Some Medical Aspects of Old Age: Being the Linacre lecture, 1922, St. John's college, CambridgeRolleston, Humphry Davy, Sir
Science
Some Medical Aspects of Old Age: Being the Linacre lecture, 1922, St. John's college, Cambridge
Rolleston, Humphry Davy, Sir
Geriatrics; Linacre lecture, St. John's college, Cambridge; Longevity
_The teeth_ are usually, but not invariably, few in the aged, for care
or lack of it, the accumulated effect of long-continued mechanical
injuries, altered calcium metabolism, and diminished resistance to
infection will necessarily influence the amount of decay. Statistics,
especially Humphry’s, show that in extreme old age very few teeth are
present, and it is tempting to correlate the diminished provision for
mastication with the lessened need for food. Sir Isaac Newton, however,
at the age of 85 was said to have lost one tooth only. The numerous
reputed instances of a third dentition can be explained only by the
appearance of a previously buried tooth through the atrophying gums,
for a genuine third dentition would necessitate the presence of dental
germs which do not exist.
_The gastro-intestinal tract_ shows atrophy of the muscular coat and
its secreting glands, so that dilatation of the thin-walled, pale
stomach and colon occur on less provocation than in adult life and
digestion is impaired; from lack of mucous secretion combined with
loss of motor vigour constipation is common. It may be added that
hypertrophy of the prostate by interfering with peristalsis of the
colon has been thought to cause gerontal constipation (Hollis[151]).
The pancreas shows fibrotic atrophy and becomes smaller and harder.
From the loss of fat and muscular atrophy visceroptosis is not uncommon.
_The liver_ diminishes in size and weight by about one half; atrophy
of considerable areas may expose the vessels and ducts on the surface
of the organ. Boyd’s tables show a difference of 18 oz. between
the weights in persons in the decade 20–30 and in those over 80.
Microscopically atrophy of the lobules and of the cells in the
centres of the lobules have been described (Luciani[152]), but the
latter change is not constant, for in a woman of 93 Salimbeni and
Gery[153] definitely noted that the cells were not atrophied. That
such atrophy of the liver cells is pathological is perhaps supported
by D. Symmers’s[154] observation that in the pancreas of such cases
the islands of Langerhans may show moderate enlargement, as if to
compensate for failure of the glycogenic function of the liver.
Pigmentation of the cells by a lipochrome is excessive, and the name
brown atrophy has been applied to the condition which is seen in the
other viscera of the old.
_The lungs_ become smaller, lighter, and the elastic tissue
degenerates; this is atrophous emphysema, and the chest capacity
diminishes. Roussy and Leroux[155] found that these lungs commonly
show endarteritis obliterans and fibrosis, conditions which favour
infarction, infection, and the terminal bronchopneumonia to which the
aged are so prone.
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