5. Buboes.
Bubo, panus (swelling resembling the thread wound on bobbin of a shuttle), paniculus (diminutive of same), inguen (swelling in the groin).
Under the name of bubo the ancient Physicians understood any form of inflammation of the lymphatic glands. Now such inflammation occurs above all other places in the inguinal region, and thus inflammation of the inguinal glands came to be especially indicated by the word, as well as the inguinal region itself. Similarly the Romans used inguen (the groin) both for the region and for the disease. Subsequently many distinctions were drawn; a phlegmonous affection combined with swelling was called a βουβὼν (bubo), while the name φῦμα (swelling) was appropriated to a swelling of the glands characterized by its rapid establishment and its tendency to suppuration (bubo with suppurative pustule in the centre), and φύγεθλον (burning swelling) to one conjoined with (cutaneous) inflammation of an erysipelas character,[408] which last form, if it passes on into induration, is known as χοιρὰς or struma (scrofulous or strumous swelling). The best exposition from the points of view equally of pathology and therapeutics is found in Galen.[409] The glands in virtue of their spongy structure are peculiarly liable to take up rheums or fluxes of all descriptions; accordingly the glands of the groin, armpits and neck swell, directly ulcers are set up in the toes, fingers or head. The body being overloaded with evil humours is another reason for the establishment of buboes, and in this case they are more difficult to cure. Further, Hippocrates[410] derived buboes in women from interrupted menstruation, and maintains[411] that the most part owe their origin to some affection of the liver.
The majority of Writers however are agreed that among other occasioning causes ulcers hold the first place,[412] though none of them speak expressly of ulcers of the genitals, unless indeed we see good to make the passage of Hippocrates discussed a little above refer to these. No doubt in this passage the words ἑλκώματα, φύματα ἔξωθεν ἔσωθεν τὰ περὶ βουβῶνας (ulcerations, tumours external and internal in the inguinal region) might admit of such an explanation, in which case the words must be taken not as referring to each single patient, but rather held to mean that ulcers and glandular swellings with a tendency to suppuration were set up, the latter occurring in some patients in the urethra, in others in the groin. Such an interpretation is favoured by the case of the Eunuch discussed in § 20, for there can be no doubt the metathesis of buboes into fistulous ulcers was noted by Celsus and other observers. Still it is highly improbable that ulcers on the feet should have afforded the sole and only cause of buboes; it is much more natural to suppose that this, as being the more rare case, was for that very reason brought into special prominence by the ancient Physicians. Besides we have seen above that the old Physicians seldom or never really had an opportunity of seeing the sympathetic buboes, as patients treated the ulcers themselves, and the buboes then disappeared spontaneously. Oribasius no less than other Writers holds buboes following on an ulcer to be without danger.
Lastly the cases are very rare in which secondary buboes under the prevailing tendency and course of the disease are thrown out on the skin, and if they do arise, the ulcer as a rule heals up. This being so, the Physician is consulted, only supposing the buboes refused to disappear. On the contrary if the ulcer was still there, the Physician sought actually to stimulate it to enhanced activity, as is distinctly implied by what Galen says (loco citato). Lint smeared with tetrapharmacum (compound of wax, tallow, pitch and resin), liquified by the addition of oleum rosaceum (oil of roses) was applied and warm poultices over that; while on the actual bubo was laid in the first instance wool moistened with oil, to which when the pain and swelling of the part were relieved, was added an admixture of salt. Plethoric or cacochymic (generating evil humours) subjects are to be bled or cupped. If the bubo is inflamed and inclined to suppurate, it must be scarified, the patient having first been purged. Dispersion is then attempted, in this case by means of pulp and honey poultices, but not by plasters, as these are apt to provoke inflammation. If pus appears, recourse must not be had at once, as some advise, to opening with the knife; rather the poultices should be persevered with till the inflammation is relieved. Acrid poultices are suitable only when the metathesis to induration has already begun.
If dispersion does not follow and the matter has collected in greater quantities, then the most elevated spot, the same where the skin is the thinnest, should be opened. Should a part of the skin be discoloured, it must be cut away. Some advise always cutting out a piece in the shape of a myrtle-leaf, others make very long incisions; but this not only causes a disfiguring scar, but often also interferes with the movement of the part. As a general rule a single incision is sufficient, which should be made diagonally across the inguinal region, not parallel with the direct diameter of the thigh, as then the edges are brought actually into contact when the limb bends.[413] After the opening of the abscess, it should be treated by preference with finely sifted frankincense, as should all forms of ulcer. We may mention further that according to Sextus Placitus Papyriensis[414] the wearing of a stag’s genitals was considered a prophylactic against buboes.