MUMPS (Epidemic Parotitis)

The infective agent in mumps is a virus which is present in the saliva during the acute stage of the illness. Infectivity probably persists from the onset of the first symptom until the swelling of the salivary glands has subsided. Although the parotid is the gland most frequently involved, it is well to remember that the submaxillary or sublingual salivary glands may be exclusively affected and that abortive attacks of mumps, owing to the lack of facial deformity, may readily be missed. Indeed, some cases present with meningitis, and parotid involve­ment either does not occur or develops as a secondary manifestation. The occurrence of a lymphocytosis in the blood is of some diagnostic value.
Mumps is not a notifiable disease. The incubation period varies from 12 to 26 days, but'usually lies between 17 and 21 days.
Preventive Treatment.—Specific Prophylaxis.—Although the prevention of mumps by the use of gamma-globulin prepared from the blood of convalescent patients—as in measles—is possible, it should rarely be practised. Indeed, it should be stated emphatically that no attempt should ever be made to avoid mumps occurring in a child under 12 years. Orchitis, which is the most serious complication, only occurs in the adult and indeed the whole course of the infec­tion is more severe once puberty is passed.General Measures.—Strict isolation of the patient is unnecessary. By the time a diagnosis is made susceptible contacts will have become infected. This usually results in a crop of secondary cases, but many people acquire immunity without developing clinical manifestations of the disease. The incubation period is so long that, when the date of exposure is definitely known, an exposed person should continue with his normal activities for the first fourteen days. The contact should be seen daily thereafter and put to bed on the first suspicion of illness. Exposure to infection should be avoided by women in the early months of pregnancy.
Curative Treatment.—General Management.—There is no specific treat­ment for mumps, and the administration of antibiotics is entirely unjustified.
The patient should be confined to bed until the swelling subsides. Rest in bed does not prevent the occurrence of orchitis, and mild cases even in adults may be allowed up by the fifth or sixth day. Difficulty in opening the mouth and pain on mastication are indications for the restriction of the diet to fluids and soft solids.
Hot dry cotton-wool or hot fomentations applied to the swollen glands will help to relieve pain and local discomfort. The mouth should be washed out with a i : 5,000 solution of permanganate of potash or other mild antiseptic preparation four times daily.
Treatment of Complications.—Orchitis usually develops when the parotid swelling is at its height and may be expected in approximately 20 per cent. of males above the age of puberty. The patient may have a very high fever, may look toxic and ill and be extremely depressed. He will need constant reassurance that recovery is the rule. The scrotum should be surrounded with cotton-wool and the inflamed parts supported either by a pillow placed between the thighs or by a suspensory bandage. The administration of corticosteroids for three to four days greatly reduces the testicular swelling. An initial dose of 40 mg. prednisolone per day should be gradually reduced as the oedema subsides.
Abdominal pain and vomiting are usually due to pancreatitis. A hot bag or hot fomentations applied to the site of the pain, with limitation of food and the exclusion of fat from the diet, will give relief. If the pain is severe, o-i g. of pethidine may be injected hypodermically.
Meningeal symptoms are not uncommon in some epidemics, "and, if severe, can be relieved by repeated lumbar puncture. There is no effective treatment for acute labyrinthitis, which is fortunately very rare.
Convalescence.—In children, convalescence is rapid. In the adult en­cephalitis is probably commoner than it is recognized and this may account for the severe mental depression which is often a feature of the illness even when orchitis has not occurred. In such cases the return to normal activity should not be hurried.