THE ORIGIN AND THE USE OF THE WORD HERPES*

THE

ORIGIN

AND

THE

USE

OF

THE

WORD

HERPES*

by

T.

S.

L.

BESWICK

THE

word

'herpes'

has

been

used

in

medicine

for

at

least

twenty-five

centuries.

However,

its

meaning

has

changed

considerably

during

this

time.

Indeed,

as

Hebra58

has

pointed

out,

'in

the

attempt

to

give

an

historical

account

of

Herpes

.

.

.

we

meet

with

almost

insurmountable

difficulties'.

Possibly

none

of

the

con-

ditions

which

we

designate

herpes

today

would

have

been

called

by

that

name

in

the

time

of

Hippocrates,

although

the

word

itself

was

already

well

known

as

a

medical

term.

The

word

leang,

derived

from

the

verb

1EQoEtV

(=

to

creep),

was

originally

applied

to

spreading

cutaneous

lesions,

usually

ulcerative,

such

as

skin

cancer,

lupus

vulgaris,

noma,

erysipelas,

ringworm,

eczema

and,

perhaps,

smallpox.

Most

of

these

are

conditions,

it

must

be

allowed,

to

which

the

epithet

'creeping'

is

far

more

apposite

than

it

is

to

any

of

the

conditions

which

we

know

as

herpes

today.

To

the

authors

of

the

Hippocratic

Corpus,

'herpes'

was

usually

a

serious

condition

and

the

word

probably

denoted

a

type

of

lesion

rather

than

a

disease

sui

generis.

For

example,

in

the

Aphorisms68

we

read

of

l%

&rOtO6,Evog

affecting

the

anus,

genitalia,

uterus,

and

bladder.

Again,

in

Epidemics

III67

mention

is

made

of

le

rsg

ooAAolaot

,eydaot.

As

Littre,

quoting

Galen,

points

out

,sydUot

in

this

context

probably

means

severe

rather

than

large:

indeed

Willan'19

considers

that

this

passage

may

refer

to

smallpox.

aEeng

hxOto',iEvog

is

also

mentioned

in

The

Use

of

Liquids71

where

we

read

that

warm

water

is

valuable

in

its

treatment.

The

word

occurs

in

the

Prorrhetics

and

in

the

Coan

Prognostications,

both

works

which

many

scholars

and

commentators,

including

Littre,

have

regarded

as

older

than

Hippocrates

himself.

In

Prorrhetics

II72

it

is

stated

that

of

all

ser-

piginous

ulcers

('.

.

.

his

quae

despascendo

serpunt',

Foes)34

herpes

is

the

least

dangerous

but

the

hardest

to

cure,

resembling

cancer

in

this

respect.

Surely

this

must

be

lupus

vulgaris,

ringworm,

or

perhaps

eczema,

rather

than

anything

we

should

call

herpes.

The

Coan

Prognostications70

described

a

kind

of

'herpes',

starting

above

the

groin

and

spreading

towards

the

flank

and

the

pubes,

which

indicates

a

dis-

ordered

state

of

the

abdomen.

This

condition

could,

of

course,

have

been

herpes

zoster.

Foes

has

no

real

justification

for

translating

lenrge

as

'serpentia

ulcera'

except

that

it

makes

better

sense

than

would

'zona'

in

the

other

contexts

in

which

the

word

is

used

in

Hippocrates.

It

is

also

perhaps

significant

that

shingles,

which

is

not

a

very

uncommon

condition,

is

not

recognizably

described

*

Based

on

part

of

a

thesis

submitted

for

the

degree

of

M.D.

at

the

University

of

Cambridge.

214

T.

S.

L.

Beswick

anywhere

else

in

the

Hippocratic

Corpus.

However

it

is

surprising

that,

if

herpes

zoster

of

the

lower

thoracic

nerve

roots

was

recognized,

the

probably

commoner

herpes

zoster

of

the

upper

thoracic

nerve

roots

is

not

described

as

well.

One

can

only

conclude

that

if

the

condition

we

call

herpes

zoster

was

called

herpes

in

the

time

of

Hippocrates,

it

was

certainly

not

the

only,

or

even

the

usual,

condition

to

be

so

designated.

What

is

perhaps

the

most

interesting

passage

in

the

Hippocratic

Corpus,

and

certainly

the

most

tantalizing,

occurs

in

Epidemics

II.

This

book

is

regarded

by

most

authorities

as

later

than

Epidemics

I

and

III,

and

not

by

Hippocrates

himself.

As

Littre"O

pointed

out

the

available

manuscript

versions

are

mani-

festly

imperfect;

indeed,

he

has

so

emended

the

text

that

what

appears

in

Foes

36

as

the

account

of

a

single

case,

that

of

Zoile,

appears

in

Littre

as

the

accounts

of

two

separate

cases.

Towards

the

end

of

the

passage,

which

as

Littre

would

have

it,

describes

two

cases

of

pneumonia

with

otitis

media,

there

is

reference

to

what

might

have

been

the

lesions

of

herpes

febrilis.

In

Foes

36

the

words

used

are

t6ec-Ec

6E

mat

leqra....

This

is

obviously

nonsense;

enq-ra

is

the

accusative

singular.

As

the

phrase

is

the

subject

of

its

sentence,

the

word

would

have

to

be

either

len%

(Nom.

Sing.)

or

lenIrsE

(Nom.

Plur.).

Littre81

has

substituted

6rgg&r

aE

mat

~EXra....

This

is

ingenious,

but

as

pointed

out

by

Professor

Page

9

is

not

much

better.

The

word

xa'

is

now

redundant

and

if

present

in

the

original

could

only

have

served

to

emphasize

kretra

which

in

this

context

needs

no

special

emphasis.

Further,

as

Professor

Page

says,

it is

most

improbable

that

any

scribe

would

have

written

lemrla

which

is

not

a

very

common

word,

and

non-

sense

in

this

context,

in

place

of

the

very

common

&erra.

The

reverse

error

is

much

more

probable,

but

as

has

already

been

emphasized

the

original

text

could

not

have

contained

the

word

lemqra.

He

suggests

that

here

we

are

dealing

with

a

case

of

lipography

and

that

the

original

reading

was:

...

M&5r)EB

aE

mat

8enqlr[sg

!E=r]a

8'7rt

7'ovAv

XeOvov

-c

-

xesa

i-

ylVOVro

'rjav2

(Og

-reiot.

This

makes

far

better

sense

than

Littre's

version

and

at

the

same

time

enables

us

to

retain

the

word

le

r-without

having

to

accept

Foes's

accusative

singular.

Unfortunately,

even

if

Professor

Page's

arguments

be

accepted,

we

cannot

be

absolutely

certain

that

the

condition

described

was

herpes

simplex.

We

are

merely

told

that

the

'lesions'

occurred

on

the

head

(XE#aA7g)

for

a

long

time

and

dried

up

on

the

third

day.

It

is

difficult

to

reconcile

the

statements

'for

a

long

time'

and

'dried

up

on

the

third

day',

unless

the

implication

is

that,

although

the

individual

lesions

dried

up

in

two

or

three

days,

new

lesions

or

crops

of

lesions

continued

to

appear

for

much

longer

than

that:

but

if

this

was

in

fact

the

author's

meaning,

his

expression

of

it

leaves

much

to

be

desired.

Another

difficulty

is

the

word

t6oTEr8.

