Chapter VI: Introduction (4)

The _senile heart_ has attracted much attention, and myocardial degeneration and fibrosis due to past infections or to coronary arteriosclerosis are extremely common. The myocardial change is of great importance in reducing the reserve power of the heart, so that cardiac failure is prone to supervene in acute infections, such as influenzal pneumonia. Chronic valvulitis akin to and associated with arteriosclerosis is common; the mitral valve is often affected and incompetent, with a loud systolic murmur at the apex which is displaced outwards; but the most characteristic lesion of advanced years is pure aortic stenosis; this is commonly regarded as part of the arteriosclerotic process in the aorta, but, as I have often noticed, the aorta may be remarkably healthy and even thinner than usual in old people with extensive calcification of the valves reducing the aortic orifice to a chink; it has indeed been thought that such stenosis of the aortic valves may protect the aorta from strain and so from arteriosclerosis. Although involvement of the bundle of His giving rise to the symptom complex of Stokes-Adams disease, and angina pectoris may complicate aortic stenosis, the presence of this valvular defect is compatible with remarkable prolongation of life. This may be due to the more placid life of these old patients, as is suggested by Sir Clifford Allbutt,[215] who regards aortic stenosis as more unfavourable in persons under 55 years of age than in their elders.

_Aneurysm of the large arteries_ is rare in the aged, although arteriosclerosis is common. Diffuse dilatation especially of the arch of the aorta and of the common iliacs is not infrequent, and occasionally latent saccular aneurysms are present. In rare instances large abdominal aneurysms causing pain or remaining latent until rupture occurs are reported. Among 112 abdominal aneurysms collected by Nunneley[216] 15 were over 50 years of age; these figures included 32 from St. George’s Hospital, three of them being over 65 years of age. Miliary aneurysms are of course extremely common in the subjects of cerebral haemorrhage.

_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.

_Gallstones_ are more frequent in advanced life, especially in women, than at other times of life, gallstones being found after death in about a third of persons over 70 years of age, though, as mentioned elsewhere, biliary colic is comparatively rare in old age.

The _urinary bladder_ in cases of prostatic enlargement shows hypertrophy succeeded by dilatation, fasciculation, and sacculation in response to the obstruction to micturition and degeneration of the muscular fibres. The ureters in similar circumstances become dilated, and the incidence of cystitis and pyelonephritis is thus favoured.

_Arthritic Affections._--Although gout is due to a defect in protein metabolism analogous to diabetes mellitus as regards carbohydrate metabolism and to obesity as a manifestation of disordered metabolism of fat, reference to this disease may be made here. Heredity has a potent influence on the incidence of the disease particularly in early life, but acquired gout is essentially a disease of the latter part of life or the early stage of old age when degeneration is beginning. The first attack may not occur until old age, and is then usually mild in character, and, in Sir William Roberts’s[222] words, appears almost as if it were an incidence of senescence. How far the various conditions spoken of as irregular gout, goutiness, or paragouty diseases, which are so numerous as to recall Murchison’s lithaemia, should be regarded as gouty is uncertain, but that they depend on disordered protein metabolism is highly probable. The connexion of gout with infection, as urged by Llewellyn,[223] has a bearing on the fibrositis and Dupuytren’s contraction often regarded as gouty phenomena. Dupuytren’s contraction of the palmar fascia, which has been thought in some instances to be secondary to arteriosclerosis of the medulla oblongata (Jardini[224]), often accompanies the fibrous pads on the interphalangeal joints of the fingers described by Garrod[225] and Hale-White.[226] The tendency of focal infections, especially oral sepsis, to become more frequent with advancing years also has a distinct bearing on the occurrence of chronic infective arthritis of various forms. The most characteristic is morbus coxae senilis which is not uncommonly associated with Heberden’s nodi digitorum, and sometimes with Morrant Baker’s cysts due to distension of synovial bursae with fluid; it may be confused with sciatica. Heberden’s nodes are unimportant and commonly free from attendant symptoms.

Spondylitis deformans with ankylosis of the articulations and ossification of the ligaments of the spine, in some cases further complicated by an extension of the process to the proximal joints of the limbs (rhizomelic spondylitis), may occur in the aged though also earlier in life.

_Osteitis deformans_ or Paget’s disease of bone begins as a rule in the later half of life, the average age being 50 years. Lannelonge[227] and Fournier[228] argued that it is a lesion due to congenital syphilis; but although luetic periostitis and osteitis may imitate it, there is no convincing evidence in favour of their contention.

FOOTNOTES

[1] _Thomas Linacre_, Linacre Lecture, 1908, St. John’s College, Cambridge, by William Osler, M.D., F.R.S., Cambridge University Press, 1908.

[2] _Life of Thomas Linacre_, by John Noble Johnson, M.D., p. 344, 1835.

[3] _De Temperamentis_, _Galeni Pergamensis_, etc. (translated by Thomas Linacre), by J. F. Payne, p. 5, Cambridge, 1881.

[4] The fourth of the five epidemics of the remarkable disease the English Sweating Sickness between 1486 and 1551 occurred in 1528–1529, and is regarded by Dr. F. G. Crookshank as influenza [_Proc. Roy. Soc. Med._, 1922, xv. (Sect. Hist. Med.) 27].

[5] The portrait of Heberden in his 86th year was painted by Sir William Beechey, R.A., who when he got to Windsor found he had forgotten his canvas and sent for a shirt on which he painted the picture, now in the dining-room of the Master’s Lodge, St. John’s College, Cambridge; there are two copies in the possession of the Heberden family, and one in the Censors’ room of the Royal College of Physicians. For some of this information I am indebted to Mr. W. B. Heberden and to Mr. W. Fleming, Bedell of the Royal College of Physicians of London.

[6] The Cambridge University Press, 1913.

[7] _Vide Gentleman’s Magazine_, 1851, N.S., xxxv. part i. 205.

[8] Γηροκομία βασιλική or _The Pourtract of Old Age wherein is contained a Sacred Anatomy, both of Soul and Body, and a Perfect Account of the Infirmities of Age Incident to them Both_, by John Smith, M.D., London, 1665.

[9] Maupas, _Arch. de zool. expér._, 1899.

[10] Woodruff, L. L., _Proc. Nat. Acad. Sc._, Washington, D.C., 1921, vii. 43.

[11] Woodruff and Erdmann, _Proc. Soc. Exper. Zool._, N.Y., 1913–14, xi. 73.

[12] Child, C. M., _Senescence and Rejuvenescence_, p. 310, Chicago, 1915.

[13] Huxley, J. S., _Journ. Microscop. Sc._, 1921, lxv. 643.

[14] Robertson, T. B., and Ray, L. A., _Journ. Chem. Biol._, 1919, xxxvii. 455.

[15] Drummond and Cannan, _Biochem. Journ._, Cambridge, 1922, xvi. 53.

[16] Sisson and Broyles, _Johns Hopkins Hosp. Bull._, Baltimore, 1921, xxxii. 22.

[17] Hopkins, G., _Journ. Physiol._, Cambridge, 1912, xliv. 425.

[18] Osborne, T. B., and Mendel, L. B., _Journ. Biol. Chem._, 1915, xxiii. 439.

[19] Metchnikoff, _The Nature of Man_, English translation, 1903, p. 272.

[20] Browne, T., _Pseudodoxia Epidemica_, p. 396, 6th edition, 1672.

[21] Eugenius Philalethes, junior, F.R.S., _Long Livers: A curious History of such Persons of both sexes who have liv’d several Ages, and Grown Young again_, 1722, p. 27.

[22] Hufeland, C. W., _The Art of Prolonging Life_, vol. i. p. 121, English translation, 1797.

[23] Mahaffy, J. P., _John Stearne_, An Address at the Bicentenary of the Medical School of Trinity College, Dublin, July 1912.

[24] Bacon, R., _The Cure of Old Age and Preservation of Youth_, p. 63, 1683. Translated by R. Browne.

[25] Hufeland, C. W., _Art of Prolonging Life_, 1797, vol. i. p. 176.

[26] Flourens, _De la longévité humaine ou de la quantité de vie sur la globe_, 1856.

