CHAPTER II.. Diseases of the Salivary Glands, Tonsils and Pharynx.

DISEASES OF THE SALIVARY GLANDS, TONSILS AND PHARYNX.

PAROTIDITIS (PAROTITIS).

The term “parotiditis” indicates an inflammatory condition of the parotid gland. Of this disease several forms exist. The disease is termed simple when due to accidental causes or infections, specific when resulting from some special disease germ like the ray fungus. Anatomically, these diseases consist in inflammation of the glandular parenchyma and connective tissue stroma which surrounds the acini.

ACUTE PAROTIDITIS.

=Causation.= The causes of acute parotiditis are varied. Mechanical violence or contusions (due to collisions with fixed bodies, horn thrusts, or blows from the ox-goad) may produce it, the glandular parenchyma and connective tissue separating the acini or the peri-glandular tissue being torn, crushed, lacerated, and often also directly infected in consequence of the injury. Ascending infection through the medium of the salivary ducts represents a second possible cause of the disease.

Finally, parotiditis may, in some cases, constitute only a localisation of a general disease. It seems a fact that in rare circumstances parotiditis may assume an epizootic character, and attack a large number of animals in a particular stable or in neighbouring stables; and if, under these circumstances, we are unable to blame the food (which has not been done), we are forced to admit the influence of infection and contagion.

=Symptoms.= Whatever the cause, the symptoms are generally well marked. In many cases the first indication of the disease is apparent or real want of appetite, always complicated with difficulty in swallowing, and often accompanied by trifling fever.

Salivation, resulting from irritation of the gland and inability to swallow, becomes abundant, and at once draws attention to the buccal cavity and adjacent parts. Inspection of the patient then reveals the existence in the parotid region of a diffuse swelling, which on palpation is found to be hot and painful, and to occupy the whole of the parotid region between the lower jaw and the upper extremity of the neck. The lesion is usually unilateral, but occasionally bilateral.

Parotiditis may terminate in resolution, suppuration, or necrosis. The suppuration may either be simply subcutaneous and extra-glandular, or may involve a portion of the salivary gland and of the parotid lymphatic gland in addition.

Necrosis is exceptional, though Moussu saw double and total gangrene of both parotids, complicated with septicæmia, in the animal, of which a sketch is given herewith.

If the disease is due to violent injury by a foreign body, traces of a wound may be found, but it is often useless to search for these, even when the parts have been pricked with a sharp goad. When the inflammation has resulted from ascending infection of the salivary ducts, exaggerated sensibility may sometimes be detected throughout the whole length of Stenon’s duct, particularly at the point where the duct crosses the jaw. There is always marked difficulty in moving the head, particularly towards the side, and sometimes in a vertical plane. The head is extended on the neck, and is held stiffly in such a way as to suggest the possibility of tetanus. Some observers have described as an important symptom marked swelling of the orifice of Stenon’s duct. It is certainly difficult to detect, and furthermore is of no great significance.

=Diagnosis.= Although diagnosis is easy, it is a difficult matter to detect the point of origin of the disease. The salivation and difficulty in swallowing might seem to suggest pharyngitis, a condition which sometimes exists simultaneously. The distinction between this disease and the forms of chronic parotiditis, or tumour formation in the parotid (due to actinomycosis, lymphadenoma, melanoma), is also easy, on account of the slow development of the last-named conditions. The only condition liable to be confused with that under consideration is abscess of the subparotid gland.

=Prognosis.= The gravity of the disease varies greatly. When 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 complication, treatment should be directed to ensuring resolution. Bleeding has been recommended; its good effects, however, are open to doubt, though one cannot entirely forbid it. All practitioners agree in recognising 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 with a weak mercurial blister, provided that the animals can be prevented from licking the wound.

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 with 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 with round-pointed scissors, and to open it with a similar instrument. The cavity should then be freely washed out with 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-opening made.

In the case of partial necrosis, all the necrotic tissue must be carefully removed, injury to vessels, which would favour septicæmic 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 induration of the gland. Any obstruction of Stenon’s duct, whatever the originating cause (foreign bodies like wheat awns, oat grains, calculi, etc.) stops the flow of saliva throughout the excretory apparatus, and produces over the entire parotid region a doughy swelling, which might seem to indicate the existence of indolent parotiditis. The collections of liquid thus produced have improperly been termed “salivary abscesses.” If ascending infection fails to occur, or if infection is unimportant and does not lead to suppuration, a relatively painless chronic parotiditis develops, and in this case movements of the head and mastication and deglutition alone are impeded.

