186 DISEASES OF THE SALIVARY GLANDS, TONSILS AND PHARYNX. 



inflammation is slight, resolution usually occurs in eight to fifteen days. 

 The onset of suppuration is announced by renewal of the fever, by more 

 marked swelling, which becomes localised at a given point, and by the 

 existence of deep or superficial fluctuation. Care, however, is required 

 to detect the last named. 



Necrosis may occur suddenly when the infecting organism is specially 

 virulent, and may affect one-third, one-half, or the whole of the gland. 

 The prognosis then becomes extremely grave, and if diagnosis has not 

 been prompt and treatment energetic, death may follow in a short time 

 from septic infection. 



Treatment. Unless some well-marked sign foreshadows a compli- 

 cation, treatment should be directed to ensuring resolution. Bleeding 

 has been recommended ; its good effects, how^ever, are open to doubt, 

 though one cannot entirely forbid it. All practitioners agree in recog- 

 nising the value of vesicant applications. The affected parts may be 

 freely dressed with an ointment containing 2 per cent, each of pulverised 

 tartar emetic and bichromate of potash, with the ordinary cantharides 

 blister, or even wdth a weak mercurial blister, provided that the animals 

 can be prevented from licking the w^ound. 



Some practitioners prefer vesicants prepared with cantharides and 

 croton oil. Whatever be the vesicant chosen, it is best after three or 

 four days to apply emollients of slightly antiseptic character, such as 

 ointments containing camphor, boric acid, salol, etc. When abscess 

 formation is recognised the abscess should be opened as early as possible. 

 Some precautions are necessary to avoid injuring important nerves and 

 vessels ; in dealing wdth a deep-seated abscess it is necessary to use the 

 knife for dividing the skin alone, to seek the abscess by blunt dissection 

 with the finger or wdth round-pointed scissors, and to open it with a 

 similar instrument. The cavity should then be freely w^ashed out wdth a 

 warm antiseptic solution — 3 per cent, carbolic solution, or 1 per cent, 

 iodine solution, etc. If necessary a drain composed of iodoform gauze 

 can be inserted, or a counter-oi^ening made. 



In the case of partial necrosis, all the necrotic tissue must be carefully 

 removed, injury to vessels, which would favour septicaemic infection, being 

 avoided. Afterwards free antiseptic irrigation should be employed several 

 times per day. 



In necrosis of the entire parotid extirpation may seem indicated ; but 

 the greatest prudence is demanded, for the operation is extremely serious 

 and delicate. 



CHRONIC PAROTIDITIS — PAROTID FISTULA. 



When a case of acute parotiditis is not .treated, and does not end 

 in suppuration, it is usually succeeded by chronic inflammation and fibrous 



