OF BUBOES.
Surgeonsapply the word bubo to inflamed glands from syphilis, wherever they happen to be. The body abounds with absorbents, which are small delicate vessels that form a net-work over the entire surface, and exist also in every structure. Their purpose is to convey the nutriment to the circulation. They formstations, as it were, or points of assemblage; and these are generally situated in the angles of the body—the groin, the armpits, hams, neck, &c.—partsmost protected from injury. When skin inflammation is present, to familiarize the meaning, the nearest glands sympathize and swell; as, for, instance, who has escaped a swelling, at one time or other of his life, in the neck, throat, or armpits? When a sore prevails on the penis, or a gonorrhœa exists, there most frequently ensues an enlargement of the glands of the groin. The result of that enlargement depends upon the nature of the inflammation. In gonorrhœa it is merely temporary, not being sufficient to provoke suppuration, or the formation and discharge of matter, or very rarely so; but in the case of venereal ulcers, where the inflammation is so conveyed, the escape from such consequences is as seldom.
The mode which nature adopts to transfer the poison is as inexplicable in its operation as the production of a swelled testicle. Buboes (herein meant), then, are—or I should say a bubo is—a specific inflammation of the glands of the groin. It usually occurs on the same side of the body as the ulcer is situated; but when the ulcer is seated on or under the frænum, there seems to be no fixed rule which side shall have the honor. Another peculiarity is, that they more readily spring up from ulcers on the prepuce than on the glans, and are more attributable to ulcers than merely inflamed surfaces. They do occur sometimes without either being apparent. To facilitate the clear understanding of what we are talking about, a drawing is presented of the inguinal glands, and the absorbents leading to and from it, which conveys but an imperfect idea of the number of the absorbents; but it serves to show the nature of them, and their mode of communication.
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Glands become inflamed from other causes than syphilis; a scratch, a bruise, or any local irritation, will occasion an enlargement of the nearest set of glands, or at least one of them. Scrofula is a specific cause. As the venereal poison carries with it its morbid nature wherever it happens to be conveyed, the glands become infected with it; and hence it is the more readily transferred to the system at large. Very frequently and fortunately the disease terminatesinthe glands; that is to say, does not extendto the circulation at large. The time that intervenes after absorption has taken place, before bubo manifests itself, is as uncertain as that of chancre appearing after connexion; but generally the party is safe a fortnight after the entire disappearance of the chancre. Where it is otherwise, some trace of irritation on the glans or prepuce is discoverable upon close investigation, or it will follow great fatigue, venereal excesses, &c. If the disease extend to the constitution, it rarely affects other glands than those primarily attacked; and hence it is rare that more than one gland becomes inflamed. Having given the received notions of the cause, the symptoms should next be described.
No person can be unaware of the approach of a bubo. There is seldom much advance of a swelling without pain, which latter may be said to attract the patient’s attention to the part, when a tumor, possibly the size only of a horse-bean, is discovered. If the swelling be venereal, it rapidly increases in size. It is at first moveable, but soon feels as though firmly fixed. There is next experienced inconvenience in walking. If the disease proceed to suppuration, a continued throbbing is felt in the part, which also swells, assumes a diffused redness, and at last an evident sense of fluctuation is perceived. It may be ushered in with a shivering fit. The skin becomes thin and tender, and a conical point protrudes, which, unless punctured, bursts and emits its contents. It is astonishing what immense destruction of parts takes place in large buboes. The theory how solids become converted into fluids—how muscle, fat, and cellular membrane, become absorbed, and a thick purulent secretion deposited, is fitter for a work addressed exclusively to medical men than to the public; and it therefore must suffice that such happen, and few persons are ignorant of the fact; but themodus operandimay at best be but the subject of conjecture.
The artist’s graver has pencilled a faithful picture (see next page) of the appearance of the disease in question. On the right side is represented a bubo that has broken, or discharged its contents, and which is in a state of healing; on the left side a bubo ready to burst; and, by way of economising space, the left testicle is exhibited in a state of varicocele, by no means an unfrequent accompaniment to the previously narrated condition, but at the same time by no means a necessary attendant, it being atotally distinct affection. Buboes present more varieties in their size, and duration, and consequences, than they do on their initiation. Cases in corroboration will be found in their proper place.
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