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JOURNAL OF GERONTOLOGY
Saturday
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VoLtuME 10, Number 3
Juny, 1955
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16, 1954,
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JOURNAL OF GERONTOLOGY
VOLUME 10, Secrion A
————
JULY, 1955
NuMBER 3
AGING PROCESSES IN THE ENDOCRINE GLANDS OF VARIOUS
STRAINS OF NORMAL MICE: RELATIONSHIP OF HYPOPHYSEAL
ACTIVITY TO AGING CHANGES IN OTHER ENDOCRINE GLANDS
HERMAN T. BLUMENTHAL, PH.D., M.D.
(From the Departments of Pathology, The Jewish Hospital, and St. Louis
University School of Medicine, St. Louis, Missouri)
INCE Steinach (33), Voronoff (35), Gley
S (13), Horsley (17), Lorand (26) and
others have reported that the gradual failure
of the endocrine glands is an important factor
| in aging processes, and that endocrine prod-
ucts may prevent or delay old age changes
and may even cause rejuvenescence, hormonal
deficiencies have been suspect as an important
factor in organismal regressive and degenera-
tive processes associated with senescence.
Such a concept may derive additional support
from the consideration that the onset of aging
is frequently dated from either the height of
reproductive activity or the time of uttain-
ment of maximum growth, both of which
processes are under endocrine influences.
Despite such considerations there remains
considerable doubt, except in the instance of
the gonadal hormones, that endocrine de-
ficiencies of notable degree develop with ad-
vancing age (Carlson, 7). Evidence for any
appreciable diminution in the hypophyseal
content of gonadotropic, thyrotropic, or
adenocorticotropic hormones in aged _ in-
dividuals is lacking (Saxton and Loeb, 31;
Blumenthal, 4), and as Carlson (7) points
out, there is no increase in the frequency of
either myxedema or Addison’s disease with
advancing age.
On the other hand, Fleishman (10) has ob-
served that “man seems to stand alone in
showing severe deficiency symptoms after re-
moval of the thyroid gland in later life.” In
general however, according to this author, the
requirement for thyroid hormone decreases
with advancing age. Further, the regressive
processes observed by Loeb (23) and others
in the thyroid and adrenal of mice are of suffi-
cient severity to indicate marked hormonal de-
Submitted for publication January 19, 1955.
investigation was supported by the Louis N. Mon-
heimer Memorial Fund.
_The author wishes to express his appreciation for the ad-
vice and assistance of Dr. Leo Loeb in the preparation of the
manuscript.
ficiency unless compensatory changes can be
demonstrated.
Aging of the endocrine system therefore re-
mains an important consideration in the evalu-
ation of all factors which contribute to or-
ganismal aging processes. However, any
analysis of endocrine factors must take into
account the state of all organs which comprise
this system and must balance regressive
changes against compensatory processes. The
present report deals with such an analysis as
regards the hypophysis, thyroid, parathyroid,
and adrenal glands. Both regressive and com-
pensatory processes have been evaluated on
a semi-quantitative basis in normal mice, with
the end in view of subsequently measuring
the effects of various hormones on both types
of changes. Such an approach has two moti-
vations with regard to combating possible ag-
ing effects of endocrine glands: 1) Retard-
ing regressive processes, and 2) enhancing
the development of compensatory mecha-
nisms.
MATERIAL AND METHOD
The hypophysis, thyroid, parathyroid, and
adrenal glands were studied in 270 female
and 96 male mice of 9 different inbred genetic
strains, with an age and strain distribution
by sexes as shown in table 1. The oldest
female mouse was 31 months of age and the
oldest male 29 months; the youngest mice of
both sexes were 4 weeks old.
All of these endocrine glands were serially
sectioned and stained with hematoxylin and
eosin. In addition to studying qualitative
changes relating to senescence, the following
semi-quantitative determinations were carried
out:
1. Organ Size. The average size of one
lobe of thyroid, one adrenal gland, and the
hypophysis was determined by totalling the
253
EST NNER eo
~~ ewe 6 ww ee eww ewes
254 BLUMENTHAL
number of serial sections cut at 6 ». In each
instance sections were made along a frontal
plane. The average figure obtained is there-
fore an expression only of thickness, but has
the advantage over weight determinations in
that the factor of tissue fluids is eliminated.
Since size and number of parathyroids are
variable, no attempt was made to determine
the average thickness of these glands.
2. Mitotic Activity: In the thyroid, adre-
nal and pituitary mitoses were counted in
every fifth section of the serially sectioned
glands and the total multiplied by 5. In the
parathyroid glands, again because of vari-
ability in size, mitoses were determined on
the basis of number per 10,000 principal cells.
3. Connective Tissue Changes: There were
4 groups in this category: 1) Deposition of
collagenous fibrous tissue observed in the
thyroid and parathyroid glands of certain
strains and separating cortex and medulla in
the adrenals of some strains, 2) proliferation
of spindle cell connective tissue in the adrenal
cortex of many strains, 3) deposition of a
substance giving a polychromatic stain with
hematoxylin and eosin in the adrenal cortex of
a few strains of mice, and 4) replacement of
the deep cortex of the adrenal by fatty tissue.
Where recorded, the intensity of these changes
is arbitrarily graded between 0 and ++++
in each mouse; spindle cell proliferation in
the adrenal was evaluated on the basis of the
percentage of cortex replaced.
4, Cell Density: This determination was
employed in studying the anterior lobe of the
pituitary and the parathyroid glands. Its pur.
pose was to obtain an indication of changes
in cell size. A glass disc containing an in.
scribed grid forming 36 squares of equal size
was inserted into the ocular of a microscope
and the average number of cells per field de-
termined by counting a minimum of 10 fields
(360 squares). In the hypophysis the error
introduced by change in the relative quantity
of interstitial connective tissue was small,
since this alteration was minimal with advanc-
ing age. In the parathyroids of some strains,
however, there was a marked increase in col-
lagenous fibrous tissue with advancing age |
and selection of areas with minimal connec.
tive tissue proliferation had to be made. The
figures shown in the columns headed “aver-
age cell density” of tables 2 and 3 bear an
inverse relation to average cell size, since
the smaller the cells, the greater the number
of cells which can be assumed to be present
in a fixed area.
5. Ductal Structures: Ductal _ inclusions
were found in the thyroid and hypophysis.
The frequency of such inclusions was recorded
and histologic changes with age noted.
6. Cortical Cell Conversion of Periadrenal
Fat: This has reference to the new-forma-
tion of adrenal cortical cells in the fibrous
capsule and surrounding fat and connective
tissue. Again, in each animal the intensity of
this process was arbitrarily graded between 0
and +++-+, and frequency was also recorded.
TABLE 1. AGE AND SEX DISTRIBUTION BY STRAINS.
Age Groups
1-4 Months 5-8 Months 9-12 Months 13-16 Months | 17-21 Months | 22-26 Months |Over 26 Months
Strain
Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female
A 0 4 2 7 8 34 6 9 14 16 3 0 0 0
D 2 7 3 11 5 29 6 9 6 4 0 0 0 0
C57 1 16 1 s 3 9 3 7 0 2 1 4 0 2
NB l 0 2 0 2 0 & 6 3 1 2 0 0
CBA 1 1 0 0 1 3 2 2 2 s 2 5 1 3
OB 0 0 0 0 0 s 0 1 3 3 0 4 0 2
C3H 0 ] 0 1 0 11 2 2 0 7 0 0 0 0
AKA 0 0 0 0 0 1 0 2 3 4 1 1 0 0
C 0 0 0 0 2 0 2 3 0 0 0 1 0 1
Total 5 | 2 8 | 29 19 | 97 | 21 43 | 34 | 47 8 17 ii =
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N
AGING IN ENDOCRINE GLANDS OF NORMAL MICE
RESULTS
Thyroid Gland. The thyroid in both sexes
seemed to be slightly thicker in mice over 17
months than in younger mice, This increase
in thickness was not a progressive one, but
appeared abruptly at about the 17th month
and was maintained thereafter. This was at
variance with the age-weight relationships,
in which there was a progressive increase in
weight to a maximum in the 13-16 months’
groups, followed by a decline in older mice.
Further, there seemed to be no. significant
difference in thickness of the thyroid gland
between the two sexes.
The fundamental histologic change with
age in both sexes and in all strains consisted
of an enlargement of the central follicles with
gradual atrophy of the lining epithelium. In
young mice the follicles were small, fairly
uniform in size throughout the gland, and
lined by cuboidal epithelium. With advanc-
ing age the centrally located follicles expanded
and the epithelium became _ progressively
flatter. This process extended outward rad-
ially and eventually involved all but a few
peripheral groups of follicles. The latter re-
mained small and the epithelium essentially
cuboidal, as in young mice (fig. 1). In those
strains in which fibrosis was marked, expan-
sion of central follicles proceeded for a time,
but eventually fibrosis limited this process and
the fibrous tissue subsequently replaced many
follicles.
On the average, mitotic activity was great-
est in the youngest age group in both sexes
and in all strains; it then diminished to a low
level until in the oldest mice mitoses were
found only rarely. The frequency of cell
division was generally slightly higher in
females than in males and the initial fall more
gradual.
The frequency of occurrence of ducts in-
creased progressively with age in both sexes.
The apparent diminution in frequency in the
oldest age groups was probably not significant
in view of the small numbers of such mice
studied, These ducts in younger mice were
small, sometimes collapsed, and generally
without secretion. They were lined by tall
eosinophilic, sometimes ciliated epithelial
cells. With advancing age they showed pro-
gressive dilatation, eventually becoming cystic
and containing a basophilic secretion (fig. 2).
257
Interstitial fibrosis of any notable degree in
the thyroid gland was absent in both sexes
until the 9-12 months’ age group; it then
progressively increased in intensity with ad-
vancing age. It also seemed to increase in
frequency with age only in females of certain
strains, but this may have been due to the
ic. 1. Thyroid of CBA virgin female 15 months
old. Magnification approximately 120X. Along the
left half of the photomicrograph follicles are small,
lined by cuboidal epithelium and contain soft colloid.
Along the right half, which represents the center of
the gland, the follicles are larger, epithelium is flat-
ter, and colloid harder.
Mag-
Thyroid of OB male 10 months old.
nification approximately 120X. Along the center of
the photomicrograph there is a collection of duct-like
structures lined by columnar epithelium; the lumens
Fic. 2.
contain a thin secretion and a few leucocytes. The
uppermost duct has become cystic and the epithelium
flattened; secretion is similar to that in smaller ducts.
258
relatively small number of males in those
strains in which hyaline fibrosis developed to
a marked degree. The average data in this
category in tables 2 and 3 are, however, mis-
leading as regards these observations, since
hyaline fibrosis was not uniform in all strains
with regard either to frequency or intensity;
such figures were grossly influenced by varia-
tions in the numbers of mice of different
Fic. 3. Thyroid of C57 breeding female 26 months
old. Magnification approximately 100X. Section
shows +++ replacement of both the thyroid and para-
thyroid glands by collagenous fibrous tissue.
Fic. 4. Parathyroid Gland, Strain D male 11 months
old. Magnification approximately 240X. Section shows
parathyroid gland containing a small cyst in the
lower right hand corner. The small compactly ar-
ranged cells are of the principal type. Number 1
indicates a clear cell, other examples of which can
also be seen. Number 2 represents the intermediate
cell; there are other examples of this type adjacent to
the one indicated, as well as in the interstitial tissue
at the top center.
BLUMENTHAL
strains in each age group. In strains CBA
and C this process was essentially absent. In
Old and New Buffalo mice it was present in
only very slight degree, even in the oldest age
group. A, AKA, and D mice of both sexes
showed a progressive increase in intensity
after 11 months, which attained a maximum
of ++ in the oldest age group. In C3H and
C57 mice of both sexes it also first became
apparent at about 11 months of age, but
progressed more rapidly; in the two oldest age
groups, all mice frequently showed either a
+++, or occasionally a ++++ intensity (fig,
3). In general, the severity of fibrosis was
more marked in females than in males.
Parathyroid Glands. Three types of paren-
chymal cells were found in the parathyroids,
By far the most abundant in all age periods
was the principal cell possessing a relatively
large vesicular nucleus and scanty basophilic
cytoplasm; these cells were arranged in sheet-
like masses or in anastomosing cords. A see-
ond, slightly larger cell type was seen dis-
tributed in small groups through the _inter-
stitial connective tissue; the nuclei of such
cells were slightly smaller and more hyper-
chromatic than those of the principal cells,
and the cytoplasm was more abundant, while
containing pale pink granules. Cells of this
type were generally ovoid, but sometimes fusi-
form in shape, and conformed most closely
to the intermediate type as described by
Maximov and Bloom (28) (fig. 4). Some
cells of this variety were found in young mice,
but they seemed to increase progressively in }
number with advancing age; they persisted
in the interstitial tissue even in aged mice |
showing advanced fibrosis. In 5 animals they
were encountered in discrete adenoma-like
masses (fig. 6); 3 of these were females of
strains A and D, 11-12 months old, and the re-
maining 2 in OB and NB males 18 months
old. A third cell type, by far the largest in
size, showed a large vesicular nucleus with
a prominent nucleolus and abundant bright-
red, granular cytoplasm. While not identical,
it most closely resembled the oxyphile cell as
described by Maximov and Bloom (28) and
was the least frequent cell type. If present at
all, it was inconspicuous in young mice and
was seen only rarely in mice under 12 months
of age. During the second year it increased
in frequency as well as in size, until in aged
mice this variety became quite huge, particu-
larly
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AGING IN ENDOCRINE GLANDS OF NORMAL MICE
larly in those mice showing advanced hyaline
fibrosis of interstitial connective tissue (fig. 5).
A fourth cell type, the clear cell, was seen
occasionally in mice of both sexes in those
strains which showed minimal hyaline fibrous
change in the interstitial tissues.
Duct formation as described in the thyroid
gland was only occasionally encountered in
the parathyroid (fig. 4). It was not seen with
sufficient frequency to establish an age trend.
Follicle-like formations lined by principal cells
were also occasionally observed, but again
no age trend could be determined.
With regard to average cell size (Cell Dens-
ity in tables 2 and 3), it was largest in the
youngest age group in both sexes. In females,
the principal cells then became progressively
smaller until the mice reached the age of 17
months, when no further significant change in
size was noted. In males, principal cell size
was also largest in the youngest age group,
but then remained essentially uniform through
the remaining age periods.
As to mitotic activity of these glands, it
was uniformly low in both sexes in all age
periods with the exception of young female
mice. In the latter mitotic activity was slightly
higher in the youngest age group and there
may have been, perhaps, a progressive diminu-
tion during the first year of life.
The frequency of hyaline fibrosis of the in-
terstitial connective tissue of the parathyroid
glands increased progressively after about the
first year in both sexes. As in the case of the
thyroid gland, the data indicating average
severity of fibrous tissue change showed a
progressive increase with age only in females
and again this was probably due to the rela-
tively few male mice in those strains in which
hyaline fibrosis develops to a marked degree.
In general, the parallelism in thyroid and
parathyroid glands as regards interstitial fi-
brosis was quite striking; this holds not only
in relation to intensity in individual mice, but
also as regards strain susceptibility. However,
in those strains which showed minimal inter-
stitial fibrosis of the thyroid with advancing
age, there was slightly more advanced fibrosis
of the parathyroid glands.
Adrenal Gland. On the average, in both
sexes, the adrenals showed a progressive in-
crease in thickness to a maximum at about
the end of the first year or slightly thereafter;
the peak appeared later in females (13-16
259
months) than in males (9-12 months) and
showed no diminution with increasing age.
In general, adrenals were larger in females
than in males.
With regard to mitotic activity, as in the
case of the thyroid, there was a gradual fall
in the average mitotic count in the adrenal
cortex, terminating at the end of 12 months
in females and 21 months in males. Following
this there was perhaps a slight rebound in the
Fic. 5. Parathyroid Gland, Strain C3H virgin fe-
male 22 months old. Magnification approximately
400X. Section shows principal cells arranged +in
cords in a parathyroid gland showing extensive ye-
placement by collagenous fibrous tissue. Number 1
indicates a giant oxyphile cell.
Fic. 6. Parathyroid Gland, Strain D virgin female
12 months old. Magnification approximately 400X.
Section shows an adenomatous nodule composed of
cells of intermediate type.
260
frequency of cell divisions in males, and a
rather marked one in females. In the latter
sex this appeared to be a compensatory re-
sponse to the replacement of cortical cells by
either cellular connective tissue or by poly-
chromatic substance, as described below, In
males the proliferation of cellular connective
tissue was considerably less and mitotic re-
bound appeared in only the two oldest age
groups, where its significance is questionable
because of the small number of mice, In
general, mitotic activity in corresponding age
groups was greater on the average in females
than in males. Mitoses in cells of the adrenal
medulla were seen only rarely and showed
no significant age or sex pattern.
The severest age changes observed in the
adrenals were also strikingly limited to the
cortex. The medulla, except in rare instances,
showed no noteworthy alteration with advanc-
ing age; in one Strain D male a pheochromo-
cytoma was found.
The most frequent senescent change con-
sisted of the proliferation of spindle-cell con-
nective tissue. This was first noted between
the fibrous capsule and the cortex, initially
spreading laterally along the plane of the
capsule, but later extending into the zona
fasciculata as thin bands between the cords of
cortical cells (fig. 7). Eventually this process
reached the reticularis, again spreading later-
ally and forming a layer between cortex and
medulla, This change was present in some
degree in all strains, but was least marked
in Strain A mice. As can be seen by compar-
ing the appropriate data in tables 2 and 3, it
appeared earlier in females (5-8 months) than
in males (9-12 months) and was considerably
more extensive in the former sex, where at
the maximum period it replaced, on the aver-
age, over 14 per cent of the volume of the
cortex,
Within the adrenal cortex when connective
tissue replacement was marked, the remain-
ing cortical cells hypertrophied; multi-
nucleated giant cells also formed and these
frequently contained a brown granular pig-
ment (fig. 10). Such pigment was also first
seen in reticularis cells in all strains and both
sexes, beginning at about 12 months of age,
after which there was a progressive increase
in the concentration per cell as well as in the
number of cells involved.
In Strain A mice of both sexes a peculiar
so
BLUMENTHAL
regressive change of the adrenal cortex was
noted, This was characterized by a deposi
tion of a substance staining polychromatically
with hematoxylin and eosin (fig. 8). It was
also observed occasionally, in small amounts,
in mice of either sex in other strains, where
it was usually limited to the junction of the
cortex and medulla. While the figures in the
appropriate columns of tables 2 and 3 indicate
essentially a variable intensity and suggest
an increase in frequency with age, beginning
with the 9.12 months age groups of both sexes,
these data are again misleading because of de.
pendency on numbers of mice and strain dis.
tribution. In Strain A mice there was a pro-
gressive increase in frequency and_ intensity,
until in the oldest age groups it was present
in the adrenal cortex of almost every Strain
A mouse, regardless of sex, in +++ or
--+++ degree.
The presence of fat cells contributing a
junctional zone separating cortex and medulla
was found only in females of Strains A and
D (fig. 11). This was seen with increasing
frequency and intensity up to the age of 12
months and was not observed after the six-
teenth month (cf. tables 2 and 3),
In addition to the rebound in mitotic actiy-
ity of cortical cells as noted in the foregoing,
there was another compensatory — process
peculiar to the adrenal cortex characterized
by a progressive conversion of periadrenal fat
and connective tissue to cortical cells. In its
arliest form, seen usually at about the
eleventh or twelfth month, but occasionally as
“arly as the eighth month, the periadrenal fat
seemed to revert to fetal-type fat in which
the cytoplasmic space became filled with
coarse granules. Progressively, these granules
became more numerous and more finely
divided, until the cytoplasm took on the finely
granular character typical of adrenal cortical
cells. This process was not everywhere uni-
form, but took the form of isolated groups of
cortical cells in the periadrenal fat. Groups
of glomerulosa cells just beneath the fibrous
capsule also proliferated to first form intra-
and subcapsular nodules of cortical cells and
then project as masses into the adjacent con-
nective tissue (figs. 8 and 9). As can be seen
in tables 2 and 3, the intensity of this com-
pensatory change increased progressively with
advancing age in both sexes, but was generally
greater in females than in males. The fre-
quency was also greater in females, but flue-
Fic
21 m
Secti
spind
capsu
thin
layer:
Fr
25 9
Alon
of zo
Two
and |
thin
small
tuat
the |
Pi
ness
a mé
and
mon
cline
fore,
A
ity
Ortex was
a deposi.
nniatically
It was
amounts,
ns, where
mn of the
res in the
5 indicate
| suggest
eginning
oth sexes,
ise of de-
train dis.
aS a pro-
intensity,
S present
ry Strain
t++ oO
buting a
| medulla
is A and
creasing
Ze of 12
the six-
tic actiy-
pregoing,
process
acterized
renal fat
s. In its
out the
onally as
renal fat
n_ which
ed with
granules
e finely
he finely
cortical
ere uni-
roups of
Groups
» fibrous
m intra-
ells and
ent con-
be seen
is com-
ely with
enerally
The fre-
yut flue-
AGING IN ENDOCRINE GLANDS OF NORMAL MICE
NWSee, Siete ee
Fic. 7. Adrenal Gland, Strain C57 virgin female
21 months old. Magnification approximately 120X.
Section shows a thick layer of compactly arranged
spindle-cell connective tissue beneath the fibrous
capsule and along the corticomedullary junction, with
thin bands of communication
layers,
between these two
Fic. 9. Adrenal Cortex, Strain D breeding female
25 months old. Magnification approximately 240X.
Along the left margin there is an area of replacement
of zona glomerulosa by spindle-cell connective tissue.
Two surface cortical nodules are present at the top
and along the right side of the photomicrograph. A
thin fibrous band, presumably capsule, separates the
smaller nodule from the cortex proper.
tuated in both sexes on a fairly high level after
the twelfth month.
Pituitary Gland. On the average, the thick-
ness of the hypophysis increased slightly to
amaximum in the 9-12 months group in males,
and to a slightly higher level in the 13-16
months group in females, after which it de-
clined in both sexes. The size curve, there-
fore, roughly paralleled the weight curve.
As in other endocrine glands, mitotic activ-
ity in the anterior pituitary progressively
261
Fic. 8. Adrenal Gland, Strain A virgin female 20
months old. Magnification approximately 120X. Along
the right hand margin of the section there is an
island of cortical cell conversion in periadrenal fat.
Within the cortex proper there is a large irregular
area of replacement of cortical cells by polychromatic
substance.
Adrenal Gland, Strain C57 male 22
Magnification approximately 240X. Sec-
tion shows multinucleated giant cells formed by co-
Fic. 10.
months old.
alescence of cortical cells, In the center at the lower
margin are pigmented reticularis cells.
diminished with advancing age. Only in the
oldest group of females was a mitotic rebound
noted, and this may be of questionable signif-
icance because of the small number of mice.
In the two youngest age groups mitotic activ-
ity occurred with greater frequency in females
than in males. Only occasional mitoses were
found in other parts of the hypophysis and
these showed no age pattern.
Unlike the other glands in this study, re-
gressive connective tissue changes were in-
262 BLUMENTHAL
significant in the anterior hypophysis, there the advanced age periods are reached, when pe
being only a slight increase in interstitial con- there is a definite diminution in average cell ch
nective tissue with advancing age. size; this decrease appears earlier in males ref
As regards the data in tables 2 and 3, in- than in females. the
dicating average cell size, they show greatest In the hypophysis, ducts were found most | — on
cell size in the youngest age group in both frequently in the anterior, and occasionally ip | bo
sexes, but the average cell size is greater in the intermediate and posterior lobes; the} ch
males than in females. This is followed by epithelium was generally cuboidal and the ho
some fluctuation on a diminished level until lumen contained an eosinophilic, colloid-like | re
material (fig. 12), As in the thyroid, these int
structures progressively dilated with advanc- ad
ing age, becoming cystic in some old mice. In im
al general, however, even in old mice only a ge
ae small percentage of animals showed this fev
' P lesion, and it was not seen in male mice. No } pe
noteworthy age changes were noted in the } = w
intermediate or posterior lobes. di
us
DISCUSSION
la
A Endocrine deficiencies related to senescence | ar
may develop in several ways: 1) By a dimi- m
11 nution in the productive and/or secretory fo
jad) “apacity of the hypophysis as a result of re- a
e i ae gressive changes within the pituitary or hypo- in
Fic. 11. Adrenal Gland, Strain D virgin female 8 thalamus; 2) by an impaired response either | ce
months old. Magnification approximately 35X. Sec- ‘ ’ 7
tion shows a thick zone of mature fatty cells separat- 1 production or secretion of the target en- m
ing cortex and medulla, docrine gland due to intrinsic regressive sk
processes, or 3) by an inability of the peri- di
pheral tissues to respond to hormonal stimula- hy
tion due either to intrinsic senescent changes Gy
which render them refractory, or diminished p
delivery of hormones because of vascular im- re
pairment. The experiments reported herein tl
deal with the first two of these possibilities. ir
An attempt has been made to distinguish e
between “degenerative” and “regressive” phe- 0
nomena in referring to certain of these aging
changes on the basis that regression would tl
connote an alteration from a more active tl
to a less active state, whereas degeneration } p
would indicate a reaction to an injurious | 1
agent. Since in many aging processes no in- d
jurious agent has been identified and in some } tl
instances the effect may be due to a diminu- | = 5
tion or lack of some stimulating substance, it si
was believed that regression would more ap- c
propriately apply in most instances at least il
until such time as causal factors could be
more adequately defined. d
A comparison of changes in total body c
Pobce 20 aac ok” teen cs soli tee weight and endocrine organ size might be a
190X.. "Section shows a ies oa lined by “flat. expected ‘ . furnish some indication of the :
tened cuboidal cells and containing a small amount ®8©€ relationship between total organismal "
of thin colloid-like material. growth and endocrine activity. Such an ex- I
ed, when
Prage cell
in males
und most
ionally in
bes; the
and the
Nloid-like
id, these
| advane-
mice, In
e only a
ved this
lice. No
d in the
nescence
ya dimi-
secretory
It of re-
or hypo-
se either
rget en- |
gressive
he peri-
stimula-
changes
ninished
ular im-
| herein
ilities.
tinguish
re” phe-
e aging
| would
active
neration
njurious
; no in-
in some
diminu-
ance, it
ore ap-
at least
uld be
1 body
ght be
of the
unismal
an ex-
AGING IN ENDOCRINE GLANDS OF NORMAL MICE 263
pectation seemed justified, since senescent
changes in the hypophysis, one of the chief
regulators of total growth, were minimal and
the curve of change in hypophyseal size in
one dimension paralleled the curve of total
body weight. However, whatever may be the
changes in secretion of hypophyseal growth
hormone as related to senescence, the present
results show that on an endocrine organ level
intrinsic aging processes in the thyroid and
adrenal cortex were generally of much greater
importance in determining organ volume than
general growth factors. Furthermore, when-
ever sex differences in body weight at corres-
ponding age periods were observed, they
were usually greater in males, whereas sex
differences in endocrine organ volume were
usually greater in females.
Moreover, a comparison of cell size as re-
lated to age such as was carried out in the
anterior hypophysis and the parathyroids
might also be expected to yield similar in-
formation regarding growth relationships on
a cellular level. Certain pertinent parallelisms
in the two glands were observed: in both,
cells were largest, on the average, in young
mice of both sexes, and in females both
showed a progressive decrease in cell size
during adult life. Furthermore, in males the
hypophysis and parathyroids showed a plateau
on a diminished level following the pre-sexual
period, which was maintained throughout the
remainder of the life period. However, in
the parathyroids average cell size was greater
in females than in males during youth and
early adult life, while in the hypophysis the
opposite seemed to be the case.
Since measurements of size of the para-
thyroid glands were not made, it is noteworthy
that Gilmour and Martin (12) found that the
parathyroids of the human male attain maxi-
mum size at age 20-30 years, when a gradual
decrease sets in, while in the human female
these glands increase in size until the age of
50. Therefore, in human males at least, the
size curve for parathyroid gland parallels the
curve of total body weight and pituitary size
in mice.
It is not possible from the present data to
determine to what extent changes in average
cell size determine alterations in the size of the
anterior hypophysis with advancing age, since
it would also be necessary to know changes
in total numbers of cells. Nevertheless, judg-
ing from the curves of mitotic activity, it
seems unlikely that the total number of epi-
thelial cells increases with advancing age,
and therefore it is unlikely that changes in
cell size account for alterations in organ size
with advancing age.
The fundamental effect of aging on cell
proliferation is a progressive diminution in
mitotic activity; in this regard present data
substantiate previous observations in the
guinea pig (2,3). In both species there was
usually a sharp drop at about the time of onset
of sexual function, with females generally
showing greater mitotic activity than males in
corresponding age groups, even during the
pre-sexual period. The exception to this gen-
eral pattern was noted in the parathyroid
glands, which showed a uniform low level of
mitotic activity throughout life, with perhaps
a slightly higher level only in pre-sexual
females. In so far as the curves of mitotic fre-
quency in the parathyroid fail to parallel those
in the hypophysis as well as thyroids and
adrenals, they substantiate a previous conclu-
sion (4) that the parathyroid glands, if in-
fluenced at all by pituitary function, react by
depression of mitotic activity.
Certain data in the present experiments in-
dicate that changes in mitotic activity in the
thyroid and adrenals with advancing age may
occur independent of pituitary influences.
Mitotic rebound in female mice was much
more marked and first occurred about 13
months earlier in the adrenals than in the
hypophysis. Further, despite the occurrence
of mitotic rebound in the hypophysis of the
oldest group of females, such a phenomenon
was never observed in the thyroid. It there-
fore seems that local factors in the adrenal
probably related to regressive phenomena as-
sociated with aging were of much greater im-
portance in initiating mitotic rebound than
any pituitary influence. However, this was
not true in the thyroid and parathyroid glands
of those strains in which marked replacement
of glandular epithelium by collagenous fibrous
tissue occurred, since no compensatory in-
crease in mitotic activity of surviving cells
was observed.
In general, changes in organ size are best
accounted for on the basis of regressive
processes in individual glands. Dominant
among the latter was the encroachment by
fibrous tissue. The replacement of glandular
epithelium of the thyroid and parathyroid
by collagenous fibrous tissue in certain strains
264 BLUMENTHAL
of mice has also been observed by Andrew
and Andrew (1) and by Loeb (23). It is
pertinent that other parallelisms in reactivity
of the thyroid and parathyroid glands have
been observed by the author and Loeb (5, 6)
in the guinea pig. Furthermore, replace-
ment of adrenal cortex by fusiform fibroblasts
in most strains, and by a polychromatic sub-
stance in Strain A, has been previously re-
ported by Loeb (23). Where sex differences
in organ size were observed they generally
corresponded to sex differences in intensity
of these regressive phenomena. In the hypo-
physis where such processes were minimal,
and in the thyroid glands of those strains
showing only minimal fibrosis, gross enlarge-
ment was best accounted for on the basis of
cyst formation; in the thyroid an additional
factor was the progressive distention of folli-
cles filled with hard colloid. The presence
of ductal structures in the thyroid which sub-
sequently become cystic has also been ob-
served by Gorbman (14), who considers them
inclusions originating from the ultimobran-
chial bodies. However, it is difficult to ac-
count for their increase in frequency with ad-
vancing age on such a developmental basis,
since it is unlikely that even small ducts in
young mice would be missed in serially sec-
tioned glands.