The

usual

meaning

is

'sweats',

and

although

sweating

confined

to

the

head

is

now

well

recognized0'

77

it

usually

follows

injury

to

the

peripheral

nerves,

especially

that

due

to

suppurative

infections

of

the

parotid,

or

is

associated

with

disease

of

the

spinal

cord

such

as

syringomyelia,

and

it

is

usually

precipitated

by

eating

or

drinking

(Gustatory

hyperhidrosis).

It

is

difficult

to

see

why

in

this

case

the

sweating

should

be

of

this

type,

unless

the

suppurative

condition

of

the

ear

referred

to

was

parotitis

and

not

otitis

2I5

T.

S.

L.

Beswick

media.

This

is

possible,

although

we

are

clearly

told

that

the

pus

was

discharged

from

the

ear.

Another

possibility

is

that

in

this

context

the

word

MQ&xeg

means

a

sweat

rash

and

not

merely

sweating:

however,

the

usual

Greek

word

for

a

sweat

rash

is

Zbea.

In

spite

of

Professor

Page's

admirable

emendation

of

the

text,

this

passage

must

unfortunately

remain

something

of

a

mystery:

we

cannot

be

certain

that

the

Coan

Physicians

described

'fever

blisters'

as

'herpes'.

That

herpes

febrilis

was

quite

familiar

to

them

is

clear,

however,

from

a

passage

in

Epidemics

VI69

which

describes

ulceration

of

the

lips

in

intermittent

fevers.

It

is

noteworthy

that

von

Barensprung11

still

clung

to

the

view

expressed

in

this

passage

that

herpes

febrilis

occurs

only

in

intermittent

and

not

in

con-

tinous

fevers,

a

view

which

as

Hebra63

points

out

is

quite

unjustified.

There

is

definite

evidence,

however,

that

after

Hippocrates

the

Greeks

did

call

shingles

'herpes'.

Scribonius

Largus104

has

the

phrase

'zonam

quam

Graeci

IeTra

dicunt'.

His

contemporary

Pliny

(the

Elder)

96

gives

a

recogniz-

able

account

of

the

shingles,

which

he

calls

'zoster'

so

that

it

is

evident

that

herpes

zoster

was

well

known

in

the

first

century

A.D.

and

probably

not

un-

reasonable

to

regard

the

'zona'

of

Scribonius

as

the

same

as

the

'zoster'

of

Pliny.

It

is

of

interest

to

remark

that

Pliny

records

the

belief

that

if

the

lesions

of

herpes

zoster

extend

right

round

the

body,

the

condition

is

fatal.

He

regards

shingles,

as

do

many

later

authors,

as

a

species

of

erysipelas.

Aemilius

Macer,

writing

in

the

first

century

B.C.,

has

two

references

to

herpes.

In

one,

where

he

speaks

of

the

virtues

of

the

house-leek,

also

recommended

by

Pliny,

he

states

'hac

fugit

apposita

sacer

ignis,

et

herpeta

mordax'.4

In

the

other,

which

refers

to

the

value

of

rue,

he

has

the

passage:

ITlius

succum,

mirandum

conficia

unguem

ad

depellendum

sacrum

quem

dicimus

ignem

et

scabiem

dertae,

quae

dicitur

herpeta

Graecae

et

Graeci

dictas

acoras

hoc

unguine

purgas,

ulcera

sunt

capitis

humore

fluentia

pingui

curat

et

ozoenas,

inmissum

naribus:

...

.

While

these

two

passages

do

not

provide

much

evidence

to

suggest

what

exactly

the

writer

meant

by

the

word

'herpes',

they

make

it

clear

that

he

regarded

'herpes'

and

'ignis

sacer'

as

distinct,

although

perhaps

related,

conditions.

This

is

important

because

the

passage

in

Celsus'9

which

deals

with

ignis

sacer

has

often

been

held

to

refer

to

herpes

zoster.

There

would

appear

to

be

no

justification

for

this

view

except

the

phrase

'fit

maxime

in

pectore,

aut

lateribus'.

But

even

if

herpes

zoster

were

one

of

the

conditions

comprehended

by

the

term

'ignis

sacer',

it

can

scarcely

have been

the

main

one.

Herpes

zoster

can

hardly

be

said

to

occur

'especially

on

the

soles

of

the

feet'

('praecipueque

in

plantis')!

Certainly

other

Latin

authors

used

the

term

'ignis

sacer'

to

describe

conditions

far

more

severe

than

zoster.

In

many

cases

it

appears

to

have

been

an

epidemic

disease:

for

example,

in

Virgil,116

Seneca,105

and

Lucretius.84

In

the

previous

section

(Sect.

3)

Celsus

deals

with

OnoQieba

and

describes

a

2i6

The

Origin

and

the

Use

of

the

Word

Herpes

deep

spreading

ulcer,

eroding

even

the

bones,

which

may

arise

as

a

complication.

In

the

older

versions

of

the

text

this

ulcer

is

designated

I

oan

O

EtaOdEvog.

How-

ever

all

modern

scholars

agree

with

Leonardi

Targa

10

that

the

correct

reading

is

#aye'atva.

Good51

claims

that

this

error

in

the

text

of

Celsus

was

largely

responsible

for

the

fact

that

later

writers

applied

the

term

'herpes'

to

conditions

in

which

ulceration

involved

not

only

the

skin,

but

the

deeper

tissues

as

well.

In

Good's

opinion

the

older

Greek

and

Latin

writers

understood

by

the

word

only

superficial,

spreading

cutaneous

lesions.

It

is

impossible

to

sustain

this

argument.

While

it

is

difficult

to

say

what

the

word

oqg

meant

to

the

writers

of

the

Hippocratic

Corpus,

it

is

nowhere

expressly

stated

that

the

term

was

only

applicable

to

superficial

conditions.

Indeed,

the

reference

already

cited

to

herpes

of

the

uterus

and

bladder

seems

to

make

it

clear

that

such

was

not

the

case.

Further,

it

seems

probable

that

Celsus

exerted

little

influence

on

medical

writers

after

his

time

until

his

surviving

works

were

printed

at

Florence

in

1478

from

manuscripts

discovered

a

few

years

earlier

by

Pope

Nicholas

V5

(1379-

I455).

Nevertheless

Saliceto99

writing

in

1275,

tells

us

that

although

herpes

was

commonly

called

'erysipelas'

by

the

laity,

'herpes'

can

be

distinguished

from

true

'erysipelas'

by

the

fact

that

'erysipelas'

involves

only

the

skin

whereas

in

'herpes'

the

underlying

tissues,

including

even

the

bone,

are

involved.

It

is

of

course

impossible

to

be

certain

that

Saliceto

had

no

direct

or

indirect

access

to

Celsus,

but

it

seems

probable

that

this

passage

expressed

the

prevailing

view

of

the

surgeons

of

his

time.

Celsus

2

gives

quite

a

good

account

of

aphthous

ulcers

in

the

mouth

and

draws

attention

to

the

fact

that

they

may

be

dangerous

in

children,

especially

those

still

at

the

breast.

Surely

some

of

the

cases

he

had

in

mind

when

he

wrote

this

must

have

been

primary

herpetic

stomatitis.

Whether

errors

in

the

available

texts

of

Celsus

were

responsible

to

any

extent

for

the

great

differences

between

the

meanings

which

later

writers

attached

to

the

word

'herpes'

is

questionable.

