50 CLINICAL APPLIED ANATOMY. 



great danger of the disease, and the production of otitis media 

 has already been alluded to. 



GERMAN MEASLES. 



Most of what has been already stated about measles also 

 applies to German measles, but it must be remembered that the 

 latter is almost always a much milder and usually uncomplicated 

 disease. Two points of difference stand out : Koplik's spots do 

 not occur in German measles, and the lymphatic glandular 

 swelling is usually more marked. The glands chiefly involved 

 are the occipital, the mastoid and the concatenate groups, but the 

 submandibular, the axillary and the inguinal glands may also be 

 enlarged. In exceptional cases the glandular enlargement may 

 precede the general symptoms for several days. 



MUMPS. 



It is highly probable that the infection of mumps gains access 

 to the salivary glands by way of their ducts, the parotid glands 

 being invaded along Stenson's ducts, and the submandibular 

 along Wharton's ducts. The fact that swelling of the second 

 parotid gland often occurs a few days after that of the first is in 

 favour of ascending duct infection. 



The only anatomical connection of the salivary glands with 

 the pancreas, testicles, ovaries and breasts is that effected by the 

 blood stream, so it is assumed that it is by this channel that 

 inflammation of these organs arises as a complication. 



The parotid swelling in parotitis corresponds exactly to the 

 position of the gland, and so may be distinguished from inflam- 

 matory swelling of the small lymphatic glands which lie close to 

 or are actually imbedded in the parotid. The inflammatory swell- 

 ing obliterates the sulcus between the mandible and the sterno- 

 mastoid muscle ; extends forwards on the masseter towards the 

 face corresponding to the anterior part of the gland and its socia, 

 and pushes the lower part of the auricle outwards from the head 

 so that the lower part of the ear lies over the central part of the 



