Ocular manifestations of mumps through the ages

Take-home

The treatment of mumps is unchanged since Hippocrates first prescribed supportive therapy, including rest, cool compressors, and pain medications.

Our Ophthalmic Heritage By Norman B. Medow, MD, FACS

Infections of the eye are not uncommon. Conjunctivitis caused by bacteria-such as Streptococcus pneumoniae-or viruses such as adenovirus-are well known to the ophthalmologist. But what about infections caused by a paramyxovirus? No, not the parainfluenza virus or the respiratory syncytial virus, but the paramyxovirus that causes mumps.

The term mumps most likely arose from British slang of the late 1500s. A mump described a person who mumbled or muttered. It was then used to describe people with this disorder whose facial swelling and sore throat led them to speak as a mump did. Hence, the term mumps was given to those with the condition.

This acute, highly contagious ribonucleic acid virus causes epidemic parotitis commonly called mumps, but it can affect the lacrimal gland and cause acute dacryoadenitis.

Historic description of disorder

What is historically important about this condition is that Hippocrates first described it in the fifth century B.C.E. His description is very accurate. The preauricular region swells-mostly bilaterally-and most often occurs during the winter and spring. Fever is often an accompaniment, although bed rest was generally not required. None of these swellings suppurated. The area affected was enlarged without inflammation or pain and generally went away without problems.

Hippocrates commented on the causality of this disorder and how it occurred in people who congregated in groups, such as in gymnasiums or in highly crowded areas. Many people, he said, had dry coughs and became hoarse.

The disease affected mostly men or children. It seldom affected woman.

In some men, pain and swelling would affect the testicles, causing much suffering. In all other respects, the patient was free of disease requiring no medical assistance.

What physicians have learned

Physicians now know that the virus has a 2- to 3-week incubation period, and enters the patient via the respiratory tract. From there it enters the salivary glands and local lymphatic glands and spreads to the other lymphatics of the body. This occurs in 7 to 10 days.

At this time, a viremia occurs that lasts about 10 to 14 days. The virus can spread throughout the body to cause orchitis, oophoritis, pancreatitis, meningitis, deafness, arthritis, and myocarditis.

Epidemics of mumps were very common during the 18th and 19th centuries. Schools, ships at sea, and even entire armies were affected. The virus was isolated in 1934 by Johnson and Goodpasture.

In the late 1970s a live, attenuated vaccine was developed to immunize the public. The vaccine was called the MMR vaccine and immunized the recipient to measles, mumps, and rubella. In the late 1990s, it became compulsory in school children in the United States. Lifelong immunity occurs in about 85% of recipients.

The treatment of mumps is unchanged since Hippocrates first prescribed supportive therapy, including rest, cool compressors, and pain medications. History has shown us once again that centuries of knowledge often resist specific treatment of disease.

The more we learn, the more we stay the same.

References

1. Adams F. The genuine works of Hippocrates. New York: William Wood. 1886:I,3;293.

2. Johnson CD, Goodpasture EW. An investigation of the etiology of mumps. J Exp Med. 1934;59:1–19.

Norman B. Medow, MD, FACS, is editor of the Our Ophthalmic Heritage column. He is director, pediatric ophthalmology and strabismus, Montefiore Hospital Medical Center, and professor of ophthalmology and pediatrics, Albert Einstein College of Medicine, Bronx, NY. He did not indicate a financial interest in the subject matter.

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