If the bubo is, therefore, painful and inflamed, my advice is as follows: Stay at home, and rest; descend to middle diet; take some aperient; and should chancres alone be present, and a treatment going on for their extinction, continue the same; or, as bubo often immediately succeeds the ulcer, and probably may be the first symptom noticed, adopt, in addition to that recommended above the treatment as advised for chancre, namely, the administration of some alterative—for instance, five grains of blue pill every night—or the Plummer’s pill every night—the aperient powder every other day; and let the local treatment be directed to remove the prevailing symptom, to subdue the inflammation, and, if possible, thereby prevent suppuration. It was formerly supposed that, unless buboes were allowed to suppurate, the system could not escape the venereal taint. Lower somewhat the vital powers, or, what may be more intelligible, diminish the general inflammatory action, establish some slight drain, by determining the secretions to the intestines or skin: and buboes, even when matter has absolutely formed, may be fearlessly absorbed, which judicious treatment will effect, in nine cases out of ten, without at all impregnating the constitution. To attain this object, warm fomentations constantly applied, and if possible the warm (hip or full length) bath every night. When rest is determined upon, if the swelling is great, red, and painful, leeches are eminently serviceable, but they must be applied in numbers of at least a dozen at a time, and repeated twice or thrice if necessary. Three or four, by the irritation of the bites when healing, and especially if the patient will not or can not remain quiet, only worry and aggravate the disease. Where the inflammatory symptoms are great, where there is fever and much heat of skin, bleeding is the speediest and most effectual plan to subdue them; and, in my opinion, it is to be preferred before the trouble and bother of leeches. Where, however, there is no remarkable excitement, local or universal, the topical application of any of the ointments suggested will often promote absorption (see Forms [35], [36], [37]).
Blisters applied over the bubo, very often disperse the swelling. Pressure also, made by means of a pad covered with tin foil (as seen in the subjoined cut), and continued for several days, frequently urges the absorption of the accumulated deposition in the gland.
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Where bubo has been suffered to proceed, and the suppuration appears inevitable, it would be highly improper to retard it: poultices and warm fomentations should be applied, and when fit, an opening should be made to permit the exit from, and prevent the extension of, the matter in the surrounding cellular membrane; the operation should not, however, be prematurely performed; the skin should be permitted to become thin before an opening is made, and that opening should be made in the most dependent position, in order to allow complete escape of the matter, lest fistulæ and sinuses should form. When an abscess is thus established, its healing must be promoted with all expedition, and care taken to preserve the strength of the patient. For the former purpose, poultices, mild healing ointments, or strapping plaster applied near the edges of the wound, should be used. Poultices may be applied with a bandage, as seen in the subjoined cut.
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When the abscess appears indolent and not disposed to heal, carrot and linseed-meal poultices may be substituted. Astringent ointments should also be employed (see Forms [38], [39], [40]), or lotions (see Forms [41], [42]), and the topical application of caustic to the edges of the wounds, or even paring them with a scalpel. The occasional use of the warm or vapor bath will give a healthy tone to the frame, invigorate the depressed powers, and promote recovery. The strength should be supported by more generous diet, and any of the formulæ comprised under the head of tonics, may be taken internally (see Forms [43], [44], [45], [46], [47], [48]). As the patient becomes convalescent, change of air, gradual exercise, the cold shower bath, or sea bathing, will be of essential service.
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Treatment of secondary symptoms.—Secondary symptoms usually appear from the sixth to the sixteenth week, but are not unfrequently protracted beyond that period; they are commonly ushered in with fever—a general sense of being ill—a quickened pulse, headache, loss of appetite, pains in various parts of the body, and restlessness at night; in short, there is disturbance of all the vital functions, until it is determined which structures are to be the retreat of the common enemy. Some authors assign the skin and throat as more liable to attack than others; but I think the distinction dependant mainly upon the natural or morbid idiosyncrasy of the invalid. At all events, the inquiry here would be foreign to the design of this work, and less useful than the advice, how best to combat the evils when and wherever they occur. I have already stated secondary symptoms to consist of eruptions, ulcerations, and disfigurations of the skin, ulcerations of the mucous membranes of the mouth, throat, and nose, pains in the joints, swellings of the bones and their coverings, and inflammation of the various fibrous textures of the body.