a, typhoid fever, scarlet fever,
measles, and other eruptive fevers.

The _post-operative_ form of parotitis is most frequently met with
after laparotomy for such conditions as suppurative appendicitis,
perforated gastric ulcer, ovarian cyst, and pyosalpinx.

These secondary forms are probably due to infection from the mouth
under conditions in which the secretion of saliva is arrested or its
escape from the gland interfered with.

The early symptoms are apt to be overshadowed by those of the general
disease from which the patient suffers. At first the gland is swollen,
hard, and tender, and the seat of constant, dull, boring pain; later
there is redness, oedema, and fluctuation. The movements of the jaw
are restricted and painful, the patient is unable to open the mouth,
and has difficulty in swallowing. The inflammation reaches its height
on the third or fourth day, and usually ends in suppuration. The pus
is scattered in numerous foci throughout the gland, and sometimes
large sloughs form. The dense capsule of the gland prevents the pus
reaching the surface and causes it to burrow among the tissues of the
neck, giving rise to dyspnoea and dysphagia. It may find its way
downwards towards the mediastinum, inwards towards the pharynx--where
it constitutes one form of retro-pharyngeal abscess--or upwards
towards the base of the skull. Not infrequently it burrows into the
temporo-mandibular joint, or escapes by bursting into the external
auditory meatus. Serious haemorrhage may result from erosion of the
vessels traversing the gland or of the internal jugular vein, or
venous thrombosis may ensue. Persistent paralysis may follow
destruction of the facial nerve; and salivary fistulae may form. Death
may take place from toxaemia even before pus forms.

_Treatment._--During the first two or three days hyperaemia is induced
by means of poultices, hot fomentations, or Klapp's suction bells, and
the mouth is frequently washed out with an antiseptic. As soon as
there is reason to believe that pus has formed an incision is made
behind the angle of the jaw, parallel to the branches of the facial
nerve, the abscess opened by Hilton's method, a finger passed into the
gland, and all septa broken down and drainage secured.

Acute infection of the #submaxillary gland# is met with under the same
conditions as that of the parotid. Both glands are occasionally
attacked at the same time.

The acute phlegmonous peri-adenitis of the su