Plague buboes are exquisitely tender and the patient usually manifests signs of extreme illness. In climatic bubo the patients rarely seem sick.
Surgical treatment is usually recommended and some advocate a radical enucleation of all glands in the region involved as we find at times apparently normal glands to show necrotic centers. My objection to enucleation is that the deep iliac glands are also often involved and it is not only impossible to remove all affected glands in such an inaccessible region but the surgical risks of wounding the deep veins are great. I have seen this accident occur more than once. Again the radical removal of all glandular structures in the groins, with subsequent scar tissue formation, obstructs lymph return so that elephantoid conditions result.
Rest in bed and hot compresses are of value when periadenitis sets in. When softening occurs the aspiration of the pus with an aspirating syringe and the subsequent injection of glycerite of boroglycerine containing 10% of iodoform are to be recommended. Some apply ointment of ichthyol, others pressure by shot bags. X-ray treatment has been recommended.
Emily strongly recommends the injection of 3 or 4 drops of iodoform ether (5%) into the center of the enlarged gland. This effects a rapid cure. The author also employs other measures such as rest in bed, wet compresses, and light mercurial ointment inunctions over the bubo at night.
Ainhum
General Considerations
This disease, equivalent clinically to a spontaneous amputation of the little toe, has been chiefly noted in the natives of the West Coast of Africa, especially among the Kroomen and in Brazil. Cases have been reported from the West Indies and rarely from the Southern States of the United States. It does not attack white people and the susceptibility of black races is probably connected with their tendency to keloid development.
There have been all sorts of suggestions as to etiology: (a) that it is related to leprosy, (b) that it is a tropho-neurosis, (c) that it results from wearing constricting bands or rings on the toe, (d) that it is connected with frequent injuries to the under surface of the little toe.
Pathologically we find a fibrous cord which has replaced the bony structures normally attaching the toe to the foot. We have, according to Unna, a ring-form sclerodermia with thickening of the epidermis causing an endarteritis with the production of a rarefying osteitis.