LONDON MEDICAL AND PHYSICAL JOURNAL. EDITED BY JOHN NORTH, ESQ. F.L.S. MEMBER OF THE ROYAL COLLEGE OF SURGEONS, AND JOHN WHATLEY, M.D. A.M. MEMBER OF THE ARCADIA OF ROME; MEMBER EXTRAORDINARY OF THE ROYAL MED. SOCIETY OF EDINBURGH; JOHN SOUTER, 73, ST. PAUL'S CHURCH-YARD, AND TO BE HAD OF ALL THE MEDICAL BOOKSELLERS. 1829. THE LONDON Medical and Physical Journal. No 365, VOL LXIL] JULY, 1829. [No 37, New Series. For many fortunate discoveries in medicine, and for the detection of numerous errors, the world is indebted to the rapid circulation of Monthly Journals; and there never existed any work, to which the Faculty, in Europe and America, were under deeper obligations than to the Medical and Physical Journal of London, now forming a long, but an invaluable series.-RUSH. ORIGINAL PAPERS, AND CASES, OBTAINED FROM PUBLIC INSTITUTIONS AND OTHER BUBO. On the Pathology, exciting Causes, and Treatment of Bubo. By S. D. BROUGHTON, Surgeon to the 2d Life Guards, and to the St. George's and St. James's Dispensary. General Observations. THERE is no species of tumor so frequently presented to the surgeon's notice, and at the same time so troublesome to manage, as the common bubo, or enlarged glands in the groin and axilla. In military practice, (especially among cavalry soldiers.) and with the labouring classes, which form a considerable portion of dispensary patients, this complaint is most often encountered. Its course is usually marked by an uncertain and variable character, and is productive of more or less constitutional irritation, while it entails a long and tedious suspension of daily duties and labours. Interposed between the trunk and the limbs, every movement of the latter irritates and inflames the tumor and the surrounding integuments. Emaciation and debility generally ensue from this state of the parts affected, and not unfrequently fever attends, so as to render repose, with cooling and soothing remedies, absolutely necessary. The absolute absorption of morbid matter, and its conveyance into the body of the gland, its positive existence there as an immediate exciting cause, and the alleged infectious nature of the suppuration in glands so excited, appear to be No. 365.-No. 37, New Series. B points resting entirely upon hypothetical bases. It may, indeed, be very fairly questioned whether such considerations should influence our treatment of buboes, upon the ground that, whatever might have been the remote cause, their appearance is unconnected with it, but as a secondary effect or consequence. The ordinary result of the dispersion of a bubo, even after suppuration has taken place, seems to warrant and support this question. In the greater number of cases commonly met with, the bubo probably arises from some local source of irritation, mechanical or otherwise, and remote from the apparent glandular affection. Thus, an irritable corn, or pressure from a tight boot or shoe, a scratch or excoriation of the skin, or any other such simple cause, acting upon parts in the absorbent line of direction leading to glands, is just as likely to excite the enlargement of one or more of them, as the introduction or formation of virulent matter; nor are the signs which buboes exhibit from either source in any way peculiarly characteristic of the original exciting cause, although their subsequent appearance may perhaps become modified by constitutional diathesis; as, for example, in a patient of a naturally strumous habit. In whatever manner the bubo may be produced, its occasional progress indicates the necessity of an early attention to the means best calculated to disperse it in the incipient stage, in order to obviate suppuration, as well as to prevent that indolent and indurated state often assumed, and in which its prolonged continuance is a source of much annoyance and discomfort to the patient. Of the Parts immediately involved in the Formation of Bubo. If the formation of buboes be carefully watched, we shall find that the glands themselves are the first and immediate seat of inflammatory action, and this condition is not commonly traceable along the course of the lymphatic vessels connected with the affected glands: frequently, indeed, the remote exciting cause is looked for in vain. Usually the mere enlargement of a single gland is not productive of much pain and irritation, until the surrounding cellular connexions become involved, and the throbbing of the neighbouring cutaneous vessels renders the integuments tense and tumefied. The little degree of nervous develop ment in these glands may account for this absence of pain at first, and their relations to other organs by means of nervous filaments point out the source of the general sympathy which they hold in common with the system, while the sensibility and profusion of the nerves of the cutis account for the increase of pain and tenderness following the progress of the inflammatory stage. Although sometimes the cellular inflammation extends far around, and an erysipelatous action occasionally supervenes, yet the inflammatory condition of the parts is most commonly circumscribed. Proximate Cause of Bubo. The proximate cause of this condition of the parts affected appears to be obstruction to the free course of the lymph. Whether on this occasion the fluid may hold suspended in it any virulent substance or not, seems to be a question relating to a very doubtful fact. The probability appears to me to be, that the proximate cause is irritation only, and not absorption of virus; and that the latter, when existing, is only the remote cause. The lymphatic obstruction probably commences in the capillary vessels, producing distention of the veins and arteries; or a state of atony may be said to belong to the vasa efferentia of the conglobate glands, induced by a distant source of irritation; and the lymph thus obstructed is poured into the surrounding cellular substance, the finer particles escaping by transpiration, and the grosser adhesive matter remaining to amalgamate the cells with the adjacent texture, so as to limit the overflowing of the lymph and to circumscribe the inflammatory action, while the hardness and tumescence in the parts themselves are thus increased. In this condition the glands so placed are most likely irrecoverably lost, and their functions transferred to others; the fluid lymph becomes dispersed, and the tumor dwindles to a small, permanently hard, and round ball. Of the Suppuration of Buboes. When the inflammatory action is incontrollable, suppuration occurs in the centre of the tumor, and the surrounding wails of matted and condensed cellular texture perfectly enclose the pus, and thus the abscess is contained in a sac. This process is gone through with different degrees of activity and celerity: when slowly conducted, the pus may often become dispersed, and the tumor so reduced to the natural level of the integuments around. But, when the formation of pus is rapid and copious, the irritation from overstrained skin is excessive, and relieved only by a spontaneous discharge of its contents, or by an artificial opening. Excepting the pain and irritation from pressure, and the |