_Spasm_, especially of arteriosclerotic vessels, may be responsible for attacks of giddiness or faintness, particularly on exertion, and there may be some doubt whether such symptoms are the outcome of cerebral anaemia or of cardiac insufficiency. Frequent transient attacks of aphasia or paralysis, due to spasm of arteriosclerotic middle cerebral arteries, may occur in patients with high blood pressure (Peabody,[217] Osler[218]). _Varicosity_ either localized, like aneurysms, or throughout the length of veins, are common, especially in the lower limbs of women who have borne children and done much standing; this condition disposes to varicose ulcers in the lower third of the leg, and to acute phlebitis. As pointed out by Trousseau, who was an illustration of his own dictum, venous thrombosis may occur in the course of intra-abdominal malignant disease. Though _dyspepsia_ of adult life often diminishes or passes away in the more tranquil conditions of old age, it is common; Fenwick[219] estimated that it occurred in 21 per cent of the population over the age of 65. Oral sepsis may be responsible for chronic gastritis and much debility in the old. _Constipation_ often comes on after 60 and is mainly due to atonic dilatation and failure of peristalsis in the colon, though diminished secretion of mucus may play a part. Prostatic enlargement has been thought to interfere with peristalsis (Hollis[220]), and in women large fibromyomas of the uterus may have this effect. Gerontal constipation is usually more troublesome in women than in men. Faecal accumulation in the rectum is a frequent cause, especially in bed-ridden subjects, of what they describe as diarrhoea, the real significance of which may be easily overlooked unless digital examination of the rectum is undertaken. The pecten band of fibrous tissue arising in the submucosa of the pecten, inside the external sphincter, narrows the anal orifice and so prevents complete evacuation of the rectum and diminishes the size of the faeces which are generally voided in short pieces. It is usually, but not always, associated with internal piles and due to the attendant congestion. W. E. Miles,[221] who described the pecten band, tells me that it may be regarded as a pathological development of advancing years, and that he has found that it may so reduce the anal orifice in the elderly that it is with difficulty the little finger can be introduced. Pruritus ani, due to piles and local congestion, is not uncommon in the aged. _Piles_ are common in the aged and are related to the frequency of constipation. Like other diseases, they do not give rise to discomfort so soon or so forcibly as in younger persons. From muscular atrophy hernia, umbilical in both sexes, in men inguinal and in women femoral, is prone to occur.