side. Within forty-eight hours a large, firm, sensitive lump forms
under the ear and extends forward on the face, and downward and
backward in the neck. The swelling is not generally very painful, but
gives a feeling of tightness and disfigures the patient. It makes
speaking and swallowing difficult; the patient refuses food, and talks
in a husky voice; chewing causes severe pain. After a period of two to
four days the other gland usually becomes similarly inflamed, but
occasionally only one gland is attacked. There is always fever from
the beginning. At first the temperature is about 101 deg. F., rarely much
higher than 103 deg. or 104 deg.. The fever continues four or five days and
then gradually declines. The swelling reaches its height in from two
to five days, and then after forty-eight hours slowly subsides, and
disappears entirely within ten to fourteen days. The patient may
communicate the disease for ten days after the fever is past, and
needs to be isolated for that period. Earache and noises in the ear
frequently accompany mumps, and rarely abscess of the ear and deafness
result. The most common complication occurs in males past puberty,
when, during recovery or a week or ten days later, one or both
testicles become painful and swollen, and this continues for as long a
time as the original mumps. Less often the breasts and sexual organs
of females are similarly affected.

=Complications and Sequels.=--Recovery without mishap is the usual
result in mumps, with the exception of involvement of the testicles.
Rarely there are high fever, delirium, and great prostration.
Sometimes after inflammation of both testicles in the young the organs
cease to develop, and remain so, but sexual vigor is usually retained.
Sometimes abscess and gangrene of the inflamed parotid gland occur.
Recurring swelling and inflammation of the gland may occur, and
permanent swelling and hardness remain. Meningitis, nervous and joint
complications are among the rarer sequels.

=Treatment.=--The patient should remain in bed while the fever lasts.
A liquid diet is advisable during this time. Fever may be allayed by
frequent sponging of the naked body with tepid water. High fever and
delirium demand the constant use, on the head, of the ice cap (a
rubber bag, made to fit the head, containing ice). The relief of pain
in the swollen gland is secured by the frequent application of a thick
layer of sheet cotton, large enough to cover the whole