pro jected into the cavity of the lesion and were entirely denuded of epithelium. It would appear, then, that the process consists of two distinct steps, the first consisting of a fibrinous inflammation of the upper prickle-cell layer, convert ing it into a nuclear, degenerated, ne crotic mass, forming later the roof-wall of the vesicle. The second, the loosen ing of the epidermis as a whole, with the formation of a subepithelial blister, whose contents again undergo coagu lation-necrosis. The blood-vessels and lymph-spaces underneath and about the lesion were found markedly dilated, and distinct, though not extensive, migration of leucocytes was evident.
Prognosis.—The disease is a benign disorder running its course, if not irri tated, in from four to twelve days. scarring is produced. Pigmentation fol lows the desiccation of the vesicles, but this soon disappears. The disease is ex ceedingly prone to recur,—in many pa tients with almost periodical regularity.
Treatment.—The treatment of herpes of the face should be of the simplest kind. All irritation should be removed. No picking, scratching, or rubbing should be allowed. The smoker should be made to give up his pipe or cigar, and all forms of tobacco had best be inter dicted.
Strong acetic acid, if applied at the outset before the vesicles have formed. will often cut short the attack or greatly lessen its severity. The action of the acid should be checked before whitening of the skin takes place. If the itching and burning are at all severe, lotions of dilute lead-water and opium, zinc oxide and lime-water, elderflower-water, cam phor-water, or weak ammonia-water may be used freely. These should be followed by a simple dusting-powder, such as starch, boric acid and talc (1 to S), stearate of zinc, or lvcopodium. Painting the parts with flexible col lodion after the vesicles have fully formed makes an admirable dressing. Ointments, as a rule, are not well borne. The Lassar paste (salicylic acid, gr. v; zinc oxide and talc, of each. drachma ij; vaselin, drachma iv) makes a good protective covering.