What

cannot

be

disputed,

however,

is

that

Galen,

who

had

far

more

influence

on

medieval

and

Renaissance

medical

writers

than

Celsus,

did

nothing

to

clarify

the

situation.

Galen

uses

the

word

repeatedly,

but

either

he

was

hopelessly

confused

as

to

its

proper

meaning

or

his

views

on

its

meaning

changed

with

time.

In

the

Definitiones"9

'herpes'

is

defined

as

an

ulcer

and,

a

few

lines

lower

down

as

a

'creeping',

superficial

ulceration

of

the

skin.

But

elsewhere

he

states:

'herpes

is

not

always

an

ulcer'.45

In

this

passage,

too,

we

learn

that

herpes

is

the

same

kind

of

condition

as

cancer

and

phagedaena.

In

a

much-quoted

passage"'

he

begins

by

saying

that

'herpes'

and

'erysipelas'

are

similar

conditions

and

goes

on

to

describe

two

types

of

herpes,

leg

e'aOtO'#eVOq

(exedens)

and

loer5

xseyXeo1aq

(miliaris).

The

latter

condition,

he

avers,

was

not

recognized

by

Hippocrates

but

was

described

by

later

writers.

In

another

work47

the

two

types

are

again

referred

to

and

we

are

told

that

when

the

word

IQon5

is

used

without

a

qualifying

adjective

oqg

xsyXLoa!

is

understood.

He

says

that

ILmg

mseyxeiag

affects

only

the

skin,

but

Lo

rto'a0o1avog

is

a

more

severe

condition

in

which

there

is

ulceration,

not

only

of

the

skin,

but

of

the

deeper

tissues

as

well.

This

statement

is

contradicted

by

his

statement48

2I7

T.

S.

L.

Beswick

that

only

those

ulcers

which

affect

the

skin

alone

are

called

lqnqg

those

affecting

the

deeper

tissues

as

well

are

called

#aye6aiva.

In

one

passage43

he

groups

together

'carbuncle',

'erysipelas',

'herpes',

and

'gangrene',

because

in

all

of

them

there

is

an

alteration

from

the

natural

colour

of

the

affected

part.

The

same

grouping,

except

that

'cancer',

'oedema',

and

'phagedaena'

are

added,

also

occurs

elsewhere:"

this

time

they

are

grouped

together

because

the

aetiology

and

pathogenesis

are

the

same.

In

a

third

passage42

'herpes'

and

'cancer'

are

singled

out

for

special

mention

because

both

sometimes

are

and

sometimes

are

not

associated

with

ulceration.

It

is

obvious,

without

quoting

further,

that

Galen

can

be

made

to

provide

authority

for

attaching

the

name

'herpes'

to

almost

any

ulcerative

condition

of

the

skin,

whether

or

not

deeper

tissues

are

involved,

as

well

as

to

some

non-

ulcerative

skin

lesions.

Certainly

there

is

nothing

to

suggest

that

the

use

of

the

word

lqg

by

Galen

necessarily

implied

that

the

lesion

so

designated

consisted

of

vesicles

or

bullae

on

the

skin.

Hebra,

59

it

is

true,

states

that

Galen

described

a

third

type

of

herpes,

1eaqq

OAvxTrativ6ng

but

the

reference

he

gives

is

incorrect,

and

I

have

been

unable

to

confirm

his

statement.

No

other

writer

familiar

to

me

says

definitely

that

Galen

described

more

than

two

types,

except

Ambroise

Pare.

92

The

latter

author,

however,

has

misinterpreted

his

authority47

believing

that

Galen

regarded

herpes

without

a

qualifying

adjective

as

different

from

herpes

miliaris.

Pare

does

not

mention

herpes

phlyctaenodes.

Galen,

and

with

him

most

subsequent

writers

up

to

comparatively

recent

times

are

consistent

in

their

views

on

the

pathogenesis

of

whatever

lesion

they

may

designate

'herpes'.

'Herpes'

is

due

to

the

excretion

or

attempted

excretion

of

acrid

waste

matter

by

the

skin,

which

is

either

eroded

or

raised

up

to

form

vesicles

or

bullae

(Galen,46

Gorraeus

3

and

Sennert

106).

The

material

being

excreted

is,

according

to

most

authors,

either

bile

alone

(herpes

miliaris)

or

bile

mixed

with

other

humours

(herpes

exedens).

Oribasius

89

quotes

Galen

almost

verbatim

and

adds

that

herpes

miliaris

is

so

called

because

it

'produces'

excrescences

like

grains

of

millet

on

the

skin.

Aetius

of

Amida6

also

follows

Galen,

but

elsewhere5

he

quotes

Herodotus

(the

physician)

who

gives

a

very

good

account

of

herpes

labialis,

although

he

does

not

call

it

'herpes',

and

notes

that

it

heralds

the

termination

of

a

fever.

This

is

probably

the

oldest

surviving

reference

to

the

view

that

fever

blisters

are

of

good

prognostic

omen

in

febrile

disorders;

a

view

contemptuously

dismissed

by

Hebra64

but

recently

shown

to

have

some

foundation,

at

least

in

pneumonia.

109

Herodotus

refers

in

this

passage

to

ulcers

of

the

'herpetic

type'

(sEQvO-txc)

in

fevers.

Paulus

Aegineta93

also

describes

the

two

types

of

herpes

and

quotes

Oribasius.

His

account

is

not

very

detailed

but

the

commentary

on

this

passage

by

the

translator2

is

valuable.

Paulus

describes

an

application

for

the

treatment

of

'herpes

phlyctaenodes'

but

does

not

attempt

to

identify

the

condition.

The

Arabic

writers

mainly

followed

Galen

in

recognizing

the

two

types,

but

added

a

third,

known

as

'Persian

fire'.

29

118

The

exact

nature of

this

latter

con-

dition

is

unknown,

but

Guy

de

Chauliac

21

tells

us

that

'Persian

fire'

and

'Sacred

2I8

The

Origin

and

the

Use

of

the

Word

Herpes

fire'

are

both

synonyms

for

carbuncle,

of

which

he

gives

an

adequate

description.

It

is

of

interest

that

according

to

Willanll8

one

of

the

Arabic

words

for

herpes,

'nemlet'

means

literally

'the

ant',

because

'formica',

'formy',

and

'fourmi'

per-

sisted

during

the

Middle

Ages,

especially

in

France,

as

names

for

erysipelas

and

herpes.

The

Arabic

writers

themselves

give

a

rather

different

account

of

'Persian

fire'.

Haly

Abbas55

says

'Livid

vesicles,

with

an

irregular

base

and

confluent,

resembling

the

effects

of

a

burn,

and

intermixed

with

puffy

tumours,

are

called

Persian

fire,

and

constitute

the

worst

kind

of

Smallpox.'

The

translation

is

Willan's.

Constantinus

Africanus,23

it

is

to

be

remarked,

gives

very

much

the

same

description,

but

calls

the

condition

'ignis

sacer'.

Avicenna9

observes

that

'anthrax'

and

'Persian

fire'

are

closely

allied.

The

latter,

'which

partakes

of

the

nature

of

herpes',

is

accompanied

by

violent,

malignant,

and

fatal

fever,

and

occurs

in

pestilential

seasons.

Willan120

believed

that

the

Arabic

writers

were

referring

to

smallpox

when

they

used

the

term

'Persian

fire'.

