MUMPS.—Mumps is a contagious disease characterized by inflammation of the parotid glands, situated below and in front of the ears, and sometimes of the other salivary glands below the jaw, and rarely of the testicles in males and the breasts in females.
Swelling and inflammation of the parotid gland also occur from injury; and as a complication of other diseases, as scarlet fever, typhoid fever, etc.; but such conditions are wholly distinct from the disease under discussion. Mumps is more or less constantly prevalent in most large cities, more often in the spring and fall, and is often epidemic, attacking ninety per cent of young persons who have not previously had the disease. It is more common in males, affecting children and youths, but rarely infants or those past middle age. One attack usually protects against another.
Development.—A period of from one to three weeks elapses, after exposure to the disease, before the first signs develop. The germ has not yet been discovered, and the means of communication are unknown. The breath has been thought to spread the germs of the disease, and mumps can be conveyed from the sick to the well, by nurses and others who themselves escape.
Symptoms.—Sometimes there is some preliminary discomfort before the apparent onset. Thus, in children, restlessness, peevishness, languor, nausea, loss of appetite, chilliness, fever, and convulsions may usher in an attack. Mumps begins with pain and swelling below the ear on one side. Within forty-eight hours a large, firm, sensitive lump forms under the ear and extends forward on the face, and downward and backward in the neck. The swelling is not generally very painful, but gives a feeling of tightness and disfigures the patient. It makes speaking and swallowing difficult; the patient refuses food, and talks in a husky voice; chewing causes severe pain. After a period of two to four days the other gland usually becomes similarly inflamed, but occasionally only one gland is attacked. There is always fever from the beginning. At first the temperature is about 101° F., rarely much higher than 103° or 104°. The fever continues four or five days and then gradually declines. The swelling reaches its height in from two to five days, and then after forty-eight hours slowly subsides, and disappears entirely within ten to fourteen days. The patient may communicate the disease for ten days after the fever is past, and needs to be isolated for that period. Earache and noises in the ear frequently accompany mumps, and rarely abscess of the ear and deafness result. The most common complication occurs in males past puberty, when, during recovery or a week or ten days later, one or both testicles become painful and swollen, and this continues for as long a time as the original mumps. Less often the breasts and sexual organs of females are similarly affected.
Complications and Sequels.—Recovery without mishap is the usual result in mumps, with the exception of involvement of the testicles. Rarely there are high fever, delirium, and great prostration. Sometimes after inflammation of both testicles in the young the organs cease to develop, and remain so, but sexual vigor is usually retained. Sometimes abscess and gangrene of the inflamed parotid gland occur. Recurring swelling and inflammation of the gland may occur, and permanent swelling and hardness remain. Meningitis, nervous and joint complications are among the rarer sequels.
Treatment.—The patient should remain in bed while the fever lasts. A liquid diet is advisable during this time. Fever may be allayed by frequent sponging of the naked body with tepid water. High fever and delirium demand the constant use, on the head, of the ice cap (a rubber bag, made to fit the head, containing ice). The relief of pain in the swollen gland is secured by the frequent application of a thick layer of sheet cotton, large enough to cover the whole side of the neck, wrung out of hot water and covered with oil-silk or rubber sheeting, with a bandage to retain it in place.
Paregoric may be given for the same purpose—a tablespoonful for adults; a teaspoonful for a child of eight to ten, well diluted with water, and not repeated inside of two hours, and not then unless the pain continues unabated. Inflammation of the testicles demands rest in bed, elevation of the testicle on a pillow after wrapping it in a thick layer of absorbent cotton, or applying hot compresses, as recommended for the neck. After the first few days of this treatment, adjust a suspensory bandage, which can be procured at any apothecary shop, and apply daily the following ointment: guiacol, sixty grains; lard, one-half ounce, over the swollen testicle.
WHOOPING COUGH.—A contagious disease characterized by fits of coughing, during which a whooping or crowing sound is made following a long-drawn breath. Whooping cough is generally taken through direct contact with the sick, rarely through exposure to the sick room, or to persons or clothing used by the sick. The germ which causes the disease is probably in the mucus of the nose and throat. Whooping cough is usually more or less prevalent in all thickly settled civilized communities, at times is epidemic, and often follows epidemics of measles. It occurs chiefly in children from six months to six years of age. Girls and all weak and delicate subjects are slightly more susceptible to the disease. Some children are naturally immune to whooping cough. One attack usually protects against another.
Development.—A variable period elapses between the time of exposure to whooping cough and the appearance of the first symptoms. This may be from two days to two weeks; usually seven to ten days.
Symptoms.—Whooping cough begins like an ordinary cold in the head, with cough, worse at night, which persists. The coughing fits increase and the child gets red in the face, has difficulty in getting its breath during them, and sometimes vomits when the attack is over. After a variable period, from a few days to two weeks from the beginning of the cough, the peculiar feature of the disease appears. The child gives fifteen or twenty short coughs without drawing breath, the face swells and grows blue, the eyeballs protrude, the veins stand out, and the patient appears to be suffocating, when at last he draws in a long breath with a crowing or whooping sound, which gives rise to the name of the disease. Several such fits of coughing may follow one another and are often succeeded by vomiting and the expulsion of a large amount of phlegm or mucus, which is sometimes streaked with blood. In mild cases there may be six to twelve attacks in twenty-four hours; in severe cases from forty to eighty. The attacks last from a few seconds to one or two minutes. Occasionally the whoop comes before the coughing fit, and sometimes there may be no whooping at all, only fits of coughing with vomiting. Between the attacks, puffiness of the face and eyes and blueness of the tongue persist. The coughing fits and whooping last usually from three to six weeks, but the duration of the disease is very variable. Occasionally it lasts many months, especially when it occurs in winter. The contagiousness of whooping cough continues about two months, or ceases before that time with the cessation of the cough. Oftentimes there may be occasional whooping for months; or, after ceasing altogether for some days, it may begin again. In neither of these conditions is the disease considered still contagious after two months. When an attack of whooping is coming on, the child often seems to have some warning, as he seems terrified and suddenly sits up in bed, or, if playing, grasps hold of something, or runs to his mother or nurse. Coughing fits are favored by emotion or excitement, by crying, singing, eating, drinking, sudden change of temperature, and by bad air.