56 DISEASES OF THE MOUTH. 



The general disturbance, depression, headache, loss of appetite, resfc 

 less sleep, etc., accompanying this as other fevers, are usually called 

 the premonitory symptoms of idiopathic parotitis. After the fever has 

 lasted two or three days, or in some cases simultaneously with its 

 occurrence, a swelling forms, which, beginning near the lobe of the ear, 

 rapidly extends over the cheek and to the neck ; usually only one side 

 is at first affected. In the middle it is firmer, at the periphery softer ; 

 the skin over it is pale or only slightly reddened. This swelling is 

 accompanied by a feeling of tension and pressure, but by no severe 

 pain ; the motions of the head are impaired, the mouth can only be 

 slightly opened, and chewing and swallowing are difficult. The secre- 

 tion of saliva may be increased, diminished, or unaltered. These 

 annoyances are so slight in proportion to the disfigurement which 

 gives the name to the disease, that the patients excite more laughter 

 than sympathy. The swelling almost always soon extends to the 

 other side of the face, and is often greatest there when it has gone 

 from the side first affected and the fever has subsided. About the 

 fifth or sixth day, occasionally even earlier, rarely later, the fever 

 ceases, and after eight or ten days the face appears natural. But 

 sometimes a circumscribed, painless, hard swelling remains for a while 

 in the region of the parotid. Far more rarely about the fifth or sixth 

 day the swelling becomes very painful, hard, dark red, and abscesses 

 form, which open outwardly or into the external auditory meatus. 



Occasionally, in the course of the disease, one of the testicles is 

 affected by an inflammation similar to that of the parotid ; this occurs 

 more frequently in men than in boys ; it is usually accompanied by 

 pain in the sacral and inguinal regions and exacerbation of fever. 

 The scrotum also becomes cedematous and forms an inelastic, doughy 

 tumor, which is not often reddened ; on careful examination we readily 

 find that there is a serous exudation in the tunica vaginalis. Inflam- 

 mation of this part usually runs as favorable a course as that of the 

 parotid does, and after a few days terminates in resolution. Occasion- 

 ally the parotitis and orchitis seem to alternate, as it were ; the for- 

 mer disappears as the latter comes on, and the reverse : hence we speak 

 of parotitis polymorpha being "fugitive," and of its inclination to 

 metastasis to the testicle. In other cases, however, the two inflam* 

 mations run on together, which renders it probable that both are due 

 to the same cause, and that the occurrence of the one is not to be 

 regarded as due to the disappearance of the other. As in men the 

 scrotum is sometimes affected, so in women the vulva or breasts aro 

 occasionally attacked with inflammatory cedema. In other cases, pain 

 in the region of the ovaries, increased by pressure, shows that an ovary 

 is inflamed, just as the testicles are in men. Cases have also been 



