Parotitis.

Synonyms.—Mumps; Epidemic Parotitis.

Definition.—An acute, infectious, and contagious disease, characterized by an inflammation of one or both parotid glands, rarely terminating in suppuration, a tendency to metastasis to the testicle in the male, and the ovaries and mammary glands in the female. This is not to be confused with a metastatic parotitis which sometimes follows or accompanies such infectious fevers as dysentery, diphtheria, and other low-grade fevers.

Etiology.—The specific cause is a contagion generated during the course of the disease, but, like that of the eruptive fevers, its exact nature is not known. Bacteriologists have as yet failed to isolate a specific microbe which will of itself produce the disease. All that is necessary for one to contract the disease, is to come in contact with the breath of the afflicted person, the excretions, especially the salivary secretions, or even the apartments occupied by the patient.

One attack secures immunity from a subsequent one, though single mumps will not prevent the opposite gland from suffering subsequently if exposed to the contagion. While it may be endemic in large cities, it nearly always prevails an as epidemic, affecting children in preference to adults, though the latter are not exempt. It prevails more extensively in the spring and fall months.

Pathology.—Trousseau claims that the lesion does not proceed beyond an exalted hyperemia and congestion, while Virchow believes that there is a catarrhal inflammation of the ducts of the glands. Certain it is that the changes, whatever they may be, are of such a slight character that suppuration rarely occurs. The gland becomes swollen and hard; but after a few days it subsides, resolution being complete.

Symptoms.—Occasionally the patient will complain of feeling ill for a day or two before the development of the disease. The head and back ache, the appetite is impaired, the bowels are constipated, and there is an unpleasant taste in the mouth.

The period of incubation is from ten days to three weeks, during which time there are rarely any symptoms which would indicate the coming trouble. Usually there is a slight chill, followed by more or less febrile reaction, and with the development of the fever the swelling of the parotid gland is first noticed. The child complains of pain just below the ear, especially when it opens or closes the mouth.

In some cases the chill and fever will be so slightly marked that the patient does not call attention to it. In others, every symptom will be marked and severe, and the patient may have a high fever for a week. The swelling may be confined to one side and run its course without the other gland being at all affected, and then it is said that the person has had single mumps. In this case he will be liable to a second attack, the other gland being affected.

There are not only the usual symptoms—pain, heat, redness, and swelling, all being marked—but we have, in addition, a peculiar nasal voice and considerable difficulty in deglutition. Any pungent substance taken into the mouth will cause pain, and it is generally suggested to the patient to try a pickle. The sourness usually causes some pain in the parotids, and the patient finds that he can hardly swallow or move his jaw. The disease runs its course in from four to eight days; the fever first declines, and then swelling gradually passes away. (Scudder.)

Complications and Sequelae.—As a rule, mumps is an innocent affair, running its course without any danger, though in rare cases very serious complications may arise. The most frequent is orchitis in the male, and mastitis, ovaritis, or vulvo-vaginitis in the female. As the swelling begins to subside in the parotid, the patient experiences a sharp pain in the newly affected organ, and in a few hours the swelling has increased and an inflammation has set up with all the intensity manifested at the original seat. It may result in suppuration or terminate in resolution. Like orchitis from gonorrhea, it has no regular course, and may terminate in three or four days, or run for ten or more days.

The most serious complications are the cerebral affections. Where the fever has run a very high course attended by delirium, meningitis has followed. Hemiplegia has also occurred. Otitis media, followed by deafness, has been recorded. The eye is not often affected, though atrophy of the optic nerve has been noted. Arthritis, albuminuria, and endocarditis have each been noticed.

Diagnosis.—The diagnosis is very easily made. The location of the swelling, in front and below the ear, with pain on moving the jaws, especially when any pungent substance is eaten, proves the character of the disease.

Prognosis.—The prognosis is always favorable.

Treatment.—This is simple but effectual. We put our patient upon aconite five drops, phytolacca ten to twenty drops, water four ounces, teaspoonful every hour. If there be a burning sensation experienced, and the child be restless and cries out in its sleep, the pulse sharp, and the tongue shows elevation of the papilla, rhus tox., five to ten drops, will replace the phytolacca.

Where the fever is intense, and there is danger from cerebral complications, put the patient on gelsemium, ten to thirty drops to four ounces of water, and give teaspoonful every hour, at the same time sponging the head with hot water. Where there is much muscular pain, give macrotys.

Locally the gland may be covered with cotton wadding, over which is placed oil silk, or cloths wrung out of hot water may be applied. Some prefer a lotion of phytolacca and echinacea.

Where the testicle is involved, strap the gland firmly upon the abdomen, and continue the internal treatment used for parotitis. The bowels should be kept open and the patient placed upon a fluid diet, preferably milk. During convalescence, care should be taken that the patient does not expose himself, thereby lessening the chances for metastatic changes.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.