[27] Cornaro, L., _Discourses on a Sober and Temperate Life_, p. 101, English translation, 1779, London.

[28] Metchnikoff, _The Nature of Man_, p. 278.

[29] Lankester, E. Ray, _The Advancement of Science_, p. 237, 1890, London.

[30] Easton, J., _Human Longevity_, 1799, Salisbury.

[31] The _Observer_ of March 26, 1922, contained a note on the discovery of a tombstone in the graveyard of Lamas Street Welsh Congregational Chapel, Carmarthen, recording the death on Nov. 14, 1831, of Ann David, aged 181 years.

[32] Sinclair, J., _The Code of Health and Longevity_, Frontispiece to vol. i., account in vol. ii. p. 274, 1807.

[33] King, G., _Census of England and Wales_, 1911, vol. vii. p. xlvi.

[34] Hufeland, C. W., _The Art of Prolonging Life_, 1797, vol. i. p. 168.

[35] Humphry, G. M., _Old Age_, p. 126, 1889, Cambridge.

[36] Hall, G. Stanley, _Senescence: The Last Half of Life_, 1922, London and New York.

[37] Mendel, K., _Neurol. Centralbl._, 1910, xxix. 1124.

[38] Rankin, G., _Brit. Med. Journ._, 1919, i. 63.

[39] Waterhouse, B., Letter to Sir John Sinclair in the latter’s _Code of Health and Longevity_, 1807, i. 33.

[40] Holland, H., _Med. Trans. Coll. Phys._, London, 1813, iv. 316.

[41] Lacassagne, A., _L’Homme vers la fin de sa vie_, p. 7, 1919, Lyon.

[42] Nascher, I. L., _Geriatrics: The Diseases of Old Age and their Treatment_, p. 18, London, 1919.

[43] Gilford, Hastings, _Med.-Chir. Trans._, London, 1897, lxxx. 17. _Disorders of Post-natal Growth and Development_, 1911.

[44] Variot et Pironneau, _Bull. Soc. pédiat. de Paris_, 1910, xii. 307.

[45] Roy, D., _Thèse de Paris_, No. 110, 1910.

[46] _Lancet_, 1889, ii. 349.

[47] Weber, Hermann, _On Longevity and Means for the Prolongation of Life_, 1919, 5th edition, by F. P. Weber, London.

[48] Brownlee, J., _The Use of Death Rates as a Measure of Hygienic Conditions_, p. 51. Special Report Series No. 60. Medical Research Council, 1922.

[49] Savage, G., _Memorial to Sir William Osler_, vol. i. p. 247, 1919, New York.

[50] Butler, S., _Evolution, Old and New_, p. 380, 1911.

[51] Weber, F. P., _Med. Press_, London, 1920, N.S., cix. 271.

[52] Compare Fischer, Martin H., _The Unpopular Review_, 1919, ix. 323.

[53] Paget, J., “Errors in the Chronometry of Life,” in _Studies of Old Case Books_, p. 92, 1891, London.

[54] Osler and McCrae, _The Principles and Practice of Medicine_, p. 834, 1920, New York and London.

[55] Clifford Allbutt, _Diseases of the Arteries including Angina Pectoris_, vol. i. pp. 164–7, 1915, London.

[56] _Lancet_, 1922, i. 874.

[57] _On the Handicapping of the First-Born_, Eugenics Lecture Series, x., 1914.

[58] Noirot, L., _L’Art de vivre longtemps_, p. 195, 1868, Dijon.

[59] Laurent, O., _Bull. Acad. de méd._, Paris, 1919, lxxxi. 835.

[60] _Annuaire internationale de statistique_, Part II., Europe, Movement of the Population, Table 12, pp. 180–81.

[61] _Statistiska Meddelanden_, Ser. A., Band I. 1 _Dödlighets- och Lifslangdstabeller for Åren 1816–1910 af Kungl. Statistiska Centralbyrån_, Stockholm, 1912, p. 28. (For this reference I am indebted to Dr. Major Greenwood.)

[62] _Public Health Reports_, Treasury Department, Washington, 1922, xxxvii. 487.

[63] Saundby, R., _Old Age, Its Care and Treatment_, p. 21, 1913, London.

[64] Easton, J., _Human Longevity_, p. xxvi, Salisbury, 1799.

[65] Browne, T., _Christian Morals_, Part I. Section XXXIII.

[66] Strachey, L., _Books and Characters_, p. 83, London, 1922.

[67] Finot, J., _Rev. mondiale_, Paris, 1922, xxxiii. 387.

[68] _The Mirrors of Downing Street_, by a Gentleman with a Duster, p. 165, 1920.

[69] Thompson, R. J. C., and Todd, R. E., _Lancet_, 1922, i. 874.

[70] Yeo, B., _XIX. Century_, 1883, xxiii. 390.

[71] _Vide_ F. Adams, _Genuine Works of Hippocrates_, Sydenham Society, vol. i. p. 10, 1849.

[72] Drinkwater, H., _Practitioner_, London, 1914, xciii. 844.

[73] For a consideration of this subject see Sir Hermann Weber’s _Means for the Prolongation of Life_, and Dr. Lapthorn Smith’s book _How to be Useful and Happy from 60 to 90_, London, 1922.

[74] Compare Allbutt, C., _St. George’s Hosp. Rep._, 1870, v. 43, and C. Hilton Fagge, _Principles and Practice of Medicine_, 1886, vol. ii. p. 22, London.

[75] Lacassagne, A., _L’Homme vers la fin de sa vie_, p. 44, Lyon, 1919.

[76] Owen, I., _Brit. Med. Journ._, 1888, i. 1312.

[77] Allbutt, C., _Diseases of Arteries, including Angina Pectoris_, vol. i. p. 250, 1915, London.

[78] Robertson, T. B., and Ray, L. A., _Journ. Biol. Chem._, 1920, xlii. 71.

[79] Williams, L., _Minor Ailments_, p. 319, 1920, London.

[80] Sharpey-Schafer, E. A., Presidential Address, Brit. Assoc., 1912, _Brit. Med. Journ._, 1912, ii. 589.

[81] Salimbeni et Gery, _Ann. Inst. Pasteur_, Paris, 1912, xxvi. 577.

[82] Fischer, M. H., _Oedema and Nephritis_, 1921, New York.

[83] Lumière, A., _Rôle des colloïdes chez les êtres vivants_, 1921, Paris.

[84] Bechhold, H., _Die Kolloide in Biologie und Medizin_, Dresden, 1912.

[85] Marinesco, G., _Études histologiques sur le mécanisme de la sénilité_, 1904; also _Presse méd._, Paris, 1922, xxx. 309.

[86] Campbell, H., _Treatment_, London, p. 153, 1909.

[87] Carrel, A., _Journ. Exper. Med._, Baltimore, 1913, xviii. 287.

[88] Loeb and Northrop, _Journ. Biol. Chem._, 1917, xxxii. 103.

[89] Carrel, A., and Ebeling, A. H., _Journ. Exper. Med._, Baltimore, 1921, xxxiv. 599.

[90] Robertson, T. B., and Ray, L. A., _Journ. Biol. Chem._, 1920, xlii. 71.

[91] Nathan, _Ann. de méd._, Paris, 1922, xi. 59.

[92] Drew, _Brit. Journ. Exper. Path._, London, 1922, iii. 20.

[93] Hufeland, C. W., _The Art of Prolonging Life_, 1797, vol. i. p. 227.

[94] Lorand, A., _Old Age Deferred_, pp. 51, 114, Philadelphia, 1921.

[95] Biedl, A., _Endocrinology_, Los Angeles, 1921, v. 523.

[96] Berman, L., _The Glands Regulating Personality_, p. 260, The Macmillan Co., 1921, New York.

[97] Lydston, G. F., _Journ. Amer. Med. Assoc._, Chicago, 1919, lxxii. 396.

[98] Stanley and Kelker, _Journ. Amer. Med. Assoc._, Chicago, 1920, lxxiv. 1501.

[99] Stanley, _Endocrinology_, Los Angeles, 1921, v. 708.

[100] Gilford, H., _The Disorders of Post-natal Growth and Development_, p. 643, 1911, London.

