RECURRING HERPES GENITALIS IN THE MALE.

972

CLINICAL AND LABORATORY NOTES a cluster of shallow circular erosions which are not indurated if they have not been irritated by caustics The or other forms of unsuitable local treatment. lesions are rather irritating and slow to heal conBY DOUGLAS GREEN, M.B. LOND., F.R.C.S. ENG. sidering their small size, but the irritation is as a rule most intense for a day or two before the vesicles The consensus of opinion is that the appear. TIIE unusual length of the period of survival after condition is due to a filter-passing virus, and its sustaining a fracture of the spine seems of sufficient frequent association with chronic venereal conditions interest to warrant publication. Perhaps some of of the genital tract, which had been noted by Doyon your readers can answer my contention that the case and Diday, suggested to me a method of treatment, is unique. During my student days it was generally and after effecting a cure in 12 cases I am of the taught that the maximum expectation of life after opinion that in the majority of cases the condisuch an injury was two years, while the average was tion is due to the presence of septic foci in the much shorter. Only recently I treated another man prostate. who lived over 12 years, after being thrown from his I had noted during the war in France that prostatic horse and sustaining a fracture of the spine through massage in cases of chronic prostatitis often brought the twelfth dorsal vertebra. about an attack of herpes genitalis in patients, The present case was somewhat similar. On whether they had previously suffered from the conAugust 8th, 1892, a telephone linesman, then aged 21, dition or not, and I noted also that the cure or improvefell from a high telephone pole and fractured his ment of the prostatic condition led to an apparent spine between the eleventh and twelfth dorsal vertebrae, disappearance of the herpes. Herpes genitalis After a stay in hospital he was sent home and was often follows extra-conjugal intercourse or excessive attended by my predecessors in this practice. On coitus, which may be the equivalent of a powerful my first making his acquaintance he was living in a prostatic massage and shake up the infected foci. spinal carriage with complete paralysis of both legs I do not know if excessive coitus or massage of the and lower abdominal muscles. Contraction of the prostate releases a filter-passing virus which acts on muscles had taken place with the result that the legs the nerve-endings in the balano-preputial groove, were stiff, the hips being in normal position to the but the following line of treatment has proved body in the supine position, the knees extended, successful in these cases. and the ankles and feet in extreme talipes equinoIn all cases of recurring herpes genitalis, whether varus with large corns over the external malleoli they suffer from a gleety discharge in the morning from friction of the bedclothes. Nursing was carried or whether they have threads in the urine or not, on by his sister, some eight or nine years older than my procedure is as follows :himself, and no bed-sores appeared in the whole period (1) The possibility of stricture is settled by passing ]he was under my observation. Naturally he had Nos. 7, 8, 9, 10, 11, 12 gum elastic bougies ; if there incontinence of urine and faeces and suffered from is a stricture it may take several weeks to reach ,cystitis. He washed out his bladder daily with a No. 12, and during this period hexamine, grs. 10 with weak solution of Condy’s fluid, using an ingenious tr. hyoscyamus Rlxx. three times a day before meals, syphon arrangement attached to an ordinary rubber is given in a small tumblerful of water. catheter. (2) When a free flow of urine has been established Twelve months ago a perinephritic abscess appeared the prostatic massage is commenced, which must be in the right loin. This was incised without the gentle at all times, but especially at first when the necessity of an anaesthetic and has since discharged prostate may be acutely tender. The patient is urine and pus through a small sinus, urine also instructed to hold his water for two hours before draining per urethram. Death finally ensued on coming to me, when he is asked to pass a few ounces March 9th, 1931, through renal insufficiency due to of urine in a conical glass, and the state of affairs in a pyelonephritis secondary to cystitis, the man then case of threads or gleet is noted-then massage is having just reached his sixtieth birthday. performed gently on a bladder still partly full, after Sheffield. which the patient is instructed to empty his bladder

THIRTY-EIGHT YEARS WITH FRACTURED SPINE.

A

completely. RECURRING HERPES GENITALIS IN THE MALE. ÆTIOLOGY AND TREATMENT.

BY J. HONORARY

AVIT-SCOTT,

M.D. BIRM.,

DERMATOLOGIST, MIDLAND HOSPITAL, BIRMINGHAM.

RECURRING herpes genitalis in the male is one of those minor ailments which besides being a great nuisance to its unfortunate owner, opens the door to much more serious infections like syphilis and soft chancre. The diagnosis is quite easy, and the disease so common that no full description is needed. When seen early the lesions, which are generally found in the balano-preputial groove, appear as a cluster of small rounded vesicles, the size of a pin’s head and containing a clear fluid. Later they appear as

(3) After the third prostatic massage which is repeated at intervals of a week, I begin instillations with weak solutions of silver nitrate. The patient after massage empties his bladder and by means of a small flexible acorn catheter size about 7 or 8 (French) fitted on the nozzle of a 1 c.cm. hypodermic syringe and the whole apparatus filled with the solution, a few drops of the silver solution in instilled in the prostatic urethra and also along the anterior portion of the canal. It is generally quite safe to start with a 1 in 3000 solution of silver nitrate. If the patient does not experience any undue desire to micturate after this and is able to hold his water for two hours or so, the next time I generally use a solution of 1 in 2500 and so on up to 1 in 500 if necessary, but 1 in 1000 which may be repeated several times is generally the maximum strength required. This is the treatment of prostatic gleet, and a very successful one too, if it is remembered that

973

ANNUAL CONGRESS OF THE OPHTHALMOLOGICAL SOCIETY.

