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    "title": "DYSART",
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    "verified_text": "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. footnote: [1] 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.",
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