The salivary ducts, however, may become so distended that the main superficial collecting duct undergoes softening, and the skin covering it becomes ulcerated, just as would occur had a true abscess formed. Under such circumstances the skin soon yields and a salivary fistula is established.

=The symptoms= consist in swelling or induration of the gland, interference with movement of the head and with mastication; the whole developing slowly without pain or fever.

The distinction of this condition from actinomycosis of the parotid may sometimes present some difficulty until a fistula develops.

=The prognosis= is grave, because there is no hope of normal conditions being restored.

=Treatment.= Treatment often proves unsuccessful. Should the condition have resulted from an obstruction, it is first necessary to attempt the removal of such obstruction, whether it be a foreign body or calculus, and so to re-establish the normal channel for the saliva. Local stimulation may be tried, though in cases of fistula without much hope of success. Smart blistering of the parts surrounding the opening and firing in points have been recommended; but rather than persist in prolonged treatment of doubtful value, it is often better to prepare the animals for slaughter.

INFLAMMATION OF THE SUBMAXILLARY SALIVARY GLAND.

Inflammation of the submaxillary gland is rare in the ox. As in the horse, it is usually caused by the penetration of foreign bodies, such as glumes or awns of grain, fragments of straw, thorns, etc., into Wharton’s duct.

The difficulty in grasping food and the restricted movement of the tongue are the first symptoms to attract attention. On examination, the region of the “barbs,” usually on one side, appears injected, swollen, inflamed, and sensitive.

The submaxillary space is effaced by the swelling of Wharton’s duct; the corresponding submaxillary gland is doughy and painful on pressure. The symptoms rarely become more threatening than this.

=The diagnosis= presents no difficulty.

=The prognosis= is favourable.

=Treatment= consists primarily in removing the obstruction from the duct. Steady pressure from behind, forwards along the course of the duct, may sometimes cause the foreign body to be ejected into the mouth, along with a jet of offensive saliva. The distended and inflamed duct soon becomes emptied, and all the symptoms rapidly diminish. In other cases, when the obstructing body is firmly fixed in position, it is necessary to open the duct within the mouth by a stroke of the bistoury.

TONSILITIS IN PIGS.

“Acute and chronic forms are seen. The former has the general causes and symptoms of pharyngitis—fever, dulness, a disposition to lie with head extended and buried in litter, drooping ears, watery eyes, indifferent appetite, painful deglutition, and sometimes vomiting. Mouth red and hot, breath fœtid, tonsils swollen, their alveoli filled with muco-purulent matter or with fœtid cheese-like masses. Cough at first dry and hard, later loose and gurgling.

In chronic form there is general swelling of the tonsils with distension of follicles by above-mentioned putty-like masses, which are often calcareous. These are due to the proliferation of microbes, which find in these alveoli a most favourable field for their propagation. The affection usually ends in recovery, but may go on to grave local ulceration and general infection.

=Treatment.= Astringent antiseptics to buccal mucous membrane. Electuaries of honey or treacle and borax, sal ammoniac, chlorate or permanganate of potash and externally stimulating embrocations to the skin of the throat. In some cases solutions of iron chloride or tincture of iodine may be used with advantage and as a wash for the mouth and fauces. Attend to general health. If constipated give Glauber’s salt or jalap, ... and elimination through the kidneys must be sought through the use of nitrate of potash or other diuretic.” (Law’s “Veterinary Medicine,” Vol. II. p. 46.)

PHARYNGITIS.

Inflammation of the mucous membrane of the pharynx is less frequent in the ox than in the horse, a fact probably due to its less sensitive character in the ox and to differences in the methods of working oxen.

=Causation.= The causes are numerous and varied; and although local microbic infection undoubtedly plays the most effective part in the development of the disease, it is none the less certain that external influences are of considerable importance. For this reason chills, sudden variations in temperature, sudden arrest of perspiration, and currents of cold air have always been invoked as causes. Cruzel thinks that the ingestion of ice-cold water in winter is sufficient to produce acute pharyngitis. The action of rough forage may of itself explain the development of pharyngitis in animals constantly kept indoors under excellent hygienic conditions. In such cases the disease may be regarded as of traumatic origin. Furthermore, it is necessary to mention direct injuries of the mucous membrane caused by clumsy examination, awkwardness in passing the probang, and attempts on the animal’s part to swallow sharp foreign bodies, which scratch, tear, lacerate, or penetrate the mucous membrane and become fixed in it.

