perchance through the inheritance of a resisting power which has enabled us to arrive at sixty years of age, and upward, find the time to rest, our teeth are gone, our stomach, from constant action, is unable to act with that promptness and energy which early in life enabled us to digest food on the run, as it were. Then the physician is called upon to encourage, stimulate, and prop up by his art, Nature's waning forces.
The manifestations of dyspepsia in the aged do not vary materially from those of adults, but the causes are somewhat different; the treatment is conceived on a plan based on the age and life-long habits of the patient. An aged stomach is not an active stomach. Atony characterizes its functional action. Acid digestion, gastric catarrh, and flatulency, are the leading forms of dyspepsia of the aged. Old people have not in general what we call a healthy appetite. One well-known writer has said that they eat because no other interesting occupation is afforded their senses. This may be true of the very aged, and it undoubtedly is a fact that most people of eighty years and upward find as much pleasure in eating as in almost any other occupation left them. The appetite is often lost when no disease can be detected. There is loss of the sense of taste, and even several days without food does not provoke hunger. In another form, the breath is somewhat offensive, the tongue furred, when in the former case it was clean.
Fisher tells us that, if this continues, it leads to senile marasmus or atrophy of the aged. Some old people suffer from a difficulty in swallowing, which seems to be the result of a partial paralysis of the throat; the pharynx does not respond to the stimulus of food as it passes over it. Solids pass more easily than liquids. Deglutition is more difficult in an upright than in a horizontal position. Fisher speaks of the case of a man sixty years of age who swallowed soft and mucilaginous preparations with great difficulty, but warm food, salty or irritating substances gave little trouble. Day has noticed the same fact, and observes that irritating or highly seasoned foods were the only ones swallowed easily. Canstatt thinks that the abuse of tea and coffee leads to the development of this state, which he says is very common in Holland.
Old people are subject to accumulations of gas in the intestinal tract, which not only occasion distress from over-distention of the stomach, causing pressure upward upon the diaphragm, and consequent interference with the heart's action, especially when lying down, but also from its passage downward into the bowels.
Diarrhœa is one of the consequences of dyspepsia, and it is not unusual to find old people who have several movements of the bowels daily, without any of the exhaustion attendant upon ordinary diarrhoeas. Another remarkable fact is, that we find, even in very old people, a diarrhœa which would naturally seem to weaken and prostrate even a strong man, but the effects of which are not noticed until
