The general hygienic management of syphilis is of fundamental importance. In many instances mercury and iodides act badly, simply because the patient's eliminative areas are not functionating with their normal activity. Injurious results from the drug specifics occur under such circumstances, and are explained by that explanation which does not explain, "idiosyncrasy." Ptyalism and iodism may both be avoided in many cases by attention to the eliminative functions. The ingestion of large quantities of water, with the concomitant increased functional activity of the skin, kidneys and bowels, is very useful in syphilis. This point is too frequently neglected. In giving iodides it is best, as is generally known, to administer them simultaneously with considerable quantities of water. It is impossible, however, without resulting stomachic disturbance, to give a sufficient quantity of water in this way to perfect elimination by the kidneys in certain cases in which the renal function is inadequate. It is in just such cases that iodism from so-called idiosyncrasy is liable to occur.
The best method of giving the iodide under such circumstances is to mix the daily dose of the drug with a given quantity of pure water, say from two quarts to a gallon, and instruct the patient to drink the entire amount, a glassful at a time, at intervals during the twenty-four hours, have succeeded in avoiding iodism in this way in patients in whom the smallest quantity of iodide given by the ordinary method produced iodism.
Hot baths are a very useful adjuvant to the treatment of syphilis. They increase tissue metamorphosis, favor; elimination, and necessarily enhance the therapeutic action of the mercury and iodide, while limiting any possible injurious effects of the drugs. In many instances hot baths alone will prevent injurious effects from mercury and iodide. A very hot bath of short duration, taken daily and followed by a cold shower or cold tub, is perhaps the best method of administration for the average patient. The ideal method, however, where its application is practicable, is the Turkish or Russian bath. The patient should drink large quantities of hot water while in the bath. Much of the efficacy of the Hot Springs treatment of syphilis is dependent upon the free ingestion of hot water while the hot bath is being given.
Attention to the bowels is very important in the treatment of syphilis. Ptyalism not infrequently results as a consequence of constipation. Obviously, the simpler forms of laxatives are best. The saline aperients taken hot in the morning are excellent.
Ptyalism~ an excessive flow of saliva.