Symptomatic or secondary parotitis with special reference to etiology

Abstract

I. INCIDENCE. 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. A. Etiology. 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 Pyaemia. This is organismal. In nearly all cases Staphylococcus Pyogenes Aureus is the cause. Predisposing Causes. 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 disease. B. The parotitis may fail to resolve and death result. 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.IV. TREATMENT. A. Prophylactic. 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 consists of:- I. Local applications of ickthyol 10 fo in glycerine,or Belladonna and Glycerine. In mild cases this is sufficient to bring about resolution. IV. Treatment. 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.