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 δυσ-, hard, ill, and πέπτειν, 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
- ↑ This aspect of the matter—“buccal digestion”—has been specially emphasized in recent years by Horace Fletcher of the United States, whose experience of the results of systematic “chewing,” confirmed by Sir M. Foster, Prof. Chittenden and others, has almost revolutionized the science of dietetics.
