There is another and occasional after-consequence of mumps which it is important to be acquainted with. This is deafness, coming on some time after the parotiditis has subsided. The hearing may be affected in one of two ways. An extension of the inflammation may take place to the Eustachian tube and middle ear. These cases are very amenable to treat ment and usually recover. There is, however, another class of cases of a much more serious character, to which attention has been directed by Mr. Dalby. In these the deafness comes on quite suddenly. The child goes to bed with his hearing perfect ; in the morning he is found to be deaf. Little can be done for form of deafness. It is probably dependent upon some altered condition of the auditory nerve, for DO appreciable lesion can be detected in the auditory apparatus. Whether the loss of hearing be complete or merely partial, little hope of material improvement can be entertained.
In some rare cases an attack of mumps has been known to be accom panied by facial paralysis from extension of the inflammation to the Portio Dura.
Diagnosis.—Alumps can only be confounded with inflammation of the parotid gland of a non-specific character, such as may occur in the course of some fevers —symptomatic parotiditis, as it has been called, or parotid bubo. In this case both sides of the face may be attacked, but the fact of the lesion being a secondary, and not a primary disease, and of the rapid suppuration which takes place when the inflammation is symptomatic, should clear up any uncertainty which might be felt as to the nature of the case.
Mumps is probably infectious from the very beginning of the disorder, and remains so for some time after the swelling has subsided. Dr. Squire
is of opinion that for at least two weeks after the disease has cleared away, the child should not be allowed to return to his healthy companions.
Treatment.—As the disease cannot be arrested, but must run its course, little active treatment is required. It is best to put the child to bed, and to keep him there as long as the temperature is elevated. Hot poultices should be applied to the parotid region and be frequently changed. If the pain be not relieved by this means, an ointment composed of equal parts of extract of belladonna and glycerine may be smeared gently upon the skin over the inflamed glands, and the poultice be applied as before. The jaws must be kept at rest, and no solid food can be allowed. Instead, the child should have strong beef-tea or gravy soup, meat jelly, milk, yolks of eggs, etc. ; but if there be high fever, with foul tongue and derangement of the digestive organs, as is most usually the case, the stomach must not be overloaded even with liquid food, and care should be taken to supply nourishment in small quantities at a time. If the fever be high and cause restlessness, the surface of the body can be sponged with tepid water. The bowels must be attended to and constipation relieved by some gentle aperient, such as compound liquorice powder or the liquid extract of rhamnus frangula.
In cases of metastasis to the mamma or testicle, perfect rest must be enforced ; and the local treatment recommended for the face should be had recourse to. The alarming symptoms which sometimes precede the appearance of the secondary lesion usually pass away in the course of a few hours. If there be great prostration, stimulants must be given, and warmth be applied to the extremities.