Actuarius

(John

Zachary),

a

Byzantine

author

of

uncertain

date,

but

probably

of

the

twelfth

or

thirteenth

century,

appears

to

be

the

first

author

who

can

be

said

definitely

to

have

applied

the

term

'herpes'

to

cutaneous

ringworm.

His

probable

date

is

ably

discussed

by

Freind.

40

Actuarius

says,

in

the

Latin

trans-

lation

of

I556,1

'Dictus

est

autem

lenqg

eo

quod

videatur

eeQv,

quod

est

serpere

per

cutem

summam,

.

.

.';

and

goes

on

to

give

a

description

which

is

clearly

that

of

ringworm

of

the

skin.

He

also

contradicts

Galen

as

to

the

meaning

of

the

word

'herpes'

without

a

qualifying

adjective:

Actuarius,

having

defined

'herpes'

as

an

ulcerative

condition

involving

the

skin

and

the

subcutaneous

tissue,

describes

lqq

xseyXelag

as

a

variety

in

which

the

lesions

are

small

pustules

on

the

surface

of

the

skin.

From

the

tenth

to

the

beginning

of

the

eighteenth

centuries

'herpes'

seems

to

have

been

a

word

used

far

more

by

surgeons

than

by

physicians.

Perhaps

'herpes

exedens'

was

regarded

as

the

most

important

kind

of

herpes

and,

like

Turner,

115

physicians

felt

that,

'this

latter

more

properly

belonging

to

a

discourse

of

ulcers',

they

should

leave

'the

same

to

be

dealt

with

in

surgical

writers'.

Saliceto

and

Ambroise

Pare

have

already

been

mentioned.

Guy

de

Chauliac

22

describes

herpes

as

a

species

of

erysipelas.

He

says

that

there

are

two

kinds

of

erysipelas

called

by

Avicenna

'spina'

and

'formica'.

A

few

lines

further

on

he

states

that

'formica'

and

'herpes'

are

the

same

condition,

and

that

whereas

'formica'

is

associated

with

ulceration,

'spina'

is

not.

Theodoric"12

(

I205-98)

speaks

of

'herpes'

or

'formica'

in

much

the

same

terms.

Jean

Fernel32

comes

closer

than

previous

writers

to

our

modern

concept

of

herpes

when

he

says:

'His

proxima

est

papula.

Est

autem

ardem

cutem

serpen-

tibus

minimis

pustulis

exasperans

ac

rodens,

Graecis

Herpes

appelatur.'

Nevertheless

he

recognizes

that

'herpes'

can

be

an

unpleasant

condition,

for

he

continues:

'Ea

quidem

duplex,

una

simplex

quae

herpes

est

miliaris,

altera

fera

quae

herpes

exedens

nuncupatur.'

He

points

out

that

the

differential

diagnosis

between

'herpes'

and

'erysipelas'

may

be

difficult

but

claims

that

219

T.

S.

L.

Beswick

'herpes'

is

a

less

severe

condition

than

'erysipelas'.

This

is

the

opposite

of

Saliceto's

view.

Gorraeus63

was

clearly

in

difficulties

when

he

came

to

write

of

'herpes'.

He

first

tries

to

follow

Galen

and

defines

the

condition

as

an

'ulcerated

tumour'

proceeding

from

an

excess

of

bile.

He

recognizes

three

types:

'herpes

esthiomenos',

of

which

he

says,

'totam

cutem

usque

ad

carnem

subjectam

exulcerat';

'herpes

miliaris'

and

'herpes

phlyctenodes'

(the

spelling

is

his).

Of

the

two

latter

types

he

says

'superficiem

solum

velut

inurit,

appellaturque

simpliciter

geqgr'.

He

wisely

does

not

attempt

to

fit

the

'zona'

of

Scribonius

Largus

into

this

scheme.

He

merely

adds:

'Caeterum

leQaa

a

latinis

zonam

vocatum

fuisse

aliquot

locis

apud

Scribonium

Largum

intelligitur,

ut

Cap.

62.

Est

autem

zona

ignis

sacri

species

quae

medium

hominem

ambit

cingitque,

dicitur

alio

nomine

coarn'e.'

Another

surgeon,

Fabricius

Hildanus66

describes

herpes

exedens

of

the

leg

occurring

as

a

complication

of

some

mild

inflammatory

condition

of

the

foot.

He

says:

'tandem

vero

herpes

exedens

totum

crus

invasit,

idque,

adeo

vehe-

menter,

ut

chirurgi

de

abscissione

tibiae

cogitarent,

sequidem

ea

in

genu

fieri

potuisset'.

This

is

clearly

no

trivial

skin

disorder.

Petrus

Forestus37

in

his

book

De

Lue

Venerea

speaks

of

'herpetes'

on

the

face

and

elsewhere

in

syphilis.

He

gives

information

about

treatment

but

no

other

details:

presumably

he

supposed

that

his

readers

would

be

familiar

with

the

condition.

Nicolaus

Tulp,'14

under

the

heading

'Exedens,

praecordiorum

herpes',

gives

an

account

of

what

is

obviously

zoster.

He

cites

Pliny

and

says

that

the

condition

is

of

the

same

kind

as

'ignis

sacer'.

He

says

that

the

underlying

tissues

may

be

involved

as

well

as

the

skin

but

does

not

particularly

stress

this.

Daniel

Sennert106

emphasizes

the

fact

that

'herpes'

and

'erysipelas'

are

similar

conditions

and

have

a

similar

aetiology.

He

has

three

types:

'H.

simplex'

('Herpes

vero

solam

cutem

exulcerat'),

'H.

miliaris'

('qui

vesiculas

in

cute

similes

milio

excitat'),

and

'H.

esthiomenos'

or

'H.

exedens',

which

is

the

'herpes'

of

Galen.

In

this

latter

view

he

was,

of

course,

mistaken.

Galen47

expressly

states

that

the

word

'herpes'

without

an

adjective

is

to

be

understood

as

meaning

'herpes

miliaris'.

Richard

Morton

8

describes

what

can

be

definitely

identified

as

herpes

febrilis,

although

he

does

not

specify

the

usual

site

of

the

eruption.

He

stresses

the

association

with

febrile

conditions

and

adds

that

fevers

accompanied

by

'herpes'

are

always

the

mildest

and

always

benign.

Boerhaavel6

mentions

'Herpes'

in

that

section

of

his

Aphorisms

which

deals

with

rickets,

but

it

is

difficult

to

know

what

he

meant

by

the

term.

He

expresses

the

common

view

that

cutaneous

eruptions

should

not

be

suppressed

by

over-

vigorous

treatment

since

by

so

doing

the

physician

may

convert

a

relatively

benign

skin

disease

into

a

severe

internal

disorder.

This

view

was

based

on

the

theory

that

most

skin

eruptions

represent

the

excretion

by

the

body

of

noxious

waste

matter

and

if

the

excretion

is

prevented

the

waste

matter

will

accumulate

within

the

body

and

result

in

some

more

serious

disturbance

of

the

patient's

health.

Van

Swieten108

in

his

commentary

on

this

passage

makes

it

quite

clear

that

220

The

Origin

and

the

Use

of

the

Word

Herpes

he

believes

that

the

condition

to

which

Boerhaave

refers

is

infantile

eczema,

and

goes

on

to

give

an

excellent

account

of

that

disorder,

one

stage

of

which,

he

says,

is

called

'Herpes

miliaris'

or

'Herpes

ficosus'.

