[1] H. Frahm, "Neue Untersuchungen ueber die dynamischen Vorgaenge in
den Wellenleitungen von Schiffsmaschinen mit besonderer
Beruecksichtigung der Resonanzschwingungen," _Zeitschrift des Vereins
deutscher Ingenieure_, 31st May 1902.
DYNASTY (Gr. [Greek: dynasteia], sovereignty, the position of a [Greek:
dynastes], lord, ruler, from [Greek: dynasthai], to be able, [Greek:
dynamis], power), a family or line of rulers, a succession of sovereigns
of a country belonging to a single family or tracing their descent to a
common ancestor. The term is particularly used in the history of ancient
Egypt as a convenient means of arranging the chronology.
DYSART, a royal and police burgh and seaport of Fifeshire, Scotland, on
the shore of the Firth of Forth, 2 m. N.E. of Kirkcaldy by the North
British railway. Pop. (1901) 3562. It has a quaint old-fashioned
appearance, many ancient houses in High Street bearing inscriptions and
dates. The public buildings include a town hall, library, cottage
hospital, mechanics' institute and memorial hall. Scarcely anything is
left of the old chapel dedicated to St Dennis, which for a time was used
as a smithy; and of the chapel of St Serf, the patron saint of the
burgh, only the tower remains. The chief industries are the manufacture
of bed and table linen, towelling and woollen cloth, shipbuilding and
flax-spinning. There is a steady export of coal, and the harbour is
provided with a wet dock and patent slip. In smuggling days the "canty
carles" of Dysart were professed "free traders." In the 15th and 16th
centuries the town was a leading seat of the salt industry ("salt to
Dysart" was the equivalent of "coals to Newcastle"), but the salt-pans
have been abandoned for a considerable period. Nail-making, once famous,
is another extinct industry. During the time of the alliance between
Scotland and Holland, which was closer in Fifeshire than in other
counties, Dysart became known as Little Holland. To the west of the town
is Dysart House, the residence of the earl of Rosslyn. With Burntisland
and Kinghorn Dysart forms one of the Kirkcaldy district group of
parliamentary burghs. The town is mentioned as early as 874 in connexion
with a Danish invasion. Its name is said to be a corruption of the Latin
_desertum_, "a desert," which was applied to a cave on the seashore
occupied by St Serf. In the cave the saint held his famous colloquy with
the devil, in which Satan was worsted and contemptuously dismissed. From
James V. the town received the rights of a royal burgh. In 1559 it was
the headquarters of the Lords of the Congregation, and in 1607 the scene
of the meetings of the synod of Fife known as the Three Synods of
Dysart. Ravensheugh Castle, on the shore to the west of the town, is the
Ravenscraig of Sir Walter Scott's ballad of "Rosabelle."
William Murray, a native of the place, was made earl of Dysart in 1643,
and his eldest child and heir, a daughter, Elizabeth, obtained in 1670 a
regrant of the title, which passed to the descendants of her first
marriage with Sir Lionel Tollemache, Bart., of Helmingham; she married
secondly the 1st duke of Lauderdale, but had no children by him, and
died in 1698. This countess of Dysart (afterwards duchess of Lauderdale)
was a famous beauty of the period, and notorious both for her amours and
for her political influence. She was said to have been the mistress of
Oliver Cromwell, and also of Lauderdale before her first husband's
death, and was a leader at the court of Charles II. Wycherley is
supposed to have aimed at her in his Widow Blackacre in the _Plain
Dealer_. Her son, Lionel Tollemache (d. 1727), transmitted the earldom
to his grandson Lionel (d. 1770), whose sons Lionel (d. 1799) and
Wilbraham (d. 1821) succeeded; they died without issue, and their sister
Louisa (d. 1840), who married John Manners, an illegitimate son of the
second son of the 2nd duke of Rutland, became countess in her own right,
being succeeded by her grandson (d. 1878), and his grandson, the 8th
earl.
The earldom of Dysart must not be confounded with that of Desart
(Irish), created (barony 1733) in 1793, and held in the Cuffe family,
who were originally of Creech St Michael, Somerset, the Irish branch
dating from Queen Elizabeth's time.
DYSENTERY (from the Gr. prefix [Greek: dys]-, in the sense of "bad," and
[Greek: enteron], the intestine), also called "bloody flux," an
infectious disease with a local lesion in the form of inflammation and
ulceration of the lower portion of the bowels. Although at one time a
common disease in Great Britain, dysentery is now very rarely met with
there, and is for the most part confined to warm countries, where it is
the cause of a large amount of mortality. (For the pathology see
DIGESTIVE ORGANS.)