The age distribution of female mice of
Strains A and D showing lipid degeneration
of the zona reticularis of the adrenal gland
indicates that this is not a senescent change,
but most likely degeneration of an androgenic
zone (X-Zone) of pre-sexual females which
takes place progressively after the onset of
estrogenic activity, and is complete at about
the end of the first year of life. The pigmenta-
tion of cells of the zona reticularis has also
been observed by Cramer and Horning (9)
and by Jayne (18). The former investigators
have produced this change by prolonged ad-
ministration of estrogen.
The observations of Furth (11) on some of
the peripheral effects of pituitary tumors in-
duced in C57 mice by destruction of thyroid
tissue with radio-active iodine suggest a possi-
ble mechanism for some of the degenerative
changes described herein. In particular Furth
(11) has observed lipid degeneration of the
zona reticularis or spindle-cell replacement of
cortical cells of the adrenal, either in mice
with a primary pituitary tumor or with a
transplanted autonomous tumor. As regards
the lipid degeneration, the experimental pro-
duction of this lesion in Strain C57, a strain
in which it does not normally occur, suggests
that mice of the two strains in which it does
occur may show a greater estrogenic activity
than other strains and secrete a greater quan-
tity of hypophyseal gonadotropins, and that a
relatively high threshold of such activity is re-
quired to produce this lesion. Regarding
spindle-cell fibroblastic proliferation in the
adrenal cortex, it is not clear from Furth’s
data (11) whether or not the C57 mice were
sufficiently old at the termination of his ex-
periments to have developed this lesion spon-
taneously.
In general, the observations noted in the
foregoing suggest the possibility that hypo-
physeal hormones may play some role in the
development of certain of the degenerative
and regressive lesions associated with aging,
particularly since previous investigations. in-
dicate no appreciable reduction in the content
of such hormones in the hypophysis of aged
individuals (4, 31). In this regard it is pert-
inent that Reinhardt and Li (29) have been
able to produce arthritis in rats with hypo-
physeal growth hormone. The specific rela-
tions of hypophyseal hormones in aging
processes are now under investigation. Cer-
tain observations of Loeb and associates (24,
25, 34) are pertinent as regards the influence
of hormonal mechanisms on the state of
stromal elements in certain organs. These in-
vestigators have reported that there is a pro-
gressive increase in amount and density of
stromal elements with age and that hormones
may counteract this effect by loosening the
stroma either by their effect on the circula-
tion, by their direct stimulating action on
epithelial parenchyma along with the release
of a hormone-like contact substance by the
epithelium, or by direct effect on the stroma.
Not all of the aging changes described
herein are of a degenerative or regressive
character. It is apparent that all of the en-
docrine organs in this study exhibit histologic
evidence suggesting a capacity for compensa-
tory changes, some of which, at least, may re-
sult in a maintenance of normal function for
a considerably longer period than would
otherwise be possible. Compensatory changes
in the thyroid such as we have described
herein have also been observed in aging rats
by Korenshevsky and Paris (19), who in addi-
tion found small adenomata. In the para-
th
ce
sc
ac
of
of
of
ital pro-
a strain
suggests
it does
activity
T quan-
1 that a
ty is re-
garding
in the
Furth’s
e were
his ex-
n spon-
in the
hypo-
in the
erative
aging,
ms in-
ontent
F aged
S pert-
> been
hypo-
> rela-
aging
Cer-
s (24,
uence
te of
‘se in-
1 pro-
ity of
nones
gy the
rcula-
n on
lease
y the
‘oma.
ribed
ssive
2 en-
logic
ansa-
y re-
1 for
ould
nges
ibed
rats
ddi-
ara-
AGING IN ENDOCRINE GLANDS OF NORMAL MICE 265
thvroids the interstitial granular eosinophilic
cells may be similar to the onkocyte cells de-
scribed by Hamper! (15) in aged humans. In
addition we have observed small adenomata
of the parathyroids in several mice, probably
of intermediate cell type. In the pituitaries
of female mice, in addition to the rebound in
mitotic activity noted herein, other investiga-
tors have observed chromophobe adenomata
in aged rats (32). As already stated, the
adrenal cortex showed the most marked mi-
totic rebound, and in these glands we have
also observed the new-formation of adrenal
cortical cells in the periadrenal fat and con-
nective tissue as well as the formation of small
adenomata. The data indicate that the latter
processes increase in intensity as cortical cell
replacement becomes progressively more
widespread. This conversion phenomenon
has also been observed by Lacqueur and Har-
rison (20) in diabetic humans, and Russi and
the author (30) have also reported that
adenomata of the adrenal cortex are 5 times
more frequent in adult diabetic patients than
in non-diabetic humans. All of the latter ob-
servations indicate that when adrenal insuffi-
ciency develops, whether on a regressive basis
or on the basis of endocrine imbalance, the
adrenal gland has a capacity for compensation.
On a total organismal level aging has
usually been defined as the sum of the changes
which occur between the time of fertilization,
the height of reproductive activity, or the
point of maximum growth on the one hand,
and death on the other. Loeb (23) has
pointed out that regardless of which of these
definitions is employed, there are specific time
curves for various species and even for in-
dividuals; and there are also time curves for
different organs within an organism. Heil-
brunn (16) has stated that “In the last analy-
sis, according to any theory, senescence is due
to protoplasmic changes which occur in in-
dividual cells.” Whether or not there are
characteristic time curves on a cellular level
remains to be determined. However, in a
review dealing with the physiologic changes
on a cellular level related to aging, Lansing
(21) has pointed out that reversion of very
old cells to the embryonic condition has been
observed by Marklung (27) as regards per-
meability of cell membrane, and by Weber
(36) with respect to viscosity of cytoplasm.
A distinction should be made between such
observations demonstrating reversion and
others which show that aging of cells can be
prevented. The well known concept of the
“potential immortality” of cells as first sug-
gested by Loeb, and demonstrated in tissue
culture by Carrel (8) and with serial homoio-
transplants by Loeb (22) represents preven-
tion of cellular aging.
On an organ level as demonstrated in the
present experiments, and probably also in
complex organisms, at least functionally, the
time curve of aging may, in large part, be de-
termined by the potentiality to develop com-
pensatory processes of the type herein ob-
served. However, in the sense that an organ
is composed of individual cells, this ability for
compensation is determined by the poten-
tiality of the individual cells to ‘manifest mi-
totic rebound and the formation of adenomata,
and by the ability of adjacent supporting tis-
sue components to undergo metaplasia with
the new-formation of parenchymal units. In
general, certain endocrine organs such as the
hypophysis, parathyroid, and adrenal thus
seem to have a longer time curve than others,
such as the thyroid and probably also the
ovaries.
But even this general conclusion must be
modified to take into account genetic factors.
Thus, for example, the thyroid and parathy-
roid glands in some strains exhibit minimal
fibrosis and some capacity for compensatory
processes, while in other strains where col-
lagenous fibrous tissue replaces large areas of
parenchyma, compensatory processes are min-
imal or absent. In addition, the intensity of
regressive changes as well as of compensatory
phenomena shows sex differences even in the
same strain.
These observations therefore seem to sub-
stantiate the conclusion of Loeb (23) that the
time curve is largely characteristic of the or-
gan and differs in different organs. While in
the present experiment it seems that hormonal
factors may influence certain aging processes
such as the proliferation of fibrous tissue ele-
ments, they probably have little or no direct
influence on reversion phenomena such as mi-
totic rebound and metaplasia of mesenchymal
supporting structures which form parenchy-
mal units.
SUMMARY
Spontaneous aging processes were studied
in the hypophysis, thyroid, parathyroid, and
266 BLUMENTHAL
adrenal glands of 96 male and 270 female
mice of 9 different inbred genetic strains,
varying in age between 4 weeks and 29
months (male) or 31 months (female).
The following semi-quantitative data were
tabulated in addition to a description of qual-
itative histologic changes: body weight, en-
docrine organ size in one dimension, mitotic
activity, intensity and frequency of senescent
changes in supporting tissues, cell size, and
intensity and frequency of certain compensa-
tory processes.
The data are discussed on the basis of pos-
sible interrelated hormonal influences on
aging changes in the endocrine glands. Con-
nective tissue changes in particular may de-
pend upon several hormonal factors. The in-
crease in size with age of endocrine glands
seems to be due primarily to intrinsic aging
changes rather than to any specific stimula-
tion by the hypophysis, despite the fact that
activity of the latter gland does not seem to
diminish with advancing age. The funda-
mental senescent changes on a cellular level
are a progressive diminution in cell size and
in mitotic activity. The parathyroid glands
are an exception in that they show an essen-
tially uniform low level of mitotic activity at
all age periods.
Evidence for compensatory phenomena,
which may at least temporarily delay the de-
velopment of endocrine deficiencies, is present
in some degree in all of these endocrine
glands. These processes take the form of re-
bound in mitotic activity, focal areas of hyper-
plasia, the formation of adenomas or the new-
formation of parenchymal cells which appear
to develop on the basis of metaplasia of sup-
porting tissue elements. The latter change
applies particularly to the cortex of the ad-
renal gland.
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a
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i of Male
‘. Arch,
to the
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themical
id Para.
A81-494,
rellelism
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STANCES,
(Age),
vid and
Potas-
n Adre-
1942,
roblems
Villiams
Tissue
“l., 15;
Adrenal
stration
rt., 44;
of the
rles C
ociated
‘umors,
Weight
Bull,
logical
inchial
chialis
3-101,
Onko-
ihren
Anat.,
| Phy-
43,
iyroid
84,
Gland
115:
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28.
29.
AGING IN ENDOCRINE GLANDS OF NORMAL MICE
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plants of Anterior Lobes of
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Lansing, A. LL:
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Harnstoff-Permeabilitiit
Protoplasma, 12:
METABOLISM IN THE AGED: THE EFFECT OF STANOLONE ON THE
RETENTION OF NITROGEN, POTASSIUM, PHOSPHORUS, AND CAL-
CIUM AND ON THE URINARY EXCRETION OF 17-KETO, 11-OXY, AND
17-HYDROXY STEROIDS IN
EIGHT ELDERLY
MEN ON HIGH AND
LOW PROTEIN DIETS
DONALD M. WATKIN, M.D., JANIS M. PARSONS, B.S., MARVIN J. YIENGST, B.S.,
and NATHAN W. SHOCK, Ph.D.
(From the Section on Gerontology, National Heart Institute, National Institutes of Health, P.H.S.,
D.H.E. & W., Bethesda, Maryland and the Baltimore City Hospitals, Baltimore, Maryland)
Although androgenic substances have been
shown to stimulate protein anabolism in ani-
mals and young men, relatively few studies
have been made on the aged. Since previous
studies from this laboratory have shown that
aged subjects are capable of responding to
the anabolic stimulus of increased dietary
protein about as effectively as young (1), the
present study was undertaken to find out
whether administration of an androgen could
produce a further anabolic stimulus when
superimposed on the stimulus of increased
protein intake in humans. For this purpose
metabolic balances of nitrogen, potassium,
phosphorus, and calcium were determined in
the same subjects when an androgen was
administered in association with both high
and low levels of protein intake. In addition
the pattern of urinary steroid excretion was
determined. Since some of the subjects used
had previously received stilbestrol, it was
possible to compare the anabolic effects of
an androgen and estrogen.
EXPERIMENTAL METHODS
Subjects. The experiments were carried
out on 8 males, aged 70 to 93 years, selected
on the basis of a detailed history, physical
examination, and a series of laboratory tests.
All subjects were ambulatory, continent, and
cooperative. Four of the subjects (T.B.,
A.Ha., A.He., and W.Ra.) had been utilized
for previous metabolic studies. A summary
of laboratory data obtained in all subjects is
shown in table 1. All were within —11 to
+18 per cent of ideal weight (13) and had
basal metabolic rates within normal limits for
their age (19). Glomerular filtration rates,
renal plasma flows, and maximum transfer
Submitted for publication April 8, 1955.
Published on a grant from the Forest Park Foundation to
the Journal of Gerontology.
rates of PAH or diodrast were within normal
limits for their age (5, 21). The subjects
gave no clinical evidence of endocrine or
metabolic disturbances and were free from
any bone lesions detectable by roentgenog-
raphy except for 2 (A.Ha. and W.Ra.), who
displayed osteoporosis as described in a pre-
vious report (2). No evidence of musculo-
skeletal diseases, chronic infections, gastro-
intestinal disturbances, or peripheral edema
was found in any of the subjects.
Detailed clinical descriptions of subjects
T.B., A.He., and W.Ra. (1) as well as A.Ha.
have been published previously (2).
T.B. A 71 year old, white, single Polish born
male who had been admitted 514 years prior to
the study for domiciliary care (1).
A.He. A 74 year old, white, separated male
admitted 214 years prior to the study for domi-
ciliary care (1).
W.Ra. An 83 year old white widowed male ad-
mitted 214 years prior to the study for domi-
ciliary care. This patient met the criteria for
the diagnosis of osteoporosis (2).
A.Ha. A 76 year old white male admitted to the
hospital 114 years prior to the study. This
patient was diagnosed as osteoporotic (2).
L.B. A 93 year old white man who had lived
in the infirmary and the hospital for over 30
years. He had had arteriosclerotic myocardial
disease for many years and was maintained
edema free on digitalis.
lip was removed at age 89. He had extensive
apical pleural thickening bilaterally. Skeletal
survey revealed no osteoporosis. Blood chem-
istries were normal. Hematologic examination
revealed a normo-chronic, normocytic anemia.
S.B. A 71 year old white man who had lived
in the hospital for 4 months. He had a history
of a recent CVA from which he had recovered
almost completely. An old penial scar sug-
gested primary syphilis. Skeletal survey, blood
chemistries, and hematologic data were within
normal limits.
268
A carcinoma of the
Sines Wicae te
Pa re
normal
ubjects
ine or
> from
genog-
), who
a pre-
isculo-
gastro-
edema
ibjects
A.Ha.
sh born
prior to
d male
r domi-
ale ad-
~ domi-
ria for
| to the
This
).
1 lived
ver 30
cardial
ntained
of the
tensive
skeletal
chem-
ination
nemia.
| lived
history
overed
r sug-
blood
within
METABOLIC BALANCES IN THE AGED 269
TABLE 1.
|
Difference |
Height | Weight from |
Subject | Age Cm. Kg. Ideal |
Weight*
| |
L.B. 93 160 | Si.t | -11.5
| 173 | 87.9 | 416.7
S.B. 71 155 | 47.8 | 9.1
A.Ha. 76 iss | #66 | —7.7
A.He. 74 165 | 77.2 | +81.2
P.K. 75 ate 2 oe
W.Ra. 83 170 | 8.5 | +17.7
JS. 76 163 | 54.2 | 2.0
(%) ‘Cal./M*/Hr.| MI./Min. | MI./Min.
Heicut, WEIGHT, BMR, AND RENAL FUNCTION Data.
| |
Standard | Standard |
Inulin | PAH | Tm pan |
Clearance | Clearance | Filtration
| Fraction
BMR
Mg./Min.
*Based on Metropolitan Life Insurance Company data (13).
tDiodrast clearance.
tTm diodrast.
§PBI normal 5.6 mg./100 ml.
P.K. A 75 year old white man, a resident of
the hospital for 4 years. Aside from occasional
bouts of bronchial asthma, the patient was in
good health. Bone survey, blood chemistries,
and hematologic data were within normal limits.
J.S. A 76 year old white man, a resident of the
hospital for 1 year prior to the study. History
suggestive of carcinoma of stomach 17 years
ago was unconfirmed. X-ray showed calcifica-
tion in the right lung field and thickened pleura.
Blood chemistries and hematologic studies were
within normal limits. Skeletal survey revealed
no osteoporosis.
Androgen selected. The synthetic aniro-
gen, stanolone*® was chosen as the anabolic
stimulus, since at the time these studies were
planned it was believed, on the basis of clini-
cal tests on females, that the androgenic
properties of stanolone were less than those
of testosterone (6, 7). The stanolone used
was suspended as microcrystals in a concen-
tration of 50 mg./ml. sterile distilled water
containing sodium carboxymethyl cellulose
(0.1%) as a suspending agent, thimerosal
(0.01%) as a preservative, and sodium ‘chlor-
ide (0.9%). The steroid was administered
ny in doses of 50 mg. on alternate
ays.
*We wish to thank the Pfizer Laboratories of Brooklyn,
New York for the supply of Neodral brand of stanolone
which they generously supplied for these studies.
a 350t 46% 21
32.6 90 427 66 21
§ 40 197 46 20
. 70 287 93 24
29.1 74 329 51 .23
31.2 77 309 76 .25
28.9 80 : ee:
30.1 69 242 39 .29
Procedure. In broad outline the experiment
consisted of 2 metabolic balance studies con-
ducted consecutively in the same 8 subjects.
A high protein diet (106 Gm./day) was fed
throughout the first study; a low protein diet
(52 Gm./day ), throughout the second. Each
study was divided into 5-day periods, the
first containing 12 and the second 13 periods.
In each study, the first 4 periods comprised
the control phase; the second 4 periods, the
experimental phase during which stanolone
was given. The postexperimental follow-up
phase lasted for 4 periods in the first study;
for 5 periods in the second.
Except for a 10 day interval between the
high and low protein phases of the experi-
ment, all subjects lived on the metabolism
ward under the supervision of specially
trained nurses 24 hours a day. Their meals
were individually weighed, prepared, and
served by a staff dietitian from a_ special
kitchen used only for the preparation of these
diets. All foods including the meat were
purchased in a single lot at the beginning of
the study. The meat was carefully trimmed,
ground, well mixed, and individual portions
were all weighed out at the beginning of
the study. The individually wrapped portions
were stored in the deep freeze until used.
Chemical analyses of the diets were made
4 times during the course of the study and
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> oa. mo | showed insignificant variations.
oe ee we ee | in intakes, as shown in tables 2 and 3 resulted
ease? +ess from refusals of the total amount of food in
individual cases. A utility room entered from
i= ,8,e% ,&,& the metabolism ward was equipped with a
oi sda has As commode, refrigerators for cold storage, and
Se tae tee shelf space for storing clean stool jars and
— urine bottles. The total urine excreted from
(= 4e4 @ 1S = 7:00 a.m. to 7:00 a.m, was collected. Five-day
= ona ——— stool collections were demarcated by capsules
8 ,8#,3 ,&,8 containing carmine administered at bedtime
- = = bie the night before the end of the period.
am eM Om mOHS jects were weighed daily before breakfast on
ty ie a = = 3° i = a kilogram scale. Fasting blood samples were
drawn during alternate 5-day periods and ex-
2 Ril ee BBR eo — sigs er ge sng eve
isn ni cael ada Fai cally for total protein, albumin, calcium,
S354 SSS | phosphorus, and alkaline phosphatase.
eee. aw The chemical compositions of the food con-
AN NAM A sumed by each subject in both high and low
28 88882 82882 protein studies are presented in tables
Me CESS BEER “s To provide variety, both the _ ig
7 ie Sete ee ow protein regimens were presented in «
Ret, dite = menus of almost identical chemical compo-
28 £8288 8838 sition. In any one 5-day period, menu I and
Baa > Gira cacao 7 aa fae aa hl Il were served twice; menu III once.
4 $5 sab ekg pees Wea Although all subjects received isonitro-
ee Peee fees genous diets, 4 (T.B., $.B., A.He., P.K.) re-
19 a ties toe RR: tie ceived diets of about 2600 calories; 3 (L.B.,
SZ BESR BRSB A.Ha., J.S.) received diets of about 1800
++ ete +444 calories, and 1 (W.Ra.) a diet of about 2200
2t 8295 E28 calories. Reduction in calories was achieved
a ee eee by removal of carbohydrate and fat without
S= Z&8SF ESER appreciable change in the content of nitrogen,
calcium, phosphorus, and potassium.
22 2228 38288 Chemical methods. The chemical methods
Shei seeepsachetet teem iaeeeietotietatil utilized have been
Sf Sere seer publications of this laboratory (1).
a 2am Sees Analyses of the urine for 17-ketosteroids,
Se ENR REED SpE ll-oxy (C.) steroids, and 17-hydroxysteroids
oe: ee. | ee oe were performed according to the methods of
~ a Holtorff and Koch (9), Corcoran and Page
SS RASRB KES : = (3), Corcoran, Page, and Dustan (4), and
a5 Sees S558 Reddy, Jenkins, and Thorn (15), respectively.
“=~ freee Reee Analyses were performed on daily urine
ea e882 4428 specimens as well as 5-day pools during the
ake Gs AGU ie ete Wa periods immediately before and immediately
818 i382 3ise33 | gy after institution of hormone therapy in an
maw wenw ooun |£ effort to detect rapid changes which other-
= __|3 wise might have been obscured in the 5-day
= | pools.
~
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SB _* urinary and fecal excretions, and over-all
$8 metabolic balance were tabulated by individ-
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280
ual periods for each subject. Average values
for all periods under the specified conditions
were computed for each subject. These aver-
ages were used for the calculation of the
mean values for testing the effect of the
steroid under conditions of high and low
protein intake. Average values for all 8 sub-
jects were computed as well as average values
for the 6 normal and 2 osteoporotic subjects.
Theoretic weight curves (17) were computed
and compared with actual weight curves,
Statistical “t” tests were performed to evaluate
the significance of changes in balance result-
ing from hormone therapy and from protein
level of the diet (20).
Hematologic values, blood chemistries, and
urinary steroid excretions were tabulated, and
average values and standard errors with levels
of significance of changes following shifts in
diet and administration of the hormone were
determined.
RESULTS
The results of the study are given by in-
dividual periods in tables 2 and 3 for each
TABLE 4,
WATKIN, PARSONS, YIENGST, AND SHOCK
subject studied, Sample experiments are
illustrated graphically in figures 1-4 which
are plotted according to the suggestion of
Reifenstein, Albright, and Wells (17), Fig.
ures 1 and 3 show the balance data for 2
subjects on the high protein intake whereas
figures 2 and 4 show similar data for the same
2 subjects on a low protein intake. The solid
line at the bottom of each chart indicates the
observed weight change whereas the dotted
line indicates the theoretic weight change,
calculated on the basis of the nitrogen and
potassium retentions,
Table 4 summarizes the balance data for
nitrogen, potassium, phosphorus, and calcium,
Observations at the high protein intakes for
the 4 experimental conditions (control, ex-
perimental, stanolone administration, and
post-treatment periods ) are shown on the line
marked H, and for the low protein intake on
the line marked L. The effects of high or
low protein intakes are indicated on the line
marked H-L. The effects of the stanolone
administration are indicated in the column
marked E-C. The standard errors of each
MEAN BALANCES.
Average balances of nitrogen, potassium, phosphorus, and calcium in 8 elderly men during pre-treatment (C),
treatment (E) and post-treatment (F) periods on high (H) and low (L) protein diets; means and standard errors
of the changes within individuals in nitregen, potassium, phosphorus, and calcium balances between treatment
and pre-treatment (E-C), and post-treatment and treatment periods (F-E), and high and low protein diets (H-L),
| Cc E E-C F F-E
Balance Diet | Control Experimental Experimental- | Post-treatment | Post-treatment-
} Control Experimental
Nitrogen | H 2.92 4.55 +1.63+ .20t 2.94 1.61+ .28t
Gm /day L 0.64 1.88 +1.24+ . 18 1.14 74+ .16*
| (H-L) +2.28+ .10f +2.67+ .21f | +1, 80+ .19f
Potassium H 8.6 16.7 +8.1+1.4f | 9.7 7.04+1,7*
mEq./day 2:4 2.2 7.4 +5.2+.6¢ | 2.3 5.1+1.0°
| (H-L) | +6.48+.59t | +9.224+1.25¢ | | +7.384.77t
Phosphorus | H | 178 300 | +122.44+27.7* 169 ~131,.5+32.9"
mg./day | ® 65 130 +65.14+11.7* | 76 —54.1+11.4"
(H-L) | +112 4413.1 | +170.6425.7t +92 .2+17.6*
|
Calcium = | H | -26.9 —32.0 —5.1+22.7 —61.5 ~29.5+18.6
mg./day L 11.2 —23.6 —34.94+15.2 +5.6 +29 .2+10.9
| (H-L) | —38.14+28.1 —8.4+15.4 —67.1415.1*
*Significant P <.01
tSignificant P <.001
me
resi
I
wel
gen
pre
of |
inc
(E
wit
N
ciw
con
tive
ing
wel
Du
anc
tior
no
the
L
met
bal:
and
tho
maf
smé
sult
bal:
tass
tha
diet
L
sub
and
pho
the
nific
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low
wer
crer
the
regi
prot
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peri
tive
duri
prot
chat
*D
as si
rents are
-4 which
restion of
7). Fig
ata for 2
+ whereas
the same
The solid
icates the
1¢ dotted
| change,
ogen and
data for
| calcium,
takes for
ntrol, ex-
ion, and
n the line
intake on
~ high or
. the line
stanolone
» column
of each
tment (C),
lard errors
treatment
iets (H-L),
F-E
reatment-
imental
H1+ .28t
74+ .16*
.0+1.7*
1+1.0*
54+32,9"
1+11.4*
5+18.6
2+10.9
METABOLIC BALANCES IN THE AGED 281
mean and the differences are shown with
results of Student's “t” test for significance.
High protein diet, Although all subjects
were in positive balance with respect to nitro-
gen, phosphorus, and potassium during the
pre-treatment period (C), the administration
of stanolone resulted in a significant® further
increase in retention of all these substances
(E) with a return to control levels after
withdrawal of the hormone (I) (table 4).
No significant effect of the steroid on cal-
cium retention was observed, During the
control periods calcium balances were nega-
tive in 6 and positive in 2 subjects while dur-
ing hormone administration calcium balances
were negative in 5 and positive in 3 subjects.
During the post-treatment periods calcium bal-
ances were negative in all subjects. Inspec-
tion of the urinary excretion of calcium gave
no evidence of a systematic change during
the steroid administration.
Low protein diet. During the pre-treat-
ment periods all subjects were in positive
balance with respect to nitrogen, phosphorus,
and potassium (table 4). Compared with
those obtained on the high protein diet, the
magnitudes of these positive balances were
small. The administration of stanolone re-
sulted in a significant increase in all these
balances. The absolute increments for po-
tassium and phosphorus were significantiy less
than those obtained when the high protein
diet was fed.
During the post-treatment periods (F), all
subjects showed a positive nitrogen balance
and all but 1 (A.He.) showed positive phos-
phorus and potassium balances. Compared to
the treatment periods the balances were sig-
nificantly less positive. The average differ-
ences in positive balances between high and
low protein during the post-treatment periods
were also significant. Compared to the de-
crements in positive balances noted during
the post-treatment periods on the high protein
regimen, the decrements noted on the low
protein regimen were smaller.
Calcium balances during the pre-treatment
period were positive in 4 subjects and nega-
tive in 4, Compared with the average balance
during the pre-treatment period of the high
protein regimen, the average calcium balance
changed in a positive direction but not to a
*Differences with p values of 0.01 or less are regarded
48 significant,
significant degree. During the treatment
period, the calcium balance in 7 subjects
moved in a negative direction. The average
decrement in calcium balance, however, was
not significant. The average difference in
calcium balance between the high and low
protein regimens during the treatment period
was positive but not significant.
Calcium balances during the post-treatment
periods were positive in 5 and negative in 3
subjects. Compared with the treatment pe-
riod, all calcium balances but one moved in a
positive direction, The average increment in
calcium balance was not significant at the
OL level. The average difference in calcium
balance between the high and low protein
diets during the post-treatment period was
positive and significant.
Inspection of urine calcium on the low
protein regimen revealed no consistent effects
of treatment on urinary calcium excretion,
Changes in serum chemistry. Average
values for serum chemistries are recorded in
table 5. In the same table appear the means
and standard errors of the changes within
individuals in serum chemistries between
treatment and pre-treatment (E-C), post-
treatment and treatment (F-E), and high and
low protein diets. The level of significance
of each of these changes as determined by
Student's “t” test is indicated,
The change from high to low protein in-
take did not have any significant effect on
blood chemistry with the exception of a sig-
nificant rise in total protein. Examination of
the data indicates a gradual rise in plasma
proteins from 7.16 Gm./100 ml. at the be-
ginning of the study to 7.72 Gm./100 ml. at
the end of the 65 days on the high protein
intake. The high value of 7.58 Gm./100 ml.
for control periods on the low protein diet
probably reflects the time lag required for
adjustment of the plasma protein to the lower
protein intake.
Administration of the steroid hormone had
no significant effect on serum calcium, total
protein, or albumin. Neither was there any
effect on phosphorus nor alkaline phosphatase
when the protein intake was high. However
with low protein diets, both phosphorus and
alkaline phosphatase activity of the plasma
diminished significantly when the hormone
was given and approached or even exceeded
control values when the hormone was with-
drawn.
282
TABLE 5.
Average values of serum calcium, phosphorus, alkaline phosphatase, total protein, albumin, and globulin
in 8 subjects during pre-treatment (C), treatment (E), and post-treatment (F) periods; means and standard
errors of the changes in serum calcium, phosphorus, alkaline phosphatase, total protein, and albumin between
treatment and pre-treatment (E-C), post-treatment and treatment (F-E), and high and low protein diets (H-L),
| |
|
| Cc E F-E
Chemistry | Diet | Control Experimental | Experimental- | Post-treatment | Post-treatment-
| | | Control Experimental
= | |
Calcium H 10.47 10.38 | — .06+ .16 | 10.34 04+ .22
mg./100 ml. 4 10.46 | 10.12 | —.34+.20 10.00 13+ .18
(H-L) +.01t.12 | +.254.16 | + .34+ .18
Phosphorus H | 2.86 | 2.78 — 08+ .09 2.87 + 09+ .06
mg./100 ml. | LL | 3.14 | 2.78 - 36+ .05¢ 2.94 +. 17+ .07
(H-L) | —.28+.08 00+ .07 — .07+ .07
Alkaline H 1.96 1.97 +.01+.17 1.99 + .02+ .10
phosphate | 2.39 | 1.83 —.55+.14* 3.19 +1. 36+ .25t
(Bodansky |
Units) | (H-L) | —.444.23 | +.14+.16 ~1.20+ .22t
Total | H a A +.03+.14 7.72 b. 52+ .13"
protein Ao? 7.58 7.24 — .34+ 16 7.57 +.34+ 24
Gm./100 mi. | (H-L) | —.41+.06¢ | -—.04+.22 +.144.11
Albumin =| H | 4.55 | 4.88 +.33+.19 5.38 +.50+.18
Gm./100 ml. | E 4.85 4.62 — .24+ .07 4.82 +.20+ 11
(H-L) — .30+.11 +.27+ .17 + .57+ .09¢
*Significant P <.01
Significant P <.001
Changes in blood cytology. Table 6 sum-
marizes, in the form similar to previous tables,
the mean values for hematocrit, hemoglobin,
red blood cell, and leukocyte counts made
during periods as indicated. Hematocrit and
hemoglobin values were not altered by either
diet changes or by hormone administration.
The major change noted in blood mor-
phology was a significant rise in leukocytes
during the hormone administration. Differ-
ential counts indicated a polymorphonuclear
response which was often associated with ele-
vations in body temperature. These changes
represent the response to the local inflamma-
tory reaction observed in most of the subjects,
at the site of injection of the hormone. There
was also a significant rise in red cell count
after withdrawal of the hormone under con-
ditions of low protein intake.
Urinary steroid excretion. Average values
WATKIN, PARSONS, YIENGST, AND SHOCK
AVERAGE CHANGES IN SERUM CHEMISTRY.
