HERPES OF THE PHARYNX.
Herpes on the skin is a common eruption in the child. Sometimes the rash appears on the pharynx, and produces great discomfort.
Causation.—The causes of herpes are doubtful. The complaint is said to be excited by exposure to cold, but a constitutional tendency appears to be necessary to its development. There is no doubt that, as Trousseau first pointed out, pharyngeal herpes is especially common during outbreaks of diphtheria, and that in such cases the zymotic disease may become en grafted upon the herpetic eruption.
Symptoms.—The complaint begins with febrile symptoms, followed after a few hours by soreness of the throat. The child complains of a painful feeling in deglutition, which is usually distinctly confined to one spot. On examination, a few whitish vesicles are seen clustered together on the soft palate, on one of the pillars of the fauces, or on one of the tonsils. Around them, the mucous membrane is redder than natural, and swollen. Sometimes the vesicles are more numerous, and more generally distributed. The vesicles last from twenty-four to forty-eight hours, and may then disappear without rupture, or burst, leaving little white spots from macerated epithelium, or circular ulcers which soon heal. Some times, instead of healing rapidly, the ulcers become covered with pulta ceous exudation, and, if the sores are numerous, the exudation may form a continuous layer. More usually, however, the patches are small and iso lated. Their seat is generally the soft palate, or one tonsil ; seldom the back of the pharynx. After three or four days the exudation becomes de tached and disappears. Sometimes more than one crop of vesicles is no ticed. Often, herpes of the pharynx is associated with the same condition of the lip ; and the vesicles are said sometimes to invade the larynx and the openings of the Eustachian tubes, so as to affect the respiration and the sense of hearing.
Diagnosis.—When the disease is seen in the vesicular stage it is readily recognised. If, however, inspection is delayed until the patches of exuda tion have formed, the case may be mistaken for one of diphtheria ; more especially, as this form of the complaint is often associated with outbreaks of that disease. If, however, herpes of the lip is present, and especially if small circular ulcers can be seen mixed up with the small patches of exu dation, we may suspect pharyngeal herpes. Still, it is often impossible to distinguish the case from a mild attack of diphtheria.
Treatment.—The complaint requires little treatment. Attention must be paid to the bowels. If the tongue is furred, it is well to administer a mercurial purge, such as a grain of calomel with two or three grains of jalapine. While the pyrexia lasts, the child should be kept in bed and put upon slops—indeed, the pain induced by deglutition will prevent his wish ing to swallow solid food. If the fever is high, tincture of aconite may be given in doses of one or two drops, every hour, or two hours. If the dis comfort in the throat is great, it may be relieved by inhalations of steam, medicated with compound tincture of benzoin ( 3 j. to the pint). If in the stage of exudation there is any fcetor of the breath, inhalations or sprays containing creasote or carbolic acid (M, xx. of each to the pint) may be made use of. As an internal remedy for children, Dr. Morell Mackenzie speaks highly of arsenic. Three or four drops of Fowler's solution may be given three times a day, directly after food, to a child five years of age. If there is any doubt as to the nature of the complaint, and diphtheria be epidemic in the neighbourhood, the treatment for that disease should be at once adopted.