[101] Bouin et Ancel, _Compt. rend. Acad. Sc._, Paris, 1903, cxxxvii. 1289, 1904, cxxxviii. 110.

[102] Lipschülz, Ottow, Wagner, and Bormann, _Proc. Roy. Soc._ Lond., 1922, ser. B, xciii. 132.

[103] Kuntz, A., _Endocrinology_, Los Angeles, 1921, v. 190.

[104] Nathan, _Presse méd._, Paris, 1922, xxx. 237.

[105] Sand, K., _Journ. de physiol. et de path. gén._, Paris, 1921, xix. 525.

[106] Blair Bell, _The Sex Complex_, p. 28, 1920.

[107] Sternberg, _Berl. klin. Wehnschr._, 1921, lviii. 556.

[108] Mott, F. W., _Brit. Med. Journ._, 1919, ii. 658; _Proc. Roy. Soc. Med._, 1922, xv. (Sect. Psychiat.), 1–30.

[109] Aron, _Compt. rend. Soc. biol._, Paris, 1921, lxxxv. 107.

[110] Retterer, E., _Compt. rend. Soc. biol._, Paris, 1919, lxxxii. 423.

[111] Walker, K., _Brit. Med. Journ._, 1922, i. 297.

[112] Steinach, E., _Verjüngung durch experimentelle Neubelebung der alternden Puberstätsdrüsen_, J. Springer, Berlin, 1920.

[113] Benjamin, H., _New York Med. Journ._, 1921, cxiv. 687.

[114] Simmonds (quoted by Marinesco), _Deutsche path. Ges._, Jena, 1921.

[115] Tiedje, H., _Deutsche med. Wehnschr._, 1921, xlvii. 35.

[116] Romeis, B., _München. med. Wehnschr._, 1920, lxvii. 600, 1821.

[117] Marinesco, _Presse méd._, Paris, 1922, xxx. 309.

[118] Lenz, L., und Schmidt, P., _Deutsche med. Wehnschr._, 1921, xlvii. 327.

[119] Moullin, C. W. M., _Enlargement of the Prostate_, p. 194, 3rd edition, 1904.

[120] Harrower, _Practical Hormone Therapy_, p. 344, 1914.

[121] Frank, _Journ. Amer. Med. Assoc._, Chicago, 1922, lxxviii. 181.

[122] Marinesco, _Études histologiques sur le mécanisme de la sénilité_, 1904.

[123] Léri, _Le cerveau sénile_, 1906.

[124] Ribbert, H., _Der Tod aus Alterswäche_, Bonn, 1908.

[125] Salimbeni et Gery, _Ann. Inst. Pasteur_, Paris, 1912, xxvi. 577.

[126] Lane, W. A., _The Operative Treatment of Intestinal Stasis_, 1918, London.

[127] Abernethy, J., _The Constitutional Origin and Treatment of Local Diseases_, 1811.

[128] Clarke, E., in _The Operative Treatment of Intestinal Stasis_, p. 246, London.

[129] Vide Saundby, _Old Age, its Care and Treatment_, pp. 5, 28, London, 1913.

[130] Pearson, K., _Arch. Middlesex Hosp._, 1902, ii. 127.

[131] Lazarus-Barlow, W. S., _Ibid._, 1905, v. 43.

[132] On analysis of the Registrar-General’s returns for England and Wales (1901–1909) C. Singer (_Quart. Journ. Med._, Oxford, 1911–12, v. 33), found that the incidence curves of carcinoma of the lip, face, and breast were exceptional in rising up to the highest age recorded (90).

[133] Laurent, O., _Bull. Acad. de méd._, Paris, 1919, lxxxi. 835.

[134] Gilford, H., _The Disorders of Post-natal Growth and Development_, 1911, London; and _Brit. Med. Journ._, 1913, ii. 1617.

[135] Goodpasture, E. W., _Journ. Med. Research_, Boston, 1918, xxxviii. 127.

[136] Oertel, H., _Ibid._, 485.

[137] Councilman, W. T., _Contributions to Medical and Biological Research_, dedicated to Sir William Osler, 1919, vol. ii. p. 918, New York.

[138] Kissmeyer and With, _Brit. Journ. Dermat. and Syph._, London, 1922, xxxiv. 175.

[139] Pringle, J. J., _System of Medicine_ (Allbutt and Rolleston), 1911, ix. 549, London.

[140] Cheatle, G. L., _West London Med.-Chir. Journ._, 1921, xxvi. 154.

[141] _Letter to a Friend_, in Greenhill’s edition of _Religio Medici_, p. 135, Macmillan, 1898.

[142] Bacon, F., _The History of Life and Death_.

[143] _Autobiography of Sir Charles Cameron_, p. 137, 1920.

[144] Graves, R. J., _Dublin Quart. Journ. Med. Sc._, 1847, N.S., iii. 339.

[145] Quoted by D. Roy, _Thèse de Paris_, No. 110, 1910.

[146] Sinclair, J., _Code of Health and Longevity_, 1807, i. 68.

[147] Boyd, R., _Phil. Trans. Roy. Soc._, 1861, cli. 241.

[148] Monauni, _Arch. d’opth._, 1921, xxxviii. 180.

[149] Nascher, I. L., _Geriatrics_, p. 36, 2nd edition, 1919, London.

[150] Clarke, Ernest, in _Operative Treatment of Intestinal Stasis_, by W. A. Lane, p. 245, 1918, London.

[151] Hollis, W. A., _Brit. Med. Journ._, 1916, i. 677.

[152] Luciani, _Text-book of Physiology_, English translation, vol. v. p. 302, London.

[153] Salimbeni et Gery, _Ann. Inst. Pasteur_, Paris, 1912, xxvi. 577.

[154] Symmers, D., _Arch. Int. Med._, Chicago, 1909, iii. 270.

[155] Roussy, G., et Leroux, R., _Ann. de méd._, Paris, 1921, ix. 161.

[156] Durante, _Manuel d’histologie pathologique_ (Cornil et Ranvier), 1902, ii.

[157] Jewesbury and Topley, _Journ. Path. and Bacteriol._, 1913, xviii. 432.

[158] Weber, F. P., _System of Medicine_ (Allbutt and Rolleston), 1905, i. 185, London.

[159] Charcot, J. M., _Clinical Lectures on Senile and Chronic Diseases_, p. 28, New Sydenham Soc., 1881.

[160] _Loc. cit._

[161] Ophülz, W., _Stanford Univ. Publications, Med. Sciences_, 1921, vol. i. Part I. p. 31.

[162] Turnbull, H. M., _Quart. Journ. Med._, Oxford, 1913–14, viii. 201.

[163] Hansen, K. M., _Ugsek. f. Laeger_, Copenhagen, 1919, lxxxi. 1281.

[164] Macnaughton, F. G., _Brit. Med. Journ._, 1922, ii. 14.

[165] Rolleston, G., _Brit. and For. Med.-Chir. Rev._, 1863, xxxi. 505.

[166] Hammar, A., _Endocrinology_, Los Angeles, 1921, v. 543.

[167] Hale-White, W., _Med.-Chir. Trans._, 1888, lxxi. 181.

[168] Findlay, G. M., _Journ. Path. and Bacteriol._, Cambridge, 1920, xxiii. 482.

[169] Councilman, W. T., _Contributions to Medical and Biological Research_, Dedicated to Sir William Osler, 1919, vol. ii. p. 919, New York.

[170] Walker, K., _Brit. Med. Journ._, 1922, i. 297.

[171] Launois, “Appareil urinaire des vieillards,” _Thèse de Paris_, 1885.

[172] Nemenow, M., _Ztschr. f. Urol._, Berl. und Leipz., 1921, xv. 45.

[173] Hertoghe, “L’Hypothyroidie bénigne chronique,” _Bull. Acad. roy. de Belg._, 1899.

[174] Mott, F. W., _Brit. Med. Journ._, 1919, ii. 658.

[175] Paul, F. T., _Lancet_, 1910, ii. 294.

[176] Haneborg, _Acta Medica Scandinavica_, 1921, Supplement I. p. 117.

[177] Bell, _Lancet_, 1922, i. 715.

