ACUTE RHEUMATISM. 51 



swelling. The raising of the auricle from the side of the head is 

 very characteristic of parotid swellings. The denseness of the 

 facial envelope which the gland receives from the deep cervical 

 fascia accounts for the great pain and for the absence of inflam- 

 matory redness from the skin over the surface. The close 

 proximity of the gland and of its glenoid lobe to the posterior 

 aspect of the mandible, the wedging of the swollen pterygoid lobe 

 between the pterygoid muscles, and the continuity of the parotid 

 fascia with that over the masseter, account for the pain which 

 accompanies all masticatory movements. The relation of the 

 gland to the under wall of the auditory meatus, and the frequent 

 presence of defects in this bony lamina, explain perhaps the 

 occasional extension of inflammation to the tympanum, but the 

 Eustachian tube always offers a direct route for infection of the 

 ear from the mouth. It is said that the so-called " carotid lobe " 

 of the gland, whic his prolonged inwards towards the great vessels, 

 may give rise to pressure on the jugular vein, and so produce 

 circulatory disturbance within the skull. The intimate relation 

 of the swollen gland to the sterno-mastoid muscle causes stiffness 

 of the neck, that part being rigidly fixed to avoid pain. The 

 inflammation occasionally extends to the facial nerve which is 

 embedded in the gland, and produces some degree of facial 

 paralysis. 



ACUTE KHEUMATISM. 



Inflammation of the fibrous structures of the body is very 

 characteristic of rheumatism, and, although in adults the cap- 

 sules of the joints chiefly suffer, rheumatic manifestations are 

 common in the tendons of muscles, in fasciae and other structures 

 consisting chiefly of connective tissue, such as the pericardium 

 and pleura. 



Articular rheumatism chiefly attacks the larger joints, the 

 wrists, elbows, ankles, and knees being particularly liable to 

 suffer, but no joint is immune. The resulting swelling and the 

 accompanying erythema of the skin are most apparent in those 

 joints which are superficial and thinly covered. Consequently 



42 



