Bartholomew's Hospital, who told me that he had often noticed the same circumstance." If we look at the comparatively large, though proportionately small, incidence of shingles on the rheumatic and gouty classes, by the light to be had from the occurrences of the disease among children and adults who are neither gouty nor rheumatic, the conclusion is hardly to be avoided that diathesis has nothing to do with the causation of this exanthem. If we then weigh the whole of the evidence (much of which is necessarily omitted) touching the relation of the damp bed to an attack of shingles, one of the few rational inferences to be drawn from it is, that the rheumatic and gouty, together with the other adults who get the complaint, get it because their beds, being either constantly or occasionally moist, favour the growth of a fungus by the spores of which they are infected; and that a proportion of the total number of children infected are infected as a consequence of wetting their beds. With this key the cases that came under the observation of Sir Thomas Watson and Mr. Wheeler may be seen to have been propter hoc, and the "special mystery" enveloping the origin of shingles is to be cleared up. The allusion in the letter of "A General Practitioner" to the association of herpes labialis with pneumonia chimes in with what has been advanced in this appendix (Epidemic Pneumonia), and suggests the view that, although the fungus which causes the eruption on the lip is a different species from that which causes herpes zoster, they are ejusdem generis: and, further, that as they perhaps require the same description of soil, the one which first seizes on the available soil in the bed may preclude the other. This, as well as the (assumed) sparseness of the shingles plant, may account for the fact that shingles and pneumonia rarely occur together in the same person. The prevalence of the two diseases at the same time, however, points significantly to the damp bed as the common source of their infections. Fièvre herpétique, from Dr. Jennings's account of the typical case, would seem to be the outcome of a very large dose of the spores which ordinarily cause herpes labialis, or an average dose of the spores of another species of herpes-inducing fungus (in either case with an admixture, probably, of the spores of other bed-reared fungi). The only further comment on Dr. Jennings's letter I have space for is, that the time may not be far distant when the "categorical reply to the customary query" of patients will be that "it is in the blood." If the hypothesis of causation submitted is sound in essentials, it follows that where there are no damp beds there will be no shingles. All the pemphiginous, urticarious, erythematous, erysipelatous, and other eruptions recognised by the nosologist, as well as all the nondescript eruptive disorders that occur independently of other affections, or appear as more or less serious complications in the course of some infective disease, together with all the maladies (not here referred to) that may occur from, or may be aggravated by, air-contamination from the spores of fungi grown on bedding, moist or dry, or on the soils of the bedroom, must be passed over. But the diseases which have been glanced at form a not unimportant part of the whole of the diseases man has brought upon himself in his hours of rest. THE END. |