The mamma in women shows involution changes and when excessive (cystic disease) these may, as Paul[175] has pointed out, be compared with prostatic enlargement in the male.
VII
PHYSIOLOGY OF OLD AGE
The basis of the physiology of old age is progressive diminution in functional activity, which corresponds to the characteristic structural atrophy of the organs and tissues. Thus the lowered functional activity of its glands is manifest in the dry skin; according to Haneborg[176] there is usually a fall in the percentage of hydrochloric acid in the gastric juice, though Bell[177] disputes this. The lessened amount of mucus from the intestine probably plays some part in the tendency to constipation. Other evidences of lowered metabolic rate are seen in the diminished efficiency of the acid-base equilibrium (MacNider[178]) and the increased degree of urea-nitrogen in the blood, as shown in 50 per cent of 41 persons between 70 and 88 years of age examined by Rappleye.[179]
Temperature.—Before the era of the clinical thermometer it was supposed that the body temperature of the aged was below normal. This belief was part of the ancient view that the cause of old age was exhaustion by the natural heat of the radical moisture which, like lamp oil, supported the innate heat and with the passage of years could not be supplied as perfectly as before; as a result of this loss of radical moisture the body was thought gradually to dry and cool.[180] But it is now known that the internal temperature is almost constant at all ages, and Charcot proved that the only real difference is that the axillary is lower than the rectal reading; this is due to the diminished vascularity of the skin and to the corresponding fall in the loss of heat, which again may be correlated with the lower metabolic rate of old age. Aub and Dubois’[181] observations on six men between 77 and 83 years of age, mainly with arteriosclerosis, granular kidney, and emphysema, showed that the basal metabolism was 12 per cent below the average for men between 20 and 50.
Blunting of sensibility to pain is a beneficent process, suggesting that with the gradual process of involution and approach to a physiological death the need for the warning normally conveyed by symptoms is no longer needed. This is connected with the simultaneous atrophy of the nervous tissues which look after the conduction, perception, and reference of pain. The latency of disease, as shown by an absence of the characteristic symptoms observed in earlier adult life, is often remarkable in the aged. Thus death may occur suddenly from extensive but entirely unsuspected pneumonia; the passage of biliary or urinary calculi may be unaccompanied by the violent colic of these events in ordinary cases, and extensive malignant disease may exist without any definite localizing discomfort. This failure in the power to react is also shown in fevers and infections (vide p. 142).
Cutaneous sensation is little affected, and indeed the aged are very sensitive to cold. Taste and smell are impaired, and presbyopia is due to changes in the crystalline lens. The pupils are contracted and the iris sluggish. From weakness of the orbicularis palpebrarum muscle ectropion and epiphora may noticeably change the facial appearance. With advancing years hearing commonly becomes less acute from various causes, and after 60 there is a successive decrease in the number of persons with normal hearing. According to Albert Gray[182] there is probably a characteristic form of deafness for the higher notes of Galton’s whistle in all old people, even when for all practical purposes there is no obvious defect or tinnitus; this he regards as due to progressive atrophy of the ligamentum spirale. Chronic progressive labyrinthine deafness, due to atrophy of the auditory nerve and fibrosis of the ductus cochleariae, is the most common condition in persons over 60. Fixation of the stapes frequently causes deafness, and the sequels of middle-ear disease accumulate with advancing years. Gouty eczema of the external auditory meatus and collections of wax may seriously interfere with hearing. Tinnitus in the elderly is commonly associated with high blood pressure and arteriosclerosis.
Appetite for food is sometimes capricious; old people may eat excessively, possibly because the pleasures of the table are the only ones to which they feel equal.
Muscular movement is slow and somewhat uncertain, and the reflexes are diminished except in the presence of sclerosis of the spinal cord. According to Moebius the knee-jerk is often absent in normal old persons, but Sternberg, by employing methods of reinforcement not available in Moebius’ time, found that it was invariably present even in the tenth decade.
The sleep of the aged is less continuous, and from interruptions often appears to them to be much less than it really is. There is often a tendency to irregularity, bad and good nights alternating. But too much attention to disturbed sleep in the aged must be avoided, as hypnotics are inadvisable, and it has been urged by Sir Hermann Weber and others that too much sleep is more harmful than too little.