Hoffmann,

74

under

the

term

'scabiei

herpetis

miliaris',

describes

a

condition

comprising

small

papules

or

pustules

on

the

skin,

which

rapidly

heal

by

drying

up

and

forming

small

flakes

(squamuli)

which

fall

off.

He

says

that

the

condition

may

occur

at

various

sites,

such

as

the

feet,

thighs,

hands,

scrotum,

and

perinaeum,

and

is

very

liable

to

recur.

Irritation

is

always

a

prominent

feature.

There

can

be

little

doubt

that

the

main

condition

he

was

describing

was

eczema,

although

he

would

no

doubt

have

used

the

term

to

embrace

other

conditions

as

well.

He

completes

his

description

by

referring

to

a

variety

in

which

there

are

no

evident

papules

or

pustules

but

in

which

the

irritation

is

even

more

intolerable.

This

variety

is

observed

especially

in

the

elderly

and

occurs

on

the

scrotum,

perinaeum,

and

round

the

anus.

In

the

latter

situation

the

condition

may

be

associated

with

the

presence

of

haemorrhoids.

A

better

description

of

senile

pruritus

could

hardly

be

demanded.

Hoffmann's

description

of

herpes

exedens,

although

he

avers

that

it

is

the

herpes

of

Hippocrates

and

the

ignis

sacer

of

Celsus,

and

that

the

underlying

tissues

are

eroded

as

well

as

the

skin,

sounds

otherwise

like

pustular

ringworm.

He

regards

it

as

related

to

erysipelas.

He

deals

with

'zona

ignea'

in

another

section

of

the

same

chapter.

His

descrip-

tion

is

worth

quoting

in

full:

'quando

autem

herpes

mali

moris

pectus

speciatim

et

praecordia

occupat

cum

cardialgia,

calore

praenaturali,

pruritu,

cutis

in-

flammatione,

pustulisque

parvis

et

lucidus

instar

cinguli

ad

manus

latitudinem

in

pectore

dispersis,

adfectus

vocatur

zona

ignea....'

Then

follow

references

to

Severinus,

Tulp,

Schultz,

and

Langius.

Daniel

Turner,115

although

earlier

in

date

than

Hoffmann,

is

much

more

modern

in

his

views

on

herpes,

as

will

be

evident

from

the

following

quotations

from

his

work:

The

herpes

is

a

choleric

pustule

breaking

forth

of

the

skin

diversely,

and

accordingly

receiving

a

diverse

denomination.

If

they

appear

single,

as

they

do

often

in

the

face,

they

arise

with

a

sharp

top

and

inflamed

base;

and

having

discharged

a

drop

of

the

matter

they

contain,

the

redness

and

pain

go

off

and

they

dry

away

of

themselves.

There

is

another

sort

partaking

of

greater

corrosion

and

malignity

arising

several

of

them

in

a

round

ring,

as

it

were,

with

smart

and

sometimes

great

itching.

This

being

called

serpigo,

by

the

common

people

tetter

or

ringworm

...

by

Celsus

Ignis

sacer,

although

by

this

latter

I

rather

think

is

meant

the

erysipelas,

an

offspring

of

the

same

choleric

humour.

The

tetter

is

a

small

cluster

of

pustules,

seizing

the

face,

hands,

or

other

parts,

of

a

rebellious

sometimes,

an

obstinate

nature,

eating

in

the

skin

and

spreading

its

taint

frequently

to

a

larger

compass,

forsaking

the

old

place

and

seizing

the

adjacent

parts.

It

neither

matures

nor

comes

to

digestion;

but

being

rubbed

will

sometimes

gleet

a

thin

sharp

water,

tho'

oftener

not,

.

.

.

There

is

another

species

of

this

disease,

appearing

in

larger

heaps

of

small

pustules

upon

several

parts

of

the

body

as

the

neck,

breast,

loyns,

hips

and

thighs;

these

are

usually

attended

with

a

light

fever

and

inflammation

round

about

them,

and

rising

up

with

white

mattery

heads,

there

succeeds

a

small

round

scab,

resembling

the

millet

seed,

from

which

the

disease

has

borrowed

the

name

of

herpes

milaris,

being

the

same

with

that

our

people

call

shingles.

221

T.

S.

L.

Beswick

Again

there

is

yet

another

sort,

which

from

its

greater

degree

of

virulence

and

corrosion

is

called

by

the

Greeks

herpes

esthiomenos

...

it

is

usually

known

as

herpes

exedens

vel

depascens;

but

this

latter

more

properly

belonging

to

a

discourse

of

ulcers,

leaving

the

same

to

be

dealt

with

in

surgical

writers,

we

shall

treat

of

the

other

three.

Turner

thus

gives

us

the

first

adequate

description

of

herpes

simplex

under

its

modern

name,

stressing

its

predilection

for

the

face

and

its

short,

self-limiting

course.

He

also

recognizes

zoster

as

a

species

of

herpes.

He

was

probably

mistaken

in

his

view

that

the

'herpes

miliaris'

of

earlier

writers

was

zoster.

It

will

be

observed

that

he

regards

ringworm

as

a

species

of

herpes,

a

view

that

was

to

prevail

until

after

the

middle

of

the

nineteenth

century,

and

he

recognizes

the

existence

of

'herpes

exedens',

although

he

regards

it

as

a

surgical

condition

and

declines

to

discuss

it.

The

latter

half

of

the

eighteenth

century

saw

the

rise

of

the

medical

noso-

logists.

These

writers

have

been

somewhat

neglected

by

medical

historians,

nevertheless

they

made

a

useful

contribution

to

medicine.

Their

initial

premises

were

sound.

They

recognized

that

unless

the

meaning

of

words

was

accurately

defined

and

the

definitions

universally

accepted,

progress

in

medicine,

as

in

the

other

sciences,

was

bound

to

be

seriously

impeded;

and

they

accepted

the

rule

of

the

botanists

and

the

zoologists

that,

as

far

as

possible,

a

word

should

bear

the

meaning

assigned

to

it

by

the

first

author

to

employ

it

as

a

technical

term.

Although

perfectly

sound,

this

second

proposition

led

to

endless

confusion

and

controversy.

Many

medical

terms

had

been

in

use

for

so

long

that

their

original

meaning

was

often

a

matter

for

pure

guesswork.

Even

if

many

of

their

conclu-

sions

were

mistaken

and

their

systems

have

been

forgotten,

they

undoubtedly

did

much

to

put

medical

terminology

on

a

sound

footing

and

drew

the

attention

of

doctors

to

the

importance

of

using

medical

terms

as

instruments

of

precision.

The

principal

nosological

systems

of

his

predecessors

are

conveniently

sum-

marized

by

Cullen25

26

in

his

Synopsis

Nosologiae

Methodicae,

although

reference

to

the

original

works

from

which

he

quotes

is

necessary

to

determine

the

individual

species

within

the

various

genera.

The

first

in

the

field

was

de

Sauvages

who

published

a

small

book,

Traiti

des

Classes

des

Maladies

as

early

as

I73I.

When

Linnaeus

saw

a

copy

of

this

book

in

the

house

of

a

physician

in

Leyden

he

at

once

discerned

a

kindred

spirit

and

initiated

a

correspondence

with

de

Sauvages

which

lasted

for

thirty

years,

although,

as

far

as

is

known,

the

two

never

met.30

De

Sauvages

published

the

first

edition

of

his

main

work,

Nosologia

Methodica

sistens

Morborum

Classes,102

in

January

I

764.*

De

Sauvages

sought

to

carry

on

the

work

of

identifying

and

classifying

diseases

by

the

study

of

their

natural

history

started

by

Sydenham.

