Abubo, (from the groin). Vogel names it bubon when in the groin; it is also named cambuca, cambuca membrata, codoccle; by some it is called fugile, and adin. It is a tumid gland which is inflamed, or tends to suppuration: but it is generally understood only of those glands which are in the arm pits or the groin. Galen says, in his first book De Diff. Febr. 'a bubo is a kind of inflammation.'
Buboes are distinguished into Mild and malignant; the mild is that without manifest disease; the malignant, when excited by some pestilential or infectious disease, as the plague, or lues venerea.
The chief danger is from the bad habit of body, or some attendant disease: if neither of these accompanies the buboes, at the worst they are troublesome, painful, and tedious.
The cure of the mild kind will easily be effected by gentle mercurials externally applied, and occasionally a purge; though, if a suppuration threaten, it is best to encourage it, and proceed as in a common abscess.
A pestilential bubo is known by its appearing at the time of a pestilence, and being attended with its symptoms; though, indeed, the bubo is sometimes the first symptom. The appearance of a bubo, when the plague either prevails or attacks a person, is generally a happy presage, and in the management repellents must not be used, but suppuration encouraged; and as soon as a tumour appears, apply the speediest suppu-ratives, and second them by the use of cordial antiseptics inwardly. Its most common seat is the arm pit or groin. See Pestis.
A venereal bubo very generally occurs in the groin, though, when the poison has been received in the hands or fingers, the arm pits are the seat; they tend very slowly to a suppuration, and are with difficulty healed when suppurated.
In the beginning, these, tumours are sore if touched; hard, and gradually increasing, they become painful; if they tend to suppurate, an inflammation appears.
The distinction of bubo is of considerable importance. We shall not enlarge on pestilential buboes, only to urge the necessity of examining, during the prevalence of any epidemic highly asthenic fever, the groins and arm pits. The severity of the regulations in former eras respecting those affected-with the plague, has led to the most dangerous concealments. We shall continue to speak exclusively of the venereal bubo.
Swellings in the groin may arise from hernia, from a retention of the testicle at the ring of the muscle, from a general scrofulous habit, or from poison absorbed from any part of the lower extremities. Those who are accurately acquainted with the situation of the lymphatic glands, which receive the absorbent vessels from the penis and from the lower extremities, for their situation is different, will not be easily deceived. It is not, however, usually suspected, that the latter are nearer to the root of the penis than the former. Those also well acquainted with the situation of the ring of the muscles, will not easily mistake a hernia for a bubo. But error is more easy in this, than in the former case. If therefore the tumour be hard, if it does not recede on lying back, if it has not receded in its earlier stages. if it does not force down on coughing or sneezing, and if the state of the bowels have not influenced it, the disease is either a bubo or a scrofulous swelling: the latter, however, is scarcely ever single. A chain of small obstructed glands occupies the groin, and the scrofulous diathesis is, in other respects, obvious. We omit mentioning the previous venereal complaints; for these are often industriously concealed, or it may happen that a bubo is the first symptom. The testicle, when detained, sticks at the ring of the muscle;. but, were the situation not sufficient to discriminate the complaint, the want of one testicle would immediately lead to a suspicion and a full examination.
It has been usual to consider buboes as arising from irritation on the glans penis and mouthsof the absorbents, or from the absorption of matter. The idea is consoling to the patient that the swelling is not venereal, but we fear it is fallacious. We know of no instance of irritation conveyed from the opening of a lymphatic to a gland, except by poison. No one will trust his health to this idea, and the distinction may be neglect-, ed. We know that some buboes yield easily, but we should not, on that account, be less apprehensive of lues following. A secondary bubo, viz. a deposition of venereal virus from the habit of the gland, has certainly no existence. The virus is directed to very different organs, and the opinion has been adopted in consequence of the deceit of patients, who are unwilling to confess the probability of a more recent infection.
It has occasioned some dispute, whether a buho should be discussed, or brought to a suppuration. Two ideas have influenced either opinion; one, just noticed, respecting the source of the bubo from irritation; the other, that the virus is there arrested, and if suppuration can be produced, may be evacuated without injury to the system. If, however, we examine injected lymphatics, we shall sometimes find, that of the numerous vessels directed towards a gland, some will not enter its substance, but pass over, or one side; nor can we be certain that, previous to the inflammation, some portion of the virus may not have been carried into the blood. To trust, therefore, to the opinion, that the poison can thus be arrested in its passage, is highly dangerous; and we lose a strong argument in favour of promoting suppuration. It is then reduced to a question of convenience; and there can be little doubt of the propriety of resolution, since in each view a mercurial course is indispensable.
To discuss buboes emetics have been employed. They undoubtedly promote absorption, but the most violent ones are requisite, and they are seldom necessary. Mercurial frictions on the part have been recommended, to extinguish, it is supposed, at once the peculiar virulence of the poison. In general, however, these from their irritation may produce inflammation; and, though for the ease of the patient's mind some part of the ointment should be rubbed on the bubo, the larger portion should be employed on the thigh, the groin, and peri-naeum. We reserve the discussion of the specific action of mercury at present. Cold applications freely employed have been useful; and the volatile liniment, rubbed around rather than on the tumour, has assisted the resolution. Leeches have been applied in the neighbourhood when inflammation has begun; and whatever plan be adopted, the patient should be kept on a low cooling diet and at rest, while frequent laxatives are interposed.
When we can thus succeed in discussing buboes, the remaining treatment will be that of syphilis. If, however, we fail, and suppuration is indispensable, we may be apprehensive of fatal effects from too great inflammation or irritation. In this case the most cooling medicines, with opium and bark, are necessary. In general, the irritation proceeds, pari passu, with the inflammation; and the cooling plan cannot be carried far, before the latter medicines are necessary. As the disease is before our eyes, we can distinguish the degree of inflammation, and be able to account for the symptoms we perceive. During the suppuration of a bubo, it is the most judicious practice to leave off mercury.
When, however, the suppuration proceeds tardily, a mercurial course will accelerate it; and in such circumstances, wine and other cordials are requisite. In these situations we can often discuss buboes, even when they appear hastening to suppuration. Poultices of the man-dragora and mezereum have been employed for this purpose.
Disputes have also arisen respecting the opening of the buboes. We certainly run little risk in suffering them to remain till they are soft, and the fluctuation of matter is evident; but we would then advise opening them, and employing the knife rather than the caustic. The latter is preferable when, from symptoms of irritation, a discharge is necessary before the abscess be quite ripe.
When the abscess is formed, it must be treated according to the usual methods, stimulated, and the constitution supported by bark and wine, if the circulation be languid; but by a contrary plan if irritable and inflamed. In either case mercury is improper; but, in intermediate circumstances, we may begin our mercurial course with little hesitation.
When sinuses are threatened, the stagnation of matter must be guarded against: if formed, they must be opened. We have seen the opening of a single sinus-give such a stimulus to the neighbouring parts, that the sore has soon assumed a healthy, instead of a cancerous aspect, without any other application. When mortification threatens, bark, wine, and opium, are necessary; when cancer, hemlock. Yet we suspect that real cancer has never been the consequence of a venereal bubo. We have never at least seen it in a long practice, nor have been informed of such an event by a competent witness. See Lues venerea, and Abscessus Inguinis.
See Heister's Surgery. Astruc on the Venereal Disease, or Chapman's Abridgment of Astruc, Bell's Surgery. Wallis's Sydenham, vol. i. 143. White's Surgery, 20. Plenck on the Lues Venerea; Swe-diaur and Bell on the Venereal Disease; Hunter: Foot.