IIforbid Anatomy.—The disorder consists in an inflammation of the ducts of the parotid and other salivary glands. with infiltration of the cellular tissue of the glands. Exudation also invades the subcutaneous tissue for some distance around, so that very widespread swelling may be the con sequence. The diseased action does not go on to suppuration, but ter minates in resolution in the course of a few days.
Symptoms.—After a period of incubation which, according to Dr. Dukes, varies from sixteen to twenty-five days, the earliest signs of the dis order are noticed. The first symptom is fever, which usually precedes by some hours any sign of local discomfort. The temperature is generally high, rising sometimes to 103°, ,and, as is often the case with children, the pyrexia is apt to be accompanied by headache and vomiting. Swelling of the parotid gland may occur at the same time as the fever, or may even precede it. In any case attention is soon attracted to the face. Aching and tenderness are complained of, situated immediately below the ear, and behind the ascending ramus of the jawbone; and on inspection the normal Idepression between the face and the neck is found to have disap peared. The swelling strikes forward into the face, and backward and downward into the neck, so that when fully developed it covers the whole of the parotid reoion. If, as often happens, the inflammation extends to the and attacks both sides, the familiar face is curiously disfigured, and is scarcely recognizable by the friends. It is enormously widened at the level of the nose and lip, and the chin may almost dis appear in the swelling of the neck. The swelling is very tense and elastic, and is extremely sensitive to pressure. The skin over it is either pale or is suffused with a rosy-red blush. The full development of the swelling occupies from three to six days ; then, after remaining unaltered for one. or two days longer, it begins to subside, and by the tenth or twelfth day from the beginning of the disorder all fulness has disappeared. During the whole of this time the aching continues, and is greatly intensified by movement of the jaw ; so that mastication becomes impossible, speech is hampered, and even swallowing is difficult and painful. One consequence of this is that saliva tends to accumulate in the mouth, and is a cause of much discomfort. Fortunately, however, its secretion is seldom greater than natural.
While the disease is in progress the fever remains high. When the swelling has reached its full development, the temperature falls, suddenly or gradually, and during the process of resolution the heat of the body is natural. The disease seldom attacks the two sides of the face quite si
multaneously. Oue side generally precedes the other by some hours or days. In rare cases the inflammation remains limited to the gland first attacked.
Although the parotid glands are primarily and principally affected in the large majority of cases, this is not the invariable rule. Sometimes the inflammation is localized in the submaxillary glands, and the parotids suffer little if at all. Dr. Penzolclt, of Erlangen, in an epidemic of undoubted mumps occurring in that town, noted some cases in which the swelling of the parotids was so slight as to be scarcely observable, while the sub maxillary glands were considerably enlarged and very painful. In one case there was in addition swelling and redness of the tonsils.
One of the most curious features of this disorder consist in the metas tases which occasionally occur. As the inflammation subsides, or even a day or two after the swelling has disappeared, a similar condition develops itself in a testicle, in the case of a boy ; the breast, if the patient be a girl. These complications are accompanied by fever and gen eral poorliness, but subside in the course of a few clays. In rare cases orchitis has been known to precede the affection of the parotid gland. Thus, a young gentleman described to me how he had had an attack of orchitis, accompanied by severe pain but a normal temperature. At this time there was absolutely no symptom connected with the face. Sixteen hours afterwards, however, slight swelling and tenderness of the parotid gland began to be noticed, and the temperature was found to be 100.6°. As the mumps subsided, the second testicle became inflamed. In this attack the temperature rose to 105°, and for some days was as high as 104°, with delirium and. distressing vomiting. Sometimes the appear ance of swelling in the organ secondarily attacked is preceded by severe constitutional symptoms. There may be high fever and delirium ; or great prostration with coldness of the extremities ; or violent vomiting and purging. In any case, great alarm is excited by the condition of the suf ferer; but all apprehensions are removed by the appearance of the local lesion. These complications are less common in children than in adults who suffer from mumps, but it is well to remember that it is possible they may occur.