However,

his

list

of

about

2400

species

is

more

a

list

of

symptoms

than

of

diseases.

In

his

classification

of

skin

diseases

he

was

influenced

by

Sennert

and

Daniel

Turner.

His

genus

'Herpes'

contains

seven

species

one

of

which

H.

Periscelis,

includes

zoster.

Later,

in

I

768,

*

There

is

some

confusion

about

the

date

of

first

publication

of

de

Sauvages's

Nosologia.

Major"

and

Pagel"

give

the

date

as

I

760

and

it

is

possible

that

some

copies

ofthe

first

one

or

two

volumes

may

have

been

issued

bearing

that

date.

However,

the

full

five

volume

work

was

printed

in

Lyons

and

published

in

1764

in

Lyons

and

Amsterdam,

although

the

title-page

bears

the

date

1763.

For

a

full

discussion,

see

Berg."'

222

The

Origin

and

the

Use

of

the

Word

Herpes

he

added

two

more,

one

of

which

is

'H.

zoster'

although

he

questions

whether

this

should

properly

be

distinguished

from

'H.

periscelis'

as

a

separate

species.

103

Linnaeus

himself79

defines

'herpes'

as

a

collection

of

crusted

pustules

on

an

'erysipelatous

base'.

To

Linnaeus

'erysipelas'

merely

meant

a

patch

of

erythema

which

healed

with

branny

desquamation.

Vogel'17

defines

'herpes'

or

'serpigo'

as

'papula

ardens,

cutem

serpentibus

minimis

pustulis

erodens';

but

he

adds,

'pupura

scorbutica,

quam

vocant,

verissima

serpigo

est'.

Twelve

years

later,

Sagar98

defines

'herpes'

as

'papularum

prurientium

in

squamas

furfuraceas

fatiscentium'.

In

the

same

class

(Vitia)

and

order

(Efflorescentia)

he

has

'phlycthaena',

defined

as

'vesicula

parva

fluido

seroso

plena,

quae

deinde

sponte

rumpitur

et

fundit

serum'.

Nevertheless

he

includes

zoster

as

one

of

his

nine

species

of

'herpes'

and

his

'herpes

miliaris'

would

probably

have

included

the

modern

herpes

simplex.

Sagar's

'H.

Simplex',

however,

is

far

more

likely

to

have

been

eczema

or

prurigo.

Both

Sagar's

classi-

fication

and

that

of

Plenck,94

which

was

published

the

following

year,

are

obviously

based

on

the

classification

of

de

Sauvages.'03

Cullen25,

26

iS

closer

to

Turner

than

the

other

writers,

although

he

has

zoster

as

one

of

the

two

species

in

his

genus

'erysipelas'

('E.

phlyctaenodes'):

Good52

quotes

Willan

and

Bateman

and

recognizes

six

varieties

of

'herpes':

H.

miliaris,

H.

exedens,

H.

zoster,

H.

circinatus

(or

H.

serpigo),

H.

iris,

and

H.

localis

(e.g.,

H.

labialis

and

H.

praeputialis).

To

return

from

the

nosologists

to

writers

on

dermatology,

the

next

author

after

Turner

who

gives

much

attention

to

'herpes'

is

Lorry.83

This

author

devotes

no

less

than

twelve

quarto

pages

to

discussing

the

views

of

his

predecessors

before

he

gives

his

own

description:

solitaria

vulgo

nascitur

una

herpetis

miliaris

areola

cute

caeteroquin

integra,

limbo

rubello

distincta.

Pustulae

emicant

vulgo

sero

repletae

sub

ipsa

epidermide

aggregatim

compositae,

interstitia

replent

lemae

epidermidis

quae

areolam

faciunt

asperam.

Inest

major

quam

pro

malo

exoriri

debere

videretur

cruciatus,

sed

mox

et

paucarum

horarum

intervallo

subnascitur

altera

pustularum

agglomeratio,

quam

aliae

mox

confertim

adnatae

per

plurium

dierum

spatium

excipiunt.

This

certainly

sounds

as

though

it

might

be

zoster.

His

contemporary

Plenck95

gives

a

somewhat

different

description:

'papu-

larum

chronicarum

ichoroso-squamosarum

semper

ulterius

serpentium

agmen'.

He

has

six

species

of

'herpes

seu

serpigo'.

Hebra6°

has

attempted

to

determine

the

modern

terms

to

which

Plenck's

species

correspond:

his

suggestions

are

given

in

parentheses

in

the

following

list:

Class

V.

Papulae.

Genus.

Herpes

seu

Serpigo

Species.

H.

simplex

(Prurigo)

H.

exedens

(Lupus)

H.

miliaris

(Acne)

H.

syphiliticus

H.

pustulosus

(Impetigo)

H.

spurius

(artificial

eczema)

223

T.

S.

L.

Beswick

Subspecies

(of

H.

spurius)

H.

periscelis

H.

collaris

H.

cerdonum

H.

a

tactu

toxicodendron

Plenck

places

zoster

in

a

separate

class

(Maculae)

as

a

genus

of

which

it

is

the

only

species.

It

is

called

'zona

seu

zoster'

and,

we

are

told,

is

not

to

be

confused

with

'zona

herpetica'

which

is

a

name

given

to

H.

collaris

and

H.

periscelis.

Fever-blisters

are

described

under

the

name

of

'miliaria

febrilia'

and

placed

in

the

genus

'Miliaria'

of

the

class

'Vesiculae

seu

Phlyctenae'.

In

the

first

edition

of

his

book,

Doctrina

de

Morbis

Cutaneis"

the

classification

is

much

the

same

except

that

zoster

is

in

the

class

'Vesiculae'

and

the

naming

of

the

various

species

of

'herpes'

is

slightly

different.

We

may

conclude

our

account

of

the

eighteenth

century

by

referring

briefly

to

Heberden

and

to

Lettsom.

Heberden56

regards

'shingles'

and

'herpes'

as

synonyms:

he

gives

a

good

account

of

herpes

zoster,

stressing

particularly

the

occurrence

of

post-herpetic

neuralgia.

Lettsom,78

on

the

other

hand,

gives

excellent

accounts

of

pruritus

ani

and

pruritus

vulvae

and

makes

no

apology

for

calling

both

conditions

'herpes'.

The

beginning

of

the

nineteenth

century

saw

the

rise

of

two men,

Robert

Willan

and

Thomas

Bateman,

whose

writings

were

to

exert

a

profound

influence

on

dermatology.

It

is

true

that

Willan's

first

serious

contribution

to

dermatology,

an

essay

for

which

he

received

the

Fothergillian

Gold

Medal

of

the

Medical

Society

of

London

in

I

790,

was

written

more

than

ten

years

before

the

close

of

the

eighteenth

century.82

However

this

essay

was

never

published

and

it is

improbable

that

Willan

exerted

much

influence

outside

London

until

after

i8oo.

Until

recently

something

of

a

mystery

has

surrounded

the

dermatological

writings

of

Willan.

As

long

ago

as

i866

Hilton

Fagge3l

drew

attention

to

the

fact

that,

although

his

book,

On

Cutaneous

Diseases,

was

not

published

until

i8o8,

Hebra57

cites

a

German

'translation'

of

I799.

