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

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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

great functional activity; in old age, it is on the contrary, often difficult to find them, and they may then only weigh a few grains. The liver in early life has proportionally a much larger volume than in old age, so also the kidneys; and although it is an opinion only based on hypothesis, we do not doubt that the gastric glands undergo similar atrophy.

To this circumstance then, we must look for one cause of the imperfect solution of food, which takes place in aged persons; but the diminished appetite and general feebleness have reference also to the state of the nervous system, and especially of the vaso-motor nerve. Still, it would be both erroneous and injurious in its tendency to regard this lessened functional activity as necessarily constituting disease, or to seek to attain the standard of early or middle life. The wants of the system do not require such a condition; and it is remarkable, that comfortable health and vigour are often maintained for months, and even for many years, upon a diet forming only a small relative part of that which is usually taken in middle life by the same person.

This feebleness of digestive power in aged persons is of great importance when disease affects other parts of the system, for then greater work is required from an organ, the functional activity of which may have been reduced almost to a minimum. Now, although we cannot restore organs already degenerated, or revive

the elasticity of youth, still much may be done to remedy this state, and there are three sources of alleviation available to us. 1. The administration of such a diet as the enfeebled stomach can digest, and the judicious use of stimulants. 2. The regulation of the general habits and condition of the patient, so that as far as possible strength may be economised, and the necessity for unusual activity of the digestive power guarded against. 3. The right use of medicines as far as they may be called for.

In reference to the first, as to the proper diet, it will often be found that the stomach may be spared very much by the use of fluid diet, by farinaceous food; and when this atonic dyspepsia is severe, by an imitation of infantile food, milk with soda water, cream with arrowroot, soups, &c. Nutrient enamata are of some service in extreme cases, but especially when acute disease supervenes upon this state of exhaustion.

When the symptoms are less severe, and solid diet can be digested, we must still give that which is easily assimilable, and free from hard and insoluble ingredients.

As to stimulants in atonic dyspepsia of advanced life, if taken in excess they increase the exhaustion, because they interfere with glandular activity and integrity; but, with wise precautions stimulants excite the stomach to more active secretion, and more powerful digestion ; a small quantity of brandy may in this way be advan

tageously added to milk, and wine judiciously administered often acts in a similar beneficial manner.

The second object of treatment is very important, namely, to spare strength by the avoidance of excessive fatigue, whether physical or mental, to take every precaution against sudden extremes of temperature, and to maintain as far as possible an equal atmospheric condition. Moderate exercise is greatly conducive to the maintenance of strength, and to the healthy performance of every function; and it affects no function in a greater degree than that of digestion.

The habit of snuff-taking and smoking produces a relaxed condition of the mucous membrane of the stomach, and impairs its digestive powers; and although, for many years the habit may have been indulged in apparently with impunity, still when the strength is diminished, this additional cause of exhaustion may prove extremely detrimental. Strong tobacco acts as a powerful sedative, but when the grains of snuff are directly applied to the stomach, as in inveterate snuff-takers they certainly are, the injury is much greater than such patients are willing to allow. In advanced life we have found this habit, although for thirty or forty years persisted in with apparent impunity, then become most pernicious in its effects.

3rdly. Medicines are not without value in these instances. We may briefly indicate some of them, and the first that we may mention is the sesquicarbonate