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disordered state of the whole abdominal viscera. Organic degeneration of the liver and kidneys often succeeds, or chronic ulcer of the stomach, with its attendant miseries ; an atheromatous condition of the arteries and capillary vessels is another sequence of alcoholic imbibition ; and this again becomes the cause of valvular disease of the heart, and it may endanger life from apoplectic effusions into the brain.
Alcohol may be a most valuable medicine, but the abuse of it entails innumerable miseries, and that which may be of temporary benefit becomes direct injury when unnecessarily continued; the temporary requirements of disease and of a failing circulation are never meant to be the guide of normal health ; and if large doses of stimulant be continued, organic disease will almost invariably follow.
DYSPEPSIA FROM WEAKNESS.—1. FROM IMPERFECT NUTRITION
AND FROM DISEASED VESSELS. 2. FROM EXHAUSTION OF THE CEREBRO-SPINAL NERVOUS SYSTEM. 3. FROM EXHAUSTION OF THE NERVE OF ORGANIC LIFE.—ATONIC DYSPEPSIA.
As an expression in the science of medicine, weakness is both indefinite and of various import, and we should be unwilling to make use of it in describing imperfect functional energy of the stomach did we not recognise a class of cases to which the term may be justly applied. Want of strength may be real or imaginary, real, when due to general exhaustion, imaginary, when any impediment to the performance of healthy function or the separation of excreta embarasses the system; and when in exhaustion and general weakness the stomach cannot perform its digestive function, the feebleness is increased, because the supply of fresh formative material is cut off.
The varieties of exhaustion may be traced to three sources. 1st. The exhaustion connected with diseased vessels, as exemplified in advanced life. During the earlier stages of life general functional activity is maintained at a high standard, the wear and tear of the system is considerable, and fresh increment is required for the general growth of the body; but during its later stages a contrary state exists, the organism works at a slower pace, the wear and tear is less, and it is not necessary that the same energy of the digestive organs should persist. It is well known that in old aye the vessels become rigid and atheromatous, the blood is less freely distributed, and there is less ability in the economy to restore preternatural disturbance, and less elasticity of the system; as in the autumnal leaf of the tree, the nutrition changes are more sluggishly performed, the vessels gradually become obstructed, and at length almost obliterated, so that in course of time the connection with the parent stem is easily severed; thus also in advanced life functional activity lessens, till at length it fails altogether.
The same diminished power is observed in the enfeebled digestion of aged persons, as we have previously remarked; they are conscious that the function is not so energetic as it formerly was, and, indeed, they are aware that the necessity for supply is also lessened, the bodily activity is less, and the appetite for food is proportionately small. The fact of this decreased functional power is testified by the structural changes in the several organs themselves, the muscles are less vascular, they contract with less power, and
undergo degenerative changes; the inner membrane of the arteries becomes rough and atheromatous, the minute capillary vessels present highly refracting particles from fatty metamorphosis. In the nerve centres there is a larger quantity of pigmental deposit, the bones become more brittle, the fibrous tissues also undergo partial ossification, and the glandular organs diminish in size ; thus in every structure there is the manifestation of the same fact, and the weakness of digestion is only a part of the general debility.
It is doubtful, whether this condition is due to the want of energy in the glands, or to the impeded flow of blood from atheromatous vessels, or to the degeneration of the nervous elements of the large ganglionic centres ; still the fact remains, and it often becomes a question of the greatest importance, how the failing power of the stomach may be revived, and how renewed energy may be given. We have already stated, that the appetite in old age is lessened, but it is sometimes found that it almost wholly fails, and the other vital functions and reparative changes are reduced to the lowest degree. If food be taken, there is no ability to digest it, and it remains in the stomach, producing pain, a sense of weight and oppression; these symptoms may be accompanied by headache and faintness, and not unfrequently are followed by flatulence, and sometimes severe colic. The functions of the brain may become so disturbed, that they produce symptoms of threatening apoplexy, as loss of consciousness, impaired or disturbed vision, and vertigo; the tongue appears to lose for a time its right muscular movement, the power of speech is gone, the words cannot be spoken, or the wrong word is substituted; numbness of the hands, or even temporary loss of power, are experienced, and these symptoms singly or together produce considerable alarm to the patient and his friends. The vessels of the brain in advanced life become rigid and atheromatous ; and we often find the middle cerebral and the basilar arteries at the base of the brain resembling bony tubes; the minute capillaries in the pia mater, and in the brain substance, are similarly affected, so that it is not surprising that with functional derangement of the stomach these serious symptoms of threatening brain disease should occur.
The valves of the heart in advanced life become also atheromatous, and its muscular fibre undergoes degeneration, so that from trifling causes the action becomes irregular, and dyspnoea and palpitation are soon induced; thus patients affected with gastric disturbance not unfrequently refer the ailment to the heart.
Again, the difference that is presented by the abdominal glands in early and advanced life is most marked, and is shewn in every part of the organism. The mesenteric glands in infancy constitute distinct, oval glands, highly vascular, and evidently possessing