[178] MacNider, _Science_, 1917, xlvi. 643.

[179] Rappleye, _Boston Med. and Surg. Journ._, 1918, clxxviii. 191.

[180] _A Discourse Of The Preservation Of The Sight: Of Melancholic Diseases: Of Rheums and Of Old Age_, composed by M. Andreas Laurentius, Ordinarie Phisition to the King and Publike Professor of Phisicke in the Universitie of Montpelier. Translated out of the French into English according to the last Edition by Richard Surphlet, Practitioner in Phisicke, p. 170, London, 1599.

[181] Aub and Dubois, _Arch. Int. Med._, Chicago, 1917, xix. 823.

[182] Gray, A. A., _Diseases of the Ear_, p. 335, 1910.

[183] _The Gray Room_, p. 261, 1922.

[184] Rivers, W. H. R., _Instinct and the Unconscious_, p. 148, 2nd edition, Cambridge University Press, 1922.

[185] Dupuis, _Journ. de psychol._, Paris, 1921, xviii. 481.

[186] Arnold, M., _Essays in Criticism_, Preface, p. x. 1886.

[187] Day, G. E., _Domestic Management and Diseases of Advanced Life_, p. 5, 1849, London.

[188] _The Adventure of Death_, p. 63, 1916, London.

[189] Hooker, D. R., _Amer. Journ. Physiol._, 1916, xl. 43.

[190] Thompson, R. J. C., and Todd, R. E., _Lancet_, 1922, ii. 503.

[191] Spence, J. C., _Quart. Journ. Med._, Oxford, 1920–21, xiv. 314.

[192] Carrel and Ebeling, _Journ. Exper. Med._, Baltimore, 1921, xxxiv. 599.

[193] Nascher, I. L., _Geriatrics_, p. 60, London, 1919.

[194] Williams, L., _Minor Ailments_, p. 332, 1920.

[195] _The Gentle Cynic, being a Translation of the Book of Koheleth, commonly known as Ecclesiastes, stripped of later Additions, also its Origin, Growth and Interpretation_, by Morris Jastrow, junior, 1919, J. B. Lippincott Co.

[196] Laurentius, A., _A Discourse of the Preservation of the Sight; of the Melancholic Diseases; of the Rheums; and of Old Age_, translated out of French into English by Richard Surphlet, 1599.

[197] Lowe, P., _The Whole Course of Chirurgerie_, 1612.

[198] Hall, J., _Paraphrase upon the Hard Texts of the Whole Divine Scripture_, 1633.

[199] _Loc. cit._, _vide_ p. 8.

[200] Mead, R., _Medica Sacra_, translated from the Latin by Thomas Stark, 1775.

[201] Moon, R. O., _The Relation of Medicine to Philosophy_, p. 217, 1909, London.

[202] Paget, J., _Studies from Old Case Books_, p. 93, 1891, London.

[203] Charcot, J. M., _Clinical Lectures on Senile and Chronic Diseases_, New Sydenham Society, 1881, p. 33.

[204] Leclercq, A., _Les maladies de la cinquantaine_, 5 vols., 1922, Paris.

[205] Gowers, W. R., _System of Medicine_ (Allbutt and Rolleston), 1910, viii. 473, London.

[206] Maclachlan, D., _A Practical Treatise on the Diseases and Infirmities of Advanced Life_, p. 213, London, 1868.

[207] Clarke, J. M., _Brit. Med. Journ._, 1915, ii. 665.

[208] Andrewes, F. W., _St. Barth. Hosp. Rep._, London, 1912, xlviii. 9.

[209] Dupré, E., _Nouv. iconograph. Salpêt._, Paris, 1905, xviii. 88.

[210] Clouston, T., _System of Medicine_ (Allbutt and Rolleston), London, 1910, viii. 935.

[211] Marie, P., et Léri, _Séméiologie nerveuse, Traité de médecine_ (Gilbert et Thoinot), p. 450.

[212] Quesnel, M., _Thèse de Paris_, 1920, No. 258.

[213] Charcot, J. M., _Clinical Lectures on Senile and Chronic Diseases_, New Sydenham Society, 1881, p. 239.

[214] Roussy, G., et Leroux, R., _Ann. de méd._, Paris, 1921, ix. 161.

[215] Allbutt, Clifford, _System of Medicine_ (Allbutt and Rolleston) London, 1909, vi. 455.

[216] Nunneley, F. P., _Aneurysm of the Abdominal Aorta_, p. 8, London, 1906.

[217] Peabody, _Trans. Assoc. Amer. Phys._, Washington, 1891, vi. 170.

[218] Osler, W., _Journ. Canad. Med. Assoc._, 1911, N.S., i. 919.

[219] Fenwick, W. S., _Lancet_, 1909, ii. 1346.

[220] Hollis, W. A., _Brit. Med. Journ._, 1916, i. 677.

[221] Miles, W. E., _Surg., Gyn., and Obstet._, 1919, xix. 497.

[222] Roberts, W., _System of Medicine_ (Allbutt and Rolleston), 1907, iii. 124, London.

[223] Llewellyn, L. J., _Gout_, 1920, London.

[224] Jardini, _Nouv. iconograph. Salpêtr._, Paris, 1906, xix. 553.

[225] Garrod, A. E., _Brit. Med. Journ._, 1904, ii. 8.

[226] Hale-White, W., _Quart. Journ. Med._, Oxford, 1907–1908, i. 47.

[227] Lannelonge, _Bull. Acad. de méd._, Paris, 1903, 3^e sér., xlix. 299.

[228] Fournier, _Ibid._, 1903, 3^e sér., xlix. 522.

INDEX

Abernethy, J., 84

Abiotrophy, 139

Acquired characters, 35, 75, 79

Activity. _See_ Functional; Muscular

Adam, age of, 14

Adami, J. G., 87

Adolescence, termination of period of, 17

Adrenals, 110

Age, the “critical,” 140
the “dangerous,” 26
exaggeration of, by elderly people, 20, 21

Albuminuria, 126

Alcohol, abuse of, 57
action of, on the tissues, 57
influence on longevity, 33, 34, 57

Alimentary canal, lymphoid atrophy of, 109

Allbutt, Clifford, 37, 55, 59, 150

Allen treatment of diabetes, 56

Amputation, for diabetic gangrene, 142

Anabolism, cellular, 67

Anaemia, secondary, 108

Anal orifice, narrowing of, 152

Anatomical changes, 60, 63, 90–114

Andrewes, F. W., 145

Aneurysms, 150, 151

Angiomas, 108

Animal life, duration of, 17, 18
experimental modification of life cycle and growth of, 11
natural death in, 13, 14
rejuvenation and senescence in, 9–11

Aortic stenosis, 149

Aphasia, transient attacks of, 151

Appetite, 56, 118

Arcus senilis, 98

Arnold, M., 123

Aron, 75

Arteries, degenerative changes in, 97, 105–107
“pipe-stem,” 106

Arteriosclerosis, 97, 105–107, 149
age incidence of, 105, 140
causes of, 105, 142
hereditary transmission of, 37
influence of smoking on, 59
prostatic hypertrophy and, 112
spasm associated with, 151
thyroid prevention of, 73

Arthritic affections, 154

Arthritis, chronic infective, 155

Atheroma. _See_ Arteriosclerosis

Athyroidism, 73

Atkinson, Edward, nonagenarian, 51

Atrophy--
brown, 103, 105
cardiac, 104, 140, 149
degenerative, 46
general, 62, 91, 139
causes of, 137, 138
genital, 114
lymphoid, 108
muscular, 103
of auditory nerve, 118
of skin and secretory glands, 141
of thymus, 109
precocious, 138
renal, 111
splenic, 109
testicular, 113

Atropine, 127, 128

Aub and Dubois, 116

Auditory nerve, atrophy of, 118

Auto-suggestion, 48

Bacon, Francis, 17, 95

Bacon, Roger, 17

Baddeley, J. J., 51

Baldness, 95
causes of, 96
thyroid extract in, 96

Barclay-Smith, E., 82

Baronsdale, W., 5

Bell, B., 75

Bell, J. R., 115

Benjamin, H., 77

Berman, L., 71

Biedl, A., 71

Biochemistry of old age, 64–68

Biological aspect of old age, 10, 11, 23, 63

Biotripsy, 93

Birth, expectation of life at, 13, 41, 42

Birth control, 24

Bladder, 133, 153

Blane, G., 142

Blood, condition of, 108, 115
increase of urea-nitrogen in, 115

Blood pressure, 125
and heredity, 37
high, 55, 124
longevity in relation to, 37
senile, 104, 124, 125

