52 THE TONER LECTURES. 



The treatment is important, especially when we consider 

 the results. Of 13 cases opened by incision, only 2 died; of 

 34 in which there is no mention of an operation, all died. If 

 small, they will either be overlooked until the post-mortem 

 reveals their existence, or if recovery take place, absorption 

 of tlie clot, and regeneration of the muscle will follow, inde- 

 pendent of treatment. If large, every possible effort should 

 be made by poultices, etc., to bring about early softening, and 

 as soon as softened, the}'^ should be opened. That the aspi- 

 rator ma^^ be of service, is probable, but as yet it is, I believe, 

 untried. 



VI. PAROTITIS. 



Parotitis is occasionally an exceedingly important surgical 

 complication, whose onset is always to be dreaded, lest it 

 bring in other evils worse than itself. Murchison believes 

 with Graves that the inflammation begins in the areolar tissue 

 between the lobules of the gland itself, but Hoffmann has 

 unquestionably shown tliat, at least in typhoid, the pancreas 

 and all the salivary glands are in a state of rapid cell prolife- 

 ration in nearly every case, and that parotitis proper is merely 

 "an exaggeration of the changes that usually take place in this 

 gland during typhoid fever, and bears the same relation to 

 these changes that ulceration and perforation of the intestine 

 do to the infiltration of the intestinal follicles." This exagge- 

 ration he believes to be due to the dense parotid fascia which 

 compresses the gland. But this is not the only role this dense 

 investing fascia plays. The compression of the swollen tissues 

 not rarely produces gangrene, so that the entire gland may 

 slough out in great masses like tow. In a case related to me 

 by Dr. Grove, it involved both glands and proceeded so far 

 that the fingers could almost meet behind the phar3'nx. 

 The compression also is very favorable to thrombosis, which 

 may extend to the brain by the diploic veins or even to the 

 internal jugular itsel£ Necrosis and septicaemia not rarely 



