_The voluntary muscles_, according to Durante,[156] contain many fibres with large globules of fat; but Jewesbury and Topley,[157] who describe coarse fat globules mingled with brown pigment in the immediate neighbourhood of the muscle nuclei in 50 per cent of cases of various kinds, and almost constantly in old subjects, regard this condition as independent of true fatty degeneration, and are doubtful if it has any pathological significance. Excessive fatty and fibrotic change is found in cases of senile paraplegia without any lesion in the spinal cord or brain. _Heart._--Some difference of opinion exists as to the condition of the heart; Parkes Weber[158] says that the only true senile change is diminution in size and weight; this as it is worded is no doubt correct; but pure atrophy is less rare in the heart than in most parts of the senile body. Charcot[159] indeed stated that it does not atrophy in old age, but preserves the dimensions of middle life. The heart may even hypertrophy in old people; this is pathological; Councilman[160] found it in 248, or 43 per cent, of 580 persons over 60 years of age, and could not refer it to aortic or renal arteriosclerosis or to the diminished capillary area in the skin; but the average blood pressure 158 systolic/88 diastolic of the cases with cardiac hypertrophy was higher than that 130/78 of the others. Fatty degeneration of the myocardium is very frequent; Charcot stated that at the Salpêtrière it was almost constant in old women, but according to Councilman there is no clear evidence that it produces permanent injury or functional insufficiency; he noted some fibrosis in 15 per cent of his cases. Atrophy of the epicardial fat--serous atrophy--is common, and increase of the so-called lipochrome pigment in the muscular fibres which become smaller and fewer--brown atrophy--is frequent as it is in the other organs in old age. Chronic valvulitis and subendocardial fibrosis are, like arteriosclerosis, common morbid changes.