+ |
for the 24-hour urinary excretion of 17-keto- |
steroids, 11-oxysteroids, and 17-hydroxyster-
oids are recorded in table 7 with appropriate |
statistics to test the significance of differences.
No significant differences in average 17-
ketosteroid and 11l-oxysteroid excretions be-
tween the high and low protein regimens
during comparable periods were noted.°
Significant increases in average 17-keto-
steroid excretion occurred with hormone treat-
ment on both the high and the low protein
regimens. A significant decrement in 17-keto-
steroid excretion occurred with cessation of
treatment. No significant changes in average
11-oxysteroid or 17-hydroxysteroid excretions
were observed with treatment on either regi-
men. Daily determinations of urinary ster-
oids immediately before and after institution
°17-hydoxysteroids were determined only on the low pro
tein regimen.
ment
hem«
treat
Obs
Hem
Per c
Hem
Gm.,
Red
cell c
(mill
Whit
cell «
of h
indi
T
weit
the }
(17
sodi
nary
extri
prot
tatic
figui
cury
outy
gen
the
assu
gen
denc
fluic
prot
stud
acct
mon
nd globulin
id standard
iin between
liets (H-L),
F-E
treatment.
erimental
04+ .22
13+ .18
09+
17+
06
02+ .10
36+ .25t
13*
50+ .18
20+ .11
17-keto- |
roxyster-
»ropriate
ferences.
rage 17-
ions be-
‘egimens
ted.®
17-keto-
ne treat-
protein
17-keto-
ation of
average
‘cretions
ier regi-
ry ster-
stitution
» low pro-
METABOLIC BALANCES IN THE AGED
TABLE 6,
283
AVERAGE CHANGES IN BLoop CyTOLoGy.
Average values of hematocrit, hemoglobin, red blood cell count, and white blood cell count during pre-treat-
ment (C), treatment (E), and post-treatment (F) periods; means and standard errors of changes in hematocrit,
hemoglobin, red blood cell count, and white blood cell count between treatment and pre-treatment (E-C), post-
treatment and treatment (F-E), and high and low protein diets (H-L).
Cc | E
Observation | Diet Control Experimental
Hematocrit H 41.6 41.7
Per cent L 43.6 42.8
(H-L) 1.98+ .65 1.01+ .30
Hemoglobin H 13,2 13.6
Gm./100 ml. i. 14.0 | 13.5
(H-L) 80+ .36 + .12+ .16
Red blood H 4.70 4.64
cell count EI 4.86 4.74
(millions) (H-L)| +.15+.08 | —.10+.08
White blood H 7134 9969
cell count L 7281 9109
(H-L) | —146.9+362.0 | +859.44+844
*Significant P <.O1
of hormone therapy revealed no changes not
indicated in the pooled data.
Theoretic weights and balances. Theoretic
weight curves were computed according to
the method of Reifenstein, Albright, and Wells
(17). However, since no balance data for
sodium or chloride were available, “prelimi-
nary calculation C” (changes in weight of
extracellular fluid not accounted for with
protoplasm) was omitted from the compu-
tation of the theoretic curve.
The theoretic weight curves are plotted in
figures 1-4 as broken lines. The actual weight
curves are plotted as solid lines.
The computation assumes a constant caloric
output, similar hydration, and similar glyco-
gen saturation at the beginning and end of
the study. Whereas there was no reason to
assume differences in caloric output or glyco-
gen saturation, there was ample clinical evi-
dence for an accumulation of extracellular
fluid in 6 patients during study of the high
protein regimen and in 5 patients during
study of the low protein regimen. The
accumulation was most marked during hor-
mone administration; in most instances it
|
|
F-E
| Post-treatment>
E-C F
Experimental- Post-treatment
Control Experimental
b.1+.73 = | 43.0 $1,214 .63
— 85+ .48 43.9 4+1,16+ .37
| 4 — 96+ .31
|
| +,444.29 | 13.9 + 32+ .21
| —.48+.25 | 13.8 +. 32+ 22
— +124 .21
| — 06+ .11 4.55 ~ 09+ .06
| =, $34.07 4.96 + .22+ .05*
| — .41+ .10* -
4+2834.4+782.2* 8472 ~ 1496.94 831.0
+1828.14+481.4* 7497 ~1612.5+588.7
+975 .0+464.8
disappeared following withdrawal of the hor-
mone.
As a consequence, therefore, of the omission
of sodium or chloride balances and of the
difference in hydration between the beginning
and the end of each study, the theoretic
weight curves must be interpreted with cau-
tion. The large discrepancy in several sub-
jects between actual and theoretic weights,
especially during the period of hormone ad-
ministration, resulted from retention of fluid.
The apparent increment in weight during the
entire study reflects in part failure of the
subjects to return at the end of a study to a
state of hydration similar to that at the be-
ginning. These two factors both tend to
accentuate the differences between theoretic
and actual weights.
Two subjects (T.B. and J.S.) demonstrated
no appreciable fluid retention at any phase of
the studies and were in the same state of
hydration at the beginning of the studies as
at the end. Theoretic and actual weights
closely paralleled one another and deviated
only slightly during the period of hormone
administration. Two patients (A.He. and
284
TABLE 7.
Average values for the 24-hour urinary excretion of 17-keto, 11-oxy, and 17-hydroxy steroids; me
standard errors of changes in the urinary excretion of 17-keto, 11-oxy, and 17-hydroxy steroids betwe
WATKIN, PARSONS, YIENGST, AND SHOCK
AVERAGE URINARY STERIOD EXCRETION.
ans and
en treat-
ment and pre-treatment (E-C), post-treatment and treatment (F-E), and high and low protein diets.
| | x a
Cc E E-C | F F-E
Observation Diet Control Experimental | Experimental- | Post-treatment | Post-treatment-
Control | Experimental
SRE SRL A - ie mites wad
| |
17-ketosteroids H 7.4 8.9 | +1.5+.2¢ | 7.3 | ~—em
(mg./day) L 6.7 8.3 | +1.64.5* 6.7 | —1.6+.4*
(H-L) +.7+ .6 +.6£.6 | = + .6+ .3 | =
| |
11-oxy H 47 | 46 | —.014.01 | 51 +.05+.3
(C21) steroids L 55 | 43 | —.12+.06 | 50 | +.07+.05
(mg./day) (H-L) | —.08+ .04 +.03+ .06 | — +.004+ .059 | —
17-hydroxysteroids L 3.3 2.8 — .54+.5 | 3.0 +.2+.4
(mg./day) |
*Significant P <.01
tSignificant P <.001
A.Ha.) showed a progressive increase in
weight throughout the studies and showed
marked deviations of theoretic and actual
weights during periods of treatment which
correlated well with clinically apparent fluid
retention. Patient A.He. was unusual in that
he retained a large quantity of fluid during
the pre-treatment phase of the high protein
study and showed a decrement of actual be-
low theoretic weight in the post-treatment
phase of the low protein study. Patients L.B.,
S.B., and P.K. showed gradual increments in
weight throughout the studies with only
minor deviations of actual from theoretic.
Patient W.R. displayed a marked retention of
fluid on the high protein regimen but no over-
all change in weight and no marked deviations
of actual from theoretic weights during the
low protein phase.
From a consideration of the theoretic
weight curves and of the clinical state of
hydration of the patients, it seems apparent
that weight increases were accelerated during
hormone therapy in 6 out of 8 subjects and
that at least part of these increments was
due to fluid retention. Only slight changes
in weight occurred during hormone therapy
in 2 patients who showed no clinical evidence
of fluid retention.
Examination of table 4 shows that the bal-
ance data are internally consistent. Thus, on
the average the retentions of K are in pro-
portion to the nitrogen retention. During
the control periods on the high protein diet
the retention of 8.6 mEq./day gives a theoretic
N retention of 3.2 Gm./day as compared with
2.92 Gm./day observed. During the control
periods on the low protein diet, the retention
of 2.2 mEq./day gives a theoretic N retention
of 0.81 Gm./day as compared to 0.64 Gm./day
actually found. During the experimental
periods on the high protein diet, the retention
of 16.7 mEq. of K/day gives a theoretic N
retention of 6.17 Gm./day as compared to
4.55 Gm./day actually found. During the
experimental periods on the low protein diets
the retention of 7.4 mEq. of K/day gives a
theoretic N retention of 2.74 Gm./day as com-
pared to 1.88 Gm./day actually found. There
is also agreement between the phosphorus
and the nitrogen retentions, neglecting the
small amount of phosphorus associated with
calcium. Thus, during the control periods on
high protein intake the expected nitrogen re-
tention was 2.67 Gm./day (.178 x 15) as
compared to the observed value of 2.92
Gm./day. During the control periods on the
low protein intake the expected N retention
was 0.98 Gm./day as compared with the ob-
served value of 0.64 Gm./day. During the
exp
inti
means and
ween treat-
S.
F-E
treatment-
erimental
6+ .2t¢
.6+ .4*
H+
.05
ABP g a
t
H-
rs
Thus, on
- in pro-
During
tein diet
theoretic
red with
> control
retention
retention
om./day
rimental
‘etention
oretic N
yared to
‘ing the
ain diets
gives a
as com-
. There
sphorus
ing the
ed with
riods on
gen re-
15) as
of 2.92
; on the
etention
the ob-
ing the
METABOLIC BALANCES IN THE AGED 285
experimental periods on the high protein
intake the expected N retention was 4.50
Gm./day as compared to the observed value
of 4.55 Gm./day. During the experimental
period on the low protein intake the expected
N retention was 1.95 Gm./day as compared
to the observed value of 1.88 Gm./day. The
agreement between the retentions of N, K,
and P level support the concept that the pos-
itive nitrogen balance represents the laying
down of tissue constituents under the anabolic
effects of both diet and stanolone adminis-
tration.
Clinical observations on steroid administra-
tion. The average dietary intake of the sub-
jects prior to start of these investigations was
estimated by observing intake on 3 separate
days and computing nutrient values with the
aid of food tables. Values varied consider-
ably depending on the individual patient.
Caloric intake ranged from 1200 to 2200 cal-
ories; protein from 40 to 70 Gm., fat from 45
to 85 Gm., and carbohydrate from 160 to 280
Gm. In the preliminary week of the study
it became apparent that the change from ad
lib feeding to a well-balanced diet which had
to be eaten was in itself a type of treatment
and produced certain side effects. The most
common complaint from the subjects was that
of being overfed. Four out of 8 could not
force themselves to consume 2600 calories
and so their intake was reduced to tolerance
levels by cutting fat and carbohydrate. By
the end of the preliminary period, however,
all subjects had adjusted to the new regimen
and were free from complaints.
On administration of the hormone, how-
ever, a number of side effects became ap-
parent. The first was the painful reaction at
the site of injection. Pain was not felt at
the time of injection but had its onset 8 to
10 hours thereafter. It was of aching quality
affecting all muscle groups in the vicinity of
the injection site. Generalized swelling of
muscle and subcutaneous tissue and erythema
of the skin near the injection site were obvious
features. Pain on motion of nearby joints was
intense. When given into the deep muscles
of the buttock, pain on motion of the hip was
severe but of less intensity than pain in the
shoulder following injection of the hormone
into the deltoid. In a few subjects the first
2 injections resulted in reactions severe
enough to interfere with walking. Elevations
in temperature and in polymorphonuclear
leukocytes were frequent during hormone
therapy. Tolerance of the pain produced by
the hormone developed in a surprising fashion
after the first 3 injections. Local reaction at
the injection site varied among individual
subjects. One (J.S.) showed no local re-
action and apparently experienced virtually
no discomfort from the injection.
Marked fluid retention was an early result
of hormone therapy in 6 of the 8 subjects.
This took the form of peripheral edema in 5
and apparent accumulations of fluid in the
chest in a sixth. Only subjects J.S. and T.B.
showed no clinically apparent. retention of
fluid.
Hormone therapy produced an early sup-
pression of appetite probably resulting from
the general malaise associated with the local
reaction and fever. By the end of a week,
however, coincident with the decrease in com-
plaints referable to the injection site, appetite
returned and complaints about the size of
the meals vanished.
A late result of hormone therapy was the
change in mental attitude of the subjects.
Joviality increased; testimonials of well-being
were volunteered; generalized euphoria
seemed to seize some; interest in the female
sex was frequently expressed; evidences of
jealousy over favors rendered by the female
nursing staff developed, and a decided change
from the customary neuter attitude of the
patients toward the nurses became apparent.
The prostate glands of all subjects were
examined digitally as to size and consistency
by a member of the research staff and by the
hospital resident in genito-urinary surgery
prior to and subsequent to hormone therapy.
No changes in the glands were noted and no
symptomatology referable to the prostate
gland developed.*
Osteoporotic subjects. The data from 2
osteoporotic subjects (A.Ha. and W.Ra.) were
examined and compared with the 6 with no
demonstrable osteoporosis. No significant
differences in over-all metabolism, serum
chemistries, hematologic values, or steroid ex-
cretions were observed.
*Dr. Leopold Gomez, resident on the Urogenital Service
at the Baltimore City Hospitals, performed the examination
of the prostates.
‘286
DISCUSSION
The metabolic balance data indicate that
stanolone is able to cause retention of the pro-
toplasmic constituents of nitrogen, potassium,
and phosphorus in men past 70 over and
above the retention achieved by an adequate
diet high in protein. When an isocaloric low
protein diet was offered to the same indi-
viduals, androgen therapy also resulted in re-
tention of nitrogen, potassium, and _ phos-
phorus, but to a quantitatively less extent
than on the high protein regimen. Calcium
retention was not produced by the hormone
on either regimen. Data on urinary steroids
revealed a significant increase in 17-keto-
steroid excretion but no other changes. Side
effects induced by the androgen used were
primarily those of pain at the injection site,
fluid retention, and increase in euphoria and
libido.
While some changes in blood chemistry
were statistically significant, they were on the
whole neither large changes nor were they
consistent. The significant differences be-
tween high and low protein diets in com-
parable periods may possibly be explained
by a general improvement in nutritional status
during the 5 months of the experiment.
The polymorphonuclear leukocytosis during
treatment periods seems definitely attributable
to the reaction set up by the hormone. In
view of the failure of other investigators
(7, 8, 14) to mention this complication, it
seems likely that the particular lot of hormone
may have contained one or more substances
which induced the local reaction, fever, and
polymorphonuclear response.
The failure to observe calcium retention in
the face of appreciable retention of nitrogen,
potassium, and phosphorus was disappoint-
ing. The 2 subjects with osteoporosis showed
calcium balances no different from the pre-
sumed normal subjects. In contrast, the oral
administration of 6 Mg. stilbestrol/day in 4
of the same subjects studied here (including
the 2 osteoporotics) resulted in a significant
increase in calcium retention (2). However
the nitrogen retention was greater following
the administration of stanolone than after stil-
bestrol in the same subjects when comparisons
are made at the same (high) level of protein
intake.
The metabolic effects of stanolone may be
compared with previous studies where testo-
WATKIN, PARSONS, YIENGST, AND SHOCK
sterone was administered. Thus Reifenstein
and Albright (16, 18) observed that testoster-
one proprionate and methyl testosterone de-
creased calcium and phosphorus excretion in
senile as well as post-menopausal and Cush-
ing’s osteoporosis. They observed that the ef-
fect of treatment on calcium metabolism was
slow in reaching its maximum and persisted
for a long time after the cessation of treat-
ment in marked contrast to the behavior of
nitrogen and phosphorus. This slow response
of calcium metabolism to treatment is a pos-
sible explanation of the failure of stanolone to
alter calcium balance in the present study
since the hormone was given for only 20 days.
The findings generally agree with those of
Kenyon and associates (10, 11, 12) who ob-
served appreciable retention of N, P, S, and
Na in both young and old men given 25 mg.
of testosterone propionate daily. Our studies
are also in accord with the finding that the
magnitude of the nitrogen retaining response
increases with higher protein intakes (10).
Pearson, Weissberg, and McGavack (14)
using stanolone in 5 aged patients noted in-
creased N retention but no retention of K,
Na, or Cl. They found no change in 17-keto-
steroid excretion at the 25 mg./day level but
an increase at the 50 to 100 mg./day level.
These observations contrast to the observa-
tions in this study where a significant increase
in 17-ketosteroid excretion was observed on
the 25 mg. daily dose level.
The effects of androgen therapy in these
patients were generally those anticipated from
previous studies in normal and diseased sub-
jects of various ages. The retention on the
low protein regimen induced by the androgen
were smaller than those induced by high pro-
tein feeding alone. This observation plus
the numerous unpleasant side effects ac-
companying hormone administration suggest
that androgen therapy, while perhaps justi-
fiable in certain cases, is not a substitute in
the aged male for an adequate intake of
dietary protein.
SUMMARY
1. The androgen, stanolone, was adminis-
tered to 8 men aged 70 to 92 years, first on
a high and then on a low protein diet during
a 5 month metabolic balance study.
2. Increased retention of nitrogen, potas-
sium and phosphorus but not of calcium was
ETOP
othe RE EINE
"ase
no
on
of
acl
tei
ro
ifenstein
estoster-
‘one de-
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d Cush-
t the ef-
ism was
ersisted
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avior of
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S$ a pos-
olone to
t study
20 days.
those of
vho ob-
S, and
25 mg.
studies
hat the
esponse
(10).
k (14)
»ted in-
toa kK
17-keto-
vel but
y level.
bserva-
ncrease
ved on
1 these
-d from
sd sub-
on the
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$ justi-
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irst on
during
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m was
METABOLIC BALANCES IN THE AGED 287
noted with androgen therapy on both regi-
mens but the greatest retention was observed
on the high protein diet.
3. An androgen thus induces the retention
of protoplasma constituents (N, K, and P)
in men past 70, over and above the retentions
achieved by an adequate diet high in pro-
tein.
4, Blood chemistries remained within the
normal range throughout the study although
certain statistically significant changes in al-
kaline phosphatase, total protein, and albumin
were noted.
5. A polymorphonuclear leukocytosis was
observed during hormone treatment. No other
hematologic changes were observed.
6. Side effects included painful injection
sites, fever, fluid retention, and an increase in
libido.
Technical assistance was rendered by Mrs. Elsie
Beard, Mrs. Margaret Bellistri, Mr. Arthur Dinan,
Mr. William Martin, and Mr. Millard Starnes. Diets
were prepared by Miss Alice Hay, Dietitian, with the
assistance of Mrs. Mae Griffin. For the detailed nurs-
ing supervision required for the balance studies, we
are indebted to Mrs. Elizabeth Strawn. Consultation
on statistical problems was provided by Dr. Max
Halperin.
REFERENCES
1. Bogdonoff, M. D., Shock, N. W., and Nichols,
M. P.: Calcium, Phosphorus, Nitrogen, and Po-
tassium Balance Studies in the Aged Male.
J. Gerontol., 8: 272-288, 1953.
. Bogdonoff, M. D., Shock, N. W., and Parsons, J.:
The Effects of Stilbestrol on the Retention of
Nitrogen, Calcium, Phosphorus, and Potassium in
Aged Males With and Without Osteoporosis. J.
Gerontol., 9: 262-275, 1954.
3. Corcoran, A. C., and Page, I. H.: Methods for
the Chemical Determination of Corticosteroids
in Urine and Plasma. J. Lab. & Clin. Med., 33:
1326-1333, 1948.
4. Corcoran. A. C., Page, I. H., and Dustan, H. P.:
Urinary Formaldehydogenic Corticoids; Normal
Values and Observations in Hypertension. J.
Lab. & Clin. Med., 36: 297-301, 1950.
5. Davies, D. F., and Shock, N. W.: Age Changes
in Glomerular Filtration Rate, Effective Renal
Plasma Flow, and Tubular Excretory Capacity
in Adult Males. J. Clin. Investigation, 29: 496-
507, May, 1950.
6. Escher, G. C.: Dihydrotestosterone Therapy of
Advanced Mammary Carcinoma. Clin. Res.
Proc.; 1: 51, April, 1958.
7. Escher, G. C., Heber, J. M., Woodard, H. Q.,
Farrow, J. H., and Adair, F. E.: Newer Steroids
in the Treatment of Advanced Mammary Cancer.
In: A. White (Editor), Symposium on Steroids
nw
10.
11.
13.
14.
15.
16.
17.
18.
19.
20.
21.
in Experimental and Clinical Practice. The
Blackiston Co., Philadelphia, 1951, pp. 375.
Gelhorn, A., Holland, J., Hermann, J., Moss, J.,
and Smelin, A.: An Evaluation of Stanolone in
Treatment of Advanced Mammary Cancer. J.
A. M. A., 154: 1274-1277, 1954.
Holtorff, A. F., and Koch, F. C.: The Color-
imetric Estimation of 17-Ketosteroids and Their
Application to Urine Extracts. J. Biol. Chem.,
135: 377-392, 1940.
Kenyon, A. T., and Knowlton, K.: Conference
on Metabolic Aspects of Convalescence Includ-
ing Bone and Wound Healing. Tr. Fourth
Meeting. Josiah Macy, Jr. Foundation, N. Y.,
June 11-12, 1943, pp. 116-118.
Kenyon, A. T., Knowlton, K., Lotwin, G., and
Sandeford, J.: Metabolic Response of Aged Men
to Testosterone Propionate. J. Clin. Endocrinol,
2: 690-695, 1942.
Kenyon, A. T., Knowlton, K. Sandeford, I., Koch,
F. C., and Lotwin, G.: A Comparative Study
of the Metabolic Effects of Testosterone Pro-
pionate in Normal Men and Women and in
Eunuchoidism. Endocrinology, 26: 26-45, 1940.
Metrop. Life Insur. Co.: Ideal Weights for Men
Ages 25 and Over. Statist. Bull. Metrop. Life
Insur. Co., 1943.
Pearson, S., Weissberg, J., and McGavack, T. H.:
Steroid Studies. I. Metabolic Effects of Andro-
stanolone in Aged People. J. Am. Geriat. Soc.,
2: 26-31, 1954.
Reddy, W. J., Jenkins, D., and Thorn, G. W.:
Estimation of 17-Hydroxycorticoids in Urine.
Metabolism, 1: 511-527, 1952.
Reifenstein, E. C., Jr., and Albright, F.: The
Metabolic Effects of Steroid Hormones in Os-
teoporosis. J. Clin. Investigation, 26: 24-56,
1947.
Reifenstein, E. C., Jr., Albright, F., and Wells,
S. L.: The Accumulation, Interpretation and
Presentation of Data Pertaining to Metabolic
Balances, Notably Those of Calcium, Phosphor-
ous, and Nitrogen. J. Clin. Endocrinol., 5: 367-
395, 1945. Correction, Ibid, 6: 232, 1946.
Reifenstein, E. C., Jr., Albright, F., Parson, W.,
and Bloomberg, E.: The Effect of Estradiol
Benzoate and of Testosterone Propionate and
of Combinations of Both on Post-Menopausal
Osteoporosis and Senile Osteoporosis. Endocrin-
ology, 30: 1024, 1942.
Shock, N. W., and Yiengst, M. J.: Age Changes
in Basal Respiratory Measurements and Metabo-
lism in Males. J. Gerontol., 10: 31-40, 1955.
Snedecor, G. W.: Statistical Methods. (4th Edi-
tion), Iowa State College Press, Ames, Ia., 1946,
xvi, 485 pp.
Watkin, D. M., and Shock, N. W.: Agewise
Standard Values for Cl, Clpy, and Tmp,, in
= Males. J. Clin. Investigation, 34: 969-970,
DIFFUSION COEFFICIENTS OF VARIOUS SOLUTES FOR HUMAN AORTIC TISSUE,
WITH SPECIAL REFERENCE TO VARIATION IN TISSUE PERMEABILITY
WITH AGE*
J. E. KIRK, M.D., AND T. J. 8. LAURSEN, M.D.
(From the Division of Gerontology, Washington University School of Medicine, St. Louis)
The development in this laboratory of a con-
venient and accurate method for determina-
tion of diffusion coefficients of gaseous and
non-gaseous solutes for tissue membranes
(5) has afforded a means of investigating the
membrane character of the human aortic wall
and the variation with age in the permeabil-
ity of this structure.
The undertaking of such study seemed de-
sirable in view of the fact that theories ad-
vanced in recent years have considered a
change in the permeability of the arterial
wall to be a factor of importance in the patho-
genesis of arteriosclerosis. The evaluation of
such concepts has been limited by the fact
that no quantitative measurements of the per-
meability of arterial tissue so far have been
reported. The present investigation was un-
dertaken with the purpose of supplying nu-
merical data on the diffusion coefficients of
various solutes for membranes prepared from
aortic tissue derived from subjects of different
ages.
METHODS
Fifty-one samples of human aortas (de-
scending thoracic) were obtained fresh at
autopsy at the St. Louis City Morgue.t The
age of the individuals from whom the sam-
ples were derived ranged between 10 and 80
years. Sterile instruments were employed for
removal of the aortas. The severed, closed
vessels were placed in sterile beakers im-
mersed in crushed ice. After removal of the
adventitia, the intima (with attached subin-
timal tissue )t was separated from the media,
and a preparation of each of these two lavers
used for diffusion studies.
Submitted for publication April 25, 1955.
*Studies on Arterial Metabolism IX. The investigation was
supported by a grant (PHS-891) from the National Heart
Institute of the National Institute of Health, Public Health
Service. A presentation of the data was given at the Seventh
Annual Meeting of the Gerontological Society, Inc., December
28 to 30, 1954, Gainesville, Florida.
+The authors are indebted to Dr. J. J. Connor for assist-
ance in obtaining specimens.
tA thin luminal layer of the media of the vessel was in-
cluded in the membrane preparations designated as intima-
subintima samples.
For each membrane preparation determina-
tions were made of the diffusion coefficients
of nitrogen, oxygen, carbon dioxide, lactate,
iodide, and glucose, using the procedure of
Johnsen and Kirk (5). Concerning details
of the diffusion technique the reader is re-
ferred to the original publication. Sterile
equipment and solutions were employed
throughout the experiments. The diffusion
measurements were carried out at 37 C. The
composition of the solutions employed in the
two compartments of the diffusion apparatus
in the different experiments is shown in table
1. The buffer solution used was a modified
Krebs’ phosphate buffer (7) of pH 7.1. The
diffusion apparatus was maintained at 4 C.
between experiments, and enough buffer so-
lution was left in the compartments to pre-
vent drying of the tissue. As shown in a
previous publication (7) respiration and gly-
colysis by human aortic tissue is noticeable
for several weeks in preparations maintained
under such conditions.
In the experiments on both gaseous and
non-gaseous solutes samples for analysis were
withdrawn in immediate succession from the
donor and recipient compartments of the ap-
paratus at the beginning and end of a dif-
fusion period. In the studies on the gaseous
solutes this was accomplished by the use of
two Van Slyke apparatuses for gas analysis.
The employment of this procedure rendered
it possible to use the equation given by
Pletscher and associates (19) for calculation
of the diffusion coefficients (see publication
by Johnsen and Kirk, 5).
At the end of the experiments the part of
the membrane delimited by the circular open-
ings of the metal diaphragms was carefully
cut out and its weight determined. The cut-
out membrane was then placed on graph
paper and a tracing of its outline made.
From the observed weight and area the aver-
age thickness of the membrane was calcu-
lated.
In order to obtain a quantitative expres-
sion of the degree of arteriosclerosis present,
288
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PERMEABILITY OF AORTIC TISSUE AND AGE
TABLE 1. COMPOSITION OF SOLUTION IN THE TWO COMPARTMENTS OF THE DIFFUSION
APPARATUS IN DIFFUSION STUDIES ON HUMAN AorTIC SAMPLES.
Solute | Content of one compartment of diffusion | Content of other compartment of diffu-
apparatus sion apparatus
Nitrogen and oxygen | Buffer medium aerated with nitrogen Buffer medium aerated with oxygen
Carbon dioxide
dioxide*
| Buffer medium aerated with carbon
| One volume of buffer medium, 4 volumes
Unaerated buffer medium
Buffer medium
Buffer medium
Lactate
of osmolar lithium lactate solution
lodide E ual volumes of buffer medium and
osmolar potassium iodide solution.
| Radioactive iodide tracer added
Glucose
of osmolar glucose solution
One volume of buffer medium, 4 volumes | Buffer medium
*Under the conditions of preparation of the donor solution the quantity of free carbon dioxide constitutes approximately 70
per cent of the total COs present in the solution.
the membrane was subsequently homogenized
in a pyrex grinder, and the total lipid and
cholesterol content of the homogenate de-
termined.
The following analytical methods were
used;
Nitrogen, oxygen, and carbon dioxide:
Gasometric method of Van Slyke and Neill
(22), as described by Kirk and Hansen (8).
Lactate: Colorimetric method of Barker
and Summerson (1), as modified by LePage
(15).
lodide: Assay of iodide content of samples
performed by measurement of radioactive
isotope (I) by means of a Geiger-Miiller
counter.
Glucose: Colorimetric method of Nelson
(17), using the reagents described by Somo-
gyi (20).
Total lipid and cholesterol content of mem-
brane: The homogenate was extracted with
alcohol-ether (and hydrochloric acid), the
alcohol-ether evaporated, and the residue re-
dissolved in petroleum ether, as described by
Kirk, Page, and Van Slyke (6). The pe-
troleum ether extract served for determination
of 'the lipid (23) and cholesterol (7) content
of the sample.
A series of experiments were carried out to de-
termine whether any significant swelling or shrink-
ing of the membranes occurred under the conditions
of the experiments. For that purpose portions of
aortic tissue of known weight (intima-subintima and
media preparations) adjacent to those used for dif-
fusion studies were suspended in buffer medium, and
in buffer medium to which lactate, iodide, or glucose
solution had been added in the same proportions as
used in the diffusion experiments. After maintain-
ing the samples for several hours at 37 C. the tissue
samples were removed from the solution, quickly
dried with filter paper, and weighed. The average
change in weight of the tissue valued —0.17 per
cent/hour in buffer medium, and —0.52, —0.15, and
—0.85 per cent/hour, respectively, in lactate, iodide,
and glucose buffer medium. Similar experiments
carried out at 4 C. showed a mean weight change
of the samples of, respectively, +0.15, +0.22, +0.14,
and +0.19 per cent/hour. No significant difference
was noted between the intima-subintima and the
media preparations.
TABLE 2. RESULTS OF REPEATED DETERMINATIONS OF
THE DIFFUSION COEFFICIENT OF CARBON DIOXIDE
FOR HuMAN Aortic TissUE MEMBRANES AFTER
INTERVALS OF 1 TO 16 Days.
CO: Diffusion Coefficient
| Inter-
Membrane First | Second val
Determina- | Determina- |(Days)
tion tion
|
a ania ae (eee ee
Intima-subintima..| 0.000565 | 0.000565 | 7
Intima-subintima..| 0.000700 0.000688 16
Pee eee 0.000411 | 0.000343 1
MIS 4 sd uk vaoe 0.000345 | 0.000360 8
Average.......| 0.000505 | 0.000489
|
290.
Measurements were further made of the diffusion
coefficient of carbon dioxide for aortic membrane
preparations shortly after the tissue was obtained
at autopsy and after the membrane had been used
for lactate, iodide, and glucose diffusion studies. The
diffusion apparatus with the inserted membrane was
stored in the refrigerator at 4 C. between the ex-
periments. The results of these studies are presented
in table 2. It will be seen from the data of the
table that a satisfactory degree of reproducibility was
noted with intervals between determinations varying
from one to sixteen days.
