Any classification of the diseases'
which have been complicated by Parotitis must
necessarily be very artificial. As fresh cases
are put on record it becomes increasingly plain
that the onset of Symptomatic Parotitis is
dependent upon causes,which may be associated
with almost any diseased condition,whether acute
or chronic, and involving almost any organ of
the body. There is no definite incubation period
of Symptomatic Parotitis. And the condition is
not infectious,it must however be regarded as
a serious complication of any disease.
II. PATHOLOGY OF SYMPTOMATIC PAROTITIS.
Infection of the parotid gland occurs
by direct spread from the mouth along Stenson's
duct to the gland,in all cases except those in
which the parotitis is part of a generalised
This is organismal. In nearly
all cases Staphylococcus Pyogenes Aureus is the
I. Diminished resistance due to lowered
vitality on the part of the patient..
II. Diminished salivary secret ion,leading
to a dry state of the mouth.
D. Anatomical appearances of the gland.
I. Normal parotid gland.
The elastic tissue of the ducts is
confined to the walls of the extra lobular ducts,
the small intra lobular ducts contain no elastic
tissue in their walls.
II. Diseased Parotid G-land.
The process of inflammation begins
in the centre of the lobule, in connection with
the small ducts which are primarily infected and
gradually the process spreads to the periphery
of the lobule.
As the parotitis advances an increasing
number of lobules becomes affected and in advanced
cases the whole of the gland becomes involved
and may be more or less replaced by necrotic tissue.
III. COURSE OF THE PAROTITIS:
A. The parotitis may resolve and the patient
make a complete recovery from the primary
B. The parotitis may fail to resolve and
I. from the parotitis,causing,as in case I
general pyaemic abscess formation.
II. from the primary disease,the persistence
the parotitis being a bad prognotic sign.
The prognosis in all cases is guarded .
No reliance however can be placed on the involvement or escape of the gland of the opposite side,
As a guide to this matter,as many'cases of double
parotitis recover and frequently those in which
only one gland is affected end fatally. Of the
four cases specially referred to, three occurring
in one ward,all ended fatally,the one in which
the parotitis was most severe and in which both
parotids were involved.recovered.
Having regard to the duct
spread theory of infection, the importance of
careful and systematic attention to the mouth
and especially to the state of the teeth,more
particularly the upper molars to which the orifio
of the duct is in such close proximity/becomes
of first importance,as lessening considerably
the chance of infection,in the event of the
patient being reduced to the low state of vital it
which predisposes to the onset of Parotitis.
The salivary secretion should be stimulated
along the lines suggested by Dr. Soltan Fenwick,
namely,to cause patients who are in a poor state
of vitality and who are suffering from an
excessively dry mouth to suck a small rubber
teat. This becomes of primary importance in
cases which are placed upon Rectal Alimentation.
B. After the onset of the parotitis treatment
I. Local applications of ickthyol 10 fo in
glycerine,or Belladonna and Glycerine.
In mild cases this is sufficient to
bring about resolution.
II. Incision of the gland.
This is necessary in cases which go on
to abscess formation and should be
carried out freely.
C. Vaccine Treatment.
An Antogenous Vaccine should be
given. In most cases a dose the equivalent of
inn million staphylococci is safe to begin with
to be repeated in 4 or fi days,depending upon the
constitutional reaction. The vaccine may best be
administered in normal saline., by the mouth.
Thisfcas so,far not been extensively used but the
result obtained in Case IV, would indicate its
use in these cases.