(MUMPS; EPIDEMIC PAROTIDITIS)
=Definition.=—Mumps is an acute, infectious, contagious disease,
occurring in limited epidemics, and characterized by inflammation of
the salivary glands, particularly the parotid, swelling slight fever
and pain over the involved glands. There is special liability to
orchitis or to mastitis.
=Etiology.=—Predisposing Factors: Mumps is peculiarly a disease of
childhood and adolescence, not being common in infancy or after the
twentieth year. It affects boys nearly twice as often as girls.
Mandibular and upper cervical lesions, both of the interosseous and
soft tissue types, are undoubtedly potent predisposing factors, as
they obstruct and interfere with nerve and circulatory function to the
glands affected. Also any condition which lowers the child’s resistance
to infections makes them more susceptible to this disease than to any
other, these conditions being fatigue, exposure to dampness and sudden
weather changes, dietetic errors, etc. The cases are more numerous in
the spring and autumn seasons. Extensive epidemics are infrequent, but
do occur in reformatory institutions and children’s homes. It is much
more widespread in large cities than in the country or villages.
=Exciting Cause;= The specific cause has not been demonstrated. The
disease is usually transmitted by direct contact, but there are
instances where it has been transmitted by a third party or by fomites.
There are two views as to the mode of infection; the first being that
the active principle travels along the course of the salivary ducts
from the mouth to the glands, probably most often through the duct
of Stenson to the parotid gland. This is the most generally accepted
theory. The second is that the infection is a general one to which
certain structures are more susceptible, principally the salivary
glands, and the parotid in particular.
=Symptoms.=—The period of incubation is from fourteen to twenty-one
days. Prodromes are usually absent, though in the more severe cases
constitutional disturbances, with chilliness, vomiting and mild fever
may precede the local inflammation. In the milder cases the local
swelling may be the first manifestation of the disease. The temperature
is usually moderate but may rise to 103 or 104 degrees in the more
severe cases. The left side is more often affected than the right.
The disease is characterized by a feeling of tension with soreness
just below the ear. Soon a slight swelling may be observed directly
under the ear and in the course of forty-eight hours it reaches its
maximum size. The parotid gland becomes greatly enlarged and the
adjacent tissues of the neck and face become tense and edematous. The
skin becomes hard and glossy and usually white in color because of the
obstruction to the circulation from pressure. The swelling is between
the angle of the jaw and the mastoid process, pushing the ear upward
and its lobule is pushed sharply outward. In the majority of cases the
other side becomes affected in two or three days, but sometimes the
spread of the disease to the other side is delayed for several days,
and occasionally the other side escapes the infection. Frequently the
swelling of the other side is so slight that it is only recognized
by the closest scrutiny. Infrequently the submaxillary glands become
affected without involving the parotid glands, but these cases are
rather rare.
The patient is usually unable to open the mouth without considerable
pain; acids, and rarely sweets, produce spasms of the jaw muscles;
speech and even deglutition are difficult; the salivary secretions are
usually increased but quite frequently they are decreased. The breath
is foul and the tongue is furred. The mucous membrane of the cheek and
pharynx are reddened and there may be a slight angina.
The spine shows subluxations of the upper cervical area, particularly
of the atlas and axis, also upper rib lesions and upper dorsal lesions
are frequently found. The lesions of the second and third dorsal, and
their ribs, are most frequently found when the submaxillary gland is
involved.
The symptoms persist from six to fourteen days, when the swelling
disappears and the patient regains normal health. Orchitis occurs in
about one-third of the cases after puberty. In infancy and childhood
it is extremely rare. Usually one testicle is involved, and is
characterized by weight, swelling and pain in the scrotum. The testicle
may become greatly enlarged when the pain becomes intense. Atrophy may
result and if both testicles are affected the loss of reproductive
ability may result. In females, usually after puberty, the breasts may
become enlarged and tender, pain and tenderness of one or both ovaries,
hematoma of the labia, or a vulvovaginal discharge may occur. However
these complications are very rare. As a rule the patient is not very
sick and relapses are very uncommon. The attack confers immunity which
is practically permanent.
=Diagnosis.=—Under ordinary conditions, especially during an epidemic,
the diagnosis of mumps is very easy. The swelling in front of and
below the ear, with the displacement of the lobule outward is quite
indicative of mumps. The relative rapidity with which the swelling
appears, develops and subsides is characteristic of mumps. In acute
cervical adenitis the swelling is below the angle of the jaw and does
not at any time correspond with the outline of the parotid gland.
In Hodgkin’s disease, which is a chronic affection of the lymphatic
glands, the salivary glands are not involved.
=Treatment.=—The patient should be kept away from other children,
and should remain in a well lighted, well ventilated room of even
temperature, and if the temperature is high or moderately high he
should be kept in bed.
The correction of all interosseous lesions is indicated, especially of
the upper cervical area, though the second and third dorsal should be
given attention because of the influence of these dorsal nerves upon
the submaxillary glands. Also correct upper rib lesions that may exist.
As mumps is an infective disease the channels of elimination should be
watched and stimulated. Build up the body resistance by treatment at
the mid-dorsal area to affect circulation and respiration; and lower
dorsal area to affect kidney and adrenal function. Watch the bowels and
keep this avenue of elimination functioning freely, using enemata if
necessary.
The diet should be liquid, of fruit juices, thin gruels, milk and
plenty of water. Tepid sponging allays the fever and restlessness.
Relaxation of the deep muscles of the neck and shoulders will do much
to make the patient comfortable, also the muscles under the angle of
the jaw. A very gentle relaxing of the tissues around the gland itself,
by crowding them toward the gland, assists in relieving the tension by
securing a better venous and lymphatic drainage.
Hot applications to the swollen glands will give a considerable relief;
these may consist of hot fomentations, hot salt bag, electric heating
pad, hot water bottle, etc. The mouth is kept in good condition by the
use of a mild antiseptic mouth wash.
Orchitis should not occur if the boy is kept warm and in bed. If it
does occur the best treatment is relaxation of the lower dorsal and
upper lumbar spinal muscles, rest in bed, support and protection of the
scrotum with cotton wool, cold applications, correction of any bony
lesions affecting the pelvic viscera.
If mastitis occurs, rib lesions will be found and should be corrected,
as they are probably the predisposing factor to this complication.
Treatment would consist of correction of these lesions, if it can be
done without irritating the inflamed glands. The manipulation of the
surrounding tissues, with gentle crowding of the normal tissues toward
the inflamed glands, without exerting any pressure on the gland itself,
is helpful and comforting. Free tissues back to the axillary lymphatics.
=Prognosis.=—The outcome is usually favorable. In the rare fatal cases,
meningitis is the usual cause of death. Under osteopathic care the
duration of the swelling, fever and pain is usually greatly lessened.
Quarantine of twenty-four days is necessary.