Finally, another series of causes, and not the least important, remains to be considered—viz., the forced administration of irritant substances like ammonia, tincture of iodine, oil of turpentine, very hot liquids, etc.

To sum up, the four great series of causes consist in direct irritation, intra-pharyngeal wounds, variations in temperature, or primary or secondary microbic infections.

=The symptoms= are characteristic. They consist in loss of appetite, difficulty in swallowing, consequent on the condition of the pharynx, and fever, which is often marked from the first. Pharyngeal dysphagia can easily be distinguished from that due to injury of the œsophagus, inasmuch as it occurs on the first attempt to swallow.

Urged on by hunger, the animal grasps food, which it chews and attempts to swallow, but immediately allows it to fall back into the manger, or ejects it by a painful coughing effort. In the case of liquids, even of lukewarm drinks, the same accident occurs, the food or liquid being returned by the nostrils. Slight salivation results from this difficulty in swallowing. The animal’s attitude is similar to that in parotiditis. The head is held stiffly, extended on the neck, in order to avoid compressing the region of the pharynx, and can only be moved slowly and with much pain. There is no apparent swelling of the parotid region, but on manipulating or pressing on the gullet the animal sometimes manifests the very acute tenderness of the parts by coughing and endeavouring to thrust away or to kick the examiner. Finally, examination of the mouth sometimes shows reddening and excessive sensibility of the soft palate and of the pillars of the fauces.

These symptoms often assume a more alarming character, or are complicated by others; in fact, the condition very rarely stops at pharyngitis, but is usually accompanied by inflammation of the larynx, of the soft palate, and of the naso-pharynx. The whole throat is then inflamed; the nose and sometimes the eyes discharge, and there is difficulty in swallowing, interference with respiration or noisy respiration, and intense fever.

=Diagnosis.= The diagnosis presents no difficulty, the symptoms mentioned being easy to identify, whether the condition be simply inflammation of the pharynx or be of a more extensive character. Nevertheless, cases occur where the symptoms are alarming, but in which one might hesitate between the diagnosis of ordinary acute sore throat and the sore throat which ushers in gangrenous coryza. A definite expression of opinion must then be deferred to a later date; for one cannot be absolutely certain whether or not the other signs of gangrenous coryza will appear.

When there is only difficulty in swallowing one might à priori suspect traumatic injury of the mucous membrane, with or without the presence of a foreign body. It is also necessary to bear in mind the possibility of difficulty in swallowing being occasioned by reflex irritation without local lesions, originating in enlargement of the retro-pharyngeal lymphatic glands as a consequence of tuberculosis or other disease.

=The prognosis= is favourable; even without treatment acute pharyngitis usually tends to recovery in eight to twelve days, and rarely becomes complicated. Nevertheless, some reserve ought to be exhibited in cases of pharyngitis due to the action of rough forage, the removal of the cause being here indispensable to any improvement. Similarly in cases of pharyngitis due to foreign bodies having penetrated the mucous membrane, which are chiefly characterised by inability to swallow, the disease may continue for a very much longer time than above indicated, unless the foreign body is discovered and removed. Inflammation is limited to a zone surrounding the point of implantation. It extends more deeply with movements of the foreign body, and may end in the formation of an abscess. Of this variety is Hopsomer’s remarkable case, in which a darning-needle finally obtained exit through the submaxillary space, in which it had caused the formation of an abscess.

=Treatment.= The treatment is the same whether we are dealing with a simple acute pharyngitis or with a more widely distributed inflammation. It consists in smartly stimulating the region of the throat with mustard, cantharides oil, or ointment, or with an ointment containing 2 per cent. of tartar emetic and of bichromate of potash, and then covering the parts with a flannel hood. This mode of treatment seems preferable to that recommended by German authors—viz., the application of cold compresses to the throat, the administration of cold gargles, etc. Moderate bleeding, to the extent of two or three quarts, has the great advantage, as in all similar cases, of lowering the temperature.

This treatment may, if necessary, be completed by the internal administration of 3 to 5 drams of Kerme’s mineral (oxysulphuret of antimony) in electuary, according to the animal’s size. Medicated inhalations diminish local irritation, render swelling less painful, and facilitate the separation of false membranes and the discharge of adherent mucous secretions.

The ordinary food should be replaced by cooked roots, lukewarm drinks and gruels, all rough fodder being prohibited.