Blood supply, diminished, 106

Blood transfusion, 66

Bodily vigour, sex gland activity as manifestation of, 69

Body, cells of. _See_ Cells
conformation of, 60
fibrous framework of, 92
structural changes in, 90
temperature of, 116
water content at birth and adult life, 64

Boerhaave, 91

Bone marrow, atrophy of, 108

Bones, injuries to, healing of, 126, 127
Paget’s disease of, 156
rarefaction and absorption of, 99
arterial degeneration with, 107

Bony changes, 98, 99

Bouin and Ancel, 73

Brain, changes in, 96, 146
degeneration of cells of, 97
organic changes in, 145
senile atrophy of, 139
shrinkage of, 100
weight of, 97

Brain cells, activity of, influence on longevity, 35, 36

Brampton, Lord, nonagenarian, 51

Bromides, intolerance to, 128

Bronchiectasis, simulating tuberculosis, 149

Bronchitis, disposition to, 147
simulating tuberculosis, 149

Bronchopneumonia, 148
and pneumonia, confusion between, 148
tendency to, 103

Brown atrophy, 103, 105

Brown-Séquard, 70

Browne, T., 14, 47, 95

Brownlee, J., 33

Buffon, 17

Butler, Samuel, 35

Calcification, of arteries, 106–107
of cartilage, 100

Calendar, length of, in the patriarchal era, 15

California, centenarians in, 41

Cambridge University, influence of John Haviland on the study
of medicine, 6

Cameron, C., 95

Campbell, H., 65

Cancer. _See_ Carcinoma

Carcinoma, 141
age and sex incidence of, 86, 140
and senescence, 86–89
rarity of, in extreme old age, 87

Cardio-vascular system, 36–38, 103–108, 124, 133, 149

Carlisle, Anthony, 8

Carrel, A., 65, 66, 127

Cartilages, calcification of, 100

Castration, phenomena of old age and, 79
secondary sex-characters following, 79

Cazalis, 107

Cell-memory, 35
longevity in relation to, 35

Cells, 62
activity of, relation to connective tissues, 68, 88, 89, 92
ageing of, 67, 88
carcinoma in relation to, 86–89
causes and significance of, 67
senility in relation to, 86, 88
changes in, infections causing, 43, 44
changes in old age, 64
colloidal changes in, 64, 68
cultivation of, 66
degeneration of, 62, 92, 135
intestinal bacteria causing, 82, 83
infections and intoxications producing changes in, 44
life cycle of, 63, 65, 88, 89
factors influencing, 65
on what dependent, 68
thyroid deficiency influencing, 72
limited vitality of, 62
sequels of, 64
products inimical to life of, 65
senile changes due to injury to, 30, 31, 67
time-rate of, 36
vital phenomena of, 63, 88, 89

Census returns, 41, 43

Centenarianism, 19
heredity in relation to, 19

Centenarians, 20, 33, 34
age exaggeration by, 20, 21
among Churchmen, 50
among doctors, 52
among professional men, 50
census returns of, 20, 21
family incidence of, 32, 33
in California, statistics, 41
in England and Wales, statistics, 40, 41
in Ireland, statistics, 40
medical, 52
personal habits of, 56, 57
rarity of cancer among, 87
sex statistics of, 21, 22
smoking among, 58
statistics of, 21, 24
deaths among, 21, 22, 41

Cerebral arteries, changes in, 97

Cerebral degeneration, 97

Cerebral haemorrhage, 145
age incidence of, 145

Cerebral thrombosis, 145

Chaderton, Laurence, centenarian, 51

Charcot, J. M., 8, 104, 116, 139, 148

Cheatle, G. L., 93

Chest capacity, diminished, 103

Cheyne, G., 55

Child, C. M., 10, 14, 56

“Childhood, second,” 122, 145

Chromophages, 94

Chromosomes, 88

Churchmen, centenarians among, 50

Cicero, 135

Circulatory system, 38

Clark, Andrew, 29, 60, 137

Clarke, E., 85, 98

Clarke, J. M., 145

Climacteric, ancient conceptions of, 27
senile, 30

Climacteric disease, 28

Climate, influence on longevity, 26, 39

Coke, Sir Edward, octogenarian, 51

Colloidal dehydration, leading to old age, 64, 65

Colon, destruction of putrefactive bacteria in, 83

Constipation, 101, 152
age incidence of, 152
gerontal, 102
tendency to, 115

Cornaro, on the duration of life, 18
writer on old age, 8

Costal cartilage, calcification of, 100

Councilman, W. T., 37, 92, 104, 107, 111, 125

Cranial bones, changes in, 100

Crosby, T., 51

Cushny, A. R., 81

Cutaneous sensation, 117

Cystitis, 154

Darwin, C., 53

Deafness, causes of, 118
senile, 118

Death, causes of, 13, 38
mental attitude to, 123
natural, 13, 14, 16, 91
from old age, 14, 91
in animal kingdom, 13, 14
probable cause of, 36
Weissmann’s conception of, 9, 16
phenomenon of, 9, 10
sudden, causes of, 117
latent pneumonia causing, 148

Death-rate, in various countries, 42
sex incidence, 22

Deaths, among centenarians, 41

Decrepitude, 30

Delirium, 146

Delusions, 146

Demange, 91, 105

Dementia, senile, causes of, 146
onset of, 145
varied features of, 146

“de Morgan’s Spots,” 108

Dental decay, 101
an accompaniment of old age, 44, 45

Dentition, third, explanation of, 101

Depression, senile, 146

de Salis, Cardinal, centenarian, 50

Descartes, 7

Desmond, Countess of, centenarian, 20

Devolution, course of, 122

Diabetic gangrene, 142

Diet, restricted, influence of, 56

Digestion, impairment of, 101

Digestive system, 38

Disabilities of old age, 90–114, 137

Disease, associated with old age, 30, 44, 139
chronic, freedom from, in old age, 44
definition of, 136
influence of, on longevity, 43
latency of, 117
old age as a, 49, 136

Doctors, duration of life of, 52, 53
centenarian, 52

Donaldson, R., 110

Drew, A., 68

Drinkwater, H., 52

Drugs, reaction to, 127–128
reaction to, during senescence, 127

Dryness of elderly bodies, 64

Ductus cochleariae, fibrosis of, 118

Dupuytren’s contraction, 155

Dysbasia, functional, 146

Dyspepsia, frequency of, 152

Early rising, 59, 60

Ears, disorders of, 143

Easton, J., 20, 47

Ebstein, 18

Eccentricities of old age, 120, 121

Ecclesiastes, interpretation of, 129

Eczema, 118, 141

Emphysema, 147, 149

Endarteritis obliterans, 103

Endocrine glands, in relation to old age, 12, 68–81

Endomixis, 9

Environment, influence on longevity, 33, 34, 39–46, 55

Erysipelas, 141
disposition to, 140
senile, course of, 142

Erythema, 141

Eunuchs, duration of life of, 79

Expectation of life, 13, 41
in various countries, 42

Extra-systoles, 124

Eyes, senile disorders of, 117

Facial appearance, 93
changes in, 93
causes of, 118

Fads, 121

Faintness, 151

Fat, reduction of, 92
subcutaneous, disappearance of, 94

Fatigue, excessive, danger of, 54
physical and mental, 119, 120
psychical, 122

Fatty degeneration of arteries, 106
of heart, 104
of muscles, 103

Femur, fracture of, 99, 127

Fertility, age limit of, in women, 26
average, estimation of, 24
old age in relation to, 23, 24, 26
social conditions influencing, 24

