Abstract
Hutchinson many years ago, while raising
the question as to whether Herpes Zoster should be
classified as a neurosis or an exanthem, is reported
to have said, "My own suspicion is that i t belongs to
neither of these classes, and further, I feel convinced
that whoever may succeed in unravelling the
mystery which at present surrounds it , must at the
same time make a discovery in Physiology**
The clinical observations that certain cases of
Herpes Zoster are infectious and occur in small
epidemics; that the disease may be associated with
Chicken Pox; and that its etiology and mode of
infection are entirely unknown, add further great
interest to this particular malady. These facts
amongst others led me to decide to investigate this
much discussed and in many respects obscure disease.
SCOPE OF THESIS.
(1 ) I decided to investigate the
records of all the cases of Herpes Zoster, 270 in
number, which have been seen in the Dermatological
Department of the Royal Infirmary Edinburgh, during
the last sixteen years, that is for the years 1907 to
1922 inclusive, with a view to gaining critical information
as to Etiology, Predisposing causes, Distributional
characteristics, Age and Seasonal incidence,
and Epidemicity of Herpes Zoster.
(2 ) I have decided to lay special stress on the
Epidemicity of Herpes Zoster.
(3) I will discuss at some length the division
of Herpes Zoster into Idiopathic and Symptomatic, such
a differentiation being of the greatest importance in
connection with the association of certain cases of
Herpes Zoster with Chicken Pox.
(4) Much attention has lately been given to the
association of Herpes Zoster and Chicken Pox, and
realising Herpes Zoster to be infectious and capable
not only of infecting another person with Herpes Zoste
but also with Chicken Pox, I decided to investigate
the recorded cases in the literature of this association
of the two diseases, and also to consult the
articles dealing with this subject, in order to make
a critical digest of the literature, with a view to
drawing some conclusions on this matter. Further, to
show from clinical manifestations the association of
the Idiopathic variety of Herpes Zoster with Chicken
Pox. I t would perhaps be as well to make mention of
the fact here, that such an investigation would necessarily
be curtailed because:- (1) Although the Dermatological
Department of the Royal Infirmary probably
records more cases of Herpes Zoster than any other
institution in Edinburgh, it does not drain a ll the
cases of the Town, many going to other Medical wards,
Leith and other hospitals, and many being seen by
general practitioners only. Further the disease not
being notifiable all the cases cannot be recorded, so
that an absolute and true record of the Epidemicity
of Herpes Zoster as representing the whole town cannot
be given. However the Royal Infirmary consistently
and regularly draws a certain class and part of the
community, so that from the records of this special
department we can draw a conclusion which is constant,
accurate, and which will also give us a very near idea
as regards the characteristics of this disease for the
whole community of Edinburgh. (2) Chicken Pox not
being notifiable we cannot give statistics showing
that an epidemic of Herpes Zoster occurs at the same
time as an epidemic of Chicken Pox, but we can however
clinically show the close association of the two
diseases, as w ill be described later.