RESULTS
1. Diffusion coefficients observed for indi-
vidual aortic membranes, and average coeffi-
cient values.
The diffusion coefficient (k) is defined ac-
cording to Hill (4) as the number of units
of a substance diffusing through 1 cm.’ of the
membrane in 1 minute at a concentration
gradient of 1 unit per ml. per cm. The re-
sults of the determinations of the diffusion co-
efficients for the 51 individual intima-subin-
tima samples are presented in table 3, and
the values for the 50 media preparations in
table 4. The tables further contain the ob-
served values for the total lipid and choles-
terol content of the individual membranes.
It will be seen from the tables that the
diffusion coefficient values observed for a par-
ticular solute show a significant variation be-
tween different membranes. That this varia-
tion to a large extent seems to be related to
the character of the membrane is suggested by
the fact that the coefficient values of different
solutes for an individual membrane tend to
vary in the same direction.
The average diffusion coefficients observed
for the intima-subintima samples (N = 51)
were: nitrogen, 0.000469, oxygen 0.000502,
carbon dioxide 0.000404, lactate, 0.000123, io-
dide, 0.000318, and glucose, 0.000104. For
the media preparations (N = 50) the mean
diffusion coefficients valued: nitrogen,
0.000551, oxygen, 0.000579, carbon doxide,
0.000375, lactate, 0.000084, iodide, 0.000258,
and glucose, 0.000076.
2. Conclusions with regard to membrane
structure of human aortic wall derived from
observed diffusion coefficients for solutes of
various molecular size.
Although the theories concerning the dif-
fusion mechanism of solutes through mem-
KIRK AND LAURSEN
branes are still imperfect, it is generally
agreed that many membranes behave as if
they possessed pores (2). If this contention
is accepted the determination of diffusion co-
efficients for compounds of different molecu-
lar weights may yield information with re.
gard to the membrane structure.
According to Davson and Danielli (2), if
the membrane possesses pores larger than the
diameter of the diffusing molecules, the laws
for simple uncomplicated diffusion should
apply. In this event the product: diffusion
coefficient X \/MW should be constant. For
diffusion through small pores having the same
order of diameter as the diffusing molecules,
the product should decrease as the molecular
diameter increases.
lar size the product value falls practically to
zero the pore size of the membrane is that of
the limiting molecular size; if the values fall
to zero over a wide range of molecular size
it may be assumed that the membrane pos-
sesses pores of diverse sizes.
In table 5 the calculated mean product
values (diffusion coefficient * \/MW) have
been entered for both the intima-subintima
and media preparations for the different so-
lutes studied. It will be seen from the table
that a fair agreement was found between the
product values for nitrogen, oxygen, and car-
bon dioxide, but that the product values for
these gases (MW 28 to 44) were about two
and a half times greater than the product
values for lactate (MW 90) and glucose (MW
180). These findings might indicate the pres-
ence in the aortic membrane of a set of
smaller pores (permitting the passage of com-
pounds of MW 28 to 44), and a set of larger
pores (permitting the passage also of com-
pounds of MW up to 180).
The behavior of the aortic membrane to-
wards iodide might seem to constitute an ex-
ception to this contention. The possibility
exists, however, that the diffusion of iodide to
a significant extent takes place also through
the non-porous part of the membrane.
3. Effect of temperature on diffusion coeffi-
cients.
Determination of the effect of temperature
on the diffusion coefficients of solutes for
membranes may yield some information with
If at a certain molecu- |
|
|
SNS MP HOHE
PERMEABILITY OF AORTIC TISSUE AND AGE 291
renerally TABLE 3. DIFFUSION COEFFICIENTS FOR PREPARATIONS OF INTIMA (WITH ATTACHED SUBINTIMAL TISSUE).
ve as if —=— = | |
ntention | | | Total Lipid | Cholesterol
ISION CO- No | Sex Age | Nitrogen | Oxygen Carbon Lactate Iodide Glucose | 9 % of Wet | % of Wet
molecu- | Dioxide Bis Weight Weight
with re- |
“ee | i at: ESS g |
aia 1. | M. | 10 | 0.00033 | 0.00044 | 0.00012 | 9.000051 | 0.000143 | 0.000027 | 0.30 0.20
(2), if 2, M. 10 | 0.00037 | 0.00038 | 0.00046 | 0.000075 | 0.000200 | 0.000082 | 0.76 | 0.29
than the 3, M. 13 | 0.00036 | 9.00037 | 0.00028 | 0.000182 | 0.000197 | 0.000017 | 1.44 | 0.49
the laws 4, M. | 20 | 0.00044 | 0.00060 | 0.00036 | 0.000114 | 0.000269 | 0.000071 | aa7 | 0.45
should : M 24 | 0.00022 | 0.00026 | 0.00041 | 0.000105 | 0.000336 | 0.000115 2.02 | 0.45
1iffusion 6. | M. | 25 | 0.00045 | 0.00048 | 0.00043 | 0.000112 | 0.000293 | 0.000067 0.49 | 0.15
nt. For 7. F. 27 | 0.00027 | 0.00031 | 0.00028 | 0.000044 | 0.000211 | 0.000023 0.64 0.23
he same 8. M. | 31 | 0.00047 | 0.00040 | 0.00043 | 0.000120 | 0.000345 | 0.000104 1.39 0.13
shecailal 9 M. 32 | 0.00029 | 0.00033 | 0.00024 | 0.000040 | 0.000165 | 0.000049 0.93 0.40
heoadl : 10 F. 35 | 0.00069 | 0.00094 | 0.00076 | 0.000142 | 0.000489 | 0.000114 2.05 1.35
olecular } 41, | a. | 37 | 0.00038 | 0.00038 | 0.00033 | 0.000126 | 0.000352 } 0.000114 | 1.07 0.68
molecu- fw. F. 37 | 0.00036 | 0.00035 | 0.00024 | 0.000076 | 0.000089 | 0.000111 0.84 0.46
ically to 3. | F. | 38 | 0.00049 | 0.00047 | 0.00024 | 0.000093 | 0.000204 | 0.000070 1.13 0.43
» that of 14 M. 40 | 0.00045 | 0.00048 | 0.00031 0.000097 | 0.000384 | 0.000118 1.70 0.26
lues fall 15 M. 41 | 0.00038 | 0.00030 | 0.00027 | 0.000046 | 0.000192 | 0.000044 1.54 0.72
ilar size 16. M. 41 | 0.00043 | 0.00048 | 0.00036 | 0.000018 | 0.000231 | 0.000051 1.12 0.14
ine pos- | 17. M. | 42 | 0.00047 | 0.00061 | 0.00041 | 0.000164 | 0.000292 0.000085 1.35 0.39
18 M. | 44 | 0.00075 | 0.00070 | 0.00050 | 0.000090 0.000389 | 0.000134 0.43 0.19
19 mM. | 44 | 0.00050 | 0.00063 | 0.00058 | 0.000067 | 0.000367 | 0.000077 0.77 | 0.06
product | 9, | M. | 45 | 0.00053 | 0.00063 | 0.00042 | 0.000060 | 0.000347 | 0.000121 0.89 0.40
V) have 21. | M. | 46 | 0.00070 | 0.00062 | 0.00047 | 0.000122 | 0.000259 | 0.000148 ex | 0.43
\bintima 22, M. | 47 | 0.00039 | 0.00058 | 0.00040 | 0.000086 | 0.000289 | 0.000089 | 0.61 | 0.25
rent $0- 23, mM. | 49 | 0.00063 | 0.00073 | 0.00035 | 0.000075 | 0.000336 | 0.000123 | 1.02 0.50
he table 24. F. 50 | 0.00037 | 0.00043 | 0.00036 | 0.000094 | 0.000290 | 9.000101 1.33 0.15
na an 25. M. 51 | 0.00075 — 0.00047 | 0.000104 | 0.000345 | 0.000062 4.20 2.70
mg 26. M. | 51 | 0.00049 | 0.00057 | 0.00038 | 0.000012 | 0.000303 | 0.000102 0.77 | 0.49
~endier + 7. | M. | 55 | 0.00036 | 0.00057 | 0.00040 | 0.000105 | 0.000291 | 0.000152 1.09 | 0.23
lues for 28, mM. | 55 | 0.00055 | 0.00068 | 0.00047 | 0.000093 | 0.000359 | 0.000081 0.85 0.12
out two 29, | M. | 56 | 0.00042 | 0.00043 | 0.00041 — 0.000367 | 0.000122 1.26 0.19
product 30. M. 57 | 0.00055 | 0 00054 | 0.00040 | 0.000121 | 0.000284 | 0.000087 1.12 0.51
se (MW 31. M. | 57 | 0.00040 | 0.00043 | 0.00033 | 0.000180 | 0.000299 | 0.000068 3.78 - 0.78
he pres- 32. F. 57 | 0.00021 | 0.00020 | 0.00020 | 0.000144 | 0.000208 | 0.000147 2.14 0.83
set of 33. F. 58 | 0.00059 | 6.00082 | 0.00049 | 0.000179 | 0.000534 — 3.25 1.58
of com- 34. mM. | 61 | 0.00029 | 0.00030 | 0.00040 | 0.000060 | 0.000490 | 0.000123 1.93 0.84
f larger 35. F. 62 | 0.00066 | 0.00074 | 0.00055 | 0.000153 | 0.000645 | 0.000214 2.00 0.45
f cm 36. M. | 63 | 0.00055 | 0 00046 | 0.00067 | 0.000114 | 0.000540 | 0.000181 1.47 0.49
37. M. | 65 | 0.00034 | 0.00037 | 0.00033 | 0.000086 | 0.000349 | 0.000155 3.52 1.60
38. M. | 65 | 0.00048 | 0.00043 | 0.00045 | 0.000256 | 0.000328 | 0.000113 1.44 0.20
rn 39. F 65 | 0.00034 | 0.00027 | 0.00040 | 0.000221 | 0.000234 | 0.000103 1.58 0.14
5 nell 40 M. | 66 | 0.00060 | 0.00056 | 0.00047 | 0.000332 | 0.000418 | 0.000162 3.40 1.11
ort: 4 M. | 66 | 0.00050°| 0.00053 | 0.00040 | 0.000103 | 0.000360 | 0.000090 0.85 0.44
sibility 42. | M. | 66 | 0.00069 | 0.00080 | 0.00049 | 0.000114 | 0.000426 | 0.000115 3.53 0.67
rdide to 43, M. 67 | 0.00037 | 0.00038 | 0.00044 | 0.000146 | 0.000346 | 0.000092 1.06 0.14
through 44, M. 70 | 0.00064 | 0.00057 | 0.00070 | 0.000173 | 0.000282 | 0.000113 1.13 0.33
>, 45. M. | 70 | 0.00038 | 0.00033 | 0.00023 | 0.000242 | 0.000299 | 0.000100 4.80 2.37
46. M. | 71 | 0.00038 | 0.00038 | 0.00031 | 0.000162 | 0.000241 | 0.000096 3.06 1.24
s coeff 47. M. | 71 | 0.00053 | 0.00090 | 0.00049 | 0.000104 | 0.000330 | 0.000129 2.02 1.34
48, F. 72 | 0.00054 | 0.00041 | 0.00048 | 0.000232 | 0.000240 | 0.000112 2.44 1.07
49. M. | 78 | 0.00054 | 0.00053 | 0.00049 | 0.000076 | 0.000348 | 0.000157 1.41 0.90
yerature 50. F. 79 | 0.00060 | 0.00060 | 0.00028 | 0.000226 | 0.000317 | 0.000133 3.42 1.86
‘tes for 51. M. | 80 | 0.00043 | 0.00043 | 0.00036 | 0.000193 | 0.000346 | 0.000127 1.94 0.88
on with
292 KIRK AND LAURSEN
TABLE 4. DIFFUSION COEFFICIENTS FOR PREPARATIONS OF MEDIA.
- | ee cee
Total Lipid
No. Sex Age | Nitrogen | Oxygen Carbon Lactate Iodide Glucose % of Wet
Dioxide Weight
1. M. 10 0.00051 0.00053 0.00038 0.000008 0.000220 0.000030 0.71
2. M. 10 0.00040 0.00037 0.00027 0.000031 0.000162 0.000080 0.90
3. M. 13 0.00025 0.00030 0.00011 0.000045 0.000130 0.000011 0.52
4, M. 20 0.00052 0.00063 0.00036 0.000091 0.000300 0.000064 0.63
5. M. 24 0.00045 0.00042 0.00040 0.000040 0.000266 0.000057 0.78
6. M. 25 0.00051 0.00041 0.00030 0.000050 0.000226 0.000054 0.49
¥ F. 27 0.00066 0.00063 0.00034 0.000116 0.000234 0.000031 0.94
8. M. 31 0.00048 0.00050 0.00032 0.000080 0.000287 0.000085 0.68
9. M. 32 0.00056 0.00057 0.00033 0.000038 0.000232 0.000092 1.20
10. F. 35 0.00055 0.00068 0.00038 0.000072 0.000294 0.000071 0.57
11. M. 37 0.00070 0.00061 0.00043 0.000118 0.000201 0.000040 1.02
12, F. 37 0.00035 0.00040 0.00027 0.000069 0.000224 0.000110 1.00
13. F. 38 0.00054 0.00053 0.00041 0.000075 0.000216 0.000070 1.12
14. M. 40 0.00043 0.00035 0.00043 0.000051 0.000346 0.000091 0.99
15. M. 41 0.00040 0.00040 0.00022 0.000093 0.000238 0.000047 0.94
16. M. 41 0.00063 0.00071 0.00068 0.000067 0.000191 0.000056 0.85
17. M. 42 0.00060 0.00055 0.00023 0.000095 0.000221 0.000048 1.75
18. M. 44 0.00041 0.00044 0.00025 0.000049 0.000212 0.000055 0.63
19. M. 44 0.00069 0.00075 0.00045 0.000081 0.000232 0.000052 0.88
20. M. 45 0.00074 0.00086 0.00031 0.000047 0.000262 0.000070 0.66
21. M. 46 0.00047 0.00046 0.00036 0.000130 0.000239 0.000090 1.40
22. M. 47 0.00048 0.00066 0.00043 0.000036 0.000190 0.000032 0.91
23. M. 49 0.00049 0.00048 0.00043 0.000117 0.000259 0.000133 0.88
24. F. 50 0.00048 0.00062 0.00040 0.000103 0.000308 0.000080 0.77
25. M. 51 0.00045 0.00059 0.00024 0.000043 0.000180 0.000037 0.92
26. M. 51 0.00047 0.00054 0.00035 0.000044 0.000216 0.000080 0.59
27. M. 55 0.00087 0.00094 0.00045 0.000005 0.000248 0.000126 1.57
28. M. 55 0.00077 0.00099 0.00030 0.000167 0.000289 0.000078 1.08
29. M. 56 0.00032 0.00031 0.00039 _ 0.000243 0.000069 0.70
30. M. 57 0.00039 0.00035 0.00033 0.000077 0.000248 0.000110 0.87
31. M. 57 0.00038 0.00050 0.00037 0.000054 0.000225 0.000066 0.60
32. F. 57 0.00062 0.00068 0.00044 0.000141 0.000332 0.000090 0.65
33. F. 58 0.00087 0.00095 0.00028 0.000046 0.000213 — 0.83
34. M. 61 0.00064 0.00046 0.00025 0.000052 0.000228 0.000045 1.42
35. F. 62 0.00060 0.00064 0.00040 0.000069 0.000306 0.000088 0.66
36. M. 63 0.00063 0.00067 0.00050 0.000101 0.000334 0.000113 0.80
38. M. 65 0.00073 0.00082 0.00049 0.000029 0.000355 0.000068 1.34
39. F. 65 0.00061 0.00069 0.00053 0.000107 0.000361 0.000110 0.59
40. M. 66 0.00069 0.00059 0.00040 0.000149 0.000327 0.000124 2.11
41. M. 66 0.00043 0.00053 0.00038 0.000061 0.000274 0.000063 0.91
42. M. 66 0.00079 0.00072 0.00054 0.000121 0.000290 0.000098 0.98
43. M. 67 0.00060 0.00061 0.00031 0.000053 0.000206 0.000077 2.05
44, M. 70 0.00070 00064 0.00044 0.000086 0.000238 0.000110 1.09
45. M. 70 0.00044 0.00048 0 00030 0.000086 0.000246 0.000033 1.39
46. M. 71 0.00054 0.00051 0.00036 0.000034 0.000250 0.000060 1.44
47. M. 71 0.00057 — 0.00038 0.000098 0.000244 0.000051 0.91
48. F, 72 0.00054 0.00048 0.00055 0.000146 0.000267 0.000134 1.05
49. M. 78 0.00056 0.00065 0.00044 0.000226 0.000339 0.000089 | 0.71
50. F. 79 0.00055 0.00058 0.00046 0.000323 0.000338 0.000203 1.12
51. M. 80 0.00050 0.00059 0.00038 0.000080 0.000309 0.000073 0.79
Cholesterol
% of Wet
Weight
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PERMEABILITY OF AORTIC TISSUE AND AGE
293
AVERAGE DIFFUSION COEFFICIENTS AND MEAN VALUES FOR PRODUCTs:
DIFFUSION COEFFICIENT X ¥ MW X 10°.
Intima (with Attached
Subintimal Tissue)
TABLE 5.
Solute MW Vv MW
Diffusion
Nitrogen 28 5.29 0.000469
Oxygen 32 5.65 0.000502
Carbon dioxide 44 6.63 0.000404
Lactate 90 9.49 0.000123
Iodide ‘3i* 11.45 0.000318
Glucose 180 13.42 0.000104
*Radioactive isotope
regard to the diffusion process and membrane
structure. Thus it is generally believed (2)
that the finding of low Quw* values for the
diffusion rates of solutes through membranes
indicates that the diffusion takes place in
water or some other solvent of comparatively
low viscosity. It should be noted, however,
that most of the observations on Q. diffusion
values have been obtained in experiments on
artificial membranes or on cell membranes of
unicellular structures. To what extent de-
ductions derived from such experiments cau
be applied to structurally more complicated
animal membranes remains uncertain at the
present stage of knowledge. In spite of this
limitation it was considered of significance to
supplement the investigations on diffusion co-
efficients of solutes for aortic tissue with de-
terminations of Q.+ values for a series of in-
tima-subintima and media preparations.
For this purpose diffusion experiments with
carbon dioxide, iodide, and glucose were
carried out at 7 C. and 37 C., using the
technique described above. The results of
the diffusion measurements on 5 intima-sub-
intima and 5 media membranes are presented
in table 6. As seen from the table the aver-
age Q,, values observed for carbon dioxide,
Diffusion coefficient at T + 10
*010 =
Diffusion coefficient at T
Diffusion coefficient at T + 30
~~ Diffusion coefficient at T
TQ20
Diffusion Coeffi-
Coefficient jcient X ¥ MW X 105 Coefficient (cient X ¥ MW X 105
Media
Diffusion Diffusion Coeffi-
248 0.000551 291
283 0.000579 327
267 0.000375 248
116 0.000084 80
365 0.000258 296
139 0.000076 102
iodide, and glucose were 2.26, 2.04, and 3.03,
respectively, for the intima-subintima samples,
and 1.65, 1.56, and 1.68 for the media prepa-
rations.
It is of interest to note in this connection
that Krogh (12) in studies on the diffusion
rate of oxygen through connective tissue mem-
branes of dogs (abdominal fascia) observed
an average Q; value of 1.47.
4. Effect of age of individuals on diffusion
coefficients for human aortic tissue.
The calculated average diffusion coefficient
values observed for the age groups 10 to 39
years, 40 to 59 years, and 60 to 80 years are
shown in table 7. The results demonstrate a
definite tendency for the coefficient values to
increase with the age of the individuals from
whom the samples were derived. This in-
crease is noticeable both in the case of the
intima-subintima and media preparations. A
comparison of the mean values for the young
and old age group of subjects included in the
study shows the increase in the diffusion co-
efficient values to range between 10 and 73
per cent. It will be noted that the increase
for the solutes of higher molecular weight
(lactate, iodide, glucose) in general was
found to be greater than the increase for the
compounds of lower molecular weight ( nitro-
gen, oxygen, carbon dioxide). If the concepts
of the membrane pore theory are accepted
,
"7
i
I
i
4
4
294 KIRK AND LAURSEN
TABLE 6. Q3o VALUES OF DIFFUSION COEFFICIENTS FOR CARBON DtOXIDE, IODIDE, AND GLUCOSE FOR MEMBRANE PREPARATIONS OF THE
INTIMA-SUBINTIMA AND MEDIA OF THE HUMAN AORTA.
p- —--~ | | | | >
| | Carbon Dioxide | Iodide Glucose
| | | Thick- Rae wee mn
Sample Membrane | Area | ness Tp. | | |
No. | Cm? | Cm. C. Diffusion | | Diffusion | | Diffusion
| Coefficient | Qs | Coefficient | Qs | Coefficient | Quy
| | | | |
J2h- ae? siege eneiaal ‘ee z Ps ee | ae Ey =
52 Intima-subintima 5.54 | 0.0862 7 0.000328 0.000224 | 0.000052
Intima-subintima 5.54 | 0.0862 37 0.000700 | 2.13 0.000263 1.17 0.000199 3.84
Media | 5.88 | 0.0725 | 7 | 0.000306 | | 0.000190 | | 0.000083
Media 5.88 0.0725 37 0.000533 | 1.74 0.000226 1.19 | 0.000157 1.90
ae | —|——_|———_ ——— —|——_—_——|____
53 Intima-subintima 5.19 | 0.0945 7 | 0.000290 | | 0 000270 | 0.000041
Intima-subintima 5.19 | 0.0945 37 0.000565 | 1.94 | 0.000473 | 1.74 0.000096 2.34
Media | 3.91 | 0.1430 | 7 | 0.000284 | | 0.000195 | 0.000052
Media 3.91 | 0.1430 | 37 | 0.000487 | 1.71 | 0.000368 | 1.89 | 0.000101 | 1.95
| |
—_—__—_—_—_— — | ————— | ——————_——_—| —____ ates Games eke en ae
54 Intima-subintima 3.66 | 0.0380 7 | 0.000154 | 0.000084 | | 0.000028 |
Intima-subintima 3.66 | 0.0380 | 37 | 0.000296 | 1.92 | 0.000266 | 3.17 | 0.000104 | 3.72
|
Media 5.16 | 0.1420 7 | 0.000317 | | 0.000209 | | 0.000039 |
Media 5.16 0.1420 37 | 0.000390 | 1.23 0.000365 | 1.27 | 0.000075 | 1.92
55 | Intima-subintima | 4.95 | 0.1580 | 7 | 0.000273 | 0.000224 | 0.000039
Intima-subintima 4.95 0.1580 37 | 0.000650 2.42 | 0.000458 | 2.05 0.000078 2.00
|
Media 5.43 0.0904 7 | 0.000103 | 0.000174 | 0.000028
Media 5.43 0.0904 37 | 0.000224 2.16 é 0.000292 1.72 | 0.000037 1.33
|__|
56 Intima-subintima 5.05 0.0715 7 0.000191 | 0.000099 a9 0.000035
Intima-subintima | 5.05 | 0.0715 37 | 0.000550 2.88 | 0.000204 2.06 | 0.000114 3.26
| | | |
| | | | | | | |
Media | 4.90 | 0.1050 7 0.000256 | | 0.000225 | | 0.000052
Media | 4.90 | 0.1050 | 37 | 0.000367 | 1.43 | 0.000389 | 1.73 | 0.000068 | 1.31
| ; | oe | Ba | | _—
| ' | | |
ate | |
Average Intima-subintima | 2.26 2.04 | | 3.03
Average Media 1.65 1.56 1.68
these findings would suggest an increase with
age particularly in the number of large sized
pores.
In figures 1 and 2 the observed average
diffusion coefficient values for the different
solutes have been plotted for each decade.
The figures also show the calculated standard
deviations of distribution for the 51 intima-
subintima and 50 media samples. As an ex-
ample of the observed actual spread of the
values the diffusion coefficients of glucose for
the intima-subintima preparations have been
plotted in figure 3.
The tendency for the diffusion coefficient
values to increase with age can also be ex-
pressed through the coefficients of correlation
between age and the diffusion coefficients.
The calculated r values and corresponding t
values for these relations are listed in table 8
It will be seen from the table that the r
values in the case of lactate, iodide, and
glucose are statistically significant at the 1
Age G
(Yea
40
Fic
efficic
intim
Sh:
distri
SOF THE
8
Qs0
3.84
1.90
been
cient
2 ex-
ation
ients.
ing t
le 8
he r
and
he 1
TABLE 7.
PERMEABILITY OF AORTIC TISSUE AND AGE
MEAN DiFFusION COEFFICIENTS OBSERVED FOR VARIOUS AGE GROUPS.
Age Group | Number of Carbon
(Years) Samples Nitrogen Oxygen Dioxide Lactate Iodide Glucose
Intima-Subintima
10-39 13 0.000393 0.000439 | 0.000359 0.000098 0.000253 0.000074
40-59 20 0.000500 0.000550 0.000400 0.000098 0.000318 0.000101
60-80 18 0.000492 0.000501 0.000442 0.000166 0.000363 0.000128
Media
10-39 13 0.000499 0.000505 0.000329 0.000064 0.000230 0.000061
40-59 20 0.000548 0.000607 0.000367 0.000076 0.000244 0.000075
60-80 17 0.000597 0.000605 0.000419 0.000107 0.000289 0.000091
AORTIC INTIMA AORTIC MEDIA
(WITH ATTACHED SUBINTIMAL TISSUE)
kxro$ k x10°
: _
r NITROGEN
NITROGEN 6o +
50
=
OXYGEN
PF DIOXIDE
16
LACTATE
14
12
10
6
40
lODIDE
:
20
4
l2 GLUCOSE
10
8
6
4
2
$88 6 & 8 &
Ce
3
OXYGEN
CARBON
DIOXIDE
30 - ,
12 ,
1o |. LACTATE
Pic.. 1.
40
YEARS
intima-subintima samples.
Shaded area represents 1 standard deviation of
Variation with age in mean diffusion co-
efficient values of various solutes for 51 human aortic
distribution for observed 51 values.
l 7
80
40
YEARS
Fic. 2. Variation with age in mean diffusion co-
efficient values of various solutes for 50 human aortic
media samples.
Shaded area represents 1 standard deviation of dis-
tribution for observed 50 values.
%
Ly
es
296 KIRK AND LAURSEN
per cent level of confidence. For the gaseous
solutes the degree of correlation found was
somewhat lower, but r values significant at
the 5 per cent confidence level were observed
for nitrogen in the investigations on the
intima-subintima preparations, and for nitro-
gen, oxygen, and carbon dioxide for the media
samples.
AORTIC INTIMA
PER CENT OF
WET WEIGHT :
2
[ TOTAL LIPID
'
1 i i i n i L j
0 20 30 40 50 60 70 60
YEARS
AORTIC MEDIA
PER CENT OF
WET WEIGHT
ip TOTAL Oe
ot
CHOLESTEROL
——gee
or i 1 1 1 i rn oe
10 20 30 40 50 60 70 er
YEARS
Fic. 3. Variation with age in mean total lipid and
cholesterol content of membrane preparations of hu-
man aortic intima-subintima and media samples.
5. Lipid composition of membranes.
The total lipid and cholesterol content of
the individual membranes used for the diffy.
sion studies are listed in tables 3 and 4. The
observed increase with age in the membrane
lipid content is illustrated graphically in figure
4.
A calculation of the coefficients of cor-
relation between the age of the individuals
and the total lipid and cholesterol content of
the membranes showed r values for the intima-
subintima samples of +0.48 (t = 3.80) and
+0.32 (t = 2.34), respectively. For the media
preparations the corresponding correlation co-
efficients were +0.32 (t = 2.34) and +0.3]
(t = 2.25).
Computations were further made for the
51 intima-subintima and 50 media _prepara-
tions of the r values for the relations between
DIFFUSION COEFFICIENTS OF GLUCOSE FOR PREPARATIONS OF HUMAN AORTIC INTIMA
(WITH ATTACHED SUBINTIMAL TISSUE)
kx10*
i 1 A. i L 4 1 j
YEARS
Ficure 4.
TABLE 8. CORRELATION COEFFICIENTS: AGE/DIFFUSION COEFFICIENTS FOR INTIMA-SUBINTIMA
AND MEDIA PREPARATIONS OF THE HUMAN AORTA.
|
Intima-Subintima | Media
il]
r t r t
pei +0.28 2.04 oy 2.60
IOUS occ, b np. 4 vse voc auases ve. +0.18 1.27 +0.29 2.08
Age/Carbon dioxide............... +0.23 1.66 +0. 36 2.67
IID ces. sig 0-0 0.p19 8 0.0 0is'ee 0-9 +0.46 3.60 +0.41 3.2
I. ob oc ak cos eeewadush +0.38 2.89 +0.39 2.93
Age/Glucose.............2-++000- +0.58 4.99 +0.44 3.35
TAE
Lipid/
Lipid/
Lipid/
Lipid/
Lipid/
Lipid/
Chole
Chole
Chole
Chole
Chole
Chole
mer
tent
coef
latic
coef
ably
latic
T
of |
bran
crea
age.
lab«
brat
fail
diff
glu
that
ntent of
re diffu.
4. The
»mbrane
in figure
of cor-
lividuals
ntent of
- intima-
0) and
e media
tion co-
1 +0.31
for the
repara-
etween
ORTIC INTIMA
— =e a |e
PERMEABILITY OF AORTIC TISSUE AND AGE
TABLE 9, CORRELATION COEFFICIENTS:
297
Tora. Lierp CONTENT OF MEMBRANE/DIFFUSION COEFFICIENTS
FOR INTIMA-SUBINTIMA AND MEDIA PREPARATIONS OF THE HUMAN AorTA.
|
|
|
r
Lipid/ Nitrogen. ws +0,.18
BEMORYGON, 6. esses esse ceeeene +0.04
Lipid/Carbon ee ee | —0.04
Lipid/Lactate...... | +0.53
Lipid/lodide..... oad +0.28
Lipid/Glucose............ . | +0.26
CORRELATION COEFFICIENTS:
Intima-Subintima
Media
|
t
|
|
‘27 +0.33 | 2.42
0.28 | +0.10 0.69
0.28 0.00 | 0.00
4.35 | +0.07 | 0.48
2.02 —0.12 0.83
1.91 | +0.20 | 1.40
CHOLESTEROL CONTENT OF MEMBRANE/DIFFUSION COEFFICIENTS
FOR INTIMA-SUBINTIMA AND MEDIA PREPARATIONS OF THE HUMAN AorTA,
Intima-Subintima
r
Cholesterol/ Nitrogen... . +0.25
Cholesterol/Oxygen........ +0.14
Cholesterol/Carbon dioxide . —0.02
Cholesterol/Lactate......... +0.32
Cholesterol/Iodide. . +0.19
Cholesterol/Glucose........ +0.16
membrane lipid content and cholesterol con-
tent on one side and the observed diffusion
coefficients on the other side. Such calcu-
lations, listed in table 9, revealed correlation
coefficients which in general were consider-
ably lower than the r values for the corre-
lations: age/diffusion coefficients.
