713 



DYSENTERY. 



DYSPEPSIA. 



714 



In the asthenia form of dysentery, the tormina, tenesmus, and 

 mucous and bloody stools are attended with great depression of all 

 the organic functions, and extreme prostration of strength. The local 

 dysenteric symptoms, exceedingly urgent from the commencement, 

 are rapidly followed by fever of a low nervous or typhoid type. This 

 form of the disease often prevails as an epidemic ; and under circum- 

 stances favourable to their accumulation and concentration, exhalations 

 from the stools of the sick seem capable of producing dysentery in 

 persons directly exposed to them, previously in a state of sound health. 



Dr. Aitken, who saw this disease in the Crimea, says, " It is the 

 mucous membrane of the great intestine, and especially of the rectum 

 and lower portion of the colon, which is the seat of the characteristic 

 lesions in dysentery." These lesions are frequently attended with an 

 exudative process, which involves the whole mucous membrane, 

 although in a number of cases only the solitary and tubular glands are 

 involved. The following are the morbid conditions of the intestine 

 observed by Dr. Aitken. 1. Forms of exudation obvious on the sur- 

 face of the mucous membrane of the rectum and colon. 2. Forms of 

 exudation not obvious to the unaided eye, but which were seen in all 

 the cases examined by the microscope, to fill the mucous tubular 

 follicles of the large intestine. 3. Forms of exudation obvious to the 

 eye and demonstrable by microscopic examination, as being developed 

 in the solitary vesicular glands of the large intestine. 4. Changes in 

 the exuded material which tend first towards its organisation and sub- 

 sequently to its destruction and removal by ulceration. 5. Ulcerative 

 changes in the tissues of the mucous membrane itself. 6. Similar 

 dysenteric lesions extending into the small intestines." In chronic 

 cases the exuded matter is either thrown off or it becomes organised, 

 and subject to the ulcerative process in the same manner as the mucous 

 membrane. In all cases the solitary and tubular glands appear to be 

 first attacked. 



The duration of dysentery is as various as its types. It may prove 

 fatal in a few days or hours, or last for weeks and even months, and 

 ultimately destroy life by inflammation and gangrene of the bowels. 

 In some cases the disease ceases spontaneously, the frequency of the 

 stools, the griping and the tenesmus gradually diminishing, while 

 natural stools return ; but in other cases, the disease, with moderate 

 symptoms, continues long, and enda in protracted and exhausting 

 diarrhoea. 



The causes which predispose to dysentery appear to be long-con- 

 tinued exposure to a high temperature, or alternations of heat and 

 cold ; hence the disease is generally most prevalent in summer or 

 autumn, after considerable heats have prevailed for some time, and 

 especially after very warm and at the same time very dry states of the 

 weather. All observation and experience show that a powerful pre- 

 disposition to the disease is formed by the habitual use of a high and 

 stimulating diet, and especially by indulgence in spirituous liquors, 

 by excessive fatigue, by exposure to night air, by salt diet, and by all 

 causes which enfeeble the constitution in general, at the same time 

 that they over excite the alimentary canal in particular. 



The exciting causes are long-continued exposure to intense heat, or 

 to sudden and great alternations from heat to cold ; exhalations from 

 vegetable and animal matters in a state of decomposition, as from 

 marsh, stagnant, river or sea water, from anininlculto and minute 

 insects, or from the flesh of deceased animals ; noxious exhalations 

 from the bodies of persons crowded together in close and confined 

 situations, and more especially, as would appear, from the discharges 

 from the bowels of persons labouring under dysentery ; scanty and 

 bad food, consisting more especially of vegetable or animal matter in a 

 state of decay, as tainted meat, stale fish, unwholesome bread, unripe 

 rice, rye, and impure water. 



In the acute form of dysentery, when the fever is high, the pain 

 intense, and the inflammation active, blood-letting from the arm has 

 been recommended, and also the local abstraction of blood by leeching 

 or cupping. The employment of purgative remedies in dysentery 

 requires the greatest discrimination and caution. If the colon be dis- 

 tended with feculent matter which it cannot discharge, no remedies 

 will succeed until this accumulation is removed ; if, on the contrary, 

 there have been already frequent and copious discharges of feculent 

 matter, the administration of purgatives should be avoided. The 

 practitioner should therefore " ''ifully examine the state of the bowels 

 with regard to then- fume^MJT emptiness of fecal matter, and their 

 actual state in this respectMn almost always be ascertained with a great 

 degree of certainty if due pains be taken to discover it. If there be 

 reason to suppose that there is any accumulation of faeces, the mildest 

 purgatives should be given, of which the best is castor oil, and this 

 should be cautiously repeated until the irritating matter is wholly 

 removed. Great relief is at the same time afforded to the distressing 

 tormina and tenesmus by emollient and opiate enemas injected in very 

 small quantities. After the subdual of the inflammatory state by 

 blood-letting, and the evacuation of the accumulated ficces by mild 

 purgatives, the great object is to soothe the irritated membrane by 

 opiates, on the judicious employment of which, and the skilful com- 

 bination and alternation of this class of remedies with mild purgatives 

 and astringents, the successful treatment of ordinary dysentery 

 mainly depends. The asthenic forms with typhoid symptoms need a 

 guarded yet active treatment, nearly the same as that which is proper 

 to typhus fever with abdominal affection. [FEVER.] 



