Etiology

It has been very clearly demonstrated that the majority, if not all cases, of zoster appear in connection with irritation or inflammation of the ganglia attached to the roots of the sensitive nerves; but what sets up this primary irritation is not always clear. Zoster has been known to appear, after exposure to cold, in connection with pleurisy, after traumatisms, and after the internal administration of arsenic. Quite recently bacilli are said to have been found in the inflamed ganglia, but how they got there does not appear very clearly.

M. Fere reports four cases of herpes zoster, which occurred nearly contemporaneously among his 150 epileptic patients at the Bicetre. The first was a young man of nineteen, who had had a few violent epileptic attacks without any unilateral symptoms. The herpes was confined to the left side of the thorax and the left side of the face, and along with it he had some spasms of the left corner of the mouth, illusory impressions of persons approaching him from the left side, and some contractions and sluggishness of the left pupil. The left side of the tongue also was much more thickly furred than the right. The temperature ran up to 107° F. at first, but all the morbid symptoms gradually subsided in a week. In the three other cases, in middle-aged men, the most prominent symptom was severe pain, with tenderness on pressure, down the spinal column. M. Fere is led to conclude from these and similar observations that the most probable cause of the herpetic eruption is a slight epidemic cerebrospinal meningitis, which may be widespread, but perhaps only of sufficient irritative power to cause the herpes at the root of one or two nerves. Such a pathological condition would not be surprising in infectious diseases, for in them some forms of meningitis are not rare.


Zoster may follow influenza: Dr. Finzi reports a case m a girl of fifteen, who, after recovering from a severe attack of influenza, was seized with neuralgic pain, accompanied with a pricking and burning sensation shooting from the back around the right side. On being seen five days later, a chain of herpetic vesicles was found extending along the seventh intercostal space, the lymphatic glands in the axilla being swollen and tender, and pressure along the course of the seventh intercostal nerve, making the patient scream with pain. In from eight to ten days the vesicles disappeared, the whole duration of the symptoms having been about a fortnight.

Another case is reported of a case of zoster corresponding to the eighth intercostal nerve of the right side in a girl of eighteen, in whom the disease appeared at the beginning of an attack of influenza and lasted a month.

The writer had a case occurring in a girl of twelve corresponding to the eighth intercostal nerve of the left side, in which the eruption made its appearance three days after the beginning of an attack of influenza of a severe form, and the eruption lasted two weeks.