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On This Day   January-04  (Benjamin Rush -1746 AD)

Benjamin Rush was one of the major political leaders who participated in the American Revolution and signed the U.S. Declaration of Independence in 1776 who insisted in medical freedom as in religious freedom but was not successful making it an article of the constitution...

 
 
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MUMPS: A CHILDHOOD DISORDER
Treatment and Complications of an Infections Disease
One of the least dangerous of the infections fevers, mumps is nevertheless liable to certain complications which require care and skilled treatment. An account of the ordinary course of the disease is given here, and of the symptoms of possible complications and their treatment.
Mumps, or, as it is technically called, epidemic parotitis, is an acute infections disease characterised by swelling of the salivary glands, especially of the parotids (q.v.). The cause of the disease is the mumps virus, of the genus Paramyxovirus, causing parotitis in man, sometimes with complications of orchitis, oophoritis, pancreatitis, meningoencephalitis and others, and transmitted by infectious salivary secretions.
It occurs usually in comparatively isolated cases, but epidemics of mumps are not uncommon, especially in schools and other institutions. It is particularly prevalent in winter and in spring, attacking mainly children between the ages of five and fifteen. For some reason which is at present obscure, boys are much more liable than girls to contract the disease.
 
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Infection is conveyed to a healthy person directly from the mouth or throat of the patient, and that fomites (that is, objects contaminated by the patient, such as books, toys, bedding, etc.) do not retain the infection for long. For this reason disinfection after a case of the disease is neither compulsory nor in the least necessary as a rule. The disease is probably contagious for about twenty-four hours before the appearance of the parotid swelling and for at least a week after the swelling has subsided. Isolation for a period of three weeks is usually advisable. The quarantine period for contacts is twenty-six days. One attack generally confers immunity for life, but second or third attacks are not unlmown. Relapses are rare.
Symptoms of Infection
The incubation period of mumps is a long one usually eighteen to twenty-two days, during which period there are few if any symptoms. The next stage a one of slight but general discomfort and malaise, with pain in the region of the ear or throat; a. slight rise of temperature, headache, vomiting, nosebleeding, or, in the case of a child, even convulsions may also occur. Very often, however, the first sign of the disease is a gradually increasing swelling of the parotid gland in front of and below the ear and along the angle of the lower jaw.
Usually, the swelling is at first confined to one side, spreading after a few days to the other side.
In a typical case the swelling and tenderness begin behind the jaw and below the ear, lifting the lobe of the ear; it then spreads forward over the jaw and down the neck, and may spread upward to the eyes. The swelling is painful to the touch. The skin over it is usually unaffected, but may become red and shiny. During this time the temperature is generally rising, and may reach 101˚ F. to 104˚ F. Movements of the jaw are painful, the pain varying with the amount of tension present. The secretion of saliva is not usually affected. It is not uucommon for the other salivary glands to become affected at the same time, especially the glands under the jaw and, less frequently, those under the tongue. The mucous membrane of the mouth and throat may be inflamed; the tear glands at the corner of the eye may also be involved.
An early sign of the disease, often present before any parotid swelling is to be seen, is known as Hathcock's sign, which consists in tenderness on running the finger along the under surface of the lower jaw on the affected side. The spleen is nearly always enlarged, returning to its normal size on recovery.
In the slighter cases there is little more than a mild and temporary local discomfort, but even in the most severe types, with delirium, high fever and great prostration, the course of the disease is nearly always favourablc.
Diagnosis and Treatment.
The recognition of mumps is usually easy, especially in children. The position of the swelling in front of and below the ear, and the raising of the lobe of the ear on the affected side, will generally be quitc enough to fix the diagnosis. It is, however important to remember that inflammation of the parotid gland does occur from other causes in adults and even, though rarely, in children. Thus, septic parotitis may arise as a sequel to a number of acute infections diseases, such as typhoid, diphtheria or scarlet fever, and may also occur with septic conditions of mouth or throat. In these conditions the parotitis is non-contagious, the glands of both sides are affected at the same time and suppuration is much more common than in mumps. A chronic enlargement of the parotid glands may be a consequence of poisoning by mercury, lead or iodine; very rarely is it a sequel to mumps.
Smokh   MUMPS: THE GLANDS AFFECTED
The swellings in front of the ears in mumps are due to the imflammation of the partoid glands. Sometimes, however, the submaxillary salivary glands which lie beneath the lower jaw are also swollen and painful.