Fibrosis, 91, 92

Fibrositis, 155

Fibrous tissues, atrophy of, 91

Finot, J., 49

First-born, handicapping of, 38
longevity in relation to, 38

Flourens, on the duration of life, 18

Food, excess of, 56

Fractures, delay in healing of, 126, 127
tendency to, 99

France, longevity in, 40

Functional activity, danger of excess of, 54
influencing longevity, 46, 55
progressive diminution in, 115, 119, 135

Gait, disordered, 122, 147

Galileo, 53

Gallstones, 153

Gangrene, diabetic, 142
senile, 142
pipe-stem arteries with, 106

Garrod, A. E., 155

Gastric juice, composition, changes in, 115
lack of, 101

Gastro-intestinal tract, changes in, 101

Generation. _See_ Reproductive power

Generative organs, internal secretion of, 70, 73–80

Genitals, external, atrophy of, 114

Giantism, 19, 20

Giddiness, 143
causes of, 151

Gilford, H., 30, 72, 88

Gisborne, Thomas, Linacre lecturer, 5

Gland activity, functional, diminution of, 115
senility in relation to, 69

Gland atrophy, 109, 110

Gland cells, life cycle of, 67

Gland secretions, influencing activity of body cells, 68, 69

Gland, endocrine, metabolism stimulated by, 81
rejuvenescence in, in relation to, 12, 73–80

Gland, endocrine, theory of old age, 70, 71, 72

Gland, endocrine, therapy during old age, 71
of prostatic enlargement, 113
rejuvenescence in relation to, 12, 73–80
_See also_ Endocrine, Pituitary, etc.

Glycosuria, 126
toxic, cause of, 142

Goethe, 53

Goodpasture, E. W., 88

Gout, 154
acquired, age incidence of, 154

Gowers, W. R., 139, 144

Graves, R. J., 95

Gray, A. A., 118

Greenwood, Major, 24

Gregory IX., centenarian, 50

Growth, 60
experimental modification of, 11
influence of endocrine gland therapy on, 12, 72, 80
retardation by vitamine deficiency, 13

Habits, influencing longevity, 55

Haemoglobin, 108

Haemorrhage, 144
cerebral, 145

Hair, changes in colour of, 94
excessive growth of, 96
of the body, loss of, 96

Hale-White, W., 109, 155

Hall, Bishop, 131

Hall, Stanley, 8, 27

Haller, 91

Halsbury, Lord, nonagenarian, 51

Hands, appearance of, 93
atrophic changes in, 94
senile tremor of, 143

Harrower, 80

Haviland, John, influence on the Cambridge medical school, 6
Regius Professor of Physic, 6
Linacre lecturer, 5

Head, senile tremor of, 143

Health, definition of, 136

Hearing, impairment of, 118

Heart, atrophy of, 104
condition of, 92, 103, 104
diseases of, 149
failure, 149
age incidence of, 140
hypertrophy of, 55, 104
and blood pressure, 104
longevity in relation to, 37
senile changes in, 104, 139, 149

Heberden, W. (the elder), 4, 54

Heberden’s nodes, 155

Height, cause of loss of, 100

Hereditary tendencies, correction of, 34

Heredity, firstlings in relation to, 38
influence on longevity, 19, 32–39

Hernia, tendency to, 153

Herpes zoster, 142

Hertoghe, 113

Hetero-suggestion, 48

High altitudes, influence on longevity, 39

Hippocrates, age of, 52

Holland, Henry, 28

Holmes, O. W., 49

Hopkins, G., 13

Hot climates, influence of, on senescence, 26, 36, 39

Huchard, 59, 105

Hufeland, C. W., 17, 23, 70

Humphry, G. M., 8, 22, 32, 34, 39, 43, 58, 60, 87, 98–100, 112, 124

Hunter, W., 124

Huxley, J. S., 11

Hygiene of old age, 55–61

Hyperpiesia, 37, 124

Hypertrichosis, following the menopause, 96

Hypnotics, 128

Hypochondriasis, 121

Hypoplasia, 63, 64

Hypothyroidism, in relation to old age, 72

Idleness, inimical to old age, 46, 47

Individuation, phenomenon of, 10

Infant mortality, sex incidence and causes, 22

Infantilism, premature senility with, 31

Infections, 140
cell changes due to, 43, 44
disposition to cardiac failure during, 149
focal, tendency to, 155
gout in relation to, 154

Insomnia, 119

Interstitial cells, 73–81

Intestinal stasis, as cause of premature old age, 82, 85

Intoxications, cause of senescence, 82
influence on body cells, 44, 55

Invalidism, auto- and hetero-suggestion producing, 48

Ireland, centenarians in, 40

Iris, sluggish, 117

Iverex, Dr., centenarian, 32

Jackson, Christopher, 3

Jackson, Hughlings, 122

James, R. R., 52

Jastrow, M., 130

Jaw, changes in shape of, 99
tremor of, 144

Jenkins, Henry, centenarian, 20

Jews, longevity of, 40

Johnson, S., 46

Joints, fractures of, disposition to, 99

Keratosis, senile, 143

Kidneys, 126
degenerative changes in, 111
granular, age incidence of, 140

King, G., 20

Klotz, O., 107

Knee-jerk, 119

Koheleth, 139

Kuntz, A., 74

Labyrinthine deafness, 118

Labyrinthine vertigo, 143

Lacassagne, A., 30, 55

Lane, W. Arbuthnot, 84

Lankester, E. Ray, 14, 19, 23

Laryngeal cartilage, calcification of, 100

Laurent, O., 41, 87

Laurentius, Andreas, 29, 46, 116, 131

Lazarus, 59

Lazarus-Barlow, W. S., 86

Leclercq, A., 140

Léri, 83, 146

Leroux, 103, 148

Lessius, Leonardus, 55

Leucocyte count, 108, 109

Leucodermia, 93

Leukaemia, 141

Leydig, interstitial cells of, 73–81

Lichtenstern, 77

Life, animal and human, duration of, 17, 18
chronometry of, 138
climacterics of, 27, 30
duration of, 9
among professional men, 50–53
chemical theory of, 66
early theories of, 17
estimation of, 18
_in vitro_, 66
various writers on, 17, 18
variation in different countries, 39
modern theories of, 18
expectation of, at birth, 13, 41
prolongation of, experimental, 12, 13, 77
following cessation of reproductive function, 23
_See also_ Longevity

Life cycle, experimental modification of, 11

Ligament, spinous, ossification of, 99

Ligamentum spirale, atrophy of, 118

Linacre, Thomas, 2
family history of, 2, 3

Linacre Lectures, 3–6

Linacre Lectureship, 1

Lips, tremor of, 144

Lipschülz, 74

Liveing, G. D., 7

Liver, atrophy of lobules and cells of, 102
changes in size and weight of, 102
cirrhosis of, 140

Llewellyn, L. J., 154

Longevity, alcohol influencing, 57
among professional men, 50, 53
auto- and hetero-suggestion influencing, 48, 49
“cell-memory” in relation to, 35
climatic conditions influencing, 39, 41
conditions favouring, 7, 33
diseases inimical to, 45
endocrine atrophy in relation to, 68–81
environment influencing, 33, 34, 39–46, 55
factors influencing, 32
fertility in relation to, 23, 24
functional activity influencing, 46, 55
hereditary aspects of, 19, 32–39
idleness inimical to, 47, 48
in the medical profession, 52
influence of past diseases on, 43
influence of blood pressure on, 37
influence of brain cells on, 36
integrity of cardio-vascular system necessary to, 36
of nations, compared, 39, 40
of the patriarchs, 15, 16
personal habits influencing, 55
potential, on what determined, 67
sex incidence of, 21, 22
smoking in relation to, 58
syphilis preventing, 45
vitality of central nervous system essential to, 36
_See also_ Old Age; Senescence