If difficulty in swallowing alone continues, the operator should examine the mucous membrane of the pharyngeal cavity with the hand, in order to discover and remove any foreign body which may have become implanted there.

PSEUDO-MEMBRANOUS PHARYNGITIS IN CATTLE.

In addition to the above acute forms of pharyngitis, a pseudo-membranous, croupal, or pseudo-diphtheritic pharyngitis has been described in the ox. It is due to polymicrobic infection, and is characterised by the formation of false membranes on the pharyngeal mucous membrane. The condition seems to be a pharyngitis of exceptional intensity, varying markedly from the classic type and being most nearly related to severe sore throat, laryngitis, gangrenous coryza, etc.

It rarely attacks aged cattle, but is readily transmissible to calves and young stock. Cadéac failed to inoculate it on guinea-pigs and rabbits. Damman succeeded with sheep and with rabbits, the latter dying in twenty-four hours after inoculation with hæmorrhage at the seat of puncture. Löffler hypodermically infected mice and produced extensive infiltration of the abdominal walls, and often of the peritoneum, surface of the liver, kidneys and intestine, on which formed a thick yellowish exudate containing the organism.

=Causes.= Löffler found filaments of a long delicate bacillus about half the thickness of the bacillus of malignant œdema. The bacillus did not grow in nutrient gelatine or in sheep’s blood serum, but readily grew in blood serum of the calf. Cadéac gives as predisposing causes: sudden chills, rapid alterations of temperature, inhalation of irritant vapours, suppression of cutaneous secretion, swallowing irritant liquids, and injuries.

=Symptoms.= The nasal membrane is reddened, thickened and covered in patches with false membrane, causing snuffling and wheezing breathing. The throat is tender and swollen, cough is frequent, gurgling, and followed by expulsion of false membrane, muco-pus and some blood. Shreds of false membrane adhere to the nose and lips. Other symptoms are: fever, accelerated pulse, dark mucous membranes, haggard countenance, mouth open, hanging tongue, stringy salivation, and constipation or diarrhœa.

The disease runs a rapid course, and death may occur in twenty-four hours. Recovery may be equally rapid, but often convalescence is protracted.

=Lesions.= Intense congestion of mucosæ of nose, mouth, pharynx, larynx, and bronchi, with here and there patches of false membrane, which may be soft or tough, according to the duration of the attack. The deep surface of the false membranes is blood-stained; and, according to Preitsch, false membranes sometimes occur in the œsophagus, rumen, and omasum, which in consequence may show patches of ulceration.

=Treatment= (as for the horse). This includes poultices, counter-irritants, laxatives, febrifuges, alkalies and antiseptics. Inhalations of medicated vapour, warm water to which has been added some antiseptic—carbolic, lysol, creolin, camphor, sulphurous acid; or for calves, iodoform, oil of turpentine, calcium sulphide, silver nitrate, coal tar. To detach the false membranes ipecacuanha and potash chlorate, or soda sulphate, or magnesia sulphate may be tried. Papayin and pepsin have been suggested as appropriate remedies. Anyodnes—digitalis, belladonna, morphia and aconite—may be useful. Tracheotomy is indicated as a last resort.

PSEUDO-MEMBRANOUS PHARYNGITIS IN SHEEP.

Roche-Lubin states that this is common in flocks as a result of moving the sheep in dusty enclosures. The dust is supposed to excite the intense croupous inflammation of the mucous membrane. The disease has been noticed in spring in young lambs shortly after weaning. Damman states that he transmitted the disease to the sheep from the exudate of the calf.

=Symptoms.= Frothy salivation with constant movements of the jaws, viscid nasal discharge, difficult deglutition, panting, snuffling breathing, throat swollen and very tender, frequent cough, discharge of exudate. The head and neck are extended, the eyes dull, appetite is lost, the mucous membranes are red or cyanotic, and the animal appears weak and listless. As respiration becomes more difficult the mouth is held open, the tongue is protruded, and with each cough shreds of false membrane are expelled. Death from suffocation is not uncommon.

=The lesions= are not different from those seen in the calf.

=The treatment= is similar to that for the calf. Tepid drinks containing hydrochloric acid, or sulphate of soda (1 lb. to 50 sheep) in the drinking water, has been recommended. Fumigation with sulphurous acid or chlorine may be tried. Small numbers may be treated by swabbing the throat with solution of sodii hyposulphis or weak caustics and antiseptics.