There is no special treatment for mumps but the patient should always be kept in bed while the parotid swelling is present. The bowels should he kept freely opened and a light diet given. The mouth must be frequently cleansed with a mild antiseptic lotion. Liquid foods like soups and porridges are best while the temperature is raised. If there is much pain on moving the jaw, the fluids may be taken through a straw. As soon as the swelling lessens and the temperature comes down, the liquids may be thickened; semi-solids, such as jellies and custards, or any other bland food requiring little or no mastication may be given. In the milder cases with little constitutional disturbance this diet may be adopted from the beginning.
No medicine is required as a rule, except for high fever an enema may be given, or for the relief of pain, when salicylates are often helpful.
Cold or hot compresses, sprinkled with tincture of iodine are sometimes placed on the gland. The dilute compound methyl salicylate ointmint B.P.C., which is readily absorbed through the skin, is also of value in relieving the pain of mumps. Glycerin of belladonna is another useful application; it is painted over the gland and covered with cotton wool. If redness and tenderness become very marked, leeches may be applied with advantage.
Very often, however, no local treatment will be necessary except for the use of a simple mouth wanh, such as potassium permaznganate, sodium bicarbonate or borax solution which should always be insisted on in even the mildest cases. A useful prcparation is the following:
Complications of Mumps.
The possible complications of mumps are numerous, but most of there are not serious. The most important is orchitis, or inflammation of a testis, which, however, many authorities look upon as a symptom of the disease rather than as a complication. Young adults are by far the most frequently affected. The orchitis generally appears about the eighth day, when the parotid swelling is at its height. One or both of the testicles may be affected, the former being more usual. The inflammation increases for three or four days, and then gradually subsides, as a rule leaving no permanent damage; but in a certain number of cases atrophy or wasting of the organ follows.
The degree of pain which is present in orchitis varies from slight local discomfort, this being aggravated by movement and prcssure, to severe stabs of pain radiating down the thigh. In female patients there may be a corresponding inflammation of the ovaries, shown by pain and tenderness in the lower part of the abdomen and by some degree of fever. This, however, seems to be less frequent an occurrence than is orchitis in the male.
Other complications include inflammation of any of the sexual organs, external or internal, in both sexes. Inflammation of the breasts may also occur, as well as enlargement of the thyroid gland.
Pancreatitis,or inflammationof the pancreas is not very uncommon. It usually appears within a week of the parotid swelling, and is characterised by more or less severe pain in the upper part of the abdomen, nausea, vomiting and diarrhoea.
Suppuration in the parotid gland is occasionally met with, and is always due to the introduction of other micro-organisms.
Affections of the ear are among the most serious of the complications of mumps, but are comparatively rare. Deafness very often occurs in these cases; and may be permanent. The eyes may also be affected in various ways, but these complications also are rare.
Inflammation of the kidneys is much more common, especially in adults suffering from a severe attack of mumps. The urine will require to be periodically examined in these cases, but complete recovery is the rule.
The only remaining group of complications of any importance is that connected with the brain and nervous system. Meningitis and neuritis are the most serious of these, but fatal cases are extremely rare.
The various complications will need special treatment. In orchitis a purge should be given at the outset, and the patient kept at rest in bed. The swollen gland must be protected by wrapping in cotton wool and supported by means of a bandage. Hot boracic fomentations may be applied, or glycerin of belladonna painted on according to the directions already given above. A tincture of iodine lotion is often of service in reducing the swelling and relieving the pain. It is doubtful whether the occurrence of orchitis can be prevented by keeping the patient in bed, but in any case no active exercise should be indulged in for some weeks after recovery.
In cases of delirium or symptoms of meningitis an ice bag or cap may be applied to the head.
In cases of nephritis, or inflammation of the kidneys, the patient is kept in bed until examination of the urine shows that the condition has cleared up. The diet in such cases will be light, and consist principally of fruit and milk foods.
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