Bacillus found in the blood and urine of a very severe case of parotitis occur ring in an adult. It may be called the "diplobacillus parotitis." In the urine the organism is very much more numer ous than in the blood. It is a small, plump rod, rather oval in shape, and about twice as long as it is broad (it is about 1 to 1.5 microns long). It stains irregularly, the ends staining very deeply, while the centre stains but faintly.
Culture-tubes containing gelatin, agar agar, blood-serum, and Loetiler's media were inoculated, but as there were no results it would seem that this organism is not capable of artificial cultivation upon the media named. Charles F.
Craig (Yale Med. Jour., Apr., 'OS).
Recurrence of mumps is uncommon, but is not unknown, as my own personal experience has positively demonstrated.
Pathology. — Opportunity for post mortem study of parotitis is so rare that its pathology is not yet fully understood. So far as known, pathological changes are confined to the salivary glands. Infec tion probably takes place through the salivary ducts, the gland-substance being first involved. The periglandular tissue is involved secondarily. In those cases in which pathological examinations have been made the salivary ducts have been found to be occluded by swelling and in flammation of their walls. The gland itself is hyperwmic and oedematous. Sup puration is rare and probably does not occur in simple parotitis. Its occasional occurrence is probably due to pyogenic bacteria which have found admission with the specific germs.
Complications and Sequels. — Among young children complications are rare. Suppuration occurs in about 1 per cent. of the cases, according to Holt, and is usually due to some accidental infection by pyogenic germs. Deafness, due not to otitis media, but to disease of the au ditory nerve, has been reported in a very few cases. It is usually unilateral and permanent. Facial paralysis, multiple neuritis, and other nervous disorders also occur in very rare instances, and nephri tis is not unknown as a sequel.
Case of paralysis of the left side fol lowing mumps. Tile complication lasted two years. Chavanis (La Loire Med.. Nov. 15, '91).
Case in which acute inflammation of both lacrvmal glands occurred in a pa tient suffering from epidemic parotitis. Schrader (Zeliender's Jilin. Slonats. f. Augenh., Dec., '91).
Rheumatism occurs as a complication in 2.S per cent. of all eases, with or
without endocarditis. Catrin (Cruz. Med. de July 6, '93).
Case of acute nephritis, with symp toms of cerebral urmnia, preceding a double orchitis due to mumps. In this ease recovery finally took place. Tous saint (Archives de Med. et de Pharm. Milit., Oct., '93).
In the small proportion of eases that suffer from aural complications the at tack usually comes on between the fourth and eighth days, and declares itself by impaired hearing, tinnitus, dizziness, nausea, and, finally. by laby rinthine deafness. The lose of hearing may be absolute. J. L. Minor (c. Y. Sled. Jou•., Alan 27, '97).
Two eases of suppuration of the pa rotid gland, with pus in the external auditory canal, a. condition which must be frequently overlooked by the general practitioner and by others who have not made a special study of the subject. the pus being regarded as coming from the middle ear instead of reaching the parts.. as it does do, by infiltration through the incisurm Santorini. F. R. Packard (Jour. Amer. Med. Assoc., Aug. 17, 1901).
A most peculiar, but characteristic, complication is orchitis. It is most com mon in adolescents and adults and is ex tremely rare in children. Among 230 cases of mumps Rilliet and Barthez saw but 10 cases of orchitis, only 1 being under twelve years. Its frequency un doubtedly varies in different epidemics.
The disease is a true orchitis, but epi didymitis in rare cases occurs either alone or complicating the orchitis. The dis ease is, as a rule, unilateral, and occurs usually between the eighth and sixteenth day of the mumps. A chill at the onset is not uncommon and more or less fever is an accompaniment. The acute toms increase somewhat slowly during a period of three to six days, when they subside and the swelling rapidly dimin ishes. So rapid, in fact, is the return to normal conditions that it is clear that the inflammation does not go beyond the stage of serous exudation. In bilateral orchitis one side precedes the other, as a rule, by one or two days. In many cases, as the orchitis develops the parotitis sides, which has given rise to the theory of metastasis. In females inflammation of the breast or ovaries occurs in very rare instances. The number of well-au thenticated cases of this complication, it must be said, is very small. Involvement of the thyroid gland and of the lym phatic nodes has been observed.