The Acute Abdomen in the Aged

female anatomy has been so designed that our instrument makers have not succeeded in devising any apparatus that can cope with incontinence. Faecal incontinence is often due to impacted faeces, when just a thin trickle gets past the mass. Enemas solve this problem and give much encouragement to both patients and relatives. Try to avoid colostomies in the aged. With the intelligent patient all goes well, but with the uneducated infection of the surrounding skin causes much discomfort and misery. Severe rheumatoid or osteoarthritic cases are not common in the real old-age group. Death brings relief from their misery at an earlier age. Cancer is not a common cause of death in the aged. Many of them die with cancer but not of cancer. The neoplasm seems to grow verv slowly in the aged, and its virulence is much reduced. Congestive heart failure is very common in ambulant elderly patients. They respond very well to bed rest and treatment with digitalis, mersalyl, and aminophylline. Many of them develop coronary disease, but this manifests itself often only by a little breathlessness, and seldom causes acute pain. An E.C.G. is diagnostic. Within three to four weeks the lesion seems to heal satisfactorily and they can be allowed up very much more quickly than the patient in his fifties. In the respiratory diseases, pneumonia has long since lost the title of " captain of the men of death." The antibiotics have controlled the ravages of that disease, and it is seldom now that one sees a case of textbook pneumonia, but influenzal and virus pneumonias still take their toll. Foot defects cause much distress to the elderly, and it is estimated that almost 10% of those who are housebound are crippled by corns, callouses, bunions, and flat-feet. The provision of an adequate chiropody service would bring much comfort to the sufferers and would enable them to lead once again a useful and independent life. Ferguson, a general practitioner in Paisley, observed, over 25 years, the incidence and cause of death of 280 patients in his own practice who were over the age of 70. He chose that age because they had escaped the pitfalls which engulf the middle-aged and because it was the classical conception of the allotted span. He found that 33 men and 57 women -32% of the whole-died from what he called normal senescence without any obvious active disease, " God's finger touched them and they slept." No post-mortem examinations were done, but it would have been of real interest to know what particular part in the most intricate machine ever designed-the human body-had worn out, and whether with more specialized knowledge life could have been usefully sustained for a further period.