Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    248/976 (page 228)
    it is generally tolerably well defined, but does not pit on pressure; and, whilst the skin over the enlargement is mostly natural in colour, it is in some cases mottled with a slight red blush, and is in rare cases of a bright scarlet hue. The redness disappears on pressure, but quickly returns on the pressure being removed. The degree of en- largement varies; whilst in some cases apparent only behind the ramus of the jaw, or even so slight that it easily escapes notice, it is more usually co-extensive with the parotid gland, and occasionally extends far beyond this, involving a large part of the face and neck, and, in some rare cases, reaching to the upper part of the chest, giving to the head and neck a pyramidal shape. The swelling increases from three to six days, then usually remains stationary for twenty-four or forty-eight hours, after this rapidly declines, and often has entirely disappeared by the eighth or twelfth day from the commencement of the attack ; the redness subsides much earlier, and is occasionally followed by a superficial desquamation of the cuticle, blot un- frequently one or both sub-maxillary glands are also involved, in which cases the swelling extends along the body of the jaw, reaching nearly to the symphysis. The pain and tenderness, dull and aching in character, vary greatly in degree ; sometimes they are only complained of on movement of the jaw, and are then seated beneath the ear, and behind the ramus of the jaw—a fact easily accounted for when it is remembered that this part of the enlargement is most affected by the movement—in other cases, however, the pain is constant and severe, and occasionally extends beyond the limits of the apparently affected tissues, reaching even to the chest and shoulder. The pain, more severe in adults than in children, usually lasts only during the time the swelling is increasing; on the other hand, tender- ness on pressure, which is always present, continues for some days longer, and is longest observed in the part first affected. The jaw is generally fixed, and the mouth slightly open; moreover, its movements are limited, or entirely prevented, the degree of im- pediment being proportionate to the amount of pain and swelling present. Consequent on the impediment in the movement of the jaw just mentioned, the speech is affected, and mastication can be. but ■norfprflv n.nd nninfullv nerformed : and when, as is sometimes