Three eases of parotitis occurring dur ing the course of pelvic disease. Epi demic parotitis was excluded. The first case developed during a pelvic perito nitis. The other two occurred during, or instead of. menstruation. In none did suppuration occur.
In article published by Paget, in 18S7, 101 similar cases had been collected. Parotitis has been reported by Paget and others as accompanying or follow ing pregnancy, delivery and abortion. menstruation (which it sometimes dis places), pelvic eellulitis and lnematoeele, operations on the vagina and uterus. ovariotomy and oi)phorectomy, the use of the catheter and sound, blows on the testicle, operations and diseases of the bowel, gastritis and gastric nicer, dis ease of the pancreas, and injuries and diseases of the abdominal wall. This varied origin excludes almost absolutely any metabolic theory, and favors a nerv ous one. V. S. Morrow (Montreal Med. Jou•., Mar., '96).
There is an intimate relation between the parotid gland and the abdominal and pelvic viscera ; this close relation prob ably exists through the medium of the sympathetic nervous system. Suppura Lion and non-suppuration of the parotid gland in these eases depends entirely upon the local condition in the gland. This complication may follow any opera tion upon the viscera of the abdomen and pelvis, but it occurs more often after an ovariotomy. The patient's life is not jeoparded per se by the occurrence of this complication. The appearance of the parotid bubo usually marks the turning point of the disease. W. H. Morley (Amer. Gymee., Dee.. 1902).
Symptoms. — The onset of secondary parotitis, if it occurs during the course of the disease, is marked by increase of the fever and other constitutional symp toms. If it occurs after the subsidence of the primary disease, the complication is usually ushered in by a chill followed by fever. The location of the swelling is similar to that of mumps. Unlike the latter disease, the gland soon becomes red, hot to the touch, and throbbing.
The course of the disease is very rapid, as a rule, fluctuation often being tained on the fourth or fifth day. Oc casionally the process is slow and tinues for many days or even weeks. If the abscess is promptly opened, the cav ity usually closes and complete recovery takes place. In pyTmia or septic condi tions, with abscesses in other regions, a fatal result is very certain to follow. Pathology.—The process is a suppura tive one. The pus may discharge through the cheek or through the external audi tory meatus, and more rarely into the mouth, oesophagus, or anterior mediasti num. The abscess may be confined to the parotid gland and its immediate sur rounding tissues or it may be so large as to involve the muscles and other soft tissues, and even the periosteum of the bones. The middle ear is not infre quently involved, as well as the central meninges. Thrombosis of the jugular and other veins sometimes leads to sep ticmia. In rare instances the process terminates in gangrene.
Prognosis.—The result depends largely upon the condition of the patient at the time of the onset of the parotitis. if much reduced by the primary disease, the complication often precipitates a fatal re sult. If it occurs during convalescence and the patient is not already reduced, a favorable result may be expected. In other words, suppurative parotitis in it self is not usually fatal. Induration and enlargement of the glands is a common result.
Treatment. — By introducing a probe into Stenon's duct at the first appearance of swelling and making pressure from the outside, a small quantity of pus may sometimes be evacuated and general sup puration prevented. If this fails, poul tices should be applied to hasten sup puration. An incision should be made, with antiseptic precautions, as soon as fluctuation can be detected. The treat ment throughout should be that appro priate for any acute abscess.
FLovn M. CRANDALL, New York.