INFLAMMATION OF THE PAROTID, ETC. 453 



circumscribed, dry, black slough forms on the cheeks or under-lip ; this 

 increases daily, till it affects half the face. Occasionally, even at this 

 stage, the child is tolerably strong, demands food, and tears gangre- 

 nous pieces out of the mouth. The appearance becomes more hideous 

 when the slough separates, and tags hang from the cheeks, between 

 which we can see the bare, loosened teeth, and blackened jaw-bone- 

 Then the smell is excessively disagreeable, the patient very weak, and 

 diarrhoea usually comes on ; thirst is almost unquenchable ; the skin 

 is cool and dry ; the pulse small and imperceptible ; finally, the child 

 dies of exhaustion. Occasionally, the disease begins to recover from 

 the first stage ; but, even after detachment of the external slough, 

 the gangrene may be limited, the swelling diminish, the general health 

 improve, the surfaces of the wound clean off, and healthy suppuration 

 occur. 



TREATMENT. Quinine, chlorine-water, charcoal, and other antisep- 

 tics, have been recommended as internal remedies ; but they are of 

 little service ; they are recommended more on theoretical grounds than 

 from experience of their benefit. We should give the patient fresh 

 air, good nourishment, a small amount of wine, and treat the gangrene 

 locally, according to surgical principles. Almost all caustics have been 

 advised for noma ; the actual cautery has obtained the greatest repu- 

 tation. The object of these applications is to destroy the gangrenous 

 parts, and to excite inflammatory reaction in the surrounding parts. 



CHAPTER X. V 



PAROTITIS INFLAMMATION OP THE PAROTID AND ITS VICINITY 



MUMPS. 



ETIOLOGY. Besides the cases caused by wounds of the parotid, by 

 the entrance of foreign bodies into its excretory duct, or by calcareous 

 deposits, which cases belong to the surgeon, we distinguish two forms 

 of parotitis : 1. Idiopathic parotitis, parotitis polymorpha (mumps) ; 

 2. Symptomatic or metastatic parotitis. 



In opposition to the generally-received opinion, Virchoio maintains 

 that the affection starts in the gland-ducts of the parotid. He has di- 

 rectly proved this in the case of symptomatic parotitis, and in the idio- 

 pathic form also it appears to us much more probable that the inflam- 

 mation should begin in the gland-ducts than in the interstitial tissue. 

 If, with Virchow, we consider idiopathic parotitis as resulting from a 

 simple catarrh, which has no tendency to suppurate, and the sympto- 

 matic or metastatic form, as caused by catarrhal inflammation of the 

 gland-ducts, that has a tendency to suppurate, the symptoms, course, 



