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.