PTYALISM.
Salivation in adults is generally due to the administration of mercury, iodides or pilocarpine. In children the various forms of stomatitis are the common causes. In all cases ptyalism or salivation should be regarded solely as a symptom, and the primary cause searched for and removed, after which as a rule the amount of secretion and the secondary changes in the mouth will soon disappear.
In mercurial ptyalism the drug should he temporarily stopped with promptness. In the modern treatment of syphilis salivation is never aimed at; though the surgeon often pushes mercury to the extent of pro ducing a slight sponginess of the gums, he is content to permit the physio logical action of the drug to go no farther, and he only allows it to proceed so far in order to satisfy himself that the system has become safely saturated by the metal. As the first symptom of ptyalism may be the precursor of a severe salivation it is necessary to stop the adminis tration at once, and as the condition of the mouth becomes normal the drug may be continued after a few days in smaller doses.
Severe salivation must be promptly dealt with. The best local applica lion will be Chlorate of Potash (1 in 4o), which should be used as a mouth wash every hour, after first cleansing the buccal cavity with a weak Solution of the Permanganate of Potassium. Before and during a course of mercury the greatest attention should be paid to the state of the gums and teeth in order to prevent ptyalism. This is most carefully attended to at Aix, and is one of the details upon which the success of the treatment there depends.
When in excessive mercurialisation the gums become much swollen and ulceration has occurred, astringents will be required. Alum (r in 4o), Chloride of Zinc (2 grs. tor oz.), Tannic Acid (r in 4o), Decoction of Oak Bark, or other vegetable astringents may be used. The overwhelming fo.tor may be met by weak solutions of Chlorinated Lime or Soda, or by a
mouth wash consisting of Carbolic Lotion (1 in So) or Iodine (i of weak tincture in So), or weak Condy's Fluid. The Glycerin of Borax is a most efficient local application, but it must be used almost continuously.
Internally, the Chlorate of Potassium may be given with advantage, and if combined with a Mineral Acid or Iron preparation containing a free acid, a better effect will be obtained.
Stimulants may be needed in bad cases, and only liquids or pulpy food can be permitted.
Though the amount of the salivary secretion can be checked by the local use or by the administration of Atropine, Belladonna, Ilyoscine or Opium, it is most undesirable to proceed upon this routine, since the salivation is an effort on the part of nature to eliminate the poison. But when ptyalism is evidently the result of some local reflex, as an ulcer of the mucosa, such a plan may be sometimes safely resorted to. There is, however, no such objection to astringent applications, which increase the tone of the mucous membrane and prevent breaking down of the gum tissue.
Iodides have sometimes proved useful, but occasionally they have been observed to seriously aggravate the condition, and they should not be resorted to till the mercury has been suspended for several days.
Bromides combined with small closes of Belladonna are suitable in the ptyalism which sometimes is associated with pregnancy.
The ptyalism caused by stomatitis must be met by the use of the agents indicated fur the primary disease, as described in the article on Stomatitis and Pyorthcea.
The opposite condition—Dry-mouth or Xerostomia—is best met by the frequent use of Glycerin; the local use of Pilocarpine may induce marked swelling of the parotid glands.