Treatment of buboes:

-JAHR Georg Heinrich Gottlieb

It must be evident from what we have said, that a bubo should no more than a chancre, be treated with cauterizing or desiccating agents, if we desire to avoid the danger of seeing secondary constitutional syphilis break out in its place. The only external application that can be permitted are warm poultices, in case the pain caused by the inflammation becomes intolerable. Even poultices must only be applied in a case of urgent necessity, after it has become evident that suppuration can no longer be prevented. If applied prematurely, they may hasten the bursting of the tumor, which might perhaps have been prevented by the use of judiciously selected agents. Taking all these points for granted, the following is my mode of treating a bubo:
(1) If, during a chancre, glandular swellings in the groin supervene, I leave these unheeded, because I am satisfied that these swellings, if the chancre is healed by truly rational means, always get well of themselves.
(2) On the contrary, if, during the treatment of chancre, a real, inflammatory bubo develops itself, or, which occurs much more frequently, if I take charge of a patient who is at the same time afflicted with bubo and chancre, I resort to Præc. ruber, unless the patient had had a good deal of Mercury given to him by his allopathic attendant; or, if the precipitate should not be sufficient, I give Cinnabaris, both remedies with the same good result.

Bubo

(3) If these remedies are not sufficient to disperse the tumor if the bubo threatens to suppurate, and the condition of the chancre does not demand any immediate, special treatment (which it seldom does under these circumstances); in such a case, I exhibit Carbo animalis, generally with the happiest result. This agent has rendered me more than once excellent service, even in cases where fluctuation had already set in; I prefer Nitri ac. to it only when this agent is likewise indicated by the fungous condition of the chancre.

(4) If, when the patients come to me for treatment, the breaking of the buboes can no longer be prevented, or if they are already discharging, I institute the treatment which I have indicated for the different forms of chancre in § 54 and 55, being guided in the selection of the remedy by the character of the ulcer.
(5) If the buboes develop themselves protopathically, or do not make their appearance until the chancre has become cicatrized, I commence the treatment, in case fluctuation is not yet present, and the patient has not yet been drugged with Mercury, with Merc. sol., or red precipitate, or Cinnabaris; but if the patient has already had Mercury, I give Aurum. Nitri ac., or Hepar sulph. If fluctuation has already set in when I begin the treatment, I first resort to Carbo animalis, and if this does not effect a speedy improvement, I change to Nitri ac.
(6) Moreover, I prescribe in most cases: (a) for gangrened buboes, Arsenicum; (b) for old indurated buboes, Carbo an., Hepar., or perhaps Sulphur; (c) for suppurating buboes, if after the extinction of all syphilitic symptoms, the sore has become converted into a clean ulcer, but the secretion of pus still continues, and the wound does not close: Silicea, Sulphur, and sometimes Hepar sulph.
At the same time, I avoid, under all circumstances and at all times, the artificial opening of fluctuating buboes; I do not even allow the use of emollient poultices except when urgently required, and discontinue them at once as soon as the inflammatory pains have become more tolerable.