DISCUSSION
The determinations of diffusion coefficients
of various solutes for human aortic mem-
branes have revealed a tendency to an in-
crease in the permeability of this tissue with
age. Since measurements conducted in this
laboratory on a simple connective tissue mem-
brane (human tentorium cerebelli) have
failed to show any significant change in the
diffusion coefficients of carbon dioxide and
glucose with age (14), it seems probable
that the increase in permeability observed in
Media
|
1.78 | +0.06 | 0.41
0.97 | —0.16 1.12
0.14 | 0.19 =| 1.34
2.34 | +0.15 1.04
1.34 +0.07 0.48
1.12 +0.23 1.62
the case of aortic tissue may be related, at
least partly, to the arteriosclerotic changes
occurring in this tissue with age. The fact
that the correlation coefficients between the
lipid (and cholesterol) content of the mem-
branes and the diffusion coefficients in gen-
eral were found to be considerably lower
than the correlation coefficients between age
and the diffusion coefficients suggests that
the lipid and cholesterol deposits in the tissue
are not mainly responsible for the observed
increase in the diffusion coefficient values
with age. It may be tentatively assumed
therefore that other changes in the tissue
associated with the arteriosclerotic processes
are of greater importance for the increase in
permeability with age. An unfavorable effect
of such increased permeability might be a
loss from the blood vessel wall of compounds
of significance for the metabolism of the
tissue.
———
Saev re vertr sr 6 FR eee BS EPs ts
FF.
298 KIRK AND LAURSEN
Under the conditions of the experiments
the aortic membrane preparations seem to
behave rather passively toward the diffusing
compounds. It will be noted that the average
diffusion coefficient values for carbon dioxide
observed in the present study were 0.000404
for the intima-subintima preparations and
0.000375 for the media samples, whereas the
corresponding mean diffusion coefficients for
oxygen were 0.000502 and 0.000579. The
calculated ratio: diffusion coefficient of
carbon dioxide/diffusion coefficient of oxygen
was thus 0.805 in the case of the intima-
subintima samples and 0.650 for the media
preparations. The lower values for the diffu-
sion coefficients of carbon dioxide as com-
pared with those of oxygen are in accordance
with what would be expected under con-
ditions of simple, uncomplicated diffusion, be-
cause the molecular weight of carbon dioxide
(MW 44) is higher than that of oxygen (MW
32).
It should be mentioned in this connection
that the contention has been widely held by
physiologists that carbon dioxide in solution
possesses a diffusion rate approximately 20
times greater than that of oxygen. This con-
ception seems to have originated through a
misinterpretation of Krogh’s definition in 1918
(12) of the diffusion constant of gases for
tissues. A discussion of this subject has been
given by Wright (28), Kirk and Laursen (11),
and Verduin (24), and will be briefly men-
tioned here.
The definition of the diffusion rate em-
ployed by Krogh (12) is based on the differ-
ence in partial pressure of the gas on the two
sides of the membrane, whereas the definition
given by Hill (4) is based on the difference
in the quantity of the gas per volume of fluid
(i.e., the concentration) on the two sides of
the membrane. If one employs Krogh’s defi-
nition of the diffusion coefficient (diffusion
constant), the coefficient for carbon dioxide
will be much greater than that of oxygen.
This is due to the fact that the absorption
coefficient of carbon dioxide in water at 38 C.
is 0.550, whereas that of oxygen is only 0.023.
For the same partial pressure of the gases
the carbon dioxide content of the water will
therefore be 0.550/0.023, or 23.9 times greater
than the content of oxygen. Since the diffu-
sion of the gases in water is inversely pro-
portional to the square root of their mole-
cular weights, the diffusion coefficient ( diffu.
sion constant of Krogh) of carbon dioxide
(at the same partial pressure difference ) will
be 23.9 X \/32/\/44, or 20.4 times greater
than that of oxygen.
The definition of the diffusion coefficient
given by Hill, which was used in the present
study and which is generally employed in the
field of chemistry when dealing with diffusion
kinetics, is, as mentioned, based on the differ-
ence in the quantity of the gas per volume
of fluid on the two sides of the membrane,
Using this definition, the ratio: diffusion co-
efficient of carbon dioxide/diffusion coefficient
of oxygen, will be equal to \/32/\/44, or 0.853,
indicating a slower diffusion rate of carbon
dioxide than of oxygen.
Of particular interest in the discussion of
diffusion coefficients of solutes for aortic tissue
is the question of the supply of the aortic wall
with oxygen through diffusion in normal and
pathologically changed vessels. The intima
of the aorta in the young human adult has
a thickness of about 0.13 mm. (3, 16). In
older individuals a notable thickening of the
intima (and subintimal tissue) frequently
occurs, and in the presence of atherosclerosis
this layer of the vessel wall may attain a
thickness of several millimeters. The media
likewise tends to increase in thickness in
middle-aged and old individuals. This is
well shown in a recent study by Wellman and
Edwards (26) on 304 samples of the thoracic
aorta obtained from individuals between 20
and 89 years of age. From the measurements
of these samples the mean thickness of the
media was found to increase from 1.30 mm.
in young adults to 1.63 mm. in 40 to 49
year old subjects.
Under normal conditions only the ex-
ternal one-third to one-half of the media of
the human aorta is supplied with vasa vaso-
rum, the luminal half to two-thirds being
avascular (27). From the values reported by
Wellman and Edwards (26) it can be calcu-
lated that the avascular layer of the human
aortic wall (intima-subintima + avascular
layer of media) in young adults will range
between 0.78 and 0.99 mm., and in middle-
aged adults between 0.97 and 1.22 mm.
The question of the supply routes for this
avascular section of the vessel wall has been
the subject of considerable study. The ma-
jority
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PERMEABILITY OF AORTIC TISSUE AND AGE 299
jority of the investigators favor the contention
that the avascular layer of the aortic wall is
supplied with oxygen and nutrients both from
the lumen of the artery and from the vasa
yasorum, the mid zone of the layer being
the borderline between the sections of the
wall predominantly nourished from within
and from without (18). A review of the
literature pertaining to this subject was re-
cently given by Kirk and Hansen (10).
It is as yet unknown whether other mecha-
nisms besides diffusion are of importance for
the supply of the arterial wall. It does not
seem unlikely, as suggested by various in-
vestigators, that the passage in vivo of a
transendothelial filtrate through the wall as
the result of mechanical forces may contribute
significantly to the supply of the vessel wall
with oxygen and nutrients. Notwithstanding
this uncertainty a consideration of the efficacy
of the supply of the tissue with oxygen
through diffusion (and the removal of carbon
dioxide and lactate), based on the diffusion
coefficient values observed in the present
study, would seem warranted.
According to Warburg (1923) (25) and to
Hill (1928-29) (4), the layer thickness of a
membrane which can be supplied with oxy-
gen through diffusion, if exposed to an oxygen
containing fluid in which the oxygen concen-
tration is maintained constant, may be calcu-
lated from an equation, provided the respira-
tory rate and the diffusion coefficient of
oxygen for the tissue are known. The formula
of Hill (Hill’s equation 4) has the following
form for a membrane exposed on one side
to an oxygen containing medium:
b=V2ky,/a
where b is the greatest thickness of the tissue
(expressed in cm.) to which oxygen pene-
trates, k the diffusion coefficient, y. the con-
centration of oxygen in the fluid (expressed
in ml. oxygen per ml. fluid), and a the rate
of oxygen consumption by the tissue (ex-
pressed in ml. oxygen consumed per ml. wet
tissue/minute ).
The oxygen content of human arterial blood
plasma is normally about 0.258 vol. per cent,
or 0.00258 ml./ml. (21). If one assumes that
the respiratory rate of human aortic tissue in
vivo is of the same order of magnitude as the
maximal Q..* rates observed in in vitro experi-
*Qoz = Cubic millimeters of oxygen consumed per milli-
gram dry tissue per hour.
ments (0.25-0.30) (7), the layer thickness of
the aorta which can be supplied with oxygen
through diffusion in young adults (average
diffusion coefficient of oxygen for media
0.000505, see table 7) may be calculated as
follows:
2b = 2/ 2 X 0.000505 x 0.00258 x 240/0.30
= 0.0912
In this calculation, a of Hill's equation lias
been substituted by Q../240, and instead of b,
2 b has been used, because the avascular
section of the aorta is comparable to a mem-
brane exposed on both sides to an oxygen
containing fluid.
For middle-aged adults, in whom an aver-
age diffusion coefficient of 0.000607 was ob-
served, the layer thickness which can be sup-
plied with oxygen through diffusion can be
calculated to value about 0.100 cm.:
2 b = 2 \/2 X 0.000607 X 0.00258 X 240/0.30
= 0.100
When compared with the values for the
thickness of the avascular section of the
human aorta, reported above, the calculated
depths to which oxygen can penetrate through
diffusion (0.91 mm. in young adults, 1.00 mm.
in middle-aged persons) suggests that the
margin of reserve for the supply of the normal
aortic wall with oxygen through diffusion is
rather small, and that the supply in the
presence of a notable thickening of the wall
through arteriosclerotic processes, or in con-
ditions of anoxemia, may be inadequate. As
mentioned previously, it is, however, not un-
likely that other mechanisms besides diffusion
are of importance for the supply of the arterial
wall with oxygen and nutrients.
An equation is further given by Hill (Hill's
equation 11), which deals with the diffusion
of a solute into a liquid phase in which its
concentration remains constant, from a solid
in which it is formed by metabolic processes
at a constant rate. This equation may be
employed to calculate the concentrations of
carbon dioxide and lactate in the mid section
of the avascular layer of the aortic wall.
If the mid zone of the membrane is at a
distance b from the fluid into which the
diffusion of the metabolite takes place, the
concentration y’ in the mid zone (expressed
in units per ml. wet tissue ) becomes:
y =— ab? /2k+ ab? /k + yo
ES — Abe TeizF
F FF3 FFFFF F FEFTD FFF
ea
IPF
——=
FISIZIP FF TIFT ZT WF F Fo5
300 KIRK AND LAURSEN
where a is the rate of production of the
metabolite (expressed in units per ml. of wet
tissue/minute), b the distance of the mid
zone from the surface of the membrane (ex-
pressed in cm.), k the diffusion coefficient of
the metabolite for the tissue, and y. the con-
centration of the metabolite in the surround-
ing fluid (expressed in units/ml. fluid).
Since the average respiratory quotient ob-
served for human aortic tissue in vitro is 0.91
(7), the Qoow*® of the tissue for a Qu of 0.30
becomes 0.30 X 0.91, or 0.272. In young
adults the mean thickness of the avascular
layer of the aorta is 0.084 cm.; since the diffu-
sion of carbon dioxide presumably takes place
both toward the lumen of the aorta and the
vasa vasorum, b assumes the value of 0.042.
The mean concentration of carbon dioxide in
arterial plasma is 2.80 vol. per cent (21), and
the value of y. consequently 0.0280. If the
mean diffusion coefficient value of carbon
dioxide for the media of young individuals
(0.000329) is employed, and the term Qeo: X
0.00417} substituted for a, the calculation be-
comes:
y’ = — 0.272 X 0.00417 X 0.042?/2 xX 0.000329 +
0.272 X 0.00417 X 0.042?/0.000329 + 0.0280 = 0.0310
The concentration of carbon dioxide in the
mid zone of the aortic wall is thus 0.0310
ml. per ml., or 3.10 vol. per cent. For middle-
aged subjects, having a mean diffusion co-
efficient of carbon dioxide of 0.000367, a calcu-
lation of the y’ value of the mid zone, for a
membrane thickness of 0.110 cm., gives a
figure of 0.0327, or 3.27 vol. per cent.
In the case of lactate the same formula as
employed for carbon dioxide may be used
(Hill’s equation 11). As shown in a previous
publication (7) the maximal aerobic gly-
colysis rate (Q" )t of human aortic tissue in
vitro is of the magnitude of 1.00; this cor-
responds to a lactic acid production of 0.0168
mg. per ml. wet tissue per minute. As seen
from table 7 the average diffusion coefficients
of lactate in aortic tissue observed for young
and middle-aged subjects were, respectively,
0.000064 and 0.000076. The lactate concen-
tration of human arterial plasma is normally
about 10 mg. per cent; the value of y. to be
*Qcoz = Cubic millimeters of carbon dioxide produced per
milligram dry tissue/hour.
tThe value 0.00417 corresponds to 1/ 240.
tQe* = Milligrams of lactic acid X 249 produced per
milligram dry tissue/hour under aerobic conditions.
used in the equation is consequently 0.100,
The calculation of the lactate concentration,
y’, in the mid zone of the avascular section
of the aortic wall in young subjects (assumed
membrane thickness 0.084 cm.) is therefore
as follows:
y’ 0.0168 X 0.042°/2 x 0.000064 +
0.0168 X 0,0427/0.000064 + 0.100 0.332
The lactate concentration in the mid zone
of the wall is thus 0.332 mg./ml. tissue, or
33.2 mg. per cent. For middle-aged subjects
the calculated corresponding y’ value (for an
assumed membrane thickness of 0.110 cm.) is
0.434, representing a lactate concentration of
43.4 mg. per cent.
As mentioned in a previous publication (9)
it is not unlikely that the lactic acid formed
by the aerobic glycolysis is neutralized in the
tissue by bicarbonate to form carbonic acid,
which is then possibly converted to carbon
dioxide through the action of the enzyme
carbonic anhydrase. In comparative diffu-
sion experiments with carbon dioxide and
bicarbonate for a human connective tissue
membrane (cerebellar tentorium) the diffu-
sion coefficient for bicarbonate has been
found on the average to be approximately
55 per cent of that of carbon dioxide (13).
If the same relation obtains for arterial tissue
it is possible, by means of Hill’s equation 4,
to estimate whether the diffusion of bicarbon-
ate from the: plasma into the arterial wall is
of sufficient magnitude to neutralize the lactic
acid formed by aerobic glycolysis.
According to the equations:
CH,CHOHCOOH + NaHCO, = CH, CHOHCOONa
+ H.CO,
H,CO, > CO, + H,O
90 mg. of lactic acid require 84 mg. of sodium
bicarbonate for neutralization, as the result
of which 44 mg., or 22.4 ml. of carbon dioxide
are formed. Since, as mentioned above, a
QY value of 1.00 corresponds to a production
of lactic acid of 0.0168 mg. per ml. wet tissue
per minute, a quantity of 0.0156 mg. of sodium
bicarbonate will be required for its neutrali-
zation. The value for a to be used in Hill’s
equation 4 is therefore 0.0156. With an aver-
age bicarbonate concentration of plasma of
25 mEq./liter, the value of y. is 2.10 (2.10 mg.
of sodium bicarbonate per ml. plasma).
For an aortic membrane of 0.084 cm. thick-
ness an
x 0.55,
b=
Since
thickne
bicarbe
of a bi
ml. we
cluded
is suff
lactic
aortic
The
neutra
0.0168
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(0.30
the ca
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0.0421
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Det
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efficie
lactat
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age ol
were |
The
for th
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carbo
iodid
the n
respo
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0.000:
,
diffus
the a
ples |
the p
Me
rates
vy 0.100,
itration,
section
issumed
1erefore
4+
).332
id zone
sue, or
subjects
(for an
cm. ) is
tion of
on (9)
Formed
in the
c acid,
carbon
nzyme
diffu-
e and
tissue
diffu-
been
nately
(13).
tissue
ion 4,
irbon-
vall is
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OONa
dium
result
oxide
ve, a
ction
‘issue
dium
trali-
Hill's
aver-
a of
) mg.
hick-
PERMEABILITY OF AORTIC TISSUE AND AGE
ness and a k value for bicarbonate of 0.000329
x 0.55, or 0.000181, the calculation becomes:
2b=2V 2 X 0.000181 X 2.10/0.0156 = 0.442
Since the calculation shows that a layer
thickness of 0.442 cm. can be supplied with
bicarbonate through diffusion in the presence
of a bicarbonate utilization of 0.0156 mg. per
ml. wet tissue per minute, it may be con-
cluded that the bicarbonate level of plasma
is sufficient to insure neutralization of the
lactic acid produced by glycolysis in the
aortic wall.
The amount of carbon dioxide formed by
neutralization of 0.0168 mg. lactic acid is
0.0168 < 22.4/90 ml., or 0.00416 ml. If this
quantity be added to the amount of carbon
dioxide produced by the tissue respiration
(0.30 * 0.91 X 0.00417 ml., or 0.00113 ml.)
the carbon dioxide concentration in the mid
zone of the avascular section of the human
aorta can be calculated according to Hill's
equation 11 by inserting the value of 0.00529
for a. Such calculation gives y’ values of
0.0421 and 0.0497, respectively, for young and
middle-aged individuals, corresponding to
carbon dioxide concentrations in the mid zone
of the wall of 4.21 and 4.97 vol. per cent.
SUMMARY
Determinations were made by the method
of Johnsen and Kirk of the diffusion co-
efficients of nitrogen, oxygen, carbon dioxide,
lactate, iodide, and glucose for membrane
preparations of the intima-subintima and the
media of the human thoracic aorta. The
age of the individuals from whom the samples
were derived ranged between 10 and 80 years.
The average diffusion coefficients observed
for the intima-subintima samples (N = 51)
were: nitrogen, 0.000469; oxygen, 0.000502;
carbon dioxide, 0.000404; lactate, 0.000123;
iodide, 0.000318; and glucose, 0.000104. For
the media preparations (N = 50) the cor-
responding mean diffusion coefficients val-
ued 0.000551, 0.000579, 0.000375, 0.000084,
0.000258, and 0.000076.
A significant tendency was noted for the
diffusion coefficient values to increase with
the age of the subjects from whom the sam-
ples were derived, indicating an increase in
the permeability of the aortic tissue with age.
Measurements of Qs values for the diffusion
rates of carbon dioxide, iodide, and glucose
301
showed average ratios of 2.26, 2.04, and 3.03,
respectively, for the intima-subintima mem-
branes, and 1.65, 1.56 and 1.68 for the media
preparations.
Calculation of the product values: diffu-
sion coefficient X WVMW for the various
solutes investigated pointed to the presence
in the aortic wall of a set of smaller pores,
permitting the passage of compounds of MW
28 to 44, and a set of larger pores, permitting
the passage also of compounds of MW up to
180
Computation by means of the equation of
Hill of the depth to which oxygen can pene-
trate through diffusion in the presence of an
assumed tissue Q.: of 0.30 revealed a narrow
margin of reserve for the supply of the avascu-
lar section of the aortic wall with oxygen
through diffusion.
The significance of these findings is dis-
cussed,
REFERENCES
1. Barker, S. B., and Summerson, W. H.: The
Colorimetric Determination of Lactic Acid in
Biological Materials. J. Biol. Chem., 138: 535-
554, 1941.
Davson, H., and Danielli, J. F.: The Permea-
bility of Natural Membranes, 2nd ed., Cambridge
University Press, 1952.
3. Griinstein, N.: Ueber den Bau der grésseren
menschlichen Arterien der verschiedenen Alters-
stufen. Arch. f. mikr. Anat., 47: 583-654, 1896.
4. Hill, A. V.: The Diffusion of Oxygen and Lactic
Acid Through Tissues. Proc. Roy. Soc., Lon-
don, Ser. B., 104: 39-96, 1928-1929.
5. Johnsen, S. G., and Kirk, J. E.: A Procedure
for Determination of Diffusion Coefficients of
Gases and Non-Gaseous Solutes for Membranes.
Analyt. Chem., 27: 838-840, 1955.
6. Kirk, E., Page, I. H., and Van Slyke, D. D.:
Manometric Microdetermination of Lipids in
Plasma, Blood Cells, and Tissues. J. Biol. Chem.,
106: 203-234, 1934.
7. Kirk, J. E., Effersge, P. G., and Chiang, S. P.:
The Rate of Respiration and Glycolysis by Hu-
man and Dog Aortic Tissue. J. Gerontol., 9:
10-35, 1954.
8. Kirk, J. E., and Hansen, P. F.: A Procedure for
Determination of the Respiration of Tissue Ho-
mogenates. J. Biol. Chem., 199: 675-687, 1952.
9. Kirk, J. E., and Hansen, P. F.: The Presence of
Carbonic Anhydrase in the Media of the Hu-
man Aorta. J. Gerontol., 8: 150-157, 1953.
10. Kirk, J. E., and Hansen, P. F.: Metabolism of
Avascularized Tissues and Changes Associated
with Ageing. In: Lansing, A. I. (ed.): Cow-
to
11.
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13.
14,
15.
16.
17.
dry’s Problems of Ageing, 3rd ed., Williams &
Wilkins, Baltimore, 1952, pp. 730-763.
Kirk, J. E., and Laursen, T. J. S.: Changes with
Age in Diffusion Coefficients of Solutes for Hu-
man Tissue Membranes. Ciba Foundation, Col-
loquia on Ageing, Vol. I. General Aspects, J. &
A. Churchill Ltd., London, 1954.
The Rate of Diffusion of Gases
Through Animal Tissues, with Some Remarks
on the Coefficient of Invasion. J. Physiol., 52:
391-408, 1918-1919.
Laursen, T. J. S.: Comparison of Diffusion Co-
efficients of Carbon Dioxide and Bicarbonate for
a Human Connective Tissue Membrane ( Unpub-
lished ).
Laursen, T. J. S., and Kirk, J. E.: Diffusion Co-
efficients of Carbon Dioxide and Glucose for a
Connective Tissue Membrane from Individuals of
Various Ages. J. Gerontol., 10: 303-305, 1955.
LePage, G. A.: Analyses for Tissue Metabolites
with in Situ Freezing Techniques. In: Potter,
V. R. (ed.), Methods in Medical Research, vol.
I, The Year Book Publishers, Chicago, 1948, pp.
337-357.
Maximow, A. A., and Bloom, W.: A Textbook
of Histology, 5th ed., W. B. Saunders Co., Phila-
delphia, 1948.
Nelson, N.: A Photometric Adaptation of the
Somogyi Method for Determination of Glucose.
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Petroff, J. R.: Uber die Vitalfarbung der Ge-
fiisswandungen. Beitr. z. path. Anat. u. allg.
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KIRK AND LAURSEN
19.
Pletscher, A., Staub, H., Hunzinger, W., and
Hess, W.: Zum Kohlenhydratstoffwechsel. I. Mit.
teilung. Helv. Physiol. Acta, 8: 306-316, 1950,
Somogyi, M.: Notes on Sugar Determination,
J. Biol. Chem., 195; 19-23, 1952.
Standard Values in Blood (E. C. Albritton, ed.);
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Van Slyke, D. D., Page, I. H., and Kirk, E.: A
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102: 635-649, 1933.
Verduin, J.: Diffusion Constant and Diffusion
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Warburg, O.: Versuche an iiberlebendem Car-
cinomgewebe. Methoden. Biochem. Ztschr,
142: 317-333, 1923.
Wellman, W. E., and Edwards, J. E.: Thickness
of the Media of the Thoracic Aorta in Relation
to Age. Arch. Path., 50: 183-188, 1950.
Woerner, C. A.: Microscopic Anatomy of the
Arterial Wall. J. Gerontol., 6: 165-166, 1951.
Wright, C. I.: The Diffusion of Carbon Dioxide
in Tissues. J. Gen. Physiol., 17: 657-676, 1933-
1934,
DI
The
nective
having
which
studies.
rarely
change
investi
fusion
cose tl
Thir
tentori
the St.
individ
rived 1
tentori
ments
beaker
TABLE
Com
Solute
Carbon
dioxi
© Glucose
Submi
from the
was give
in obtaii
_ Und
mately
W., and
‘I. I. Mit.
16, 1950,
mination,
on, ed.);
val Data,
ces, Na-
port No,
e Deter. |
Solutions |
Measure. |
924,
, 2s
ation of }
. Chem,
Diffusion |
,
om Car-
Ztschr,,
hickness
Relation
of the
, 195].
Dioxide
}, 1933-
DIFFUSION COEFFICIENTS OF CARBON DIOXIDE AND GLUCOSE FOR A
CONNECTIVE TISSUE MEMBRANE FROM INDIVIDUALS OF
VARIOUS AGES*
T. J. S. LAURSEN, M.D., AND J. E. KIRK, M.D.
(From the Division of Gerontology, Washington University School of Medicine, St. Louis)
The human tentorium cerebelli is a con-
nective tissue membrane of simple structure,
having a thickness of approximately 0.5 mm.,
which makes it suitable for use in diffusion
studies. Since furthermore the tentorium
rarely becomes the site of major pathologic
changes this membrane was chosen for an
investigation of the effect of age on the dif-
fusion coefficients of carbon dioxide and glu-
cose through connective tissue.
METHODS
Thirty-five samples of the human cerebellar
tentorium were obtained fresh at autopsy at
the St. Louis City Morgue.+ The age of the
individuals from whom the samples were de-
rived ranged between 1 and 78 years. The
tentorium was removed with sterile instru-
ments and immediately placed in a sterile
beaker immersed in crushed ice.
TABLE 1. COMPOSITION OF SOLUTION IN THE Two
COMPARTMENTS OF THE DIFFUSION APPARATUS.
|
|
Content of one com- Content of other
Solute partment of diffu- | compartment of
sion apparatus | diffusion appa-
ratus
—__— —_ a ———————————— en ES eee ——
Carbon |
dioxide | Buffer medium aer- | Unaerated buffer
ated with carbon medium
dioxidet
Glucose One volume of buffer | Buffer medium
medium, 4 volumes
of osmolar glucose |
solution
Submitted for publication April 25, 1955.
*The investigation was supported by a grant (PHS-891)
from the National Heart Institute of the National Institute of
Health, Public Health Service. A presentation of the data
was given at the Seventh Annual Meeting of the Gerontological
Society, Inc., December 28 to 30, 1954, Gainesville, Florida.
_ tThe authors are indebted to Dr. J. J. Connor for assistance
in obtaining specimens.
_ Under the conditions of preparation of the donor solu-
tion the quantity of free carbon dioxide constitutes approxi-
mately 70 per cent of the total COz present in the solution.
303
The diffusion experiments were carried out
at 37 C. under sterile conditions as described
by Johnsen and Kirk (2). The composition
of the solutions employed in the two com-
partments of the diffusion apparatus in the
experiments with carbon dioxide and glucose
are shown in table 1. The buffer solution used
was a modified Krebs’ phosphate buffer (3)
of pH 7.1. The carbon dioxide analyses were
performed by the gasometric method of Van
Slyke and Neill (8), as described by Kirk
and Hansen (4). For the glucose determina-
tions the colorimetric method of Nelson (5)
was employed, using the reagents described
by Somogyi (7).
The diffusion coefficient, defined accord-
ing to Hill® (1), was calculated by means of
the equation given by Pletscher and associ-
ates (6), as described in the publication by
Johnsen and Kirk (2).
RESULTS
The results of the diffusion coefficient meas-
urements on the 35 preparations of the cere-
bellar tentorium are presented in table 2.
It will be seen from the table that the mean
coefficient values observed for carbon dioxide
for the age groups 1 to 29, 30 to 49, 50 to 59,
and 60 to 78 years were, respectively,
0.000432, 0.000428, 0.000458, and 0.000449.
For glucose the corresponding average values
were 0.000128, 0.000100, 0.000116, and
0.000128. No significant change in the dif-
fusion coefficients with age was thus found
either in the case of carbon dioxide (MW
44) or glucose (MW 180).
The mean diffusion coefficient value of
0.000444 found in the 35 experiments with
carbon dioxide is of the same order of magni-
tude as the coefficient values for this gas re-
ported by Wright (9) in studies on connective
tissue membranes from dogs.
*Number of units of a substance diffusing through 1 cm.*
of the membrane in 1 minute at a concentration gradient of
1 unit per ml. per cm.
304 LAURSEN AND KIRK
TABLE 2. DirFUsION COEFFICIENTS OF CARBON DIOXIDE AND GLUCOSE FOR HUMAN TENTORIUM CEREBELIL, Met
metho
| : tale | : coeffic
| Thickness of Diffusion Diffusion a hu
No. Sex Age Tentorium Coefficient of Coefficient of imple
| Years mm. Carbon Dioxide Glucose simp ‘
| | signifi
| : the a
1. | M. 1 0,636 0.000326 0.000156 samp]
me toe 8 10 0.652 0.000524 0.000054 and tl
3. | “ES ASS 0.381 0.000325 0.000121
4. s | = 0.543 (0.000498 0.000165
ah ee | a5 0.314 0.000285 | 0.000128 | 1 Hil
6. | oe ae 0.437 0.000632 | 0.000145 Aci
noe Les Aig)! MRL ore Ei A eS See aD Ser
Mean 0.495 0.000432 | 0.000128 2. Joh
SE ee De = | i. De
7. M 31 0.503 0.000372 | (0.000150 anc
8. F 35 0.618 0.000527 | 0.000112 Ch
9, M. 41 0.733 0.000520 | (0.000126 3. Kir
10. M. 44 0.468 0.000425 0.000150
11. M. | 44 0.425 0.000292 0.000106
12. M 45 0.324 (0.000388 0.000095
13. M 47 0.482 0.000434 | (0.000104
14. F | 48 0.466 ().000471 0.000108
15. M. | 49 0.515 0.000417 0.000094
|
Mean 0.504 0.000428 0.000100
|
16. F. 50 0.507 0.000483 | 0.000134
17. M. 51 0.424 0.000483 0.000126
18. M. 52 0.636 0.000495 | 0.000117
19, a a | 0.599 0.000469 0.000098
20. M. 55 | 0.615 | 0.000497 0.000122
21 M. 56 | 0.612 | 0.000441 0.000101
22 M. 56 | 0.557 | 0.000537 0.000129 ;
23 oe ie | 0.444 0.000285 0.000109
24 M. | $8 | 0.528 | 0.000429 0.000089 |
25 M. | 59 0.564 | 0.000461 | 0.000136 f
Mean 0.549 0.000458 | 0.000116
26. M. 60 0.634 0.000346 0.000082
27. F. 62 0.455 0.000509 (0.000167
28. M. 63 0.592 0.000348 0.000130
29. M 64 0.461 0.000400 0.000130
30. M 65 0.477 0.000313 | 0.000153
31. F. 65 0.667 | 0.000697 0.000178
32. M. 66 0.700 0.000406 | 0.000081
33. M 66 0.493 0.000475 | 0.000105
34. M 67 0.557 0.000483 | 0.000115
35. M 78 0.537 0.000510 | 0.000134
Mean | 0.557 0.000449 0.000128
Grand Mean 0.531 0.000444 | 0.000121
REBELL,
~
ee ed a
CONNECTIVE TISSUE PERMEABILITY AND AGE
SUMMARY
Measurements were made at 37 C. by the
method of Johnsen and Kirk of the diffusion
coefficients of carbon dioxide and glucose for
a human connective tissue membrane of
simple structure (cerebellar tentorium). No
significant correlation was observed between
the age of the individuals from whom the
samples were derived (range 1 to 78 years)
and the diffusion coefficients for these solutes.
REFERENCES
1. Hill, A. V.: The Diffusion of Oxygen and Lactic
Acid Through Tissues. Proc. Roy. Soc., London,
Ser. B, 104: 39-96, 1928-1929.
. Johnsen, S. G., and Kirk, J. E.: A Procedure for
Determination of Diffusion Coefficients of Gases
and Non-Gaseous Solutes for Membranes. Analyt.
Chem., 27: 838-840, 1955.
3. Kirk, J. E., Effersge, P. G., and Chiang, S. P.:
tr
9.
305
The Rate of Respiration and Glycolysis by Human
and Dog Aortic Tissue. J. Gerontol., 9: 10-35,
1954.
Kirk, J. E., and Hansen, P. F.: A Procedure for
Determination of the Respiration of Tissue Ho-
mogenates. J. Biol. Chem., 199; 675-687, 1952.
