DISEASES OF THE MOUTH. 



and so-called metastases of the affection are less inexplicable than if 

 we follow the old view, which considered the intercellular substance 

 of the gland as the starting-point and peculiar seat of the affection. 



Idiopathic parotitis is rarely sporadic ; it almost always occurs in 

 epidemics ; these usually come in the spring and autumn, that is, in 

 cold, damp weather, rarely in the dry, warm weather of summer. They 

 vary in duration and extent ; occasionally they are confined to certain 

 institutions, foundling houses, barracks, etc. Trustworthy observations 

 render it most probable that the disease spreads by contagion. It does 

 not appear to us justifiable (with Mittiet) to consider mumps as an in- 

 fectious disease, and the inflammation of the parotid as the local ex- 

 pression of a constitutional disease, and to regard it as analogous to 

 the affections of the skin that accompany the acute infectious diseases. 

 The same objections that we have raised to considering whooping- 

 cough among the infectious diseases, in the ordinary sense of the term, 

 urge us to separate mumps from them also, in spite of its contagious- 

 ness. Infants and old persons usually escape epidemic parotitis ; males 

 are more frequently attacked than females. 



Symptomatic parotitis results from severe diseases, like typhus ; 

 in some epidemics of this disease it- follows almost all cases. More 

 rarely it is seen in the course of cholera, septicaemia, measles, small- 

 pox, dysentery, or as an accompaniment of pneumonia. We do not 

 exactly know the relation of such cases of parotitis to these diseases. 

 The oral catarrh, which always accompanies abdominal typhus, might 

 excite the suspicion that the parotitis accompanying this disease was 

 induced by a propagation of the catarrh of the mucous membrane of 

 the mouth along the excretory ducts of the glands. But, opposed to 

 this view is the fact, that the frequency with which it occurs in typhus 

 is not proportionate to the intensity of the affection of the oral mucous 

 membrane, as well as the circumstance that parotitis, running the same 

 course, occurs in other affections that are not complicated by oral ca- 

 tarrh. Since symptomatic parotitis is seen not only in infectious dis- 

 eases, but also in pneumonia, we cannot say that it is induced by an 

 irritation of the gland from infected blood. The hypothesis, that under 

 some circumstances it has a critical indication, and exercises a favorable 

 influence on the course of the original disease, is disproved by facts ; 

 it always forms an unpleasant and undesirable complication. 



ANATOMICAL APPEARANCES. We do not exactly know the ulti- 

 mate anatomical changes of parotitis. As the course of the disease is 

 almost always favorable, there is rarely an opportunity for anatomical 

 examinations. Nevertheless, from the softness of the swelling, and 

 the slight amount of pain that it causes, ancj. especially from its usuallv 

 "apid disappearance, without leaving any traces, we may believe thai 