DYSLYSINE. [CHOLIC ACID.] 



DYSLYTE. A nitrogenous product not yet analysed, obtained by 

 the action of nitric acid upon citraconic acid. It is produced simul- 

 taneously with eubjte. 



DYSPEPSIA (Avtrirc^ia, dyspepsia), Indigestion, the difficult and 

 imperfect conversion of the food into nutriment. Digestion is a part 

 of the great function of nutrition ; its ultimate object is to convert 

 the aliment into blood. Between the articles taken as food and the 

 nutrient fluid of the body the blood, there is no obvious analogy, and 

 there is a wide difference in nature. Hence the function of digestion 

 consists of a succession of stages, at each of which the food undergoes 

 a specific change. Each change is effected by a peculiar process, for 

 the accomplishment of which a special apparatus is provided. Of these 

 processes the chief are mastication, deglutition, chymification, chylifi- 

 cation, and fsecation. [DIGESTION, in NAT. HIST. Div.] The healthy 

 condition and the natural action of every individual organ belonging to 

 the portion of the apparatus proper to each of these processes is neces- 

 sary to the sound state of the function of digestion. It is easy there- 

 fore to see by how many causes it may be disturbed ; in how many 

 different organs the source of the disturbance may have its seat, of how 

 varied a nature the disturbance may be, and how greatly the dis- 

 turbance of the digestive function may derange the other functions of 

 the body. 



In the history of the human family there is no known community of 

 human beings in any country, and no age of human life, in which the 

 first necessity of existence, that of taking food for the nourishment of 

 the body, is not the cause of disease and death to great numbers, and 

 of uneasiness, nay, sometimes even of intense pain, to far greater num- 

 bers. Why is this ? Why is the digestive process more productive of 

 suffering, disease, and death in man than in the lower animals of a 

 similar structure, in which the function, considered in a physiological 

 point of view, is scarcely at all less complex ? The correct answer to 

 this question would include a clear account of the causes of dyspepsia, 

 and would suggest the appropriate remedies for the disease. 



Digestion being an organic function, when this function is healthfully 

 performed, for reasons which have been fully developed, it is unattended 

 with consciousness. The first effect of the disturbance of this function 

 is to render the patient not only conscious, but painfully conscious, 

 that he has a stomach. A sense of nausea, sometimes, when the affec- 

 tion is severe, even vomiting, an obscure feeling of uneasiness, fulness, 

 distension, weight in the region of the stomach, occasionally amounting 

 to pain, and even severe pain, flatulence, eructation, a sensation of 

 sinking, and lastly, a loss of appetite, constitute the train of uneasy 

 sensations which, coming on after the reception of food, indicate dis- 

 ordered digestion, and which take the place of the feelings of refresh- 

 ment and exhilaration which result from healthy digestion. 



When these uneasy sensations are occasioned by a disordered state 

 of the stomach, the disorder may consist in a derangement either of its 

 secreting arteries, or its mucous glands, or its organic nerves, or its 

 muscular fibres, inducing a deficient secretion of the gastric juice, a 

 deficient secretion of mucus, a diminished or increased irritability of 

 the muscular fibres, by which the motions of the stomach are disturbed. 

 If the gastric juice be deficient, the first step in the digestive process 

 cannot take place, the food cannot be dissolved ; if the mucus be ex- 

 cessive, the contact of the gastric juice with the food may be prevented : 

 if the muscular fibres of the stomach are torpid or too irritable, the 

 food may be detained too long or too short a time in the stomach. 



The causes of dyspepsia are either those which act directly and 

 immediately upon the stomach itself, or those which act upon the 

 whole body or upon particular parts of it, but which still affect the 

 stomach principally and almost solely. 



Of the first kind are noxious, irritating, and indigestible substances 

 taken into the stomach as articles of food or drink, such as tainted 

 meat, decayed vegetables, unripe fruit, very acid matters, ardent 

 spirits, &c. ; and even wholesome food taken too frequently or in too 

 large a quantity, especially when its nature is very nutritious, as when 

 it consists principally of animal matter, or when a large quantity of 

 nutriment is presented to the stomach in a very concentrated form, or 

 is rendered too stimulating by being highly seasoned ; the abuse of 

 fermented and spirituous liquors, which is one of the most frequent 

 causes of dyspepsia in its severest and most fatal forms ; and large 

 quantities of fluids, habitually taken at too high a temperature, as very 

 hot tea, coffee, or soup. 



Of the second kind, or the causes which act upon the whole body or 

 upon particular parts and functions of it, are want of pure air ; hence 

 the frequency of dyspepsia in large and crowded cities, and more espe- 

 cially in narrow and confined lanes and alleys, in the dirty and ill- 

 ventilated houses of the poor. Want of exercise : from physical 

 inactivity all the organs of the body languish, but the stomach first 

 and most. Intense study or close application to business too long 

 continued, implying both want of air and want of exercise. Mental 

 emotion, more especially the depressing passions, fear, grief, vexation, 

 disappointment, anxiety, and hope deferred. Exposure to the influence 

 of cold and moisture. In persons with weak stomachs and delicate 

 skins, a cold damp day, more especially suddenly succeeding a hot day, 

 often produces a severe attack of dyspepsia. Hence it is that dyspeptic 

 complaints are so prevalent when cold and damp weather first sets in. 

 Cold is a sedative to the nervous system, as heat is an excitant ; and 



