On several occasions in which blood has been effused freely into the pelvic cavity, either as a consequence of tubal pregnancy, or as a sequel to an operation, such as an abdominal myomectomy, and the blood has been allowed to remain, or it has been inefficiently drained, the patients have died from septic pneumonia.
In cases of septic thrombosis the patients run a definite risk from pulmonary embolism. When the embolus is large the patient sometimes dies in a few minutes (see [p. 101]); but even in cases where the embolus is too small to promptly destroy the patient’s life, its lodgment in the lungs entails in some instances a very serious illness, and occasionally a fatal termination.
Parotitis. Septic parotitis, or, as it is sometimes called, symptomatic or secondary parotitis, to distinguish it from mumps, is an occasional sequel to abdominal operations of all kinds. Careful observations have shown that parotitis is more common after operations for septic conditions, and, although it occasionally occurs after operations which run an afebrile course, the conditions underlying it are mainly septic in character.
Septic parotitis is distinguished from mumps in the following points:—
It occurs as a complication of some other affection, is in itself non-contagious, and occasionally suppurates. There are two views held in regard to its etiology: some hold that it is due to direct infection of the duct (Stenson’s) of the parotid gland by micro-organisms from the mouth, whilst others maintain that the path of infection is mainly by the blood-stream.
Two able investigations have recently been published in regard to this condition, in which one writer (Bucknall) supports the view that it is an ascending affection from the mouth, and the other (Tebbs) brings forward evidence that the elements of infection reach it by the blood-stream.
Lequeu has seen many cases of post-operative parotitis, and at his suggestion Verliac and Morel investigated the condition in the laboratory. They came to the conclusion that this variety of parotitis originates in the ducts of the gland.
When parotitis complicates post-operative convalescence, it is almost entirely confined to septic cases: it may occur within two days of the operation or as late as the thirtieth day. It is more common between the sixth and tenth days, and its advent is accompanied by much disturbance. The parotid swells and becomes painful and tender; the skin over it is red and often brawny. These signs are accompanied by fever, malaise, and depression of spirits. In mild cases they subside in a few days, but in severe cases rigors occur, with high fever and suppuration.
The mild cases are best treated with warm fomentations, frequently changed. If suppuration occurs, the pus will need to be evacuated by a scalpel, but incisions in a suppurating parotid gland should be carried out with careful regard to the branches of the facial nerve (pes anserinus), and the large vessels intimately associated with it.
The surgeon need not be in a great hurry to use the scalpel in these cases, for it seems occasionally as if the skin would slough, and yet when it is incised no pus escapes. This septic parotitis is deceptive in the red and brawny appearance of the skin covering the swollen gland, and the misleading sense of fluctuation. In many instances the inflammatory products escape by way of the parotid duct.