Symptoms. — The  dyspepsia  of  old  age  is  common  to  all
classes  of  the  community,  but  is  rather  more  frequent  in  women
than  in  men. It  usually  develops  between  sixty  and  seventy
years  of  age  and  gradually  increases  in  severity  with  advancing
years. As  a  rule,  the  symptoms  commence  in  an  insidious
manner,  but  occasionally  their  onset  is  somewhat  abrupt
and  dates  from  an  accident  or  an  acute  illness. Flatulence
invariably  constitutes  the  most  prominent  symptom  of  the
complaint  On  rising  from  bed  in  the  morning  a  sense  of
fulness,  weight,  or  distention  is  usually  experienced  in  the
upper  part  of  the  abdomen,  accompanied,  perhaps,  by  nausea,
giddiness,  or  palpitation,  and  not  infrequently  followed  by  an


SYMPTOMS. 355

attack  of  retching  which  serves  to  expel  a  quantity  of  odourless
gas  from  the  stomach. As  time  goes  on  it  is  noticed  that  the
appetite  for  breakfast  steadily  diminishes  and  articles  of  food
which  were  previously  enjoyed  are  renounced  one  after  another
until  a  piece  of  toast  or  a  few  thin  slices  of  bread  and  butter
constitute  the  entire  meal. At  midday  the  desire  for  food  is
more  pronounced  and  a  fairly  substantial  meal  may  be  taken
with  relish,  but  during  the  afternoon  epigastric  discomfort,
eructations  of  gas,  and  a  marked  disinclination  for  mental  work
frequently  manifest  themselves. With  the  progress  of  time
the  sense  of  general  discomfort  becomes  gradually  augmented
and  it  is  found  that  abdominal  distention  and  gaseous  eructa-
tions are  almost  constantly  present,  although  the  individual
himself  is  often  oblivious  of  the  constant  noisy  belchings  or
borborygmi  which  annoy  his  acquaintances  and  distress  his
relatives. Occasionally  pyrosis,  preceded  by  a  cramping
pain  in  the  epigastrium,  is  a  troublesome  symptom,  but  regur-
gitations of  an  acid  fluid  into  the  throat  are  rarely  the  subject
of  complaint. Nausea  and  retching  after  food  are  by  no
means  infrequent,  but  vomiting  is  seldom  observed. Palpita-
tion of  the  heart,  flushing  of  the  face,  tightness  of  the  chest,  and
a  difficulty  of  inspiration  are  common  in  stout  persons  and
greatly  add  to  the  general  distress. The  flatulence  is  often
particularly  severe  at  night  and  for  some  hours  the  patient
niay  be  obliged  to  sit  up  in  bed  and  to  make  frequent  and
varied  efforts  to  expel  the  gas  from  his  stomach. 