force is required in massaging the prostate and as this form of herpes is considered to be of a different. that instillations with strong solutions of silver nitrate nature than the one we are now considering, the The occurrence was probably a curious coincidence. do more harm than good. After three or four weeks of treatment by massageI second patient was relieved from a mild but generalised followed by instillations one finds that the pruritus of over 12 months’standing which I intended instead of being tender all over, is only tender over to deal with at a later date. As a dermatologist I attach more importance tocertain areas and then I massage gently over those The a the indicates to me. local which patient prostate which feels what may be called normal, and spots treatment of recurring herpes genitalis consists in is free from pain and lumps on massage, and to the not irritating the lesions ; the parts should be cleaned absence of heavy sinking threads in the urine than with warm water, dried carefully, and dusted freely to the presence of a few pus cells and a few fine floating with pure talcum powder. During the treatment of threads in the urine, which may be due to a supercatarrhal inflammation of the mucous membrane, two cases I had curious experiences. One patient I developed a typical eruption of herpes zoster affecting as a rule clearing up completely in a month or two the left buttock and left thigh down to the knee, and in the absence of over-treatment.

no

prostate,

ficial

MEDICAL SOCIETIES OPHTHALMOLOGICAL SOCIETY. ANNUAL CONGRESS.

THE

annual congress of the United

of

the

Ophthalmological Society Kingdom took place at University College, London, from April 23rd to 25th, under the presidency of Mr. LESLIE PATON. Among papers contributed was one on Non-luetic Argyll Robertson Pupil

numerous

by Mr. R. FOSTER MooRE. It recorded eight additional cases since his paper on the subject in 1924. Twelve of the total 15 cases were in females, so the condition could be said to be commoner in the female than in the male sex. He could not be definite about age incidence, since a number of the cases were discovered quite by accident, some had not been known to the patient, and in none was the date of onset accurately known. Some might be congenital, though in only one case was it suggested that the condition had been present ever since birth. The ages of onset given ranged from birth to 42. In 14 cases the fundi were examined with the aid of a mydriatic, but in none was any important abnormality discovered. The visual acuity did not seem to be affected; in 14 cases it was 6/6 in each eye after correction. The condition was usually unilateral and the pupil might be described as semi-dilated. It was practically inactive to the light stimulus, whether direct or consensual. Contraction occurred with convergence, but the rate of such contraction varied much, as also did its completeness. There was always a slow relaxation. Accommodation was not paralysed, and Mr. Foster Moore did not think the ciliary muscle was involved. It was important, he said, to discover whether these pupils bore any relation to syphilis in the patient, or whether any general nervous disorder coexisted. In none of this series was there a history of syphilis, or discovered syphilitic lesion. In two cases there was a slight drooping of the upper lid. Leber’s Optic Atrophy. Dr. RITCHIE RUSSELL (Edinburgh) read a paper on Hereditary Aspects of Leber’s Optic Atrophy. This disease, he said, did not seem uniformly to follow the rules of inheritance of a single recessive character. In Leber’s disease an affected male rarely had affected grandsons. The mode of inheritance was not the same in the various sex-linked diseases, and in some strains at least an accessory factor was concerned in their development. Dr.

Russell’s paper dealt with four cases in the generation in a family living in the Orkneys.

same.

The first patient, a man aged 40, had loss of vision and pains in the legs. At first there was only slight dimness of vision after reading ; it did not interfere with his work as a carpenter. Later he had severe pains in the right eye, which lasted a week, and with these pains the vision failed rapidly in both eyes. Coincidently he had pains in both feet, and they became swollen. Vision had improved but. little. He had five healthy children. Higher cerebral functions were apparently undisturbed. Both the discs were blue-grey in colour ; the edges were sharply outlined, and the lamina cribrosa was prominent. No changes were apparent in the maculse or the periphery of the retinse. The pupils were 4 mm. in diameter, circular, equal, and regular in outline. Ocular movements were full in all directions. Neither nystagmus nor diplopia was present, but the patient could not converge. No disturbance of muscle power, tone, or coordination was noted ; neither was there any abnormality to light touches, to pain, or appreciation of passive movement. The other cases were somewhat similar, with variations. Three cases in the generation followed-

consanguineous mating; probably the original’. a trait of the malady. Perhaps a second factor, not sex-linked, and multiplied by the consanguinity, was concerned in the manifestation of the disease. Dr. Russell did not think this likely,. but the consanguinity might have reduced the general vigour of the stock and so caused a dormant trait to become manifest again. Leber’s disease showed a

stock bore

evidence of its presence until years after birth, and in this it stood alone in this group of diseases. It could be classed as an instance of inherited tissue

no

vulnerability. Mr. A. W. ORMOND read notes Ocular

Symptoms

on

in Osteitis Deformans.

The case he described was reported by Dr. Herbert French in 1920, and eight years later Mr. Ormond saw him because of his ocular condition. The first complaint had been of pains in the right tibia, followed by pain and aching in all bones. A curvature of the radius was noted, and at a later stage there was pain in the head bones. He had not had typhoid fever, nor lived abroad, there was no history of syphilis, and he was an abstainer and non-smoker. Early in the illness he complained of a flickering to the right in his eyes, and he tended to move to the right instead of straight ahead. Vision in the left eye was defective ; and he could not see with it unless he looked towards the ground. When Mr. Ormond saw him there were definite pathological changes in the fundus of the left eye involving the macular area. Vision of the right eye at that time was 6/6, but that of the left was less than 6/60, and there was only peripheral vision. A large choroidal haemorrhage was seen, with much disturbance of retinal pigment. Later there was much failure of vision in the right eye, and similar changes to those’ in the left, the visual acuity being no more than 6/36. This year the patient could not see 6,60 with either eye, and central vision was very depresd. In the right eye