* * * * *

In young and in adult pigs pseudo-membranous pharyngitis is often only a manifestation of pneumo-enteritis. It therefore calls for no special description at this point. No exact investigation of the organisms which produce these forms of pharyngitis with false membrane formation has been made in veterinary surgery. We only know that these diseases are not true diphtheria due to “Klebs’ bacillus.” Treatment should be very energetic from the commencement, but otherwise it differs in no respect from that ordinarily adopted.

Tonics and stimulants, like alcohol, wine, coffee, etc., are indicated.

“Pseudo-membranous pharyngitis has long been recognised as a contagious disease of swine, attacking especially swine kept in herds or in close, insanitary pens. Young pigs are more liable to attack than older animals, perhaps, owing to the older animals having suffered the disease in early life.

Modern observation shows that pharyngitis with false membranes is common in swine plague, and the present tendency is to refer all such cases to that category. It is, however, altogether probable that the occurrence of local irritation, with the addition of an irritant or septic microbe altogether distinct from that of swine plague or hog cholera, gives rise at times to this exudative angina. Certain it is that septic poisoning with the food is not at all uncommon in the hog, in the absence of these infectious diseases.

=Symptoms= are those of sore throat, with much prostration, a croaking cough, yellow discharge from nose and mouth, and marked muscular weakness. The tongue, tonsils and soft palate are red, swollen, and studded with patches of false membrane. The identification of swine plague may be made by the history of the outbreak, the number of animals affected, the tendency to pulmonary inflammation, the enlarged lymph glands, the presence of the non-motile bacillus, which does not generate gas in saccharine media, and which readily kills rabbits and pigs with pure cultures of the germ.

=Treatment.= Isolation, cleansing and disinfection. Locally antiseptics and generally a febrifuge regimen will be advisable.”

PHARYNGEAL POLYPI.

The term “pharyngeal polypi” includes tumours of varying character, which affect the polypus form, and occur with considerable frequency in the bovine species. Many of these polypi are simply actinomycotic growths springing from the pillars of the fauces, from the upper parts of the palate or from its posterior surface. Less frequently they arise from the lateral walls or the free surface of the hard palate.

=Symptoms.= The symptoms are so characteristic that the diagnosis rarely presents much difficulty. They may shortly be described as indicative of repeated obstruction in the pharyngeal, œsophageal or laryngeal region. At the moment of deglutition, the polypus is thrust towards and obstructs the œsophageal orifice.

Reflex stimuli are thus excited, which prevent deglutition; an attack of coughing occurs, and food mixed with saliva is ejected from the mouth and nostrils. The attack of coughing displaces the polypus either in a forward or lateral direction, and swallowing then again becomes possible, until by changing its position the growth produces fresh signs of obstruction.

In other cases the polypus may only be of such small size as to impede the food passing through the pharynx on its way into the œsophagus or to cause difficulty in respiration by partially blocking the pharyngeal portion of the nasal cavities. In such cases deglutition is only checked and rendered slower.

Or again, the pedicle of the polypus may be sufficiently long to allow the growth at certain moments to fall in front of the laryngeal opening. Respiration is then painful, difficult and noisy. Unless the growth is displaced during the subsequent attack of coughing, asphyxia may appear imminent, or may even occur unless assistance is afforded.

Guided by these symptoms, the operator will explore the pharynx manually, and thus discover the position and size of the tumour. Tumours of the naso-pharynx produce very similar symptoms.

=The prognosis= is based on the information obtained by manually exploring the pharynx. It is relatively favourable if the polypus has a well-marked neck, but is very grave if the tumour is largely sessile and cannot be removed.

=Treatment.= Medical treatment appears useless except in cases of polypi due to the presence of actinomyces. The administration of iodine and iodide of potassium, in large doses, may then lead to resorption; but extirpation is often preferable.

In other cases extirpation is the only rational treatment. The operation necessitates the performance of provisional tracheotomy in order to avoid risk of asphyxia. The growth may be directly removed through the buccal cavity without incision, provided that it prove possible to pass the chain of an écraseur around the pedicle; or through the buccal cavity, with incision, after vertically or obliquely dividing the soft palate; or, lastly, through the larynx, after performing median laryngotomy, thus obtaining access to the pharynx.

Only the first method of intervention is to be recommended; the last two are more delicate. They necessitate after-treatment, and when the patients are in a condition for slaughter it is frequently preferable to send them to the butcher. The essential point is not to act without a full knowledge of the causes.