Recently considerable advance has been made in our knowledge of
dysentery, and it appears that there are two distinct types of the
disease: (1) amoebic dysentery, which is due to the presence of the
amoeba histolytica (of Schaudinn) in the intestine; (2) bacillary
dysentery, which has as causative agent two separate bacteria, (a) that
discovered by Shiga in Japan, (b) that discovered by Flexner in the
Philippine Islands. With regard to the bacillary type, at first both
organisms were considered to be identical, and the name _bacillus
dysenteriae_ was given to them; but later it was shown that these
bacilli are different, both in regard to their cultural characteristics
and also in that one (Shiga) gives out a soluble toxin, whilst the
other has so far resisted all efforts to discover it. Further, the
serum of a patient affected with one of the types has a marked
agglutinative power on the variety with which he is infected and not on
the other.
Clinically, dysentery manifests itself with varying degrees of
intensity, and it is often impossible without microscopical examination
to determine between the amoebic and bacillary forms. In well-marked
cases the following are the chief symptoms. The attack is commonly
preceded by certain premonitory indications in the form of general
illness, loss of appetite, and some amount of diarrhoea, which gradually
increases in severity, and is accompanied with griping pains in the
abdomen (tormina). The discharges from the bowels succeed each other
with great frequency, and the painful feeling of pressure downwards
(tenesmus) becomes so intense that the patient is constantly desiring to
defecate. The matters passed from the bowels, which at first resemble
those of ordinary diarrhoea, soon change their character, becoming
scanty, mucous or slimy, and subsequently mixed with, or consisting
wholly of, blood, along with shreds of exudation thrown off from the
mucous membrane of the intestine. The evacuations possess a peculiarly
offensive odour characteristic of the disease. Although the
constitutional disturbance is at first comparatively slight, it
increases with the advance of the disease, and febrile symptoms come on
attended with urgent thirst and scanty and painful flow of urine. Along
with this the nervous depression is very marked, and the state of
prostration to which the patient is reduced can scarcely be exceeded.
Should no improvement occur death may take place in from one to three
weeks, either from repeated losses of blood, or from gradual exhaustion
consequent on the continuance of the symptoms, in which case the
discharges from the bowels become more offensive and are passed
involuntarily.
When, on the other hand, the disease is checked, the signs of
improvement are shown in the cessation of the pain, in the evacuations
being less frequent and more natural, and in relief from the state of
extreme depression. Convalescence is, however, generally slow, and
recovery may be imperfect--the disease continuing in a chronic form,
which may exist for a variable length of time, giving rise to much
suffering, and not unfrequently leading to an ultimately fatal result.
The dysentery poison appears to exert its effects upon the glandular
structures of the large intestine, particularly in its lower part. In
the milder forms of the disease there is simply a congested or inflamed
condition of the mucous membrane, with perhaps some inflammatory
exudation on its surface, which is passed off by the discharges from the
bowels. But in the more severe forms ulceration of the mucous membrane
takes place. Commencing in and around the solitary glands of the large
intestine in the form of exudations, these ulcers, small at first,
enlarge and run into each other, till a large portion of the bowel may
be implicated in the ulcerative process. Should the disease be arrested
these ulcers may heal entirely, but occasionally they remain, causing
more or less disorganization of the coats of the intestines, as is often
found in chronic dysentery. Sometimes, though rarely, the ulcers
perforate the intestines, causing rapidly fatal inflammation of the
peritoneum, or they may erode a blood vessel and produce violent
haemorrhage. Even where they undergo healing they may cause such a
stricture of the calibre of the intestinal canal as to give rise to the
symptoms of obstruction which ultimately prove fatal. One of the
severest complications of the disease is abscess of the liver, usually
said to be solitary, and known as tropical abscess of the liver, but
probably is more frequently multiple than is usually thought.
