BUBO.
Suppuration of the lymphatic glands in the groin is usually a compli cation of the soft sore caused by Ducrey's bacillus, and the gonococcus acts sometimes in a similar manner. The resulting swelling or bubo is to be differentiated from the true syphilitic gland swelling, which is of almost stony hardness and is painless and non-suppurative. The possibility of a dual infection must always be borne in mind.
Rest to the part is essential, and sometimes the pressure of an elastic bandage over a firm padding of cotton-wool may prevent suppuration. This may also be effected in the early stage of the bubo by painting the skin over it with Tr. Iodi Fort. or Iodized Phenol (t part of iodine dis solved in 4 of carbolic acid), or by coating it with strong solution of Nitrate of Silver, or even by the use of ice or an evaporating lotion. Leeching is objectionable at all stages owing to the danger of infection through the bites. The application of a Klapp's suction bell over the swollen gland for io to 15 minutes causes hyperaemia of the skin, and may produce abortion of the swelling. Where much acute inflammatory pain is present hot fomentations may be applied or warm poultices used. A good routine application is Ichthyol and Glycerin (i in 4). In all cases the
penile sore should be cleansed and treated with antiseptics.
Some surgeons inject a few minims of Carbolic Acid, a r per cent. solution of Benzoate of Mercury or Tr. Iodi Mit. with the view of prevent ing suppuration, but often these aggravate matters and hasten the break ing down of the gland tissue.
If pus has already formed a small incision should be made parallel to Poupart's ligament through the tissues down to the swollen gland without waiting till the skin becomes infected. Through the opening•the softened gland may be removed when its contents are found not to be entirely liquefied or the cavity may be curetted and packed with Iodoform gauze. Thomson and Miles recommend one or more small incisions and the application of the suction bell afterwards.
If the skin has already become undermined, the edges of the wound may require to be excised in order to facilitate healing and prevent sinus forma tion, the resulting sore being treated as a chronic ulcer after cleansing with hydrogen Peroxide, i in soo Sublimate solution, or by dusting with lodoform. When sinuses remain these should be filled with Bismuth Jelly. See also under Chancre.