Lorand, A., 70

Lowe, Peter, 131

Luciani, 18, 102

Lungs, changes in, 103
diseases of, 147, 148

Lydston, G. F., 71

Lymphadenoma, 141

Lymphoid tissues, atrophy of, 63, 108

Maclachlan, D., 144

Maignon, Abbé, centenarian, 50

Malignant disease, 87, 141
cell senility in relation to, 88

Mammae, involution changes in, 114

Mania, senile, 145, 146

Mansell-Moullin, C. W., 78

Mansfield, Lord, octogenarian, 51

Marasmus, senile, 139

Marie, P., 146

Marinesco, 64, 78, 83, 97

Marx, K., 47

Mead, Richard, 131

Medical men, centenarians among, 52
duration of life of, 52, 53

Melancholia, senile, 146

Memory, impairment and loss of, 120, 122

Menopause, onset of old age at the, 26
ovarian changes at, 63, 79

Mental activity, influence on old age, 47, 48, 50, 54
unimpaired, in advanced age, examples of, 50, 51, 53

Mental deterioration, 49, 119, 122, 145, 146
causes of, 47, 48, 49
onset of, 53

Mental fatigue, tendency to, 120

Mental state, 119, 122, 123
and the physical, want of harmony between, 123
influence of, 48–50

Metabolism, disordered, 115, 116, 117, 154
gland therapy stimulating, 72, 81

Metchnikoff, E., 8, 13, 18, 82–86, 91, 97, 123

Methuselah, 14

Michael Angelo, mental activity at advanced age, 53

Micturition, disorders of, 153

Middle ear lesions, 143

Migraine, 140

Miles, W. E., 153

Mind, 121
and body, in old age, 47, 50
disintegration of, 120
disorders of, 122, 145, 146
_See also_ Mental

Molière, 53

Mönckeberg’s sclerosis, 106
causes of, 142

Montaigne, 14, 56

Moon, R. O., 136

Moore, Norman, 5

Morbus coxae senilis, 155

Morphine, 127, 128

Mott, F. W., on functions of cells of testes and ovaries, 75

Muscles, voluntary, changes in, 103

Muscular activity, danger of excess of, 54
impaired, 99, 119, 135

Muscular atrophy, 99, 119, 135
among workmen, 54

Myocardium, degeneration of, 104, 149

Myxoedema, as secondary senilism, 72

Nails, condition and appearance of, 96

Nanism, senile type of, 31

Nascher, I. L., 30, 98, 127

Nathan, 68, 74

National habits, influence on longevity, 40

Natural death. _See_ Death

Neck, senile tremor of, 143

Nemenow, 112

Nephropathy, chronic atrophic, 111

Nerves, cutaneous exposure of, 141

Nervous apprehension, tendency to, 122

Nervous disease, 145

Nervous system, 38
vitality of, hereditary factor in longevity, 36

Neurasthenia, 122

New growths, rarity of, 87, 89

Newton, Isaac, 53

Nicotine, effects of, 59

Nunneley, F. P., 151

Obesity, 60

Occupational neuroses, 54

Octogenarians, among active professional men, 51
census statistics of, 21

Oertel, H., 88

Old age, acceleration of, factors favouring, 26
anatomical and physiological changes in, 63
as a disease, 47, 136
attainment of, on what dependent, 6, 7, 10
biochemistry of, 64–68
biological aspect of, 10, 11, 23
bodily conformation in, 60
causes of, 62–89
cell changes leading to, 64, 65
“cell-memory” in relation to, 35
comparative freedom from chronic disease in, 44
death during, common causes of, 38
disabilities of, 137
disease in relation to, 44
diseases associated with, 93–114, 139–156
fertility rate in relation to, 23, 24, 26
glandular, endocrine, theory of, 70, 71, 81
healthy and morbid, distinction between, 135
hereditary aspects of, 32–39
hygiene of, 55–61
infantilism and, 31
mental activity during, 50, 54
examples of, 50, 51, 53
natural death from, 14
on what dependent, 10
onset of, 26
signs of, 29
pathological, 30, 82, 90
of septuagenarians, 53
physiological, 26, 90, 135
physiological and pathological confusion between, 90
factors in, 26
physiology of, 115
premature, 30
hot climates favouring, 26, 36
intestinal stasis as a cause of, 85
mental causes of, 48, 49
production of, Metchnikoff’s theory, 83
rarity of natural death from, 14, 91
sex incidence of, 21, 22
stages of, 29
vitality of body cells in, 62–68
writers on, 8, 15, 16
_See also_ Senescence; Longevity

Onychogryphosis, 96

Ophülz, W., 105

Oral sepsis, 44, 155

Orthobiosis, 55, 84

Osler, W., 2, 36, 151

Osteitis deformans, 156

Osteomalacia, senile, 139

Osteoporosis, senile, 99

Ovarian extract, rejuvenescence in relation to, 80

Ovaries, activity and function of cells of, 73, 74
degenerative changes in, 114
fibrotic atrophy of, 63
following menopause, 79
in relation to senescence, 75
internal secretion of, evidence of existence of, 79
senile, 114

Over-eating, 56, 118

Overwork, danger of, 54

Owen, I., 57

Paget, James, 36, 138

Paget’s disease of bone, 156

Pain, blunting of sensibility to, 117

Pallor, 93

Pancreas, fibrotic atrophy of, 102

Paralysis agitans, 144
age and sex incidence of, 144
causes of, 144
senile tremor compared with, 143

Paraplegia, senile, 138, 146
causes of, 146, 147
varieties of, 147

Parathyroids, 110

Parietal bones, changes in, 100

Parkinsonian syndrome, 144

Parr, Thomas, centenarian, 20

Pathological old age, 53, 82, 90

Patriarchal ages, length of the calendar during, 16

Patriarchs, explanation of reputed old age of, 15, 16

Pearson, K., 38, 86

Pecten band, 152, 153

Penis, changes in, 114

Pennington, Isaac, 6

Peristalsis, failure of, 152

Philalethes, Eugenius, on old age, 15

Phlebitis, 151

Phlebosclerosis, 107

Physical and mental states, want of harmony between, 123

Physiological life of man, 19

Physiological old age, 90
and morbid senility, distinction between, 135–138

Physiology of old age, 115–128

Pigmentation, cellular, 103
cutaneous, 93

Piles, 153

Pitman, Henry, medical centenarian, 52

Pituitary extract, influence on weight and growth, 12
rejuvenescence in relation to, 12, 80

Pityriasis versicolor, 141

Planarian flat worms, experimental modification of life cycle and
growth of, 11

Plasma, vital phenomena of, 65–67, 88

Plethora, senile, 124

Pneumonia, 147, 148
disposition to, 140
sudden death from, 117

Premature senility, 30
causes of, 48
hot climates predisposing to, 26, 36
syphilis producing, 45

Presbyopia, 117

Pringle, J. J., 94

Prior, Matthew, 3

Professional men, age of retirement of, 54
longevity of, 50–54

Progeria, 30

Prostate gland, 27
_climacterium virile_ due to changes in, 27
hypertrophy of, 101, 112
age incidence of, 140
cause of, 112
cell changes in, 112, 113
glandular therapy of, 113
vesical disorders due to, 153
senile changes in, 111

Protoplasm, products inimical to vitality of, 65
vital phenomena of, 64, 65, 88

Protozoa, rejuvenation and senescence in, 9–11

Prurigo, senile, 141

Pruritus, senile, 141, 142

Pseudo-paraplegia, 146

Psychical activity, diminished, 119

Psychical fatigue, 122

Puberty, functional activity of cells of testes and ovaries at, 75
period of, 17

“Puberty gland,” 73

Puerilism, 122, 145

Pulmonary changes, 103, 147

Pulmonary tuberculosis, 148

Pulse-pressure, 125

Pulse-rate, 124

Pupils, contraction of, 117

Purgatives, 128

Pyelonephritis, 154

Quinquagenarians, diseases of, 140, 145, 156

Rectum, faecal accumulation in, 152

Reflexes, 119

Regression, 122

Rejuvenescence, 10
associated with reproduction, 9, 10, 64
attainment of old age dependent upon, 9, 10
experimental production of, 76, 77
following vasectomy, 78
gland extracts in production of, 12, 73, 80, 81
in animal life, 9, 10
power of reproduction favouring, 23, 24, 69
restricted diet in relation to, 56
testicular grafts producing, 77

Renal inadequacy, 126

Reproductive power, favouring rejuvenescence, 23, 24, 69
waning of, onset of old age following, 26
prolongation of life after waning of, 23