_Treatment._--Where the disease is endemic or is prevailing
epidemically, it is of great importance to use all preventive measures,
and for this purpose the avoidance of all causes likely to precipitate
an attack is to be enjoined. Exposure to cold after heat, the use of
unripe fruit, and intemperance in eating and drinking should be
forbidden; and the utmost care taken as to the quality of the food and
drinking water. In houses or hospitals where cases of the disease are
under treatment, disinfectants should be freely employed, and the
evacuations of the patients removed as speedily as possible, having
previously been sterilized in much the same manner as is employed in
typhoid fever. In the milder varieties of this complaint, such as those
occurring sporadically, and where the symptoms are probably due to
matters in the bowels setting up the dysenteric irritation, the
employment of diaphoretic medicines is to be recommended, and the
administration of such a laxative as castor oil, to which a small
quantity of laudanum has been added, will often, by removing the source
of the mischief, arrest the attack; but a method of treatment more to be
recommended is the use of salines in large doses, such as one drachm of
sodium sulphate from four to eight times a day. This treatment may with
advantage be combined with the internal administration of ipecacuanha,
which still retains its reputation in this disease. Latterly, free
irrigation of the bowel with astringents, such as silver nitrate,
tannalbin, &c., has been attended with success in those cases which have
been able to tolerate the injections. In many instances they cannot be
used owing to the extreme degree of irritability of the bowel. The
operation of appendicostomy, or bringing the appendix to the surface and
using it as the site for the introduction of the irrigating fluid, has
been attended with considerable success.
In those cases due to Shiga's bacillus the ideal treatment has been put
at our disposal by the preparation of a specific antitoxin; this has
been given a trial in several grave epidemics of late, and may be said
to be the most satisfactory treatment and offer the greatest hope of
recovery. It is also of great use as a prophylactic.
The preparations of morphia are of great value in the symptomatic
treatment of the disease. They may be applied externally as
fomentations, for the relief of tormina; by rectal injection for the
relief of the tenesmus and irritability of the bowel; hypodermically in
advanced cases, for the relief of the general distress. In amoebic
dysentery, warm injections of quinine _per rectum_ have proved very
efficacious, are usually well tolerated, and are not attended with any
ill effects. The diet should be restricted, consisting chiefly of soups
and farinaceous foods; more especially is this of importance in the
chronic form. For the thirst ice may be given by the mouth. Even in the
chronic forms, confinement to bed and restriction of diet are the most
important elements of the treatment. Removal from the hot climate and
unhygienic surroundings must naturally be attended to.
BIBLIOGRAPHY.--Allbutt and Rolleston, _System of Medicine_, vol. ii.
part ii. (1907), "Dysentery," Drs Andrew Davidson and Simon Flexner;
Davidson, _Hygiene and Diseases of Warm Climates_ (Edinburgh, 1903);
Fearnside in _Ind. Med. Gaz._ (July 1905); Ford in _Journal of
Tropical Medicine_ (July 15, 1904); Korentchewsky in _Bulletin de
l'Institut Pasteur_ (February 1905); Shiga: Osier and M'Crae's _System
of Medicine_, vol. ii. p. 781 (1907); Skschivan and Stefansky in
_Berliner klinische Wochenschrift_ (February 11, 1907); Vaillard and
Dopter, on the treatment by antidysenteric serum, _Annales de
l'Institut Pasteur_, No. 5, p. 326 (1906); J.A. Pottinger,
"Appendicostomy in Chronic Dysentery," _Lancet_ (December 28, 1907);
Robert Doerr, _Das Dysenterietoxin_ (Gustav Fischer, Jena, 1907); F.M.
Sandwith, "Hunterian Lecture on the Treatment of Dysentery," _Lancet_
(December 7, 1907).
DYSPEPSIA (from the Gr. prefix [Greek: dys-], hard, ill, and [Greek:
peptein], to digest), or indigestion, a term vaguely given to a group of
pathological symptoms. There are comparatively few diseases of any
moment where some of the phenomena of dyspepsia are not present as
associated symptoms, and not infrequently these exist to such a degree
as to mask the real disease, of which they are only complications. This
is especially the case in many organic diseases of the alimentary canal,
in which the symptoms of dyspepsia are often the most prominent. In its
restricted meaning, however (and it is to this that the present article
applies), the term is used to describe a functional derangement of the
natural process of digestion, apart from any structural change in the
organs concerned in the act.
