IV. Other Infectious Diseases.
Synonyms:—Parotiditis; epidemic parotitis.
Definition:—An acute contagious disease of childhood and early adult lift, characterized by inflammation of the parotid glands, which may also involve all of the salivary glands, and be conveyed to the mammae in the female, and to the testicles in the male.
Etiology:—From the beginning to the extreme end of an attack this disease is highly contagious. One attack usually conveys immunity from future attacks. No specific micro-organism has yet been discovered as its cause. The infection is conveyed by the salivary secretions by expectoration, or the breath, and may be carried on the clothing by one not subject to an attack, from a patient to a susceptible individual. It may occur in only one gland, but it usually involves both. It may be epidemic or endemic in character. Inflammation of these glands in isolated cases will occur when no epidemic exists, as a complication of pneumonia, typhoid and other serious, acute, prostrating diseases. The author treated at one time a most aggravating and intractable case, with suppuration in both glands, in a woman about thirty-five years of age, who was suffering from a severe and protracted attack of pneumonia. It is argued upon good grounds that these are cases of septic inflammation rather than of mumps proper, as in mumps there is seldom suppuration.
Symptomatology:—The period of incubation of mumps is irregular in length of time, from a few days or a week to three weeks. Stiffness in the jaw, swelling in one or both of the parotid glands, and some pain, especially if anything sour is eaten, are the conspicuous symptoms. During the incubation period there is malaise, headache, indisposition, nausea and vomiting. The swelling, uniform in shape, increases until it fills the depression beneath the ear and extends downward, involving the neck and the space under the chin. It produces great distortion of the countenance. The temperature is usually about 102° F., but ranges from 101.5° F. to 104°. F. Movement of the jaw is painful and mastication is nearly impossible. There is often ringing in the ears, dulness of hearing, dizziness and mental hebetude. In extreme cases there is mild delirium, or nervous excitability or irritability. The disease is usually so mild as to receive no attention, but it is not impossible that it become very severe, and a typhoid condition, or intractable complications, render it very serious. It continues about fourteen days.
Metastasis of this disease, at puberty or beyond, to other glandular organs is not uncommon, and may be very serious. Orchitis of one or both testicles is most common and is more difficult of treatment when so appearing. The metastasis occurs usually when the symptoms of the original malady are abating, with a recurrence of all constitutional symptoms in an exaggerated form. In girls the mammary glands may become inflamed, before as well as after puberty, and in adult life the ovaries and labia may be attacked also.
When nervous irritation is marked there may be convulsions, and meningitis has occurred also. Pancreatitis and tenderness in the region of the stomach is claimed to be a not uncommon complication.
Diagnosis:—The disease must be distinguished from inflammations in the alveolar process, or toothache, from tonsilitis and inflammation of the lymphatic glands.
Treatment:—The treatment is very simple. Aconite for the fever is usually the directly indicated remedy. The addition of small doses of phytolacca, as adapted to glandular inflammation, will usually be all sufficient. A mild alkaline drink should be given and the patient kept warm in bed. Quiet is essential to those above twelve or fourteen years of age, to prevent complications. If other glands threaten to become involved, a full dose or two of ten grains of acetate of potassium with a continued use of aconite and phytolacca will avert the danger. A bandage applied over the mammary glands in adult women, and a support to the testicles in men, are essential. Libradol mild, applied hot, or antiphlogistine will ameliorate all of these symptoms. Cold should never be applied to the parotid glands when inflamed. If they are simply protected from exposure that will be all that is necessary in mild cases. In severe cases hot, wet compresses may be applied for an hour or two at a time with advantage. Acid foods or drinks of all kinds must be avoided and the diet should be simple and nutritious. Complications will suggest the indicated remedy in each case.
The Eclectic Practice of Medicine with especial reference to the Treatment of Disease, 1910, was written by Finley Ellingwood, M.D.