[Reprinted from the American Gynecological and Obstetrical Journal 
for November, 1896.] 
TWO CASES OF PAROTIDITIS FOLLOWING 
C CELIOTOMY.* 
Wilmer Krusen, M. D. 
First Case: Non-suppurative Parotiditis. 
L. O., aged seventeen years, an Italian, admitted to the Jeffer- 
son College Hospital, October n, 1893. 
Diagnosis.—Retroversion of uterus with inflammatory adhesions 
and hypertrophied cervix. The patient was operated on October 
16th by Dr. Montgomery, the cervix amputated by Schroder’s 
method, the abdomen opened and both appendages removed, and 
the uterus sutured to the anterior abdominal wall. 
On the second day after the operation a marked swelling of the 
right parotid gland was noticed, with localized heat and marked 
tenderness. At first cold lead water and laudanum was applied; 
later, simply the ice-bag, and the symptoms and signs gradually 
disappeared. No evidence of suppuration, either locally or constitu- 
tionally, was present, and her subsequent recovery was uneventful. 
Second Case: Suppurative Parotiditis. 
A. S., aged thirty-two years, was admitted to Jefferson Hospital 
on January 3, 1896. 
Diagnosis.—Uterine fibroid and ovarian cyst. Operation on 
January 7th by Dr. Montgomery performing supravaginal hyster- 
ectomy and removing the cyst. On January nth, the fourth day 
after the operation, the patient developed a parotiditis, the gland 
being markedly swollen, swelling extending forward to the cheek, 
upward beyond the zygoma, downward and backward to the neck; 
* Read before the Philadelphia Obstetrical Society, October 1, 1896. 
Copyright, 1896, by J. D. Emmet, M. D. 2 
Wilmer Krusen, M. D. 
it was tense, hot, and very painful. After about four days the swell- 
ing subsided, only to reappear on the 24th inst., seventeen days 
after the operation. Four days later the most prominent portion of 
the gland was incised, and about four drachms of pus evacuated. 
After this the swelling gradually abated, and the patient was dis- 
charged on February 19, 1896. An examination of the pus made 
by Dr. D. Braden Kyle showed the presence of Streptococcus 
pyogenes. 
The occurrence of parotiditis after coeliotomy is one of the more 
infrequent sequelae, and, according to Pozzi, has always been con- 
sidered as evidence of a certain degree of septicaemia. In fact, it was 
formerly the cause of a grave prognosis. 
In the first case reported one would suppose that change in the 
parotid gland depended simply on the inexplicable sympathetic con- 
nection between the ovary and parotid gland (which seems closely 
allied to the sympathy existing between the uterus and the thyroid 
gland). The normal temperature and absence of other evidences of 
suppuration, and the rapid subsidence of other symptoms, argues 
against the septic process. In the second case the development of the 
parotiditis, followed by the total disappearance of the swelling, and 
ten days later the occurrence of a secondary parotiditis suppurative 
in character, is unusual. An interesting fact in regard to these two 
cases is that they were both foreigners, one an Italian, the other a 
German, neither one being able to communicate with nurses or at- 
tendants in English. In the second case, acute mania was also a 
complication. In neither case did an examination reveal any com- 
plication within the pelvis. From these cases we may infer that 
there is a sympathetic parotiditis following operations or injuries 
to the abdominal or pelvic viscera, which is simply and purely 
reflex, while another class of cases is probably septic in character, 
and attended by suppuration in the gland. Cases have been re- 
ported of parotiditis following not only abdominal operations, but 
also operations for perineorrhaphy and haemorrhoids. 
In the wide experience of Goodell he records but three cases, 
and he considers them not due to a mere coincidence, but caused 
by a reflex sympathy between the ovaries and these glands. What 
has been termed parotid bubo may occur after ovariotomy, usually 
associated with general septicaemia. Ross, of Toronto, in a paper 
before the American Association of Obstetricians and Gynaecolo- 
gists, reports a case of suppurative bilateral parotiditis developed Two Cases of Parotiditis following Cceliotomy. 
3 
on the tenth day after operation, and the case terminated fatally 
on the forty-sixth day. Prior to death paralysis of the left side of 
the face and drooping of the left eyelid were noticed. 
Paget has collected one hundred and one cases of parotiditis 
following injury to the abdominal or pelvic organs, and due not to 
pyaemia, but to reflex nervous action. Fifty of these were due to 
slight injuries, as a blow or the introduction of a pessary. It may 
occur during pregnancy. In seventy-eight of these cases, forty-five 
of them were suppurative and thirty-three resolved without sup- 
puration. Symptomatic parotiditis may occur in typhoid fever, pneu- 
monia, scarlet fever, and other medical diseases. In some of these 
cases the inflammation extended from the mouth to the parotid 
gland, and argues in favor of cleanliness of the mouth and atten- 
tion to the teeth and tonsils. The treatment is carried out on ordi- 
nary surgical principles.