REGIONAL ZOSTER.—Herpes zoster may attack any part of the body, but it apparently exhibits a preference for cer tain sites, and to its appearance in these localities certain names indicative of the region affected are given. Thus we have zoster capillitii, z. frontalis, etc. When the disease invades two adjoining regions more precise terms, such as zoster cervi co-brachialis, z. intercosto-humeralis, and so on, are used. The general features of each are the same, but, owing to ana tomical differences, some characteristics need special description.
Zoster is not infrequently found at tacking the various regions of the head. In the scalp (z. capillitii) the lesions are apt to be the seat of severe burning sen sations, the occipital region being most often the part affected. Over the fore head (z. frontons) disfiguring scars are likely to result. The branch of the supra-orbital nerve that passes upward is here the one that is usually involved. The ear (z. auricularis) is sometimes at tacked, and the cheeks, side of the nose, and chin are not unusual sites. The dis ease may appear in the mouth-cavity (z. buccalis), upon the inner wall of the cheek, and the gums. Zoster exhibits its greatest severity when the eye (z. ophthalmicus) is attacked. The first branch of the fifth nerve is then affected. The nasal filament of the same nerve is often implicated and the eruption ex tends downward upon the nose and cheek. The pain is severe. The con junctiva is reddened and swelled, the cornea is inflamed, and iritis may follow, with marked disturbance of vision and oedema of the neighboring parts. In its severer forms disintegration of the eye ball with loss of sight occurs and a re sulting meningitis may lead to a fatal issue. Sympathetic involvement of the other eye may take place.
While we must regard zoster of this region as a grave affection liable always to destroy the eyesight and endanger life, yet instances are on record in which the attack, though serious, resulted most favorably.
Case of bilateral zoster ophthalmicus occurring in a patient suffering with chronic pneumonia and diffuse inter stitial nephritis. The case was anom alous in that the attack came on with out pain and exhibited a variety of lesions. The eruption consisted of pust ules, vesicles, and bulke occurring at the same time. By the end of the third day these lesions had broken down com pletely, forming freely-discharging ul cers. The greater part of the fare region was affected. The disease ran its course in three weeks and ended in com plete recovery. Robertson (London Lancet, July 7, 'SS).
Zoster is more frequently encountered on the surface of the thorax (z. pector
alis) and the neighboring abdominal (z. abdominalis) parts than elsewhere on the body. The right side is more often affected than the left. In the thoracic region the intercostal nerves are at tacked. The pain is marked and when occurring before the eruption appears is apt to be mistaken for pleurisy. The presence of fever is needed to establish the latter affection. In zoster of the thorax considerable interference with breathing is liable to be experienced, owing to the pain occasioned by move ments of the chest-wall. Duhring notes that the pain here may simulate the dis tress occasioned in angina pectoris. Be cause of the peculiar distribution of the diseased areas in these parts in the form of a belt or girdle has arisen the com mon designations of zoster as zona or cingulum. It is not unusual for the dis ease to be preceded in this situation for some time before its eruption by its char acteristic pain. The nerves affected in abdominal zoster come from the dorsal and lumbar portions of the cord.
Two cases of thoracic herpes zoster iu which a diffuse radialgia was observed. This is a painful sensation in the spinal region, both spontaneous and increased by pressure. It is localized along the chain of the spinal apophyses and a little on each side of these, and extended from the third dorsal to the second lumbar vertebra in the cases observed. In some cases zoster is a indic ative of disturbances of nutrition of the nerve-elements in course of the evolu tion of an infectious malady. Terr6 (Edinburgh Med. .Tour., Sept., '901.
Herpes zoster brachialis involves the shoulder and upper arm to the elbow.
It may extend down the forearm, and even as far as the finger-tips, attacking the palmar surface of the hand; but this is rare. The flexor surface of the arm is more often selected than is the ex tensor.
In zoster femoralis the disease spreads over the buttock, thigh, and down the leg. It usually does not go below the knee and the feet are as seldom attacked as are the hands.
Case of universal zostcr. The subject was a man, 30 years of age, who had suffered from two severe attacks of malaria. The first occurred at the age of twenty-seven and lasted for a number of months. At thirty he was affected a second time with the disease. This was accompanied by severe neuralgic pain and burning sensations. Within a few days from the beginning of the fever the zoster appeared and was universal in its distribution. Even the conjunctiva and the mouth, nose. and anal cavities were invaded. Colombini (Commentaris delle Mal. Cut. e Genito-lirin., '93).