752 CHRONIC INFECTIOUS DISEASES. 



Joes not discharge itself until the inflammation of the surrounding tis- 

 sues has also resulted in numerous abscesses. After breaking of the 

 abscess and discharge of the matter, the resulting ulcer shows the 

 ' properties of a chancre and discharges inoculable pus. Its edges are 

 ragged, bluish red, and generally somewhat undermined ; its floor is 

 covered with false membrane, and it is very slow to heal. A chancre 

 thus produced from a virulent bubo may become phagedenic or gan- 

 grenous, and may give rise to wide-spread destruction, which some- 

 times terminates in erosion 6f the femoral vessels, or in peritonitis. 



TREATMENT. It matters little whether a virulent adenitis be ac- 

 companied by a chancre or not ; in either case, the probability that the 

 inflammation of the gland will not end in suppuration is so small, that 

 we may spare the patient the applications usually recommended to 

 discuss a bubo, such as leeching, inunction of blue ointment, method- 

 ical bandaging, and the like. I usually cover a bubo with a simple 

 plaster, generally the emplastrum fuscum (emplas. galbani. co.), and 

 make it fast with a spica bandage. Under such treatment the bubo 

 now and then subsides; in other instances, it suppurates without 

 causing the patient much' annoyance. Should fluctuation appear at a 

 point which unmistakably corresponds to the gland, I immediately let 

 out the matter through one or more punctures ; but if the surrounding 

 areolar tissue be already in a state of phlegmonous inflammation, and 

 if fluctuation appear, which does not seem to be in a gland, but to 

 pioceed from a phlegmonous abscess, I am not so hasty in opening it, 

 but prefer to wait until the parts about the softened spot are also in 

 a state of suppuration, and until the hardness has disappeared under 

 the pressure of the pus. As soon as this occurs, and after the skin 

 over the point of fluctuation has become well thinned, I convert the 

 entire top of the abscess into an eschar, by persistent rubbing with 

 caustic potash. During this process (which I learned at the Hamburg 

 hospital) the adjacent parts must be protected from contact with the 

 liquefying potash. This treatment is, no doubt, painful, but has this 

 great advantage, that no fistulous track nor sinuses ever form, and that, 

 the day after the separation of the eschar, the bottom of the abscess 

 presents the aspect of a healthy ulcer. According to my experience, 

 also, this cure is much more rapid than when we have to make punc- 

 ture after puncture, as fresh points of fluctuation show themselves, to 

 lay open fistulas as they form, and to remove the undermined edges of 

 the ulcer. 



Latterly, I have often had recourse to another mode of treating 

 virulent buboes, and with striking effect. I put a vesicatory upon the 

 tumor, cautiously open the resulting blister, and then allow a new 

 cuticle to form under a simole dressing. I then immediately blistei 