Nelson, N.: A Photometric Adaptation of the
Somogyi Method for Determination of Glucose.
J. Biol. Chem., 153: 375-380, 1944.
Pletscher, A., Staub, H., Hunzinger, W., and
Hess, W.: Zum Kohlenhydratstoffwechsel. I. Mit-
teilung. Helv. Physiol. Acta. 8: 306-316, 1950.
Somogyi, M.: Notes on Sugar Determination.
J. Biol. Chem., 195: 19-23, 1952.
Van Slyke, D. D., and Neill, J. M.: The De-
termination of Gases in Blood and Other Solutions
by Vacuum Extraction and Manometric Measure-
ment. I. J. Biol. Chem., 61: 523-573, 1924.
Wright, C. I.: The Diffusion of Carbon Dioxide
in Tissues. J. Gen. Physiol., 17: 657-676, 1933-
1934,
LACK OF ADAPTATION TO LOW OXYGEN PRESSURE IN AGED ANIMALS
E. FLUCKIGER, D.Sc., AND F. VERZAR, M.D.
(From the Physiological Institute, University of Basel, Basel, Switzerland)
Adaptation to a barometric pressure of
about half an atmosphere, or the equivalent
low partial oxygen pressure, necessitates vari-
ous adjustments in the animal body. Respira-
tion and circulation, as well as erythrocyte
and hemoglobin production, are changed.
We found (1) it to be a very characteristic
phenomenon that, in rats, after lowering the
atmospheric pressure to 350 mm. Hg (cor-
responding to 6,500 M. simulated altitude),
the rectal temperature drops several degrees
in a few hours. In about 4 or 5 days body
temperature is restored to normal, although
the pressure was kept low. It was also
demonstrated (2) that rats kept at 350 mm.
Hg for a fortnight developed a status, which
we called “retained adaptation,” i. e., if these
animals were brought to atmospheric pres-
sure (732 mm. Hg at Basel) and within a few
days returned to 350 mm. Hg, only a slight
decrease in rectal temperature was observed.
At 732 mm. Hg this status of retained adapta-
tion slowly returned to the full reaction, until,
10 days later, when exposed to 350 mm. Hg,
the same drop of rectal temperature was seen
as originally.
This drop of temperature and its restora-
tion to normal is an objective sign of adapta-
tion which can easily be observed. We have
used this phenomenon in the present publica-
tion to investigate whether this adaptation to
low pressure is the same in young, adult, and
aged animals.
METHODS
The technique of these experiments was
similar to that employed in our earlier studies
(1). Sixty-four white male rats of our labora-
tory stock, 45 to 570 days old, were used in
groups of 4 animals for each age level, giving
a total of 16 groups. Of these, 2 groups were
tested more than once: 1 group was studied
when 2% and 4% months (70 and 135 days)
old (experiments 74b and 79b), and 1 group
was tested at the age of 12, 14, and 20 months
(360, 420, and 600 days) (experiments 74a,
79a, and 85a).
~ Submitted for publication December 15, 1954.
Published on a grant from the Forest Park Foundation to
the Journal of Gerontology.
The rats were fed with a standard diet ad
libitum. They were placed in a tank of about
125 L. capacity, in which the pressure was
diminished to 350 mm. Hg and kept constant
at about + 10 mm. Hg. At 350 mm. Hg
there was an air flow through the tank of
about 4.5 L. per minute. The temperature
within the tank was about 22 C. During the
first 24 hours the tank was opened several
times in order to observe the drop in rectal
temperature. During the next days the tank
was only opened once daily, the animals taken
out for about 20 minutes, and their rectal
temperature measured with a mercury ther-
mometer. This was done regularly at about
10 to 11 a.m., 24 hours after the last feeding.
Afterwards the rats were placed back into
the tank, with fresh food and water. The tank
was equipped with a window allowing ob-
servation of the behavior of the rats. The
weight of the animals was taken at regular
intervals and in several series also blood hemo-
globin was measured by the Sahli method.
Retained adaptation was tested in 13 of
the 16 groups. This was done in the follow-
ing way: After a period of about 14 days of
adaptation to 350 mm. Hg the rats were kept
at 730 mm. Hg for 48 hours and then exposed
again to 350 mm. Hg. Since retained adapta- |
tion never lasts longer than about a fortnight,
there is no danger that the reaction at a later
trial was influenced by the first exposure to
low barometric pressure. However, the re-
sults in these groups were checked with the
other groups which were only used once.
RESULTS
The results of our experiments are tabu-
lated as mean values for each group in table
1. There are always individual differences
in each group. The drop of body temperature
and the time in which normal body tempera-
ture is restored should be compared. Ex-
amples of temperature curves of different age
groups are shown in figure 1 and 3.
Table 1 shows that there is no difference
in the initial drop of rectal temperature be-
tween young and old animals; their maximal
value was 5.3 C. in 6 weeks (42 days) old
306
Series
93
67
83 b
91
81 b
741
85
80
74
83
89
85
LS
diet ad
F about
re was
onstant
m. Hg
ank of
erature
ing the
several
rectal
e tank
; taken
rectal
, ther-
about
eding.
k into
e tank
1g ob-
The
egular
hemo-
nod.
13 of
ollow-
ays of
> kept
posed
lapta-
night,
| later
ire to
1e re-
h the
ice,
tabu-
table
ences
ature
pera-
Ex-
t age
rence
> be-
<imal
) old
ADAPTATION TO LOW OXYGEN PRESSURE 307
TABLE 1. Boor TEMPERATURE ADAPTATION 0 OF F Rats TO REDUCED BAROMETRIC PRESSURE.
| =F |
} | \ | \
| | |
| |
| Adaptation Retained Adaptation
Age and seal og gps iS. sah a 1, ae ee a. ea :
Series | Numberof | | | Rt Restored | RtRestored | Remarks
| Animals | Rt*at | Maximal} =| Rt at | Maximal ks ee
| | Beginning | Drop of | | | Beginning | Drop of | | |
| (C) | Rt(C.)| Day | Rt CC.) | €C) | RECC)) Day | Rt (°C.)
|
al _ — | ————__—_——— 2 — |—-——— a RY ——_$—$ $ —|§ —$ $$ | ———— ——___— — ———
93 | S4weeks | 37.55 | 4.7 £81 RS Gere Se =
n=7 |
67 | Gweks | 376 | 53 | 4. | 37.4 | 37.2 22 | 4. 37.0 | 72 hours at
n=5 730 mm. Hg
83 b 8 weeks 37.2 3.4 3. 79 | WA 1.8 1. 37.2
n=4 }
88 8 weeks 37.4 | 5.2 7 37.4 | 37.0 | 2.7 2 36.9
n=4 |
| | | | |
9 CO 9 weeks 37.3 4.1 5. 37.2 | ah op o —
n=4
| |
81b | 9 weeks 37.6 3.4 4. | 888 37.5 | 3.2 2. 37.4
n=4 | |
| | |
74b | 2%months | 38.0 4.5 5. | 37.9 ws | os ts. 37.7
n=4
9 | 3months | 37.3 4.6 5. | BS - | - — —
n=4 |
| |
79b | 414 months Sy.i 28 5. | 38.0 | Be 1-33 2. 37.8
n=4 |
85b | 5 months 73.2 3.4 4. | 372 | 37.2 | 1.9 :. 37.1
n=4 |
80 | 7months 37.2 4.2 4. 37.3 | 36.4 10 | 1. 36.5
n=4 | |
| | ;
74a 12 months 38.1 4.7 5 | Be | Ws | 2.3 3. 37.3 no restoration}
n=4 10. | 36.3
| | |
83a | 14months | 37.4 | 3.5 5. 35.8 | 37.3 | 2.6 $. 36.0 no restoration
n=4 10. 36.0 |
79a | 14months | 38.0 5.2 5. 36.3 37.4 4.1 2. 35.6 no restoration
n=4 | 10. -| 36.0 |
89 | 19months | 37.6 5.3 om | 35.2 37.4 | 3.8 | 3. 35.4 no restoration
ait }- 10. | 36.1 | |
16 36.1 | |
85a | 20months 37.2 | 4.9 5. | 36.6 | 37.2 3.8 3. 35.6 | no restoration
paeey” | l b> ia. | 35.4 |
| ees See ee
*Rt = - Rectal temperature in °C. at 10:00 to 11:00 a.m.
+No restoration of Rt having taken place Rt values are given for certain days.
308
(group 67) as well as in 19 months (570
days) (group 89) old rats.
The difference between young and old rats
lies in the ability to restore the original body
temperature. In 40 to 210 day (7 months)
old animals, restoration is complete in 3 to
5 days; on the third day of low pressure their
rectal temperature is mostly above 37 C. and
often as high as 37.8 to 38.0 C. Figure 1
shows one of these groups. The 20 rats of
12, 14, 19, and 20 months of age (groups 74a,
83a, 79a, 89, 85a) were unable to restore their
body temperature, and figure 3 is an example
of how restoration of the body temperature is
often at first attempted and how later it again
falls. On the tenth day at low pressure body
temperature was between 35.4 and 36.3 C.
Thus, in the course of aging, the rats lose
the ability to restore normal body tempera-
ture at low oxygen pressures.
Retained adaptation, i. e., the reaction to
350 mm. Hg of formerly adapted rats after
2 to 3 days of a pressure of 732 mm. Hg to
a new decreased pressure of 350 mm. Hg
was also different in old animals. The oldest
groups (79a, 89, 85a) showed the largest drop
in body temperature, as much as without a
previous adaptation. More characteristic is
that while the young animals restored body
temperature within one to two days (fig. 2)
o oy"
4 \. #
\
Exp. 748
02468 12h12 4 6 9d
Fic. 1. Series 74b, 4 male rats, 2% months old,
adaptation to 350 mm. Hg in 2 days.
FLUCKIGER AND VERZAR
in the rats of 14, 19, and 20 months of age
there was no return to normal body tempera.
ture, even after the third day of exposure to
low barometric pressure. Some of the old
animals died after exposure to low atmos.
pheric pressure (fig. 4), which never oe.
curred with young animals.
It is known that exposure to low barometric
pressure, especially during the first few days,
results in a decrease of body weight, or in-
hibits growth in young animals through a de-
crease of food intake (4) and the body water
content (3). The data shown in table 2 are
examples,
In order to characterize the influence of
low barometric pressure on the different age
groups by another criterion, the hemoglobin
of the blood from the tip of the tail was de-
termined in several series. In rats 2 months
*
5
i
' -33
i A fA. A is A i A
02468 12h
12h 1 2d
Fic. 2. Retained adaptation of the same animals
(Series 74b) after 48 hours at 730 mm. Hg and then
again at 350 mm. Hg.
TABLI
old tl
durin
(grou
in he
of ex
the te
globir
value:
posur
<
38
37
36
35-
344
334
32-
4
31-
30
|
0
Fic
incon
of age
"mM pera-
sure to
the old
atmos-
ver 0c.
ometric
Vv days,
or in-
h a de.
/ water
» 2 are
nce of
nt age
globin
ras de-
nonths
7
36
.
37
-36
imals
then
ADAPTATION TO LOW OXYGEN PRESSURE
TABLE 2.
Age and Mean
Series Number of Initial
Male Rats | Weight (Gm.)
83 b 2 months 98
n=4
88 2 months 89
| ne=4
91 | 9 weeks 115
ne-=4
80 7 months 216
ne=4
83a 14 months 334
| ne=4
|
89 | 19 months 289
n=4 |
old the hemoglobin changes were followed
during the first 5 days by daily determinations
(group 83b). It was found that an increase
in hemoglobin started only on the fifth day
of exposure, reaching 130-142 per cent on
the tenth day (100 per cent = 16 Gm. hemo-
globin per 100 cc.). In table 3 hemoglobin
values estimated after different periods of ex-
posure to 350 mm. Hg are shown. The mean
i.
38 }
37
31-
30-
d Eup. 698
02468 12h12 4 6 913d
Fic. 3. Series 89b, 4 male rats, 19 months old,
incomplete adaptation to 350 mm. Hg.
309
CHANGES IN WEIGHT OF MALE Rats OF DIFFERENT AGES Exposep T0 Low OxyYGEN PRESSURE.
Mean
Days at Weight Difference
350 Mm. Hg (Gm.) (Gm.)
10 102 + 4
17 94 +5
15 108 - 7
10 202 | ~14
10 309 | —25
17 275 | —23
=
hemoglobin content at 732 mm. Hg of 14
rats 2 to 14 months old was found to be 106
per cent (range 99-115) when 100 per cent
= 16 Gm. Hb per 100 ml. From the table
oC
4 38
-
37
-36
+35
rm r’ ‘
02468 12h 12 4 6d
Fic. 4. No retained adaptation of the same ani-
mals (Series 89b) after 48 hours at 730 mm. Hg
and then again at 350 mm. Hg.
310 FLUCKIGER AND VERZAR
TABLE 3. CHANGES IN MEAN BLOOD HEMOGLOBIN IN MALE Rats AT DIFFERENT AGEs,
ExPosED TO Low OxYGEN PRESSURE.
Se as ——.
Age and Mean Lowest
Series Number of Days at Hemoglobin % and Highest
Animals 350 Mm. Hg (100 = 16 Gm. %) | Value
Controls at 732 mm. Hg...... 2-14 months — 106 99-115
n= 14 |
|
Bisa eich e esl awehises 2 months 10 }
n=4 | |
} 137 | 125-145
edi he ah i ovine eikss acta oa 9 weeks 10 |
n=4 }
rE soote ioe Siig! ie eg! Soni OO 314 months 14 166 146-180
n=4
|
IS SE OE, Aa peal Sees 14 months 10 158 155-166
n=4
SEES eee eRe Te Tar 20 months 11 149 146-152
n=4 |
it follows that the capacity of the rats to in-
crease the blood hemoglobin did not diminish
up to 20 months of age (table 3).
DISCUSSION
It is not definitely known what causes the
drop of body temperature at the beginning of
the exposure to low partial oxygen pressure.
Since there are no proofs of altered blood cir-
culation under low pressure, the most prob-
able explanation is a diminished heat produc-
tion. Then in the course of adaptation of the
young animals, the metabolism which is neces-
sary for normal heat production is increased.
In aged animals, however, this increase in
metabolic activity to restore and maintain
normal body temperature, i. e., their adapta-
tion capacity, is diminished; they are also
barely able to reach a state of adaptation
which can be retained when kept at 732
mm. Hg.
This inability to adapt to low oxygen pres-
sure is an astonishingly early sign of aging.
It is, so far, the only example of functional
adaptation which disappears with age that
we were able to observe.
Our experiments show at the same time
that the reactivity of the bone marrow in re-
spect to hemoglobin production under low
oxygen pressure was not decreased in the
old animals. This finding is in line with the
results of other experiments, where no de-|
crease in compensatory hypertrophy of the
kidney or of the adrenal cortex could be seen
in old animals (5).
From this point of view the demonstration
of a decrease of metabolic adaptation to low
oxygen pressure in aging rats becomes an es-
pecially interesting sign of aging.
SUMMARY
1. Adaptation to low barometric pressure
(350 mm. Hg) was studied in 64 male rats
between the ages of 45 to 570 days (2 to 20
months ).
2. Adaptation was tested by the decrease
and the restoration of body temperature dur-
ing 15 days’ continuous exposure to a low
atmospheric pressure of 350 mm. Hg. In
addition retained adaptation was also tested
after an additional study of 48 hours at nor-
mal barometric pressure (732 mm. Hg at
Basel).
3. Fourteen to 20 month old rats are com-
pletely unable to restore the normal body
temperature after the initial drop during the
first few hours of exposure to low barometric
pressure. They also show a decreased re-
tained
the find
4, Tl
the inc
young ‘
day ex:
1. Fliick
titutic
mosp
reoid
diese
349-<
west
Highest
ilue
115
-145
-180
—166
-152
rith the
no de. |
of the
re seen
‘tration
to low
an es-
ressure
le rats
. to 20
crease
e dur-
a low
z. In
tested
t nor-
Ig at
- com-
body
ig the
netric
d re-
ADAPTATION TO LOW OXYGEN PRESSURE
tained adaptation. This is in contrast to
the findings in young animals.
4. There is no significant difference in
the increase of blood hemoglobin between
young and old rats in response to a 10 to 15
day exposure to 350 mm. Hg.
REFERENCES
|, Fliickiger E., and Verzar, F.: Senkung und Res-
titution der Kérpertemperatur bei niedrigem at-
mosphirischem Druck und der Einfluss von Thy-
reoidea, Hypophyse und Nebennierenrinde auf
dieselbe. Helvet. physiol. et pharmacol. acta, 10:
349-359, 1952.
2.
3.
311
Fliickiger, E., and Verzar, F.: Ueberdanern der
Adaptation an niedrigen atmosphirischen Druck,
nachgewiesen an der Wiirmeregulation. Helvet.
physiol. et pharmacol. acta, 11: 67-72, 1953.
Picon-Réategui, E., Fryers, G. R., Berlin, N. L.,
and Lawrence, J. H.: Effect of Reducing the At-
mospheric Pressure on Body Water Content of
Rats. .Am. J. Physiol., 172: 33-36, 1953.
Sundstrém, E. S., and Michaels, G.: The Ad-
renal Cortex in Adaptation to Altitude, Climate
and Cancer. University of California Press, Berk-
eley and Los Angeles, 1942, p. 47
Verzar F., and Fliickiger, E.: Adaptation to Low
Atmospheric Pressure. Symposia and Abstracts,
International Association of Gerontology, Third
Congress, 1954, p. 263.
THE EFFECT OF AGE UPON THE RELATIVE GONADAL
ADRENOCORTICAL
ACTIVITY OF THE MALE
SIDNEY PEARSON, Ph.D., AND THOMAS H. McGAVACK, M.D.
(From the New York Medical College, Metropolitan Hospital Research Unit, New York, New York)
It is generally accepted that gonadal se-
cretion of testosterone by males decreases
with increased age, whereas adrenocortical
activity either remains constant or does not
decrease as much as testicular function in
the same period. Because the secretion of
steroids by the testes and adrenal cortex
plays a vital role in the metabolic processes
in the body, a-knowledge of the gonadal and
adrenocortical activities may be very helpful
in any evaluation or treatment of the aged.
One measure of gonadal function is the
androgenic activity of the urinary 17-keto-
steroids, for androsterone, a major androgenic
constituent in these steroids, is one of the two
principal metabolites of testosterone (2, 3,
6). The colorimetric assay of the urinary 17-
ketosteroids by the Zimmermann reaction is
considered by most people to be a measure
of gonadal activity, but Hamilton (4) cast
doubt upon this assumption on the basis of a
comparison of bioassay of androgens and
assay by the Zimmermann reaction and a re-
view of the data of earlier workers. In this
laboratory a chromatographic procedure has
been in use which can be performed more
easily than bioassay by most clinical labora-
tories and which may provide an index of
gonadal activity and of relative gonadal-
adrenocortical function.
PROCEDURE
Twenty-four hour urine samples were col-
lected over periods ranging from 1 through
12 days. The neutral 17-ketosteroids ex-
creted by young, aged, and hypogonadal
males were chromatographed over alumina
and benzene, 0.1 per cent ethanol in benzene,
0.5 per cent ethanol in benzene, and ethanol
as described by Wilkins and Carlson (7).
A total of 44 fractions were obtained. The
Zimmermann reaction (5) was used to meas-
ure the ketosteroids.
~ Submitted for publication December 30, 1954.
Presented at the Seventh Annual Scientific Meeting of the
Gerontological Society, Inc., Gainesville, Florida, December
28-30, 1954.
Patients S, T, CY, B, D, JS, JD, P, SW, and
W were normal males. Patient SJ had Paget's
disease, C was agonadal, and ST and M were
hypogonadal males.
Solutions of crystalline steroids were also
chromatographed.
RESULTS
Figure 1 is the chromatogram of the urinary
17-ketosteroids excreted by a normal 20 year
old male in a 24-hour period. The chroma-
togram has been divided into 5 areas. That
fraction which contained less steroids than
the following fraction was taken as the end
of an area. The sum of the steroids in the
fractions which make up each area represents
the excretion of a distinct steroid or group of
steroids. In table 1 are the data which show
what percentage of the daily neutral urinary
17-ketosteroids were found in each of the
5 areas.
CHROMATOGRAM OF URINARY I7-KS
OF NORMAL 20 YEAR OLD MALE
AREA
e70}- \ a ae 3 ‘ es *
240). . :
: :
o J '
2 210).
< ;
S ' :
© 180,
« '
cS) ‘
= 150). ;
‘
4
S 120}.
«
a
- 90
°o
Y
w 60.
=x
30)
°. a sonnei =
5 oo te 8s Bw MH. 0 6 Se
FRACTION
Figure 1.
When androsterone was chromatographed,
it appeared in area 3. Etiocholanolone ap-
peared in area 4, and 11-hydroxyetiocholano-
lone was eluted in area 5.*
~ ©Crystalliine steroids were supplied by Dr. E. L. Hender-
son, Schering Corp., Dr. J. R. Jewel, Ayerst, McKenna and
Harrison, Ltd., New York, New York, and Dr. H. Rudel,
Chas. Pfizer & Co., New York, New York.
312
On 1
pected
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Emp
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that tl
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neutral
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Su
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That
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iphed,
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Hender-
ma and
Rudel,
RELATIVE GONADAL ADRENOCORTICAL ACTIVITY IN THE MALE
DISCUSSION
On theoretic grounds area 3 might be ex-
pected to be a measure of androgenic activity
of the urinary steroids. Androsterone, which
is derived principally from testosterone, is
the main contributor to this androgenic ac-
tivity and this steroid appears in area 3 when
chromatographed.
Empirically, it would also seem that the
percentage of steroids in area 3 is a measure
of gonadal function. The agonadal male, C,
had a very low percentage of his steroid in
this area, and with one exception, W, the
aged and hypogonadal men had a smaller
percentage of their steroids in area 3 then
did the young men. Therefore, it would seem
that the percentage of 24-hour urinary 17-
ketosteroids in area 3 is a possible measure
of testosterone production in the male. If
this is true, then the 24-hour urinary 17-
ketosteroid excretion is not a measure of gon-
adal activity or androgenic potency of the
urinary 17-ketosteroids for there was no cor-
relation between the total 24-hour urinary
neutral 17-ketosteroids and the percentage
of these steroids in area 3 (table 1). The
313
greater ketosteroid excretions of B, D, and
SW were apparently not due to greater gon-
adal activity.
Etiocholanolone, which with androsterone
is a major urinary 17-ketosteroid metabolite
of testosterone (2, 3, 6) appears in area 4
when chromatographed. However, a large
part of urinary etiocholanolone precursors
originate in the adrenal cortex. By chromato-
graphic methods one cannot distinguish be-
tween etiocholanolone derived from. testo-
sterone and that which originates in the ad-
renal cortex and, therefore, area 4 would not
be expected to be an effective measure of
gonadal or adrenocortical function. The data
in table 1 show no significant difference in
the percentage of steroids in area 4 between
the groups studied.
Since areas 3 and 4 contain androsterone
and etiocholanolone which together probably
make up more than 90 per cent of the urinary
17-ketosteroid metabolites of testosterone, the
steroids in the other areas, 2 and 5, are most
likely derived almost entirely from corticos-
teroids; the steroids in area 1 are probably
artefacts derived from androsterone (1) and
so are not included as corticosteroid deriva-
RESULTS OF CHROMATOGRAPHIC FRACTIONATION OF 24-HoUR NEUTRAL URINARY 17-KETOSTEROIDS.
% of Urinary 17-Ketosteroids in Area
TABLE 1.
Average 24-Hour |
17-Ketosteroids
Subject Age
Mg.* | Days | 1 2
. ae 20 22.8 2 2.8 5.5
a ae 21 21.0 2 1.6 77
re 21 | 68] 1 | 60] 69
JD... 53 8.5 | 5 8.9 | 12.1
ee 53 “31 4 4.9 | 24.4
¥:,, 57 64 | 4 3.8 | 17.1
a 58 10.3 2 93 | 36.5
Js 60 71 4 2 ae
D 63 13.3 3 4.5 | 13.2
W 70 9.2 12 9.8 13.7
SJ. 75 6.2 | 6 1.7 | 68
C 43 7.0 2 0.8 | 29.0
M 63 7.4 2 3.8 19.9
St 67 6.3 1 3.4 8.4
Remarks
2+ 5
3 4 5 | 2+5 oe
54.9 | 30.4 | 6.4 | 11.9 | 0.22 | None
49.1 32.4 9.2 | 16.9 | 0.34 | None
68.2 | 144 | 4.5 | 11.4 | 0.17 | None
24.6 | 40.3 | 14.1 | 26.2 | 1.06 | None
9.4 | 48.3 | 13.0 | 37.4 | 3.98 | None
10.7 | 50.7 | 17.7 | 34.8 | 3.25 | None
12.0 | 21.8 | 20.4 | 56.9 | 4.74 | None
16.2 | 45.0 | 12.4 | 35.7 | 2.20 | None
28.9 | 38.6 | 14.8 | 28.0 | 0.97 | None
43.0 | 26.3 | 7.2 | 20.9 | 0.49 | None
25.5 | 48.5 | 17.5 | 24.3 | 0.95 | Paget’s Disease
|
7.7 | 51.2 | 11.3 | 40.3 | 5.24 | Agonadal
15.5 | 36.2 | 14.6 | 34.5 | 2.23 | Hypogonadal
27.6 | 418 | 27.2 | 0.99
|
18.8 | | Hypogonadal
| |
*The data are average values for urine excreted in 1 to 12 days.
314
tives. The percentage of steroids found in
these areas, 2 and 5, should increase as testi-
cular activity decreases, and it was found
that the aged, hypogonadal, and agonadal
men had a higher percentage of their urinary
17-ketosteroids in areas 2 and 5 than did the
young men.
The relative activity of the adrenal cortex
and the gonads may be important because net
metabolic effects of mixtures of steroids may
be a function of hormonal balance, i.e., rel-
ative amounts of the steroids present. The
ratio of the percentage of the steroids in areas
2 and 5 to the percentage in area 3 should
be a measure of this relative activity. As
testicular activity decreases this ratio should
increase if there is not a corresponding de-
crease in adrenocortical activity. The higher
values of this ratio that were found in the
older men and those with reduced testicular
activity indicate that, in the aged, adrenocor-
tical activity either does not decrease or does
not decrease as much as gonadal activity.
SUMMARY
1. Aliquots of 24 to 72-hour urinary neutral
17-ketosteroids excreted by 3 young, 8 aged,
1 agonadal, and 2 hypogonadal men were
chromatographed.
2. The chromatographically obtained data
support the generally accepted belief of a de-
creased testicular activity in the aged.
3. Data are presented which indicate that
the 24-hour excretion of neutral urinary 17-
ketosteroids is not necessarily a measure of
gonadal activity or androgenic potency of the
urinary 17-ketosteroids.
PEARSON AND McGAVACK
4. It is suggested that chromatographic
separation of urinary neutral 17-ketosteroids
may be a simpler method for the measure.
ment of gonadal activity or androgenic po.
tency of these steroids than is the procedure
for the bioassay of androgens.
The authors would like to thank Mr. George R,
Schism for his technical assistance in this work.
REFERENCES
1. Dingemanse, E., Huis in’t Veld, L. G., and Har-
togh-Katz, S. L.: Clinical Method for Chromato-
graphic-Colorimetric Determination of Urinary
17-Ketosteroids; Normal Adults. J. Clin. Endo-
crinol. & Metab., 12: 66-85, 1952.
2. Fukushima, D. K., Bradlow, H. L., Dobriner, K,
and Gallagher, T. F.: The Fate of Testosterone
Infused Intravenously in Man. J. Biol. Chem,
206: 863-874, 1954.
3. Fukushima, D. K., Dobriner, K., and Gallagher,
T. F.: Studies with Testosterone-d in Normal
Men. J. Biol. Chem., 206: 845-861, 1954.
4. Hamilton, J. B.: Androgenic Activity per Mill-
gram of Colorimetrically Measured Ketosteroids in
Urine: An Index of the Respective Contributions
from Testicular and Extra-Testicular Sources. J.
Clin. Endocrinol. & Metab., 14: 452-471, 1954.
5. Pearson, S., and Giaccone, S.: A Rapid Modifica-
tion of the Zimmermann Test for Ketosteroids ( Ab-
stract). J. Clin. Endocrinol., 8: 618, 1948.
6. West, C. D., Reich, H., and Samuels, L. T.: Urin-
ary Metabolites after Intravenous Injections of
Human Subjects with Testosterone. J. Biol.
Chem., 193: 219-226, 1951.
7. Wilkins, R. B., and Carlson, L. D.: Qualitative
Studies of Neutral 17-Ketosteroids in Normal Sub-
jects. J. Clin. Endocrinol. & Metab., 12: 64T-
665, 1952.
In a
that t
charact
compa:
mental
domin¢
amoun
ever, V
with st
normal
individ
determ
change
In the
an inc
ease ir
viated
study
tion b
the oc
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The
descril
associ
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54 yea
ure an
rhythr
studie
rangin
four ¢
had b
EEGs
had su
Roma
of cas
slow
Straus
descri
cardia
and c
found
Subm
°Dr.
Connect
Departn
graphic
steroids
1easure-
nic po-
ocedure
eorge R.
rk.
ind Har.
hromato-
Urinary
1. Endo-
‘iner, K,
tosterone
Chem,
allagher,
Normal
L.
ar Milli.
roids in
‘ibutions
rces, J,
1, 1954,
fodifica-
ds ( Ab-
.
: Urin-
ions of
J. Biol.
alitative
ial Sub-
2: 647-
h
THE ELECTROENCEPHALOGRAM OF AGED PATIENTS WITH
CARDIAC AND CEREBRAL VASCULAR DISEASE
W. D. OBRIST, Ph.D., AND L. F. BISSELL, M.D.*
(From The Moosehaven Research Laboratory, Orange Park, Florida)
In a recent study evidence was presented
that the electroencephalogram undergoes
characteristic changes in old age (17). When
compared with young adults, the EEGs of
mentally normal old people have a slower
dominant (alpha) rhythm and a greater
amount of slow (delta) wave activity. How-
ever, wide individual differences were found,
with some people up to 90 years old having
normal, young-adult records. Because of this
individual variation, it becomes of interest to
determine what factors might be related to
changes in the aged electroencephalogram.
In the above group there was a tendency for
an increased incidence of cardiovascular dis-
ease in individuals whose EEGs markedly de-
viated from young adult norms. The present
study was undertaken to determine the rela-
tion between brain wave characteristics and
the occurence of clinical heart disease and
cerebral vascular disease in aged subjects.
The literature contains several references
describing electroencephalographic changes
associated with cardiac and cerebral vascular
disease. In 1933, Berger (1) presented a
54 year old patient with congestive heart fail-
ure and mental changes who had a slow alpha
thythm (6-7 c./sec.). Ewalt and Ruskin (8)
studied a group of patients with heart disease,
ranging from 18 to 81 years of age. Twenty-
four of 25 patients with congestive failure
had bursts of 3-4 c./sec. slow waves in their
EEGs, and 10 out of 26 patients not in failure
had such slow waves. Ina paper on delirium,
Romano and Engel (18) presented a number
of cases with cardiac failure and prominent
slow waves in the electroencephalograms.
Strauss, Ostow, and Greenstein (26) have
described several abnormal EEGs in patients
with cardiovascular disease. In 21 cases ‘of
cardiac insufficiency with pulmonary disease
and cyanosis, Stuhl, Cloche, and Kartun (27)
found a slow alpha rhythm and the occurrence
Submitted for publication January 21, 1955.