The causes of this trouble may be divided into (a) those which concern
the food, and (b) those which concern the organism. Among the causes
connected with the food are not only the indulgence in indigestible
articles of diet, but the too common practice of eating too much of
what may be otherwise quite wholesome and digestible; and irregular, too
frequent or too infrequent meals. The quantity of food required by
different individuals varies between wide limits, but also the quantity
required by the same individual varies considerably according to
circumstances, more food being needed in cold than in warm weather, and
more in an active open-air occupation than in a sedentary one. The
thorough mastication of the food is a very important precursor of
digestion,[1] and this only too often fails, either owing to haste over
meals or because of painful or deficient teeth. Again, the quality of
the food is of importance, some kinds of flesh being harder and more
difficult of mastication than others. This is especially the case with
meat that has been smoked or salted, and with that cooked too soon after
the death of the animal. Drinks are a common source of dyspepsia. Beer
when new and its fermentation not completed is especially bad. Vinegar
and acid wines, if taken in large quantities, tend to produce gastric
catarrh, and tea is a very fruitful source of this trouble. Even too
much water at meal-times may cause indigestion, since the food in the
mouth is apt to be softened by the water instead of saliva, and also the
gastric juice becomes unduly diluted, rendering the digestion in the
stomach too slow and prolonged. Carious teeth and oral sepsis, from
whatsoever cause, lead to the same trouble.
Of the causes which concern the organism, nervous influences come first.
Bad news may take away all power of digestion and even provoke vomiting,
and any worry or mental trouble tends to bring on this condition.
General weakness and atony of the body affects the stomach in like
degree, and, if the muscles of the abdominal wall be much wasted, they
become too weak to support the abdominal viscera in place. Hence results
a general tendency for these organs to fall, giving rise to a condition
of visceroptosis, of which an obstinate dyspepsia is a very marked
feature. Adhesions of the intestines from old inflammatory troubles,
floating kidney and bad circulation may each be a cause of painful
digestion. Again, a dyspepsia that will not yield to treatment is often
one of the symptoms of renal disease, or, in young people of fifteen to
twenty years of age, it may be the earliest sign of a gouty diathesis,
or even of a more serious condition still--incipient phthisis. Chronic
dyspepsia, by weakening the organism, renders it more liable to fall a
prey to the attacks of the tubercle bacillus, but, on the other hand,
the tuberculous lesion in the lung is often accompanied by a most
intractable form of dyspepsia. From this it is clear that any condition
which lessens the general well-being of the organism as a whole, apart
from its producing any permanent morbid condition in the stomach, may
yet interfere with the normal digestive processes and so give rise to
dyspepsia.
The symptoms of dyspepsia, even when due to a like cause, are so
numerous and diversified in different individuals that probably no
description could exactly represent them as they occur in any given
case. All that can be here attempted is to mention some of the more
prominent morbid phenomena usually present in greater or less degree.
Very briefly, a furred tongue, foul breath, disturbance of appetite,
nausea and vomiting, oppression in the chest, pain, flatulence and
distension, acidity, pyrosis and constipation or diarrhoea are a few of
the commonest symptoms.
When the attack is dependent on some error in diet, and the dyspepsia
consequently more of an acute character, there is often pain followed
with sickness and vomiting of the offensive matters, after which the
patient soon regains his former healthy state. What are commonly known
as "bilious attacks" are frequently of this character. In the more
chronic cases of dyspepsia the symptoms are somewhat different. A
sensation of discomfort comes on shortly after a meal, and is more of
the nature of weight and distension in the stomach than of actual pain,
although this too may be present. These feelings may come on after each
meal, or only after certain meals, and they may arise irrespective of
the kind of food taken, or only after certain articles of diet. As in
most of such cases the food is long retained in the stomach, it is apt
to undergo fermentive changes, one of the results of which is the
accumulation of gases which cause flatulence and eructations of an acid
or foul character. Occasionally quantities of hot, sour, tasteless or
bitter fluid--pyrosis--or mouthfuls of half-digested food, regurgitate
from the stomach. Temporary relief may be obtained when another meal is
taken, but soon the uncomfortable sensations return as before. The
appetite may be craving or deficient, or desirous of abnormal kinds of
food. The tongue registers the gastric condition with great delicacy;--a
pasty white fur on the tongue is considered a sign of weakness or atony
of the digestive tract; a clean pointed tongue with large papillae, and
rather red at the edges and tip, is a sign of gastric irritation; and a
pale flabby tongue suggests the need of stimulating treatment.
Constipation is more common in the chronic forms of dyspepsia, diarrhoea
in the acute.
Numerous disagreeable and painful sensations in other parts are
experienced, and are indeed often more distressing than the merely
gastric symptoms. Pains in the chest, shortness of breathing,
palpitation, headache, giddiness, affections of vision, coldness of the
extremities, and general languor are common accompaniments of dyspepsia;
while the nervous phenomena are specially troublesome in the form of
sleeplessness, irritability, despondency and hypochondriasis.
As regards _treatment_ only a few general observations can be made. The
careful arrangement of the diet is a matter of first importance.