This

ninety-year-old

riddle

has

recently

been

solved

by

the

discovery

in

the

library

of

the

Department

of

Pathology

at

Cambridge

of

an

imperfect

copy

of

an

earlier

English

edition.

15,

107

Unfor-

tunately

Willan

never

lived

to

complete

the

second

volume

of

his

work,

which

was

to

have

included

the

Order

Vesiculae

containing

the

genus

Herpes.

We

have

therefore,

no

full,

first-hand

account

of

Willan's

views

on

the

conditions

which

should

be

included

in

this

genus,

and

must

rely

on

a

few

scattered

remarks

in

the

first

volume

and

on

what

we

learn

from

the

writings

of

his

faithful

disciple

and

colleague

at

the

Carey

Street

Dispensary,

Thomas

Bateman.

In

I

8I

3

Bateman

published

the

first

edition

of

his

book,

A

Practical

Synopsis

of

Cutaneous

Diseases,

according

to

the

arrangement

of

Dr.

Willan.

This

little

book,

although

it

contains

but

one

plate,

was

deservedly

popular

and

went

through

six

editions

in

the

next

eleven

years.

I

have

used

the

third

edition

of

18I4.12

In

I

817

Bateman

published

the

first

edition

of

a

companion

volume,

illustrated

by

coloured

plates

and

entitled

Delineations

of

Cutaneous

Diseases.

13

Shortly

after

224

The

Origin

and

the

Use

of

the

Word

Herpes

Willan's

death

in

I8I2

Bateman

had

acquired

all

Willan's

plates

and

a

large

amount

of

material

intended

by

Willan

for

his

second

volume,

as

well

as

the

copyright

of

his

book

On

Cutaneous

Diseases.

The

Delineations

contained

most

of

the

plates

included

in

Willan's

book,

some

of

them

re-engraved,

as

well

as

a

great

many

new

ones.

Bateman12

recognized

six

species

of

the

genus

'Herpes',

all

of

which

are

characterized

by

one

or

more

localized

crops

of

small

superficial

vesicles

on

the

skin

which

heal

spontaneously

within

ten

or

twelve

days.

Healing

cannot

be

accelerated

by

treatment,

indeed

injudicious

applications

may

delay

recovery.

None

of

the

species

is

infectious.

His

species

are:

H.

phlyctaenodes,

H.

zoster,

H.

circinatus,

H.

labialis,

H.

praeputialis,

and

H.

iris.

The

last

was

not

included

in

the

genus

by

Willan,

and

it

was

more

than

half

a

century

before

Bateman's

mistake

was

recognized

and

erythema

iris

accorded

its

proper

status

as

a

variety

of

erythema

multiforme.24

319

I'll

The

'H.

phlyctaenodes'

of

Bateman

appears

not

to

have

been

a

single

clinical

entity.

In

his

description

of

'H.

zoster'

he

does

not

mention

the

occurrence

of

lesions

on

the

face

or

limbs,

and

it

seems

probable

that

Bateman

(and

presumably

Willan

too)

would

have

called

zoster

in

these

situations

'H.

phlyctaenodes':

certainly

his

illustration

of

the

latter

con-

dition

looks

exactly

like

zoster

in

the

cutaneous

distribution

of

the

third,

or

second

and

third

lumbar

roots.

13S

62

However,

he

also

mentions

another

variety

of

'H.

phlyctaenodes',

which

he

calls

the

'miliary

variety'.

In

this,

the

vesicles

are

smaller

and

the

condition

may

spread

over

almost

the

whole

body.

He

gives

no

illustration

of

this

second

varietyand

its

exact

identity

is

a

matter

for

conjecture.

Apart

from

his

failure

to

recognize

that

it

may

occur

elsewhere

than

on

the

trunk,

his

description

of

'H.

zoster'

is

adequate.

His

'H.

labialis'

and

'H.

praeputialis'

are

the

same

as

the

varieties

of

herpes

simplex

designated

by

these

terms

today.

Bateman's

'H.

circinatus'

appears

to

have

been

some

variety

of

ringworm,

although

he

denies

this.

It

might

be

argued

that

the

reason

why

Willan's

book

made

such

an

impact

on

dermatology

was

that

he

was

the

first

author

in

this

field

to

make

extensive

use

of

coloured

plates.

That

this

argument

cannot

be

sustained,

however,

is

clear

from

the

fact

that

the

far

more

lavishly

and

competently

illustrated

works

of

his

contemporary

Alibert,

although

much

admired

during

his

lifetime,

are

now

regarded,

even

in

his

own

country,

as

medical

works

of

art

rather

than

as

serious

contributions

to

the

science

of

dermatology;

whereas

Willan,

like

Turner,

has

been

acclaimed

the

'Father

of

English

Dermatology'

and

much

that

he

wrote

is

still

acceptable

today.

Of

Alibert's

two

systems

of

classifying

skin

diseases,

the

second

is

undoubtedly

an

improvement

on

the

first.

However

Bateman

12

is

not

far

from

the

truth

when

he

says

'The

merit

of

his

publication

belongs

principally

to

the

artists,

whom

he

has

had

the

good

fortune

to

employ'

and:

'He

has,

moreover,

thrown

together

his

genera,

without

any

attention

to

their

affinity

or

disimilarity,

making

an

arbitrary

whole

of

disjointed

parts.'

Of

the

place

of

herpes

in

Alibert's

first

classification7

little

need

be

said.

As

Bateman12

points

out

his

'definition'

of

the

genus

'Les

Dartres'

is

so

wide

and

so

vague

that

almost

any

skin

disorder

225

T.

S.

L.

Beswick

could

be

included

in

one

of

its

seven

species.

The

second

system

of

classification

is

better,

although

Alibert's

views

on

the

proper

use

of

the

word

'herpes'

differ

fundamentally

from

those

of

Willan

and

Bateman.

Alibert8

says

with

some

justification;

'l'etymologie

revele

la

juste

signification';

certainly

a

tendency

to

'creep'

is

not

a

striking

feature

of

the

conditions

Willan

designates

'herpes'.

Alibert

continues:

'le

mot

herpes

...

est

deja

consacre

pour

exprimer

un

genre

de

dermatoses

rampantes,

tellement

refractaires

aux

moyens

de

l'art

que

leur

opiniatrete,

pour

ainsi

dire,

passee

en

proverbe':

this

is

more

questionable.

He

collects

together

a

most

heterogeneous

group

of

disorders

to

constitute

his

genus

'Herpes'.

His

'species

I',

'H.

furfuraceus',

is

undoubtedly

ringworm:

his

'species

II',

'H.

squamosus',

comprises

seborrhoeic

dermatitis,

pruritus

ani

et

pudeno-

dorum,

epidermophytosis

of

the

groin,

chronic

scaly

eczema,

cheiropomphalyx,

and

acute

exfoliative

dermatitis.

Those

disorders

which

Willan

and

Bateman

call

'herpes',

he

designates

'Olophlyctis',

except

herpes

zoster

which

is

placed

in

a

genus

of

its

own

('Zoster')

with

two

species,

'Zoster

acutus'

and

'Zoster

chronicus'.

The

latter

differs

from

the

former

in

that

it

is

followed

by

post-

herpetic

neuralgia.

The

species

of

the

genus

'Olophlyctis'

are:

'O.

miliaire'

(?

ringworm),

'O.

volatile'

(infantile

eczema),

'O.

prolabiale'

(herpes

labialis),

'O.

progeniale'

(herpes

genitalis),

and

'O.

hydroique'

(hydroa).