*Dr. Obrist is currently at the Institute of Living, Hartford,
Connecticut, and Dr. Bisseli is at the University Hospital,
Department of Internal Medicine, Ann Arbor, Michigan.
315
of delta waves in over half of the records.
Hann and Franke (11) obtained a marked
slowing of the EEG during cardiac asystole
in patients with hypersensitive carotid-sinus
syndrome.
The electroencephalogram has also been
found to have abnormal slow waves in cases
of cerebral arteriosclerosis with psychosis
(15). In cerebral thrombosis and hemor-
rhage, Strauss and Greenstein (25) and Cohn
and associates (3) have shown that delta ac-
tivity may appear in the EEG, depending on
the severity and depth of the lesion. That
these delta waves are often transient in nature
and may improve with the clinical status of
the patient was demonstrated by Roseman,
Schmidt, and Foltz (19), who made serial
recordings.
The clinical studies cited above suggest that
alterations in circulatory dynamics can pro-
duce EEG abnormalities by depriving the
brain of oxygen and essential foodstuffs. It
is well established that the central nervous
system has the most exacting metabolic re-
quirements of the body. Unlike other tissues,
its metabolism is primarily aerobic and it is
unable to incur any significant oxygen debt.
This is reflected in the sensitivity of the elec-
troencephalogram to even mild hypoxia,
which produces a slowing of the alpha fre-
quency (2). A more severe degree of oxygen
lack results in the appearance of delta ac-
tivity (5). Similar EEG changes have been
found to occur in hypoglycemia. Engel and
Margolin (6) emphasize the relationship of
these metabolic factors to the electroenceph-
alogram. They present a series of cases in
which EEG abnormalities accompany states
of cerebral anemia, anoxemia, and _alterc:|
glucose metabolism. According to Engel and
Romano (7), some of these abnormalities are
reversible with the appropriate therapy, e.g.,
oxygen administration.
The above findings suggest a partial ex-
planation for the electroencephalographic
changes found in old age. Diseases of the
circulatory system are common in old people,
316
and it seems reasonable to assume that de-
ficiencies in the blood supply to the brain
may produce alterations in cerebral meta-
bolism. Physicians have for many years ob-
served the relation between cardiovascular
disease and mental changes. The EEG offers
a possible means of evaluating the influence
of cardiovascular disease upon cerebral meta-
bolism and mental function.
When approaching the problem of elec-
troencephalographic changes in chronic dis-
ease of old age it is essential to compare the
records with those of a group of healthy in-
dividuals. Most of the previous studies on
cardiac and cerebral vascular disease have
failed to include a normal control group of
similar age. The present investigation was
designed to permit such a comparison.
MATERIAL AND METHODS
Sixty males ranging in age from 66 to 91
years were the subjects of this experiment.
All were residents of Moosehaven, a home
operated by the Loyal Order of Moose for
its retired members. Subjects were selected
for study on the basis of a preliminary inter-
view. Those with a history of epilepsy, severe
head injury, neurosyphilis,* or diabetes were
eliminated from the sample. The subjects
were then classified into a group of normal
controls (21 cases) and into 3 groups with
vardiovascular disease (39 cases). The
criteria and procedures used for this classifi-
vation are outlined in detail below.
An attempt was made to rule out cases
with advanced pulmonary, renal, or hemato-
*One case of late latent hues was included.
OBRIST AND BISSELL
logic diseases. Because of the limited number
of subjects available for study, a few indi.
viduals with such disorders were of neces.
sity included in the sample. In the normal
control group there were 3 cases of chronic
bronchial asthma and emphysema. In the
total cardiovascular group there was 1 case
with chronic bronchial asthma and emphy-
sema, | case with hypertrophic emphysema,
6 with anemia (Hgb. 9-10 Gm./100 ml.) and
2 with probable nephrosclerosis. It was be.
lieved that the inclusion of these cases in the
sample would not greatly interfere with the
interpretation of the results.
A break-down of the sample is presented in
table 1, showing the number of cases and
mean age of each of the groups. None of
the normal group were hospitalized or in
a convalescent status, but better than a third
of the total cardiovascular group were in
the hospital or were convalescent. All of the
normal subjects were working from three to
eight hours per day doing light maintenance
and kitchen tasks, whereas less than half of
the cardiovascular group were so engaged.
The hospitalization, work status, and _ intelli-
gence of the various groups are also shown
in table 1. Although there was obvious men-
tal deterioration in some individuals and a
few had personality disturbances, none of the
subjects in the present sample were psychotic
or unable to function in the group. All of
the subjects had normal intelligence, with
1.Q.’s ranging from 81 to 131 (corrected for
age). The average of the normal group, how-
ever, was somewhat higher than for the total
ardiovascular group, being 105 and 98, re-
spectively.
TABLE 1. DESCRIPTION OF SAMPLE: NorRMAL SuBJECTS AND PATIENTS WITH
CARDIOVASCULAR DISEASE (TOTAL = 60).
| | | |
No.of | Mean | % Convalescent | % Mean
Group | Cases | Age or in Hospital | Working 1.9.
| | } |
| | | |
| |
PE) OUND Goh e ek os SEs wei dels siwwoae's | 21 | 77 0 100 105
. | | |
Be eR ION 255 io 50s. daly occult wicavest 20 79 15 55 97
C. Cardiac and Cerebral Vascular... .. . | 14 77 64 36 102
D. Cerebral Vascular only............ | 5 74 | 40 20 97
Total Cardiovascular (Groups B, C, D). .| 39
77 36 | 44 98
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THE EEG IN CARDIOVASCULAR DISEASE
TECHNIQUES
A careful medical history was obtained from each
subject, with special emphasis on the symptoms of
heart disease and cerebral vascular disease. On some
of the patients information was obtained from ad-
mission health reports and previous medical records.
A complete physical examination was conducted, with
careful attention given to the cardiovascular system
and signs of neurologic deficit. On a few patients
circulation time measurements were performed.
Laboratory work included the examination of a
random urine specimen for albumin and reducing
substances (Clinitest), an a microscopic inspection
of the sediment. Hemoglobin was determined by the
dilution technique with 0.1 per cent solution of Na,
CO, on a Leitz Photocolorimeter. Vital capacity was
performed on a McKesson-Scott vital capacity ap-
paratus, the maximum of 3 attempts being reported
in liters. Electrocardiograms were recorded in a re-
dining or semi-reclining position on a Sanborn Viso
Cardiette. Three standard leads, the augmented limb
leads, and 6 precordial chest leads were obtained on
each patient. P-A chest x-rays were taken at 6 feet
in the upright position on a Westinghouse Simplex
machine.
Electroencephalograms were recorded on an eight-
channel Grass instrument. Eight scalp electrodes were
placed over the 4 major areas on each side of the
head: frontal, parietal, occipital, and mid-temporal.
Both bipolar and monopolar tracings (to a reference
ear electrode) were obtained. Since elderly individ-
uals are prone to become drowsy, an effort was made
to insure full wakefulness throughout the test. The
actual recording time varied from 30 to 45 minutes
for each subject. Recordings were made for the most
part within two to three hours after an adequate
meal, Careful note was made of the medications
taken, especially barbiturates and other sedatives that
are known to affect the EEG. Several of the car-
diac patients were taking digitalis or nitroglycerine
intermittently. The effect of the cardiac glycosides
on the EEG is not known, but is now being investi-
gated,
TREATMENT OF DATA
Following the collection of all of the data described
above, a final diagnosis or diagnoses were made.
The subjects were then classified into 4 groups:
Group A—Normal. 1) No evidence of clinical
heart disease; 2) Absence of a history or physical
findings compatible with cerebral vascular disease.
Group B—Cardiac Disease. Evidence of clinical
heart disease only.
Group C—Cardiac and Cerebral Vascular Disease.
1) Evidence of clinical heart disease; 2) Evidence
of a cerebral vascular accident.
Group D—Cerebral Vascular Disease. Evidence of
a cerebral vascular accident only.
The diagnosis of clinical heart disease was made
on the basis of the medical history, physical findings,
heart size, and electrocardiogram. The criteria for
diagnosis of heart disease proposed by the New
York Heart Association (29) were closely adhered to
throughout. The diagnosis of cerebral vascular dis-
317
ease was made on the basis of a well-defined history
of cerebral vascular accident, which in most cases
was supported by neurologic findings. Hypertension
was defined as a blood pressure greater than 150/90.
Electrocardiograms were read independently,® and
the criteria of the New York Heart Association were
for the most part adhered to. Chest x-rays were also
interpreted independently,® and determinations of
the transverse diameter and frontal area of the heart
were made. Ungerleider’s Tables were used to ex-
press heart size in percentage of predicted values.
A heart with a transverse diameter at least 10 per
cent greater than predicted value was considered ab-
normal. In the majority of cases the frontal area
correlated well, but was used only as supporting
evidence.
Electroencephalograms were analyzed in essentially
the same manner described in a previous publication
(17). On the basis of these earlier findings, par-
ticular attention was given to the frequéncy of the
alpha rhythm and to the incidence of slow (delta)
waves. Additional variables were analyzed that
seemed important in light of the findings of other in-
vestigators.
Alpha rhythm was defined as a 7 to 13 c./sec.
sequence of waves appearing from the posterior re-
gion of the head and sensitive to light. A mean
alpha frequency was determined by averaging 30
measurements of the monopolar occipital rhythm at
points distributed throughout each record. Each
measurement was based on the duration of 10 con-
secutive waves. Particular attention was given to
the incidence of EEGs with rare alpha, that is, records
in which the alpha rhythm is present less than 25
per cent of the time in the waking’ subject.
Delta activity was defined as waves of 6 c./sec.
or less, having an amplitude of at least 25 micro-
volts. These slow waves were judged either absent
or present for each subject. Delta waves were not
considered present unless they occurred regularly
throughout the waking record from one or more
leads. The absence or presence of an appreciable
amount of fast activity (15-35 c./sec.) was noted
for each person. It was judged present in all records
where the waves had an amplitude of at least 20
microvolts and were fairly continuous in one or more
leads. Besides these characteristics, note was made
of any marked asymmetry, that is, a tracing in which
one hemisphere has a consistently higher voltage than
the other hemisphere.
RESULTS
The diagnosis, laboratory and electroen-
cephalographic findings are presented for
each subject in table 2. A total of 60 males
with a mean age of 77 years were classified
into 4 groups of approximately equal age. A
summary of the data follows:
*We are indebted to Dr. Ernst P. Boas for reading the
electrocardiograms, and to Dr. Lionel G. Barraza for inter-
preting the x-rays.
-
318 OBRIST AND BISSELL
TABLE 2. THE DIAGNOSIS, LABORATORY, AND EEG FINDINGS FoR EACH CASE.
Vital |
Case Diagnosis Age Blood Heart* | Capacity EKG
No. Pressure Size (L.)
Group A—Normal
5 None 75 138/76 Normal | 4.1 Normal
| °
7 None 82 132/72 Normal 2.9 | Abnormal
Incomplete left bun-
dle branch block |
9 | Bronchial asthma and emphysema 69 128/70 Normal 2.8 Normal
14 None 87 118/70 Normal 4.5 Normal
18 | Bronchial asthma and emphysema 86 132/68 Normal 2.8 Normal
20 None 77 150/84 Normal 3.6 Normal
27 None 72 124/60 Normal 3.5 Normal
30 None 86 132/74 Normal 1.8 Normal
33 | Bronchial asthma and emphysema 81 136/75 Normal 2.4 Normal
34 None 70 112/74 Normal 5.0 Normal
37 None 83 130/75 Normal 3.2 Normal
38 None 74 132/76 Normal 4.1 Normal
40 None 71 100/66 Normal 4.6 Normal
41 None 78 138/88 Normal 4.4 Normal
44 None 76 138/70 Normal 3.8 Normal
45 None 84 128/80 Normal 2.4 Normal
46 None 71 134/78 Normal 3.7 Normal
51 None 67 116/74 Normal 3.2 Normal
52 None 70 120/74 Normal 3.5 Abnormal
Right bundle branch
block
Alpha 9.3
Alpha 9.2
Alpha 9.4
Alpha 8.9
Alpha 9.1
Fast activity
Alpha 10.2
Alpha 8.9
Alpha 8.9
Alpha 9.6
Delta (bilateral
diffuse)
Alpha 9.0
Alpha 10.4
Alpha 8.9
Alpha 8.7
| Rare alpha
Fast activity
Rare alpha
Alpha 10.1
Rare alpha
Alpha 9.6
Fast activity
Rare alpha
Fast activity
6
ilateral
)
0
9
ity
ity
THE EEG IN CARDIOVASCULAR DISEASE 319
TABLE 2. THE DrAGNosis, LABORATORY, AND EEG FINDINGS FOR Eacu Case (Continued)
Vital
Case Diagnosis | Age | Blood | Heart* | Capacity EKG EEG
No. | | Pressure | Size | (L.) (C./See )
| | | |
Group A—Normal—Cent'd
| | |
53 | None | 81 |, 122/62 | Normal | 5.1 | Normal | Alpha 9.2
57 | None | 71 138/74 Normal | 3.8 Normal Alpha 10.9
Group B—Cardiac Disease
EE ) = aes poe = ee .
1 | Rheumatic heart disease with mitral in- | 73 | 124/74 1 | A Abnormal | 3.4 | Abnormal Alpha 8.5
sufficiency | | 58% | Auricular fibrillation Delta (left tem-
Anemia (9.8 Gm. Hgb.) | | | | poral)
| Fast activity
| | |
|
2 | Arteriosclerotic heart disease with cardiac | 87 | 104/62 Normal 1.9 | Abnormal | Alpha 7.8
insufficiency | Myocardial dam- | Delta (bilateral
Hypertrophic emphysema | | | age | parietal)
| | | | |
6 Arteriosclerotic-hypertensive heart disease| 71 | 208/110 Normal 1.8 Abnormal | Alpha 8.2
| Nephrosclerosis | | Right bundle branch |
Anemia (9.2 Gm. Hgb.) | | block |
| | |
8 Arteriosclerotic-hypertensive heart disease | 78 | 170/88 | Normal | 2.7 Abnormal Alpha 8 .4 (rare)
Left bundle branch |
| block
bie. t | | |
| |
10 | Arteriosclerotic-hypertensive heart dis- | 80 | 170/90 | Abnormal | 3.2 Abnormal | Rare alpha
| ease with coronary thrombosis | 20% | Anterior ard poste- | Fast activity
Anemia (9.2 Gm. Hgb.) | | terior infarction |
ll | Caleific aortic stenosis 82 | 124/76 | Abnormal | 3.6 | Normal A'pha 9.1
18% || | Delta (bilateral
| | | occipital)
| | | |
12 | Arteriosclerotic heart disease with coro- | 81 | 126/80 Abnormal | 2.9 | Abnorma: | Alpha 7.5
nary sclerosis 10% ~=i+| Right bundle branch | Deita (bilateral
| | block | frontal)
|
. } | j
17 | Arteriosclerotic heart disease with anginal | 82 | 140/80 | Abnormal | 2.1 Normal | Alpha 8.0
| syndrome 13% | | Asymmetry
| (Blood pressure 180/115 in 1950) | | (L>R)
| | | | |
| ; | | |
22 Rheumatic heart disease with aortic in- | 66 | 118/50 | Abnormal | 2.9 Abnormal | Alpha 9.1
sufficiency 43% Left ventricular
| Anemia (9.8 Gm. Hgb.) | strain
23 | Arteriosclerotic-hypertensive heart disease| 81 | 152/90 | Abnormal 30 Abnormal | Alpha 9.3
13% | Myocardial damage |
| |
ent dizziness, 1 year
Vital |
Capacity | EKG
(L) |
|
3.2 Abnormal
Auricular fibrillation
| Left bundle branch
block
2.2 | Abnormal
| Auricular fibrillation
|
2.7 Normal
3.1 | Normal
3.8 Abnormal
| Right bundle branch
| block
-—— | Normal
3.2 | Abnormal
| Right bundle branch
block
3.0 Normal
|
|
|
2.3 | Abnormal
| Nodal rhythm
3.7 Abnormal
| EEG
(C./Sec.)
Alpha 7.4
Delta (bilateral
diffuse)
Alpha 8.7
Fast activity
| Alpha 8.4 (rare)
Delta (bilateral
occipital)
Rare alpha
Alpha 7.8
Rare alpha
Fast activity
Alpha 6.9
Asymmetry
(L>R)
| Alpha 9.4
| Myocardial damage |
|
|
Abnormal
Left ventricular
| strain
"|
320 OBRIST AND BISSELL
TABLE 2. THE DIAGNOSIS, LABORATORY, AND EEG Finpinas ror Eacu Case (Continued)
syst ae | |
| |
|
Case | Diagnosis Age | Blood | Heart*
No. | Pressure | Size |
Group B—Cardiac Disease—Cont'd
; ey | |
28 | Arteriosclerotic heart disease with coro- | 89 | 105/70 Abnormal |
nary sclerosis 46%
29 | Arteriosclerotic heart disease with coro- | 67 126/80 | Abnormal
nary sclerosis 38%
43 | Arteriosclerotic heart disease with cardiac | 73 146/74 Abnormal
insufficiency | 10%
48 | Calcific aortic stenosis | 91 130/70 | Abnormal |
A% i+
49 | Arteriosclerotic heart disease with coro- | 84 138/78 | Abnormal
nary sclerosis 20% |
54 | Rheumatic heart disease with aortic in- | 81 182/86 Abnormal |
sufficiency 36% = |
Hypertension
55 | Calcific aortic stenosis 84 132/76 Abnormal
Nephrosclerosis | 21%
Anemia (9.0 Gm. Hgb.)
| }
| |
58 | Rheumatic heart disease with mitral in- | 76 130/70 Abnormal |
sufficiency 34%
59 | Rheumatic heart disease with mitral ste- | 77 180/92 Normal
nosis
Hypertension
60 | Arteriosclerotic-hypertensive heart dis- | 69 170/94 | Normal
ease with coronary sclerosis
Group C—Cardiac and Cerebral Vascular Disease
aan 5 ere ane
3 | Arterioscler otic-hypertensive heart disease; 76 190/114 | Abnormal
Cerebral vascular accident with persist- | 64%
|
Delta (bilateral
occipital)
| Alpha 8.3
Delta (bilateral
parietal)
Fast activity
Alpha 8.4
Alpha 9.7
Fast activity
Case
No.
16
i
oo
35
0G
Sec.)
4
ilateral
2)
7
ivity
4 (rare)
jilateral
al)
ha
zx
ateral
1)
}
ateral
)
ity
Case
No.
31
THE EEG IN CARDIOVASCULAR DISEASE
TABLE 2.
Diagnosis
| Age
Blood
Pressure
Heart*
Size
| Vital
| Capacity
(L.)
THE DIAGNOSIS, LABORATORY, AND EEG Frnpinos For Eacu Case (Continued)
EKG
Group C—Cardiac and Cerebral Vascular Disease—Cont'd
Rheumatic heart disease with mitral in-
sufficiency
Cerebral vascular accident with left hemi-
paresis, 6 years (2 years)}
Calcifie aortic stenosis
Cerebral vascular accident with right
hemiplegia, 2 months
Arteriosclerotic heart disease with coro- |
nary thrombosis
Cerebral vascular accident with disturbed
gait and personality change, 4 years
Arteriosclerotic heart disease with coro-
nary sclerosis
Cerebral vascular accident with persistent
vertigo, 2 years
Arteriosclerotic-hypertensive heart disease
with anginal syndrome |
Cerebral vascular accident with left hemi- |
paresis, 2 years |
| Arteriosclerotic heart disease with cardiac
insufficiency
Cerebral vascular accident with transient: |
left hemiparesis, 2 years
Arteriosclerotic-hypertensive heart disease
(Blood pressure 170/110 in 1948)
Cerebral vascular accident with slurred |
speech and confusion, 3 years
Arteriosclerotic heart disease with coro-
nary thrombosis
Cerebral vascular accident with visual dis-
turbance and disturbed gait, 4 years
Arteriosclerotic-hypertensive heart disease
Anemia (9.8 Gm. Hgb.)
Cerebral vascular accident with left facial
paresis and incontinence, 1 year
Arteriosclerotic heart disease with coro-
nary sclerosis
Cerebral vascular accident with left hemi-
paresis, 4 years
80
86
84
7
>
84
69
~I
bo
140/74
130/66
120/74. |
146/76
188/104 |
126/80
140/76
136/82
160/100
132/72
Abnormal
15%
Abnormal
12%
Abnormal
20%
Normal
Abnormal
18%
Abnormal
20%
Abnormal
18%
Normal
Abnormal
30%
Abnormal
14%
3.7
to
a=
3.4
Abnormal
Auricular fibrillation
Normal
Abnormal
Posterior infaretion
Abnormal
Left bundle branch
block
Abnormal
Left ventricular
strain
Normal
Abnormal
Left ventricular
strain
Abnormal
Posterior infarction
Normal
Abnormal
Right bundle branch
block
321
EEG
(C./See.)
Alpha 7.9
Alpha 9.3
Alpha 7.9
Alpha 9.0
Alpha 9.2 (rare)
Alpha 8.2
Delta (bilatera:
diffuse)
Alpha 8.5
Delta (bilateral
diffuse)
Rare alpha
Fast activity
Alpha 9.1
Asymmetry
(L>R)
Alpha 8.9
322 OBRIST AND BISSELL
TABLE 2. THE DIAGNosis, LABORATORY, AND EEG Finpinas For Eacu Case (Continued) Grou
—— — : were ©
ously ¢
Vital healthy
Case Diagnosis Age | Blood Heart* | Capacity EKG ERG of ther
No. Pressure Size (L.) | (C./See.) vital cé
ata Sem non eel ae seh | _ | rhythm
in all si
Group C—Cardiac and Cerebral Vascular Disease--Cont’d for you:
Shy SSeS: Ean Mare Ualieiaal for the
36 |Arteriosclerotic heart disease with cardiac | 80 | 145/82 | Abnormal | 4.3 _— | Alpha 8.4 was Te
insufficiency 20% cent of
Cerebral vascular accident with right |
hemiparesis and Parkinsonism, 5 years | Grou
| jects w
42 | Arteriosclerotic heart disease with cardiac | 71 148/84 Abnormal 3.3 Normal | Alpha 8.8 heart d
insufficiency 29% ease W:
Cerebral vascular accident with right tients.
hemiparesis, 4 years (2 years)t heart d
: : ‘ ‘ ciency,
50 | Arteriosclerotic heart disease with coro- | 68 | 146/68 | Abnormal 3.8 | Abnormal Alpha 8.9 be
nary thrombosis 16% Posterior infarction | Asymmetry stenosis
Cerebral vascular accident with left hemi- (R>L) have C
plegia, 2 years subject:
classifie
Tet Wa eas nea aaa naa ease.
Group D—Cerebral Vascular Disease group °
eh erie Fay REE yt meth PS lS a a less the
| jects, v
4 | Cerebral vascular accident with left hemi- | 69 120/74 _ 2.3 Normal | Alpha 9.9 (rare) entire {
plegia, 24% years Delta (right tem- peared
| poral)
| Asymmetry group,
| (R>L) se
cardiac
15 | Cerebral vascular accident with left arm | 77 170/90 | Normal 2.4 Normal Alpha 8.4 alpha 1
paresis and transient aphasia, 1 year | Fast activity
(3 months)f Grou
Hypertension (220/100 in 1952) Disease
‘ ; : have e
39 | Cerebral vascular accident with persistent | 73 | 150/88 | Normal 3.0 | Normal Alpha 8.0 is addi
dizziness and visual disturbance, right =o
eye, 5 years tory of
Bronchial asthma and emphysema ing deg
| osclero’
47 | Cerebral vascular accident with left pare- | 87 | 210/92 | Normal — _ | Alpha 7.8 mon, o
sis, incontinence and aphasia, 6 years | had hy
— had rhe
56 | Cerebral vascular accident with righ Vormz 2 Norm | F ficiency
ght | 66 156/84 Normal 2.8 Normal | Alpha 8.0 7
hemiparesis, 3 years (6 months)t | Delta (bilateral nosis,
Hypertension | parietal) group '
| ; of less
- subject
‘igures under Heart Size indicate percentage above predicted value for the transverse diameter.
tA repeat cerebral vascular accident. group
curred
subject
thythm
) (rare)
ht tem-
teral
THE EEG IN CARDIOVASCULAR DISEASE 323
Group A—Normal. Twenty-one subjects
were considered normal controls, as _previ-
ously defined. All of these subjects were
healthy and active in the community. None
of them had hypertension. Their average
vital capacity was 3.6 L. An EEG alpha
rhythm greater than 8.5 c./sec. was recorded
in all subjects, which is within normal limits
for young adults. The mean alpha frequency
for the group was 9.4 c./sec. Delta activity
was recorded in only one individual (5 per
cent of the group).
Group B—Cardiac Disease. Twenty sub-
jects were found to have evidence of clinical
heart disease only. Arteriosclerotic heart dis-
ease was most common, occurring in 12 pa-
tients. There were 5 patients with rheumatic
heart disease, 2 of whom had mitral insuffi-
ciency, 2 aortic insufficiency, and 1 mitral
stenosis. Three patients were considered to
have calcific aortic stenosis. Seven of the
subjects had hypertension, and thus were also
classified as having hypertensive heart dis-
ease. The average vital capacity for the
group was 2.8 L. A slow alpha rhythm of
less than 8.5 c./sec. was recorded in 12 sub-
jects, with a mean alpha frequency for the
entire group of 8.3 c./sec. Delta activity ap-
peared in 8 cases. In contrast to the normal
group, where only one record deviated from
young adult standards, 70 per cent of the
cardiac cases (14 out of 20) had either a slow
alpha rhythm, delta activity, or both.
Group C—Cardiac and Cerebral Vascular
Disease. Fourteen subjects were found to
have evidence of cerebral vascular disease
in addition to cardiac disease. All had a his-
tory of cerebral vascular accident with vary-
ing degrees of neurologic impairment. Arteri-
osclerotic heart disease was again most com-
mon, occurring in 12 subjects, 4 of whom also
had hypertensive heart disease. One patient
had rheumatic heart disease with mitral insuf-
ficiency, and another had calcific aortic ste-
nosis. The average vital capacity for the
group was 3.4 L. A slow EEG alpha rhythm
of less than 8.5 c./sec. was obtained in 4
subjects. The mean alpha frequency for the
group was 8.8 c./sec., and delta activity oc-
curred in 2 cases. Forty-three per cent of the
subjects (6 out of 14) had a slow alpha
thythm and (or) delta activity. These trac-
ings differ from normal, but to a lesser extent
than those in Group B.
Group D—Cerebral Vascular Disease. Five
subjects were found to hav. evidence of
cerebral vascular disease only. All had cere-
bral vascular accidents with residual neuro-
logic signs. Three of the patients had hyper-
tension. The average vital capacity was 2.6
L. A slow alpha rhythm of less than 8.5
c./sec. was obtained in 4 subjects. The mean
alpha frequency for the group was 8.4 c./sec.,
and delta activity was recorded in 2 cases.
All of the subjects in the group had either
a slow alpha rhythm, delta activity, or both.
ELECTROENCEPHALOGRAPHIC
COMPARISON OF GROUPS
A. Alpha Frequency. Fifty-two subjects
had measurable alpha rhythms. The occipital
alpha frequencies of these individuals are
plotted in figure 1. As can be seen, those
A. NORMAL
B. CARDIAC
°
6 $ C. CARDIAC
: AND C.D.
, —- 7
65- 7.0- 7.5- 8.0-] 8.5- 9.0- 9.5- 10.0- 10.5-
69 74 79 84589 94 99 WA 10.9
D. C.V.D.
ALPHA FREQUENCY
Fic. 1. Distributions of occipital alpha frequency
for normal aged men and for subjects with cardiac
and cerebral vascular disease (C.V.D.). Each dot
represents an individual case. The vertical line
indicates the lower limit of normal alpha frequency
in young adults. Mean frequency: Group A= 9.4
c./sec., Group B = 8.3 c./sec., Group C = 8.8. c./sec.,
and Group D = 8.4 c./sec.
324
people classified as normal had, on the whole,
higher frequencies than those subjects with
vardiac and cerebral vascular disease. Taking
8.5 c./sec. as the lower limit of normal alpha
frequency in young adults (vertical line on
the graph), it is found that none of the normal
aged subjects in the present study had a fre-
quency below this value. In contrast, about
two-thirds of the individuals with cardiac dis-
ease had alpha frequencies below 8.5 c./sec.
A similar trend is seen in the few cases with
cerebral vascular disease only. However, the
subjects in Group C with both disorders
showed less of a tendency to deviate below
this value, although their mean frequency was
still below that of the normal group. Taken
together, 54 per cent of the cases of the 3
vardiovascular groups were below 8.5 c./sec.
When all of the individuals in the 3 groups
with cardiovascular disease are combined, a
mean 8.5 c./sec. is obtained. This compares
with a mean of 9.4 c./sec. found for the
normal group. A statistical test of the sig-
nificance of this difference gives a “t” of 4.7,
which is significant at the .001 level of con-
fidence. It should be noted that the means of
all groups are well below the average for
young adults, which is around 10.2 ¢./sec.
B. Delta Activity. Table 3 reveals the
incidence of slow wave activity observed in
the present sample. Whereas only one out
of 21 cases in the normal group had delta ac-
tivity (subject #33 had emphysema), 8 out
of 20 individuals with cardiac disease had
such slow waves. A similar proportion is
found in the small group with cerebral vas-
cular disease. It is interesting to note that,
TABLE 3, INCIDENCE OF DeLtTA Activity In AGED
MALES.
| |
| Total No. \No. with) % with
Group | of Cases | Delta Delta
} | |
(ay | Pe ee 21 | Ras 3
B. Cardiac only...... 20 8s | 40
C. Cardiac and Cere-
bral Vascular. .| 14 RAtia
D. Cerebral Vascular | |
PS. SS 5 o fe
Total Cardiovascular | |
(Groups B, C, D). 39 12 | 31
OBRIST AND BISSELL
as in the case of alpha frequency, the sub.
jects with both cardiac and cerebral vaseu.
lar disease did not show as striking a devia.
tion from normal as did individuals with
either of these disorders alone. Only 2 out
of 14 cases in Group C had delta wave ac.
tivity. When the 3 groups with cardiovas.
cular disease are combined, about a third
(31 per cent) of the cases are found to have
slow waves. This compares with only 5 per
cent for the normal group.
Most of the slow waves appeared. bilater.
ally, but in 2 cases there was a unilateral mid-
temporal focus, In 7 subjects the bilateral
activity was definitely stronger over a_par-
ticular region of the cortex, but in 4 instances
it was diffuse, involving all areas. Table 2
gives the location of delta activity in each
of the cases.
C. Fast Activity. There seems to be no
significant difference in the amount of fast
activity (15-35 c./sec.) between normal sub-
jects and those with cardiovascular disease,
About 19 per cent of the normal individuals
had an appreciable amount of fast activity,
as defined above. This compares with 21
per cent for the total subjects in Groups B,
C, and D.
D. Rare Alpha. The number of individ-
uals with little or no alpha rhythm (present
less than 25 per cent of the time) was about
the same in both the normal and cardiovascu-
lar groups. Nineteen per cent of the normal
group had a rare alpha rhythm, as compared
to 21 per cent of the subjects in Groups B,
C, and D. Most of the people with no alpha
rhythm had a low-voltage-fast type of record,
and a few were classified as having appreci-
able fast activity.
