INFLAMMATION OP THE PAROTID, ETC. 457 



recorded, where, in the course of idiopathic parotitis, fatal meningitis 

 has been developed. 



When symptomatic parotitis occurs at the height of typhus or any 

 of the above-mentioned diseases, the apathetic patients do not usually 

 complain of pain or any other symptom. Occasionally slight chills or 

 an exacerbation of fever precede the formation of the parotid tumor. 

 This sometimes forms gradually, at others very rapidly, and generally 

 affects only one side. If parotitis comes on during convalescence from 

 typhus, etc., it is accompanied by the same symptoms that we have 

 described for idiopathic parotitis. Symptomatic parotitis also may end 

 in resolution. This occurs most readily when the tumor has formed 

 gradually and attained only a moderate hardness and extent. The 

 diminution in size is sometimes slow, sometimes rapid. When about 

 to suppurate, the swelling becomes uneven, nodulated, and very red ; 

 it usually shows fluctuation at several points, and, when opened 

 spontaneously or artificially, benign pus is evacuated. Occasionally 

 the opening occurs simultaneously outward, and into the external 

 auditory meatus, nore rarely into the mouth or pharynx. Finally the 

 pus may burrow a..ong the sterno-cleido-mastoid muscle, or the oesoph- 

 agus and trachea, and form abscesses at the lower part of the neck 

 or even enter the chest (Bruns). While mortifying, the skin cover- 

 ing the tumor becomes dark blue and discolored ; the tumor, which 

 was previously hard, becomes doughy and sinks in ; after a spontaneous 

 or artificial opening, a discolored pus, mixed with shreds of tissue, is 

 evacuated. 



TREATMENT. As idiopathic parotitis almost always ends in a cure, 

 if left to itself, we have little to do but protect the patient from inju 

 rious influences, and to regulate the digestion and bowels, while the 

 disease lasts. We keep the patient in his chamber, cover the swell- 

 ing with wadding or a spice-bag, and as long as the fever lasts let him 

 avoid eating much meat or other protein substances which would not 

 be readily digested (see diseases of the stomach). In some cases an 

 emetic or laxative may be necessary. If hardness and greater sen- 

 sibility of the swelling, with increase of the fever, excite fears of sup- 

 puration, we may attempt to check it by applying leeches. If we find 

 fluctuation, we should apply cataplasms, and open the abscess early, to 

 prevent further destruction of the parotid, or perforation of the pus 

 into the external auditory meatus. Irritant applications have been 

 used to prevent metastases, and sinapisms and blisters have even been 

 applied to the parotid region, to induce a return thither of the inflam- 

 mation that had affected the scrotum and testicles. As experience 

 has shown, such treatment can only prove injurious. 



In symptomatic parotitis even local blood-letting is badly borne, oir 