For

a

time

Alibert's

works

were

much

esteemed,

but

ultimately

even

his

own

pupil

Biett

came

to

use

Willan's

nomenclature

in

his

lectures.

Another

early-nineteenth-century

writer

on

dermatology

was

Tilesius.113

It

was

after

reading

his

paper

on

'Herpes'

that

Willan

decided

to

place

the

vesicular

and

bullous

eruptions

in

separate

genera.12

His

views

on

'herpes',

however,

are

very

different

from

Willan's.

He

recognizes

two

divisions

of

the

genus

'Herpes',

the

vesicular

and

the

papular.

The

former

comprises

the

following

species:

'H.

phlyctaenodes'

(?

herpes

zoster),

'H.

erysipelatosus'

(?

erysipelas),

and

H.

miliaris

(apparently

some

form

of

eczema).

Jaconelli,

75

like

Willan,

regarded

'herpes'

as

a

superficial

vesicular

eruption

of

the

skin;

but

from

his

description

it is

clear

that

the

principal

condition

he

had

in.

mind

was

eczema.

It

will

be

apparent

that

even

as

late

as

the

beginning

of

the

nineteenth

century

opinion

was

very

much

divided

as

to

the

proper

significance

to

be

attached

to

the

word

'herpes'.

Willan's

view

that

the

term

should

be

restricted

to

those

conditions

characterized

by

the

appearance

of

localized

groups

of

vesicles;

a

short,

self-limiting

course,

and

the

absence

of

more

than

mild

con-

stitutional

symptoms

was

destined

to

prevail.

That

it

did

so

was

probably

due

to

the

fact

that

it

was

embodied

in

a

system

of

classification

of

skin

diseases

which

was

far

in

advance

of

its

rivals,

rather

than

because

of

the

weight

of

ancient

authority

which

Willan

was

able

to

adduce

in

its

support.

However

victory

was

not

won

immediately:

Alibert

outlived

Willan

by

twenty-five

years:

Cazenave18

introduced

the

term

'Herpes

tonsurans'

to

describe

ringworm

of

the

scalp.

This

term

was

in

use

in

human

medicine

at

least

as

late

as

i88I,

73and

veterinary

surgeons

still

refer

to

certain

types

of

animal

ringworm

as

herpes.

76

However

most

authorities

accepted

Willan's

use

of

the

word

(see

Hebra6l).

226

The

Origin

and

the

Use

of

the

Word

Herpes

'Herpes

iris'

was

to

remain

a

member

of

the

genus

'Herpes'

until

the

eighties

of

the

nineteenth

century

when

it

was

accorded

its

proper

status

as

a

variety

of

erythema

multiforme;

although

Hebra65

had

said

twenty

years

before

that

he

had

been

tempted

to

regard

'Herpes

iris',

'Erythema

iris',

and

'Erythema

multi-

forme'

as

variants

of

the

same

morbid

process.

Of

'Herpes

phlyctaenodes'

we

hear

little

after

Hebra62

declined

to

recognize

its

existence

as

a

separate

entity.

Although

the

'Herpes

circinatus'

of

Willan

and

Bateman

was

probably

ringworm,

Hebra65

appropriated

the

term

to

describe

a

variant

of

'Herpes

iris';

after

his

time

it

gradually

fell

into

disuse.

Finney33

and

Pringle97

recognized

but

two

species

of

herpes:

herpes

catar-

rhalis

and

herpes

zoster.

The

latter

divides

herpes

catarrhalis

into

two

types:

herpes

facialis

and

herpes

progenitalis.

Nevertheless,

as

pointed

out

by

Bulkley17

herpes

gestationis

had

been

described

by

Gibert

as

early

as

1840.

0

Erasmus

Wilson

121

described

two

cases

of

the

disease

which

he

called

'herpes

circinnatus

bullosus'.

Shortly

afterwards

Milton86

recorded

a

similar

case

to

which

he

gave

the

same

name.

But

when

he

repeated

his

account

of

this

patient

in

his

book87

he

changed

the

name

to

'herpes

gestationis':

this

designation

was

adopted

by

Bulkley5O

in

his

very

full

account

of

the

disease.

Dermatitis

herpetiformis

was

first

described

by

Fox

as

hydroa

in

i88o38

and

named

four

years

later

by

Duhring28

in

a

classical

paper.

In

spite

of

general

agreement

that

the

use

of

the

term

'herpes'

should

be

restricted

to

herpes

zoster

and

herpes

febrilis

(catarrhalis),

various

accounts

appeared

during

the

second

half

of

the

nineteenth

century

of

cases

of

so-called

herpes

which

were

clearly

neither

of

these

two

conditions.

Examples

are

Dukes's

account

of

a

case

of

'Acute

general

Herpes',29

Curgenven's

cases

of

'Herpes

Contagiosus'

27

and

Sangster's

case

of

'abortive

Herpes'

which

appears

to

have

been

a

case

of

pityriasis

rosea.

100

In

this

necessarily

brief

historical

review

it

has

been

quite

impossible

to

notice

all

the

authors

who

have

used

the

word

'herpes'

and

no

attempt

has

been

made

to

list

those

who

have

written

on

skin

diseases

without

making

use

of

the

term.

The

only

condition

which

has

maintained

its

claim

to

the

name

'herpes'

during

the

greater

part

of

the

period

reviewed

and

retains

the

name

today

is

herpes

zoster.

Herpes

labialis

(febrilis)

may

have

been

known

by

the

name

of

'herpes'

by

Hippocrates,

but

it

certainly

was

not

the

principal

condition

he

so

designated.

The

first

author

to

give

a

clear

account

of

herpes

febrilis

under

the

name

of

'herpes'

was

Richard

Morton

in

I694.88

The

present-day

use

of

the

word

is

essentially

that

of

Daniel

Turner115

and

of

Robert

Willan,12

although

both

of

these

authors

admitted

certain

varieties

of

cutaneous

ringworm

to

the

genus

'Herpes'

which

we

exclude.

The

validity

of

the

term

'herpes

gestationis'

is

questionable.

The

disease

differs

from

dermatitis

herpetiformis

only

in

its

association

with

pregnancy:

the

histological

changes

are

identical

in

the

two

conditions,

as

are

the

subjec-

tive

symptoms

and

the

appearance

and

distribution

of

the

eruption.

However

227

T.

S.

L.

Beswick

the

term

has

been

hallowed

by

time

and

will,

no

doubt,

continue

to

be

employed.

The

term

'dermatitis

herpetiformis'

itself

is

less

objectionable,

and

until

more

is

known

of

its

aetiology,

there

would

be

little

point

in

trying

to

substitute

any

other

name.

The

recognition

of

the

common

aetiology

of

herpes

facialis,

herpes

labialis,

herpes

febrilis,

and

herpes

genitalis,

has

led

to

the

relegation

of

these

terms

to

a

purely

descriptive

role

as

different

clinical

manifestations

of

one

disease,

herpes

simplex.

Now

that

it

has

become

clear

that

the

same

virus

can

cause

lesions

in

the

mouth,

eye,

oesophagus,

and

internal

organs,

it

is

only

reasonable

to

extend

the

term

'herpes

simplex'

to

include

these

less

common,

non-cutaneous

manifestations

of

the

infection

as

well.

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