Retas, Joseph, centenarian, 33

Rheumatism, in old age, 44

Rhizomelic spondylitis, 155

Rhondda, Lord, 49

Richardson, B. W., on the duration of life, 18

Rivers, W. H. R., 122

Roberts, W., 154

Robertson and Ray, 12, 60

Rodent ulcer, 143

Roussy, G., 103, 148

Routh, Martin, centenarian, 50

Roy, D., 32, 95

Russian peasants, longevity of, 40

Salimbeni and Gery, 63, 84, 93, 102

Sand, K., 75

Saundby, R., 8, 44, 85

Savage, G., 34

Sclerosis, arterial, 105–107
Mönckeberg’s, 106, 142
spinal, 97

Scrotum, 114

“Second childhood,” 122, 145

Sedatives, 128

Self-preservation, instinct of, 122

Self-reliance, loss of, 48, 49

Seminal tubules, activity and function of, 74
atrophy of, 74, 112, 113
prostatic enlargement following, 112
regeneration of, 74

Senescence, 136
castration not a disposing factor to, 79
causes of, 62–89
Metchnikoff’s theory, 82, 83
pathological, 82
toxaemic, 82
cell changes during, 62–68
in ovaries and testes, 75, 76
colloidal dehydration leading to, 64, 65
diseases associated with, 139
endocrine glands in relation to, 68–81
healthy and morbid, distinction between, 135
nosological compensations of, 140
progress of, 135
rarity of carcinoma in, 87
rejuvenescence necessary to, 10
thyroid deficiency in relation to, 72
_See also_ Longevity; Old age

Senile climacteric, 30

Senile type of nanism, 31

Senility, 136

_Senium ex morbo_, 136

Sense organs, impairment and failure of, 117–121

Sensibility to pain, blunting of, 117

Septuagenarians, nervous disease among, 145
pathological old age of, 53

Sex characters, secondary, cause of, 75
following castration, 79

Sex glands, changes in, _climacterium virile_ due to, 27
internal secretion of, 70

Sex incidence of old age, 21, 22

Sexagenarians, diseases common to, 140
nervous disease among, 145

Sexual activity, as manifestation of bodily vigour, 69, 70
duration of, 69
leading to rejuvenescence, 69
waning of, 126

Sexual appetite, on what dependent, 75
perverted, 114

Sexual atrophy, as cause of old age and senility, 69–71

Shaking palsy, 144

Sharpey-Schafer, E. A., 63

Sight, impairment of, 117

Sinclair, John, 8, 20, 35

Singer, C., 86

Skeleton, changes in, 98

Skin, 93, 115
diseases of, 141
disposition to, 141
dry, 115
venules and angiomas on, 108

Skull, 100

Sleep, diminished, 119
over-indulgence in, 60

Smell, impairment of sense of, 117

Smith, John, 8, 131

Smith, Lapthorn, 53

Smoking, influence on longevity, 58–59

Sophocles, mental activity at advanced age, 53

Sour milk, destruction of intestinal bacteria by, 83

Spasm of arteriosclerotic vessels, 151

Spastic paraplegia, 147

Spinal cord, degenerative changes in, 97, 147

Spleen, atrophy of, 63, 109

Spondylitis, rhizomelic, 155

Spondylitis deformans, 99, 155

Stapes, fixation of, 118

Starvation, influencing the onset of senescence, 56, 57

Starvation treatment, 56, 57

Steinach, E., 11, 77, 78

Sterne, John, on the attainment of old age, 16

Stevenson, T. H. C., 41

Strachey, L., 47

Structural changes of the body, 90

Symmers, D., 102

Syphilis, influence on longevity, 45

Taste, impairment of, 117

Teeth, decay of, 44, 101
loss of, 44, 45, 99, 101
causes of, 101

Temperance, a characteristic of centenarians, 57

Temperature, and longevity, 26
of body, 116

Testes, atrophy of, 113
cells of, activity and function of, 73, 74
in relation to senescence, 75
changes in, following vasectomy, 77, 78
internal secretion of, 69–72, 74
prostatic atrophy in relation to, 112

Testicular extract, rejuvenescence in relation to, 80

Testicular grafts, rejuvenation by, 71, 72, 77
results of experiments, 76, 79

Thompson, R. J. C., 37, 44, 49, 96, 125

Thompson, W. J., 40

Thrombosis, 144
age incidence of, 145
cerebral, 145
venous, 151

Thymus, atrophy of, 109

Thyroid deficiency, 138
baldness resulting from, 96
effect on activity of body cells, 72
prostatic enlargement in relation to, 113

Thyroid extract, rejuvenescence in relation to, 80
for prostatic enlargement, 113

Thyroid gland, degenerative changes in, 109, 110

Tinnitus, 118

Tissues, connective, relation of cellular activity to, 68, 88, 89, 92

Titian, 53

Tobacco, and arteriosclerosis, 59
influence on longevity, 58
symptoms due to, 59

Todd, R. E., 37, 44, 49, 125

Toxaemia, as a cause of senescence, 82, 86
degenerative changes due to, 44, 55, 56, 86
intestinal, as cause of senescence, 82, 85
over-eating causing, 56

Transfusion, 66

Tremor, senile, 143

Tropical life, influence on longevity, 26, 36, 39

Trousseau, 151

Tuberculosis, senile, 148

Tumours, 86, 141

Turnbull, H. M., 106, 114

Ulcer, rodent, 143

Urea-nitrogen in the blood, 115

Urinary bladder, hypertrophy of, 153

Urine, condition of, 126

Uterine changes, 114

Valvulitis, chronic, 149, 150

Vanity, senile, 120, 121

Variation, correlated, 23

Varicosity, 151

Vascular lesions, 144

Vasectomy, changes due to, 74
changes in testes following, 77, 78
effect on sexual activity, 76
rejuvenescence following, 71, 78

Veins, changes in, 108

Venous thrombosis, 151

Vertebrae, changes in shape of, 99

Vertigo, causes of, 143

Visceral degeneration, 102, 103

Visceroptosis, 102

Vitality, danger of excess of, 54
loss of, 115, 119, 135
waning of, 139

Vitamins, influence on growth, 13

Voltaire, mental activity at advanced age, 53

Voronoff, testicular grafting by, 78

Walker, Kenneth, on changes in the testes, 112
on prostatic enlargement, 112, 113

Walking, functional disturbances in, 147

Waterhouse, B., on the onset of old age, 27

Watson, Thomas, Linacre Lecturer, 5

Weber, Hermann, 8, 34, 43, 57, 119

Weber, Parkes, 35, 104

Weissmann, 9, 16

“Will to live,” 35, 47

Will power, failure of, 122

Williams, Leonard, 61, 113, 128

Wilson, S. A. K., 144

Wounds, healing of, 126

Wrinkles, cause of, 93

Yeo, B., 50

Zorten, Petrasch, centenarian, 20

THE END

_Printed in Great Britain by_ R. & R. CLARK, LIMITED, _Edinburgh_.

By SIR HUMPHRY ROLLESTON, K.C.B., M.D.

DISEASES OF THE LIVER, GALL-BLADDER AND BILE-DUCTS

Second Edition. Illustrated. 8vo.

31s. 6d. net.

_LANCET._--“An admirable work of reference in every sense. It presents all the information obtainable from a very wide experience and an encyclopaedic acquaintance with the literature of the subject in a practical, interesting, and readily available manner.... We feel confident that it will long remain the standard work of reference upon the subjects of which it treats.”

_BRITISH MEDICAL JOURNAL._--“This is the most considerable work on diseases of the liver which has appeared since the classical treatise of Murchison. It fully deserves to take a high place among modern text-books, and we heartily congratulate Dr. Rolleston on his success.”

_EDINBURGH MEDICAL JOURNAL._--“This compendious treatise is a veritable mine of information on diseases of the liver and biliary passages. No aspect of the subject, however small, seems to have escaped the author’s notice, and his elaborate descriptions of the pathology and clinical signs of liver disease, drawn from his own large experience and an exceptional acquaintance with the literature, render the book invaluable for study and for reference.... Dr. Rolleston’s book is unquestionably a standard authority, and is a model of what a treatise on a single department of medicine ought to be.”

A SYSTEM OF MEDICINE

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