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].