In cases of a doubtful nature on or near the genitals one should keep in mind the following points: The chances of irregular herpes should always be con sidered; the lesions and inguinal glands should be frequently examined until the diagnosis is clear. In the meantime irritants and mercury should not be used. Cooper (Brit. Med. Jour., May, 1900).
If there be a history of exposure to a probable source of infection, sufficient time to exclude the possibility of such infection must be insisted upon before a final answer be given. This, in the case of chancroid, need be but a few days. The pain, the intense inflamma tion, the formation of a true ulcer, and the development of the single inguinal bubo will tell the story. If haste is necessary the autoinoculability of the secretion may be tried.
If true chancre be expected, at least six weeks from the time of the exposure should be allowed to elapse before a definite decision can be rendered. The sluggishness of the lesion, the indura tion, the double inguinal enlargements, and the characteristic eruption will dis tinguish it.
Differential diagnosis must be made between genital herpes and eczema, or between it and chancre. The vesicles in eczema are microscopical in size and in numerable, and disappear rapidly. The chancre is less superficial than herpes; its borders are more irregular; its base is also irregular, and accompanied by some enlargement of the glands. By placing upon a piece of glass some scrap ings from a soft chancre, there are found elastic fibres whicn are not met with in herpes. Finally, inoculation with soft chancre shows a redness from its second day, and a vesicle upon the third, which is rapidly followed by ulceration. Four nier (Revue Internat. de Med. et Chir., June 25, '90).
Etiology.—Herpes genitalis occurs in both sexes, but with relatively greater frequency in the male than in the female. In persons subject to the dis order any irritation of the genital re gions is likely to induce an attack. Ungratified sexual excitement, local uncleanliness, coitus, masturbation, fric tion with the underclothing, passage in the male of a sound or pressure in the saddle on horseback or the bicycle are common and fruitful sources of the mis chief. In some women it appears at each catamenial epoch. preceding, ac companying, or following the period. It is frequent during pregnancy. Ve nereal disorders, such as gonorrhoea and chancroid, as has been so well shown by Doyon, are apt to induce it. They are not, however, as he endeavors to show, its invariable precursors. Vaginitis and leucorrheea are prone to give rise to the disease, the irritating discharges acting as the exciting factor. Fournier and Unna have shown that it is very common in prostitutes and lewd women. In women infected by their husbands with syphilis or gonorrhcea it is said to be in frequent.
From an experience of twenty-four years in the Hospital for Venereal Dis eases in Copenhagen, the writer finds that 2.6 per cent. of prostitutes have herpes vul•aris. Out of S77 cases of herpes, 73.4 per cent. of the women were menstruating when examined; and many stated that they had the eruption only at the time of their period. It had no apparent connection with previous venereal troubles, or with their practice of indulging in sexual intercourse during the flow. Vnlvar herpes believed to be nearly always a menstrual exauthem, probably of trophic origin. The vesicles
are most numerous immediately before the flow. They appeared in 70 per cent. of the cases on the labia majora. Bergh (Centralb. f. Gynlik., Feb. S, '90).
Herpes genitalis is a disease of early and middle adult life. It rarely occurs in infancy and seldom after fifty years of age. Like herpes of the face, it some times appears to arise without appre ciable cause. Disorders of digestion and constipation are named as exciting fac tors, but it is doubtful if such be the case.
A redundant prepuce is unquestion ably an exciting element in men. Bala nitis is sometimes regarded as a cause, but the probability is that it' is due to the same derangements that induce the herpes.
Prognosis.—Ilerpes genitalis is a dis ease that recurs with exasperating quency and occasionally makes life a burden to its victim. But, aside from the tormenting pruritus and the belief in its venereal origin, it is seldom that it gives rise to much that can be char acterized as more than mere annoyance. The patient's fears need to be allayed and faulty sexual habits and hygiene cor rected. The tendency of the trouble is toward rapid healing. Where ulceration results from the improper use of caus tics the process may be much prolonged and phimosis with distinct narrowing of the prEeputial orifice may result: Treatment.—Caustics should never be used in the treatment of. herpes of the genital organs. Grave ulceration is liable to result and the more important factor of accurate diagnosis is almost sure to be clouded. The simplest antiseptic washes with absolute cleanliness are sufficient. Immersing the parts, where possible, in a warm solution of boric acid, or bathing them with the same twice a day and dusting afterward with europhen or aristol, is all that is needed. Wreak solutions of bichloride of mer cury, zinc sulphate, or potasshun per manganate, may be used. Duhring speaks highly of the following for mula:— T Zinci sulphatis, Di-3j. Potass. sulphide, 3 i-5j.
Spt. vini rectificatus, 5j. Aqua?, f3vij.
M. Sig.: Shake and apply frequently and freely.
All sources of irritation should be re moved. Borated cotton makes a good covering.
For herpes pudendalis, an ointment of 30 grains of tannic acid to the ounce of cold cream used, the mixture to be applied frequently during the day. Many cases seem to be of malarial origin and are benefited by quinine and Fow 1 lees solution. Carstens (Phys. and Smug.. Oct.. '95).
The treatment of herpes is simple. Scratching must he avoided; absolute cleanliness and avoidance of all irrita tion are imperatively demanded. In the beginning a little lint covered with vaselin is sufficient for genital herpes. Later on, talcum powder or bismuth subnitrate is useful. All measures fail during the acme of vulvar herpes. Cold cream and starch poultices quiet the pain. After the subsidence of this period, baths and inert powders are use ful. Buccal herpes calls for nothing but emollient gargles. Fournier (Revue In ternat. de Med. et Chir., June 25, '96).
In dressing the penis no bandage should be used. It interferes with the return-circulation and is liable to induce phimosis. Arsenic may be tried as a prophylactic, and cold sponging of the body should be practiced daily. In per sistent cases the use of the faradic cur rent daily over the spine may be tried.
In patients with a long foreskin cir cumcision should be advised.