Parotitis after injury or disease of the abdomen or pelvis / by Stephen Paget.

  • Paget, Stephen, 1855-1926.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Parotitis after injury or disease of the abdomen or pelvis / by Stephen Paget. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    fore, assume, in some of them, the influence of the nervous system as at least part cause ? This influence of the nervous system is the more probable, if we consider how often retention or suppression of urine follows ab- dominal or pelvic operations; here the influence of the nervous system cannot be doubted. Again, attention has lately been drawn to the fact that in many cases of disease of the thoracic or abdominal viscera, there is inequality of the pupils ; they differ not only in size, but also in their susceptibility to light; and this difference between them may change as the disease goes on. This inequality of pupils is, it is said, most often found in those diseases which not only affect the system generally, but which, like pneumonia, pleurisy, and hepatic and renal colic, are also definitely localised. In the same way, with regard to parotitis after abdominal or pelvic lesions, we may admit that the general condition of the patient may help to cause it, without denying the local influence of the reflex nervous system. Finally, it seems probable that this change brought about in the gland is not a spasmodic closure of the duct, such as Yerneuil de- scribes, but some change in the gland itself—not a retention, but a suppression. Retention of saliva, as shown by many cases collected by M. Terrier, causes a mere passive dilatation of the gland, which varies in a transient fashion with every meal, never suppurates, is never accompanied by disturbance of the general health, and vanishes when a probe or a catheter is passed up the duct. Perhaps this parotitis may be due, as Mr. Knaggs of Huddersfield has suggested, to a reaction consequent on long-continued constriction of the arteries of the gland. But here I will take to heart the warning given by Graves in the Clinical Lecture already quoted. “I shall leave the explanation, he says, “to my juniors, who always explain matters, according to my observation, much more readily than their seniors.” Note.—It may be observed that Dr. Gowers, in his work on Diseases of the Nervous System, chap, i, p. 92, gives a case where the patient, “thirteen days after a stab-wound in the abdomen, which healed well, had an attack of parotitis, with facial palsy ; on the fortieth day there developed paralysis of the tongue, vocal cords, and limbs ; and on the sixth day after the onset of these symptoms he died from respiratory palsy. Extensive peripheral neuritis was the only nerve- lesion.” London : Printed by the British Medical Association, 429 Strand, W.C.