Quantity must be regulated by the digestive capabilities of the
individual, his age, and the demands made upon his strength by work.
There is little doubt that the danger is in most instances on the side
of excess, and the rule which enjoins the cessation from eating before
the appetite is satisfied is a safe one for dyspeptics. Due time, too,
must be given for the digestion of a meal, and from four to six hours
are in general required for this purpose. Long fasts, however, are
nearly as hurtful as too frequent meals. Of no less importance is the
kind of food taken, and on this point those who suffer from indigestion
must ever exercise the greatest care. It must be borne in mind that
idiosyncrasy often plays an important part in digestion, some persons
being unable to partake without injury of substances which are generally
regarded as wholesome and digestible. In most cases it is found very
helpful to separate the protein from the farinaceous food, and the more
severe the dyspepsia the more thoroughly should this be done, only
relaxing as the dyspepsia yields. No fluid should be drunk at
meal-times, but from one to two tumblers of hot water should be drunk
from an hour to an hour and a half before food. This washes any remnant
of the last meal from the stomach, and also supplies material for the
free secretion of saliva and gastric juice, thus promoting and
accelerating digestion. The only exception to this is in the case of a
dilated stomach, when it is wholly contra-indicated. With regard to
mastication, Sir Andrew Clark's rule is a very good one, and is more
easily followed than the ideal theory laid down by Horace Fletcher,
according to whom any food is digestible if properly treated while still
in the mouth. Clark's rule is that as the mouth normally contains
thirty-two teeth, thirty-two bites should be given before the food is
swallowed. This, of course, is a practical doctor's concession to human
weakness. Mr Fletcher would train every one to "chew" till the contents
of the mouth were swallowed by reflex action without deliberate act; and
he applies this theory of mastication and salivation also to drinks
(except water). Again, a lack of warmth being a source of dyspepsia,
this should be attended to, the back of the neck, the front of the
abdomen and the feet being the parts that require special attention. The
feet should be raised on a stool, the ankles protected with warm
stockings and a woollen "cummerbund" wound two or three times round the
body. Experience has shown that in this complaint no particular kind of
food or avoidance of food is absolutely to be relied on, but that in
general the best diet is one of a mixed animal and vegetable kind,
simply but well cooked. The partaking of many dishes, of highly-seasoned
or salted meats, raw vegetables, newly-baked bread, pastry and
confectionery are all well-known common causes of dyspepsia, and should
be avoided. When even the simple diet usually taken is found to
disagree, it may be necessary to change it temporarily for a still
lighter form, such as a milk diet, and that even in very moderate
quantity.
The employment of alcoholic stimulants to assist digestion is largely
resorted to, both with and without medical advice. While it seems
probable that in certain cases of atonic dyspepsia, particularly in the
feeble and aged, the moderate administration of alcohol has the effect
of stimulating the secretion of gastric juice, and is an important
adjuvant to other remedies, the advantages of its habitual use as an aid
to digestion by the young and otherwise healthy, is more than
questionable, and it will generally be found that among them, those are
least troubled with indigestion who abstain from it. Rest should be
taken both before and after food, and general hygienic measures are
highly important, since whatever improves the state of the health will
have a favourable influence on digestion. Hence regular exercise in the
open air, early rising and the cold bath are to be strongly recommended.
The medicinal treatment of dyspepsia can only be undertaken by a
physician, but the following is a very brief resume of the drugs he
depends on to-day. Bicarbonate of soda with some bitter, as quassia,
gentian or columba, is much in vogue as a direct gastric stimulant. In
irritable dyspepsia some form of bismuth in solution or powder; and, to
assist digestion through the nervous system, nux vomica and strychnine
can be relied on. To give directly digestive material, hydrochloric
acid, pepsin and rennet are prescribed in many forms, but where there is
much vomiting ingluvin is more efficacious than pepsin. When farinaceous
food is badly borne, diastase is helpful, given either before or with
the meal. To prevent fermentation, phenol, creasote and sulpho-carbolate
of soda are all extremely useful in skilled hands; and for intestinal
decomposition and flatulent distension, bismuth salicylate with salol or
ss-naphthol is much used. Cyllin, and charcoal in many forms, may be
taken both for gastric and intestinal flatulence. But all these drugs,
of proved value though they are, must be modified and combined to suit
the special idiosyncrasy of the patient, and are therefore often worse
than useless in inexperienced hands. The condition of the bowels must
always have due attention.
See also DIGESTIVE ORGANS; NUTRITION and DIETETICS.