Five cases of inguinal bubo / by G.H. Colt.

  • Colt, G. H.
Date:
[1907]
Catalogue details

Licence: In copyright

Credit: Five cases of inguinal bubo / by G.H. Colt. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    adherent to the skin but .vielded no fluctuation. It was tender. Under a general antesthetic the surrounding skin was shaved and prepared for operation and the mass of glands was dissected out through a vertical incision two and a half inches in length made over the most prominent part of the swelling. The Internal saphenous vein was found to be involved in the mass ; it was ligatured above and below and the intervening portion was removed with the glands. The wound was closed with silkworm gut except for a small drain and dry dressed. On cutting into the swelling numerous foci of pus were found and a broth culture was taken from one of these. The tube showed no growth on the third day. The mass of glands was of the same con- sistence throughout and a microscopical examination of a section showed chronic inflammation with foci of necrosis. There were no signs of sarcoma. The wound discharged large quantities of serum through the drainage into the dressings. It mostly healed by first intention and it seemed probable that if the main lymphatic vessels, both afferent and efferent, or as many as could be seen as they .joined the glands, had been ligatured the healing of the wound would have been facilitated. The cavity left beneath the skin granulated up from the bottom and the base thus became joined to the skin over it. The place of exit of the drainage finally healed on May 24th. The total duration of the man’s illness was nine and a half weeks. This patient at the present time is well. The scar is sound and painless. He has noticed that his right leg swells more than his left when he stands up for long at a time. Case 3. —The patient, aged 43 years, was admitted on Jan. 30th and <lischargeil on March 4th, 1905. lie first noticed an aching pain in his right groin on Dec. 2nd, 1904, and on examining himself discovered a lump where he felt the pain. On the 19th he came to the surgery. The diagnosis was inguinal bubo and the swelling was fomented. The patient was instructed to rest at home and to continue the fomenta- tions every four hours. There was no history of venereal disease and no source of infection was discovered within the area before specified. On Jan. 7tb. 1905, fluctuation could be elicited in the swelling and under nitrous oxide anfpsthesia a vertical incision one and a half inches long was made over the most prominent part of it and pus was evacuated. A second incision one inch long was made parallel and to the inner side of the first and drainage was established here as a counter opening. The patient continued at home and fomented the wounds every four hours. Owing to their extremely sluggish appear- ance and the pain in them and in the leg the man was admitted as an in-patient. At this time (Jan. 30th) the local condition w'as as follows : There were two parallel vertical incisions in the right groin, the outer one e.xtending upwards over the mid-point of Poupart.’s ligament and one and a half inches long, the inner one one inch distant from the first and one inch long. The edges of these incisions were thick and not shelving and were dark purple, the purple colour extending into the sur- rounding skin for half an inch in all directions. Pus was discharged through the incisions and there was some slight thickening apparent beneath them. On the 30th, under general annosthesia, an elliptical Incision was made around the two wounds, giving them a margin of half an inch, and all the skin inclosed by this incision was cut away. The base of the wound left by this proceeding was scraped and the wound was packed with gauze. The ulcer was syringed out with 1 in 40C0 toiniodide of mercury lotion and dressed once daily. In a week the