The other salivary glands are not in frequently involved, and in rare cases the submaxillary glands alone are affected.
The secretion of saliva is usually di minished, but occasionally it is increased. This, together with the painful swelling of the face, cedema of the throat, and constitutional symptoms, renders the patient extremely wretched. Attempts to examine the throat are often futile, the patient being scarcely able to open the mouth. He will make no attempt at mastication and refuse food, owing to the pain during deglutition. These symp toms are especially prominent when the tonsils are involved. Even speaking is then painful. Although the swallowing of acids commonly causes severe pain, it does not always do so, and the popular belief that it is an infallible sign for mumps is erroneous.
Constitutional symptoms are usually not severe. The fever is rarely high.
The temperature ranges in ordinary cases from 100° to 102° F. It frequently does not go above 101° at any time dur ing the attack, but in severe cases it may reach 104° or even more. Other symp toms are those common to all febrile con ditions. When the swelling is extreme, pressure upon the vessels of the neck may cause headache and marked cerebral dis turbance. Delirium is sometimes due to this cause. The severity of the disease varies greatly in different epidemics. In some the children are but slightly ill; in others they are quite seriously so when the disease is at its height, and are left weak and amernic.
Epidemic of mumps in which the sub maxillary glands instead of the parotids were affected. Of the 16 cases affected, 10 began by a swelling of the left sub maxillary gland and 6 of the right. The swelling usually disappeared in from 10 to 15 days. Three boys complained of testicular pain. J. Hoppe (lltinchenei med. \Voch., No. 34, '99).
Diagnosis. — The rapid onset and al most equally rapid subsidence of the glandular enlargement is a most charac teristic feature of mumps. This, to gether with the location of the tumor and its peculiar shape and large size, dis tinguishes it from acute enlargement of the lymphatic nodes, as well as chronic malignant growths. The location of the tumor is usually sufficient to distinguish it from the cervical swellings of scarlet fever and diphtheria, but examination of the throat should always be made in cases in which there is the slightest doubt.
Etiology.—Although mumps is spread by contagion, susceptibility is probably less than to any of the other contagious diseases. Close contact is usually neces sary. The disease is rarely carried from one person to another by a third, but that is known to have occurred. The disease is rare under four years and very few cases in infants have ever been reported. It is rare in adult life and still more so in old age. It is most common between the ages of five and fourteen.
Case of mumps in a man years of age who, before the development of the disease, probably had come in contact at church with persons in whose family parotitis had existed. The patient died. H. J. Wolcott (Amer. Jour. Med. Sci ences, Dec., '99).
The period of infection is doubtful.
Contagion is possible from the first symptoms or even before the swelling of the glands has appeared. The power of infection seems to continue in some cases for several days after the first symptoms have disappeared. Isolation, to be effective, must be continued for at least a week after the swelling has tirely subsided or nearly three weeks from the first symptoms.
Epidemics of mumps occur more com monly in the fall and spring than at any other season. They vary greatly in fre quency of occurrence and the extent of territory involved, occurring in some localities almost annually and in others only at intervals of many years. The fective power of the disease varies cidedly in different epidemics. Epi demics of measles and mumps are fre quently associated.
Micro-organism found by von Leyden in the secretion of the parotid, ob tained by catheterization of Stenon's duct, described. The organism is mor phologically and culturally character istic; it is a motile diplococcus, resem bling in form, position in cells, and stain ing properties the gonococcus. It grows on ordinary media, also on ascitic fluid and milk, which lastly is curdled by it. Inoculation of animals. even direct in jections into the parotid and the testicle, were unsuccessful. The coccus possesses a very slight virulence. Michaelis (Ber liner klin. Woeh., Apr. 12, '97).