HERPES.
Herpes Labialis seldom requires treatment; when the irritation is severe the vesicles may be fomented by applying a small sponge squeezed out of hot water; after drying the part it may be painted over with Flexible Collodion. The sores which follow are sometimes very slow in healing when the patient keeps picking away the scab; the application of a solution with a camel's-hair brush of ro grs. to the ounce Nitrate of Silver hastens resolution, or the crusts may be kept moistened by Glycerin of Borax.
Herpes Prepulialis is also a fleeting ailment, but sometimes in ataxic patients it proves an intractable affection. The best method is to employ a desiccating powder like Zinc Oxide, Calamina or Fuller's Earth when the prepuce is long and an ointment when the glans is uncovered.
Herpes Zosler, Shingles or Zona is seldom diagnosed till the eruption of vesicles has already appeared, though the primary pain may be so severe as to demand a hypodermic of Morphia. When the cause of this 27 pain has not: been suspected and any severe form of counter-irritation has been employed to lessen it, such as sinapisms, blisters, &c., the eruption is always formidable and sloughing of tissue may follow. The use of a spray of Ethyl Chloride is most comforting at this early stage when applied to the skin near the spine at the level of the involved nerve, and it is equally soothing at a later stage after the eruption has dis appeared.
Upon the appearance of the first few vesicles arises the question of treatment to cause abortion of the eruption. Dupas lays absorbent wool soaked in 90 per cent. Alcohol over the developing vesicles, and covers it in with oiled silk. Unna paints the region over with Ichthyol or covers it with Zinc and Resorcin Gelatin. Alcoholic solutions of Resorcin (2 per cent.), of Thymol or Menthol have been used for the same purpose, but in all probability no local application has any aborti facient action.
The hest routine is to powder freely over the site of the eruption with equal parts of Zinc Oxide and finely powdered Starch, and cover with a soft uniform layer of absorbent wool, which should be kept in position by a bandage or girdle. This prevents the vesicle being ruptured by friction against the clothing, or by scratching. Any desiccating powder as Fuller's Earth. Talc, Calamina, Bismuth, &c., may be similarly em ployed. The application of Uuna's Zinc jelly at this stage is a favourite method of treatment with many physicians; the writer prefers the powder and wool, as it can be often removed easily for inspection. Boric Acid
in dry powder may be substituted for the zinc where the skin is liable to be infected as in uncleanly patients. Claisse treats the vesicles like burns of the second degree; after puncturing each with a sterilised needle Ire dresses with Picric Acid Solution, and always finds healing most rapid and satisfactory. Where the vesicles when first seen are already ruptured by friction the best application will be an ointment; any soothing, astringent and antiseptic unguent may be freely applied on lint or old sterilised linen, as . Liq. Pluntbi Fort. ass.
Hvd. gr. x.
Ungt. Zinci Oxid. 3ij.
When pain is severe during the eruptive stage, zo grs. Camphor, to grs. menthol or 5 grs. Cocaine may be added to the above.
Analgesics may he required internally, and the safest of these is Anti !mine given in ro-gr. doses, morphine being only employed where the pain is very severe, as in herpes attacking the ophthalmic division of the fifth nerve. In this form of zoster, Cocaine may be instilled into the conjunctival sac and the lids and temples covered over with an ointment of Calomel (i5 grs. to r oz.), dry powders being contra-indicated, as the ulceration will be encouraged to proceed under the crusts and lead to extensive scarring. The eye must be watched, as the accompanying conjunctivitis and keratitis may lead to serious ulceration and perforation ending sometimes in danger to the globe.
Neuralgia is very liable to remain after the eruption has completely resolved itself, and in elderly subjects this may become formidable, especially in eye cases, but not infrequently also when the trunk nerves have been involved. Quinine, Antipyrine, Phosphide of Zinc gr.), and in gouty subjects Colchicum, Aspirin or Salicylates may be employed. The continuous and high-frequency currents often afford relief, whilst improved hygiene, liberal feeding„ change of air, rest and alteration of the environment may be tried. Morphia is contra-indicated in such cases owing to the danger of establishing the opium habit. Arsenic is often[recommended, but Eustace has observed several cases of bilateral herpes which were caused by arsenic, and he believes that the bilateral type is always so produced.