[Recurrent parotitis in children].

From time to time a child is seen with swelling of the parotid gland in whom mumps is diagnosed, yet the parent states that the patient has had that disase several times before. Due largely to the work of Payne (1933, 1938, 1940) the condition of recurrent parotid swelling has been defined as a clinical entity, but most of the published accounts refer to adults. The disease, however, is by no means rare in children, as can be seen from the fact that 17 examples have been seen in one part of the Midlands in the past five years. The salient features of these patients are recorded in the table. The essential feature of the condition is swelling of one or both parotid salivary glands. This recurs once or many times (Fig. 1). Sometimes the swelling is confined to one side, but recurrences need not always affect the same side and both sides may be involved on each occasion; or a unilateral case may become bilateral or vie versa. In the examples recorded here the whole parotid gland has been enlarged and there FIG. 1.-Right-sidd parotitis. was usually tenderness, but there has been no redness or oedema of the overlying skin. In frequently recurring cases not only does the enlargement tend to be greater than in those which relapse rarely, but enlargement of varying degree may persist between periods of activity. Pain has been a variable feature: probably some discomfort is always experienced and this may rarely be severe. Usually the sufferers complain of moderate discomfort for the duration of the swelling, which has lasted from a few minutes, especially after treatment, to several weeks. The onset has usually been abrupt and has in less than a quarter of the patients coincided with the taking of food, although one boy, before he was treated, could always provoke an attack by taking vinegar. The frequency of attacks has varied from about one a year to one a week. The orifice of Stenson's duct has not appeared abnormal, though Bigler (1946) has described redness and oedema, but no thickening of the duct has been felt. When the disease was active mucopurulent saliva could nearly always be expresed from the affected gland. In the majority only a small quantity was obtained, but in those children from whose saliva the pneumococcus was isolated a larger amount appeared and in two on several occasions purulent discharge was seen to drip from the orifice of the parotid duct. In most of the patients the secretion presented the 'snowstorm' effect described by Payne (1938), the flakes being small masses of mucus and cells suspended in mucopurulent saliva. After treatment the 'snowstorm' appearance was infrequently seen and between periods of activity little or no discharge could be expressed. Fever and leucocytosis have been inconstant features. The temperature was often normal at the height of the swelling. The maximum white cell count has been 24,800 per c.mm. with 78% polymorphonuclear cells in a case from which both the haemolytic streptococci and pneumococci were isolated. As a rule the white count has been from 8 to 10,000 leucocytes per c.mm. The usually more severe pneumococcal cases have tended to be associated with the most marked leucocytosis. The diagnosis is confirmed by sialography, which showed characteristic changes in 13 of the 14 cases in which it was done. This is in contrast to the findings of Bigler (1946) who recorded normal radiographs in the few cases of his series in which this examination was performed. In each case a plain film was taken to exclude the presence of a calculus which was never found. Next, following the technique of Payne (1931) and