E. Asymmetries. In the normal group
there were no marked bilateral asymmetries.
Thirteen per cent of the total cardiovascular
group had such asymmetries. Of the 5 in-
dividuals with a marked voltage difference
between hemispheres, 3 had a definite his-
tory of cerebral vascular accident.
ELECTROCARDIOGRAM
Incidence of Abnormality. (Twenty-five
subjects were considered to have abnormal
EKGs. There were 4 cases of left bundle
branch block and 6 cases of right bundle
branch block. Four records were compatible
with
Three
damag'
ular st
had ca
auricul
Two of
abnorn
group.
and tl
branch
ditiona
of hea
extrasy
of recc
dence
subjec
the fin
Relc
gram.
depen
of inte
tween
such :
out fa
reason
Fic,
quenci
electro
indivic
freque
c./sec.
> sub.
vascu-
devia.
with
2 out
Ve ace
iovas-
third
» have
5 per
ilater-
| mid-
ateral
/ par
ances
ble 2
each
no
F fast
sub-
seASC,
duals
ivity,
h 2]
ps B,
livid-
esent
ibout
ASCU-
mal
yared
s B,
pha
cord,
reci-
roup
tries.
salar
> in-
ence
his-
-five
‘mal
ndle
ndle
ible
THE EEG IN CARDIOVASCULAR DISEASE 325
with a diagnosis of coronary thrombosis.
Three patients had evidence of myocardial
damage and 4 had the pattern of left ventric-
ular strain. All patients with this pattern
had cardiac enlargement. Four patients had
auricular fibrillation, and 1 a nodal rhythm.
Two of the subjects with electrocardiographic
abnormalities were in the normal control
group. One had a right bundle branch block
and the other an incomplete left bundle
branch block, but both lacked sufficient ad-
ditional evidence to establish the diagnosis
of heart disease. Ventricular and auricular
extrasystoles occurred in a high percentage
of records, but this was not considered as evi-
dence of abnormality. Table 2 shows the
subjects who had abnormal EKGs, indicating
the findings in each case.
Relation of EKG to the Electroencephalo-
gram. Electrocardiograms were analyzed in-
dependently of the EEG, and it is therefore
of interest to determine the relationship be-
tween these two electrical indices. In making
such an analysis it seemed desirable to rule
out factors other than heart disease. For this
reason, the 19 subjects with evidence of cere-
|
NORMAL EKG
(N= 20)
on
10.0 10.5 11.0
90 9.5
8
70 7.5 8.0 8.5
a
o" ABNORMAL EKG
; il.
70 7.5 80 85 9.0 9.5 10.0 10.5 11.0
ALPHA FREQUENCY
Fic. 2. Comparison of the occipital alpha fre-
quencies of aged men having normal and abnormal
electrocardiograms. The graphs are based only on
individuals in Groups A and B. The mean alpha
frequency for subjects with normal EKGs is 9.3
c./sec., and for those with abnormal EKGs, 8.3 c./sec.
bral vascular disease were omitted from the
statistical comparisons. Figure 2 shows the
alpha frequency distribution of two groups
of individuals: those with normal electro-
cardiograms, and those with abnormal EKGs.
It is evident that there is a considerable dif-
ference in the alpha frequency of the two
groups. Whereas the mean frequency of the
group with normal EKGs is 9.3 c./sec., the
mean frequency of the abnormal group is
only 8.3 ¢./sec. A “t” of 4.3 is obtained for
this difference, which is significant at the
001 level of confidence.
HEART SIZE
Incidence of Abnormality. Twenty-seven
of the subjects in the total cardiovascular
group were judged to have cardiac enlarge-
ment (transverse diameter at least 10 per
cent greater than predicted value). None of
the normal control subjects had enlarged
hearts. Table 2 indicates which individuals
had cardiomegaly, listing the transverse di-
ameter in each case.
Relation of Heart Size to the Electroen-
cephalogram. Analysis was confined to sub-
jects in Groups A and B, in order to rule out
the effects of cerebral vascular accident. In-
dividuals with a normal heart size had a mean
occipital alpha frequency of 9.2 c./sec., while
subjects with cardiomegaly had a mean alpha
frequency of 8.4 c./sec. The difference be-
tween the figures is significant at the .01 level
of confidence.
PRESENTATION OF ILLUSTRATIVE CASES
Congestive Heart Failure with EEG Changes. Sub-
ject #28 was an 89-year-old male who had been a
resident of Moosehaven for one year. He had been
in reasonably good health and was physically ac-
tive, working as a kitchen helper. In October, 1952,
the patient complained of dyspnea, orthopnea, de-
pendent edema, and dizziness. Auricular fibrillation
was noted, and the patient was digitalized. How-
ever, symptoms continued, and when seen in Febru-
ary, 1953, he was said to have suffered a “heart at-
tack.” At this time the patient was agitated, rest-
less, and gave a disoriented history of low reliability.
Physical examination revealed an elderly male who
was sitting in bed, cyanotic, and in respiratory dis-
tress. Wt. 150 lb., Temp. 97.8 F., Pulse 96 (irregu-
lar), Resp. 32 (Cheyne-Stokes), BP 105/70. Marked
distention of the neck veins was noted in the upright
position. There was dullness to percussion at the
left base, and diffuse moist inspiratory rales with
rhonchi over both lung fields. The left border of
cardiac dullness was at the anterior axillary line.
326
The rhythm was grossly irregular with an apex
rate of 124 and a pulse deficit of 28. No murmurs
ere heard. The liver was palpable 6-8 cm. below
the right costal margin and there was questionable
ascites. A 4-plus pitting edema of the lower ex-
tremities and sacral region was present. The EKG
showed auricular fibrillation and left bundle branch
block. Chest x-rays revealed marked cardiac en-
largement and left pleural effusion.
The diagnosis of arteriosclerotic heart disease and
congestive failure was made, and appropriate therapy
instituted. The clinical response was dramatic. The
patient lost 15 Ibs. in weight through diuresis and
gradually resumed activity. He continued to be
physically active and was maintained on Digitoxin,
0.1 mg. daily, restricted salt diet, and intermittent
mercurial diuretic injections. His weight was stable
at 133 to 135 lbs., and he was free of edema. He
died suddenly while watching television in June,
1953.
Figure 3 presents serial EEG recordings taken be-
fore, during, and after congestive heart failure. The
first and third tracings were taken during periods of
cardiac compensation and show a normal alpha
rhythm for this age of 8.6 and 8.5 c./sec., respec-
tively. On the other hand, the tracing obtained
during congestive failure shows a marked slowing
of the dominant alpha frequency to 7.4 c./sec.
LEFT OCCIPITAL TO EAR
COMPENSATED ~ 7/82
Vey nv
CONGESTIVE HEART FAILURE ~ 3/53
COMPENSATED - 5/53
WV yi
RIGHT FRONTO-PARIETAL
DURING HYPERPHEA
PAA nn pin PALI PN AL AAPL AL ALANNA fl rafts
AFTER 25 SEC. APNEA
PLDI AIAN IVA DWN
| 50 uv. ——_———— 1 sc.
Fic. 3. Top 3 tracings: Before, during, and after
congestive heart failure in an 89-year-old man with
arteriosclerotic heart disease and auricular fibrilla-
tion. Bottom 2 tracings: During hyperpnea and at
the end of a 25 second period of apnea in an 81-
year-old man with Cheyne-Stokes respiration, bron-
chial asthma and emphysema. There is a half-minute
interval between the 2 tracings.
OBRIST AND BISSELL
Cheyne-Stokes Respiration with Cyclic EEG
Changes. Subject #33 was an 81-year-old male who
had been a resident of Moosehaven for 13 years
working as a janitor. He had always been in rea.
sonably good health until the past 2-3 years, when he
began to notice increasing dyspnea on exertion. He
developed a chronic cough productive of a thick,
tenacious mucoid sputum, which was worse at night.
He was aware of wheezing respirations much of the
time, but denied previous symptoms of asthma. There
was a questionable history of perennial hay fever
prior to coming to Florida.
Physical examination revealed an elderly male who
seemed younger than his stated age. A _ respiratory
wheeze was audible. Wt. 155 lb., Temp. 98F,
Pulse 74, Resp. 18 (regular), BP 136/75. No dis.
tention of neck veins was noted. There was a
marked increase in the A-P diameter of the chest
with a prolonged expiratory phase of respiration,
The diaphragms were low and relatively immotile,
Lung fields were hyperresonant to percussion, and
auscultation revealed diffuse musical rales and rhon-
chi on expiration. Cardiac percussion was unsat-
isfactory. The heart sounds were diminished in in-
tensity. No murmurs were heard, P. was accentv-
ated. A regular rhythm was interrupted by fre-
quent dropped beats. The liver was not palpable
and there was no edema of the extremities. The
vital capacity was 2.0, 2.4, 2.3, L. on 3 attempts.
Chest x-rays revealed increased translucency of the
lung fields and flattened diaphragms suggestive of
emphysema. The cardiac silhouette was less than
predicted size for height and weight. The EKG was
interpreted as within normal limits with right axis
deviation and auricular extrasystoles.
The initial EEG showed an occipital alpha fre-
quency of 9.6 c./sec. with bilateral diffuse delta ac-
tivity. A short time later the patient was noted to
have developed Cheyne-Stokes respiration, and the
EEG was repeated. This time a pneumogram was
recorded with the EEG, and periods of apnea ranging
from 20 to 40 seconds’ duration alternated with pe-
riods of hyperpnea. During and immediately follow-
ing hyperpnea, the EEG was characterized by nor-
mal low voltage fast waves. However, during and
immediately following periods of apnea, the EEG
developed abnormal slow waves. A sample of this
record is also presented in figure 3.
This subject was classified in Group A because of
the absence of cardiac findings and no evidence of
a cerebral vascular accident. It is interesting to
note that he is the only individual with an abnormal
EEG in the group of normal controls. The presence
of bronchial asthma and the severity of the pul-
monary emphysema may well be related to the EEG
abnormality.
DISCUSSION
The results of this study indicate that the
electroencephalograms of aged people with
cardiac and cerebral vascular disease have
a significantly slower alpha rhythm and a
greater incidence of delta wave activity, when
compar
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THE EEG IN CARDIOVASCULAR DISEASE
compared with a control group of normal
subjects of the same age. These findings are
difficult to interpret in the light of present
knowledge. The results do not indicate
whether a causal relationship exists between
cardiovascular disease and the electroen-
cephalographic changes. One possibility is
that some basic factor in the aging process
affects both the central nervous system and
cardiovascular system concomitantly. On the
other hand, the effect of cardiovascular dis-
ease on cerebral circulation and brain me-
tabolism may directly influence the electro-
encephalogram.
Studies of cerebral blood flow and oxygen
utilization may shed some light upon the
latter possibility. The normal cerebral blood
flow accounts for 16 per cent of the total
cardiac output and the brain accounts for
20 per cent of the total oxygen consumption
(14). The imperative dependence of the
brain on a constant and generous supply of
oxygen is well recognized clinically, and as
previously stated, any compromise may be
reflected in the EEG. Scheinberg (21) found
a 39 per cent reduction in cerebral blood
flow in patients with congestive heart fail-
ure, which is comparable to the decrease in
cardiac output. An increase in arterio-venous
O, difference did not completely compensate
for this reduction, so that cerebral metabolic
rate was decreased. Novack and associates
(16) also obtained a reduced cerebral blood
flow and oxygen utilization in congestive fail-
ure, but they questioned whether this is a
function of cardiac dynamics or simply re-
lated to the degree of arteriosclerosis in aged
subjects. In elderly individuals with cerebral
arteriosclerosis, Scheinberg (20) and Freyhan,
Woodward, and Kety (10) found that cere-
bral O. utilization and blood flow were sig-
nificantly lower than in young adults. The
degree of reduction was related to the mental
status of the patient. However, Fazekas,
Alman, and Bessman (9) noted a considerable
overlap in the distribution of cerebral blood
flow between normal old subjects and patients
with arteriosclerosis and mental changes.
This serves to emphasize that the rate of
blood flow is not the only factor which may
influence cerebral function.
Electroencephalographic abnormalities
might be expected in conditions where there
is obvious hypoxia, such as in severe con-
327
gestive heart failure, or pulmonary insufli-
ciency with cor pulmonale. The case of con-
gestive heart failure in the present study is
an illustration of this point. Similar cases
have been presented by other investigators
(6, 8, 18). The relationship of pulmonary
insufficiency and superimposed cardiac dis-
ease to EEG changes has been emphasized
by Stuhl, Cloche, and Kartun (27), who
studied 21 patients, all of whom had severe
pulmonary insufficiency and cyanosis. Twelve
subjects had definitely abnormal electroen-
cephalograms with slowing of the basic
rhythm and delta activity. Seven of the 8
most abnormal records occurred in patients
who had cor pulmonale in addition to the
pulmonary insufficiency. They concluded that
the presence of cardiac disease seemed essen-
tial for the EEG changes observed. A more
direct approach to this problem was recently
made by Heine (12), who measured cerebral
blood flow and oxygen consumption in a
variety of cases with cardiovascular disease
and correlated it with electroencephalographic
findings. The relationship between cerebral
oxygen consumption and EEG abnormality
was not striking, but a trend was evident.
There were consistent EEG abnormalities in
all cases of cor pulmonale with decreasing
cerebral O. consumption. An interesting re-
lationship between pulmonary function and
EEG is illustrated in the present study by
subject #33, who had emphysema and bron-
chial asthma with Cheyne-Stokes respiration.
It is not so obvious why electroencephalo-
graphic abnormalities should appear in less
severe cardiovascular conditions where com-
pensation is adequate and there is little evi-
dence of hypoxia. The possibility arises that
repeated, transient cerebral anemia and an-
oxemia may have an accumulative effect upon
the EEG. A patient who is usually well com-
pensated may at times engage in activities
that momentarily place demands upon the
cardiovascular system in excess of its reserve.
Hickam and Cargill (13) showed that a pa-
tient with heart disease may have a normal
cardiac output at rest, but still have easily
demonstrable failure with mild exertion. An
upright position, itself, may reduce cardiac
output and cerebral blood flow by as much
as 20 per cent in normal subjects (22, 24).
Wilson and associates (28) present evi-
dence that systemic circulatory insufficiency
328
is an important factor in the development of
cerebral vascular pathology. The influence
of exercise and posture upon the cerebral
blood flow of patients with cardiovascular dis-
ease remains to be evaluated. The results
of the cerebral metabolic studies previously
cited cannot be expected to reflect the state of
circulatory dynamics under usual living con-
ditions, since the subjects were examined in a
recumbent position at rest.
That the level of activity in patients with
cardiac and cerebral vascular disease may be
related to the appearance and degree of EEG
slow wave abnormality was suggested by the
present study. The unexpected finding of a
higher alpha frequency and less delta ac-
tivity in Group C (cardiac and cerebral vascu-
lar disease) when compared with Group B
(cardiac disease only) might be explained
on this basis. The activity level of Group C
was, by necessity, much less as the result of
the disability incurred from the cerebral vas-
cular accidents. For example, all of the 20
subjects in Group B were ambulatory and
only 3 were receiving convalescent care;
whereas in Group C, the activity level was
very low, with 9 out of 14 patients receiving
convalescent care and 4 in a bed or wheel
chair. Thus, in cardiac patients, it would
seem that a higher level of activity is as-
sociated with abnormal EEG’s and a lower
level with more normal records.
An explanation for some of the changes seen
in the aged EEG is suggested by the interest-
ing hypothesis of “cerebral vascular insuf-
ficiency” introduced by Corday, Rothenberg,
and Putnam (4). They drew an analogy
from coronary insufficiency where there oc-
curs a disproportion between the blood sup-
ply of the myocardium and metabolic de-
mands. Reversible EEG slow wave abnor-
malities were demonstrated experimentally in
monkeys when unilateral narrowing of the
carotid artery was combined with hemor-
rhagic hypotension, resulting in a reduction
of cerebral blood flow. These authors extend
the concept to several clinical conditions, in-
cluding hypotension associated with cardiac
dysfunction. Similar slow wave abnormalities
were produced by Skillicorn and Aird (23) in
human arteriosclerotic patients by means of
unilateral compression of the carotid artery.
Certainly a reduction in cerebral blood flow is
associated with slow waves in the electro-
OBRIST AND BISSELL
encephalogram. Further investigation js
needed to determine whether such a reduction
is responsible for the EEG frequency changes
observed in aged patients with cardiovascy.
lar disease.
SUMMARY
Electroencephalographic and clinical ob.
servations were made on 6C male subjects be-
tween 66 and 91 years of «ge. On the basis
of a medical history, physical examination,
and laboratory data, including an electro.
cardiogram and chest x-ray, “he subjects were
classified into 4 groups, according to the pres-
ence or absence of cardiac and cerebral vas-
cular disease. There were 21 normal control
subjects and 39 with cardiac disease, cere.
bral vascular disease, or both. The latter
group consisted of 20 patients with heart dis-
ease onlv, 14 patients with both cardiac and
cerebrai vascular disease, and 5 with evidence
of cerebral vascular disease only.
The electroencephalograms of the normal
and cardiovascular groups were compared,
and the following conclusions were drawn:
1). The occipital alpha rhythm was sig-
nificantly slower in persons with cardiovascu-
lar disease (8.5 c./sec.) than in normal sub-
jects of the same age (9.4 c./sec.).
2). The incidence of delta activity was
greater in individuals with cardiovascular dis-
ease*than in normal subjects of the same age.
3). The greatest differences in alpha fre-
quency and delta activity were observed be-
tween normal subjects and those with cardiac
disease only. None of the individuals in the
normal group had a slow alpha rhythm (less
than 8.5 c./sec.) and only one out of 21 had
delta activity. In the cardiac group, 14 out
of 20 (70 per cent) had either a slow alpha
rhythm, delta activity, or both.
4). There were no significant differences
between the normal and cardiovascular
groups with respect to fast activity, or to the
absence or presence of alpha rhythm, but
there was a tendency for the cardiovascular
group to have more asymmetries.
5). A relationship was observed between
both the electrocardiogram and heart size,
and the frequency of the alpha rhythm. As
a group, individuals with abnormal electro-
cardiograms and (or) cardiomegaly had sig-
nificantly lower alpha frequencies.
The }
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THE EEG IN CARDIOVASCULAR DISEASE
The possible significance of the above re-
sults was discussed in relation to cerebral
blood flow and metabolism and to related
electroencephalographic studies. It is ap-
parent that the slowing of the alpha rhythm
and appearance of delta wave activity in the
electroencephalograms of aged subjects is cor-
related with the presence of cardiovascular
disease. However, it is recognized that many
factors are involved, and that a causal rela-
tionship does not necessarily exist between
cardiovascular disease and the EEG. It is
clear that further work is needed to determine
the exact interrelationship between cardio-
vascular disease, cerebral blood flow and
metabolism, and the electroencephalogram of
the aged patient.
The authors wish to thank Dr. Nathan W. Shock for
his valuable suggestions concerning the design of this
experiment.
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1. Berger, H.: Uber das Elektroenkephalogramm
des Menschen. Fiinfte Mitteilung. Arch. f.
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Brazier, M. A. B.: Physiological Mechanisms Un-
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1948.
3. Cohn, R.,
to
Raines, G. N., Mulder, D. W., and
Newman, M. A.: Cerebral Vascular Lesions:
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181, 1948.
4. Corday, E., Rothenberg, S. F., and Putnam, J. J.:
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A. N.: Cerebral Physiology of the Aged. Am.
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S. S.: Cerebral Blood Flow and Metabolism in
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Psychoses of Senility. J. Nerv. & Ment. Dis.,
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Hann, J., and Franke, H.: The Electroencephalo-
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Heine, G.: Comparison of EEG, Cerebral Blood
Flow and Cerebral O.-Consumption in 113 Cases
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Liberson, W. T., and Sequin, C. A.; Brain Waves
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and Shenkin, H. A.: Studies of the Cerebral
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Romano, J., and Engel, G. L.: Delirium: _ 1.
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Roseman, E., Schmidt, R. P., and Foltz, E. L.:
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Sheinberg, P.: Cerebral Blood Flow in Vascular
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Scheinberg, P., and Stead, E. A., Jr.: The Cere-
bral Blood Flow in Normal Male Subjects as
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with Observations on the Effect of Tilting and
Anxiety. J. Clin. Investigation, 28: 1163-1171,
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Skillicorn, S. A., and Aird, R. B.:
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Artery Compression. Arch. Neurol. & Psychiat.,
71: 367-376, 1954.
Stead, E. A., Jr., Warren, J. V., Merrill, A. J.,
and Brannon, E. F.: Cardiac Output in Male
Subjects as Measured by Technique of Right
Atrial Catherization. Normal Values with Ob-
servations on Effect of Anxiety and Tilting. J.
Clin. Investigation, 24: 326-331, 1945.
Heart
Electroen-
330
25. Strauss, H., and Greenstein, L.: The Electro-
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encephalogram in Cerebrovascular Disease. Arch.
Neurol. & Psychiat., 59: 395-403, 1948.
Strauss, H., Ostow, M., and Greenstein, L.: Di-
agnostic Electroencephalography. Grune
Stratton, New York, 1952.
and
Stuhl, M. L., Cloche, M., and Kartun, M. P.: In-
térét de 1-Electroencephalographie dans I’Etude
OBRIST AND BISSELL
des Insuffisances Cardiaques avec Cyanose,
Arch Mal. Coeur, 45: 921-926, 1952.
- Wilson, G., Rupp, C., Jr., Riggs, H. E., and
Wilson, W. W.: Factors Influencing the De.
velopment of Cerebral Vascular
J.A.M.A., 145: 1227-1229, 1954,
Nomenclature and Criteria for Diagnosis of Dis.
eases of the Heart and Blood Vessels. New York
Heart Assn., Inc., New York, 1953.
Accidents,
THI
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THE PREVALENCE OF MANIFEST ATHEROSCLEROSIS AMONG RANDOMLY
CHOSEN ITALIAN AND JEWISH GARMENT WORKERS
A PRELIMINARY REPORT
FREDERICK H. EPSTEIN, M.D., AND ERNST P. BOAS, M.D.
(From the Research Department, Sidney Hillman Health Center, New York, New York)
The present communication constitutes a
preliminary report on the prevalence of mani-
fest atherosclerosis and related conditions
among a group of working people, chosen at
random, and including two major groups of
different ethnic origin, Italians and Jews,
most of whom immigrated to the United
States in their youth and who were compar-
able in their occupational and economic back-
ground. Although the persons examined are
not a representative cross-section of the
American population, the factors of selection
were known and the resulting homogeneity
of the groups made them particularly suitable
for etiologic studies.
DESCRIPTION OF SAMPLE
AND METHODS
The persons examined are members of a
Garment Workers’ Union, the New York Joint
Board of the Amalgamated Clothing Workers
of America, who provided a research grant
and facilities for this work at their out-patient
clinic, the Sidney Hillman Health Center of
New York. The union population from which
our sample was drawn consists of some 32,000
men and women. The methods of random
sampling were described in a previous pub-
lication (3). The present data are based on
506 men and 398 women, all of age 40 and
over, representing 91 per cent of those se-
lected. Thirty-six per cent of the men and
51 per cent of the women were of Italian
parentage, 54 per cent of the men and 35
per cent of the women were of Jewish parent-
age. The remaining 13 per cent belonged
to different ethnic groups, mostly natives of
North-Eastern Europe; a few were Negroes
(table 1.)
The presence or absence of atherosclerosis
was established by most of the available
clinical means. In many cases, atheroscle-
Submitted for publication February 3, 1955.
Published on a grant from the Forest Park Foundation to the
Journal of Gerontology.
Presented at the Seventh Annual Scientific Meeting of the
Gerontological Society, Inc., Gainesville, Florida, December
28-30, 1954,
rosis cannot be diagnosed clinically. The di-
agnosis of coronary artery disease was made
from classical symptomatology or unequivocal
electrocardiographic changes as previously
described in detail (3). The diagnosis of
obliterative disease of the leg arteries was
based on the absence of two or more major
pulses in the legs, with oscillometric readings
as an additional guide. Cerebral artery dis-
ease was diagnosed from a definite history
of a major or minor stroke or its neurologic
residua. Aortic calcification was diagnosed
from roentgen films of the thorax and lateral
exposures of the abdomen. The accuracy of
roentgen diagnoses of calcification was
checked in a separate study, correlating pre-
mortem radiologic and postmortem pathologic
findings (8). It was found that radiologically
demonstrable calcification usually signifies
advanced atheromatous disease. Hyperten-
sion was diagnosed if one diastolic blood pres-
sure reading exceeded 95 mm. Hg, or if two
systolic readings, taken % hour apart, ex-
ceeded 150 mm. Hg.
Determinations of blood sugar concentra-
tions were performed by the method of Bene-
dict (7) on samples obtained three or more
hours after the last meal. Blood sugar values
exceeding 130 mg. per cent, with or without
glycosuria, were considered as indicative of
diabetes mellitus.
The observations on the incidence of ather-
osclerosis were supplemented with determina-
tions of serum cholesterol and phospholipid
values. Such analyses were performed on 504
men and 393 women. The cholesterol an-
alyses were performed by the method of Abell
and associates (1), whereas for phospholipid
determinations the procedure of Fiske and
Subbarow (5) was employed.
RESULTS
As seen from figure 1 the prevalence of
manifest atherosclerosis increases with age,
until, in the later sixties, 54 per cent of the
men and 70 per cent of the women are demon-
331
332 EPSTEIN
PERCENT
100 +
~ ee
80 4
——
——,
70 4
M 60 4
E 60 -
N 40 4
30 4
20 ~
~ 4 Rae
AGE 40-44 45-49 55-59
60-64
126 127
50-54
59
AND BOAS
PREVALENCE OF ATHEROSCLEROSIS BY AGE AND SITE OF LESION
KEY
COKONARY
ARTERY DISEASE
WERAL ARTERY
SE & CEREGRAL
Y DISEASE
ALL AGES
206
a
100
90
80
WI 70
0} 60
My] 50
E | yo
N] 30
20
10
AGE 40-44
WUMBER 53
50-54 55-59
95 84
45-49 60-64
78 66
Fic. 1,
TABLE 1, DescRIpTION OF SAMPLE: EtTHNnic Groups,
MEAN AGE,
| |
| Men | Women
Ethnic | | |
Group | Num Mean Age! Num- |Mean Age
| ber | Years | ber | Years
| |
Caan a
| | |
Italian........| 179 | $5.7 | 208 | 54.4
Jewish........| 275 | $8.5 | 138 | 53.2
Other......... s2 | 57.7 | $5 | 50.5
__ | Seep 506 | 57.5 | 398 | 53.3
|
strably affected. When all ages are com-
bined, the over-all prevalence of ather-
osclerosis in the 4 different sites studied is
35 per cent among the men and 26 per cent
Ha
65-69
20
70-74
2
75-79 ALL AGES
0 398
Prevalence of atherosclerosis by age and site of lesion,
among the women. The over-all prevalence
among the women would no doubt approxi-
mate that among the men more closely if
women in their seventies were represented.
At ages above 50, women show manifestations
of atherosclerosis as commonly as men. This
is clearly a reflection of the fact that calcifi-
cation of the aorta as the sole stigma of ather-
osclerosis is more common among women, as
shown in the uppermost sections of the bars.
Many persons had calcification in addition to
other stigmata of atherosclerosis.
As seen from the lower sections of the bars
in figure 1 coronary disease increases steadily
with age among men, the frequency being
about 3 per cent in the forties, 10 per cent
in the fifties, 15 per cent in the sixties, and
around 40 per cent in the seventies; the over-
all prevalence among men is 12 per cent.
Among women, on the other hand, the over-
all frequency of coronary disease is only 3
Age
40-44
45-49
50-54
55-59
60-04
65-69
70-74
75-79
All Ag
per cet
coronal
great {
riphera
areas
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ASE
ARTERY
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nee
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rs,
to
ATHEROSCLEROSIS AMONG ITALIANS AND JEWS
333
TABLE 2. PREVALENCE OF HYPERTENSION AND DIABETES.
Men Women
Age % % % %
Total Hypertension | Diabetes | Total Hypertension Diabetes
40-44 53 9.4 2.0 53 17.0 1.9
45-49 45 20.0 0 78 19.2 2.6
50-54 59 18.6 8.8 95 } 32.3 6.5
55-59 126 26.2 9.6 84 46.5 9.8
60-64 127 28.3 66 51.6 12.1
65-69 67 32.8 6.0 | 20 75.0 25.0
70-74 22 59.1 4.5 | 2 50.0 0
75-79 | 7 | 71.4 | 28.6 0 |
All Ages 506 26.5 6.8 | 398 36.1 7.7
per cent. In women, the low prevalence of
coronary disease contrasts sharply with the
great frequency of aortic calcification. Pe-
ripheral and cerebral atherosclerosis (hatched
areas of bars in figure 1) are omitted from
discussion, since the number of cases in which
these forms were encountered is so small.
The observed incidence of hypertension in
the groups studied is listed in table 2. It will
be seen from the data given in this table that
hypertension is more prevalent among women
than among men, a finding which is in ac-
cordance with known experience. In _ their
late sixties, about 30 percent of the men but
some 75 per cent of the women have elevated
blood pressures, the latter figure being based
on 15 out of 20 women.
The prevalence of diabetes is also shown in
table 2. At younger ages, the prevalence of
diabetes is similar in men and women. Be-
yond the age of 60, diabetes is more frequent
among women. The figures for the late six-
ties are based on a total of 20 women and
67 men. The over-all prevalence of diabetes
is about 7 per cent in both sexes.
The relative frequency of atherosclerosis
among the men in the 4 sites studied is 46 per
cent in the presence of hypertension, as com-
pared with 31 per cent in normotensives.
Among women, the association of hyperten-
sion and atherosclerosis is more marked.
Thirty-eight per cent of hypertensive women
show one or more of the 4 stigmata of ather-
osclerosis studied, as compared with 17 per
cent among normotensive women. The high
prevalence of atherosclerosis in women, which
chiefly manifests itself as calcification of the
aorta, is associated with the frequency of
hypertension among women. Among the men,
the influence of hypertension upon the total
frequency of atherosclerosis is somewhat less
than among the women.
As regards diabetes, among the men the
relative frequency of atherosclerosis in the
4 sites studied is about twice as frequent
among diabetics as compared with non-dia-
betics, 62 per cent as against 33 per cent.
There were too few diabetic women with
atherosclerosis in the sample for a similar an-
alysis.
Ethnic differences in the prevalence of
atherosclerosis between the two main groups
studied, Italians and Jews, are presented in
figure 2. The over-all prevalence of ather-
osclerosis is higher among the Jews in either
sex and in most age groups, although it would
seem that the difference diminishes with age.
For calcification of the aorta, there is no con-
sistent difference in trend among Italian and
Jewish men. The incidence of hypertension
is 25 per cent in both Italian and Jewish men.
The prevalence of diabetes is likewise the
same among Italian and Jewish men, approxi-
mately 7 per cent. The Jewish women, on
the other hand, show a greater incidence of
aortic calcifications, possibly because of the
greater frequency of hypertension among
them. Forty-four per cent of the Jewish
334 EPSTEIN AND BOAS
PREVALENCE OF ATHEROSCLEROSIS - ETHNIC GROUPS
MEN: uuuwtI79 ITALIANS ~...275 JEWS WOMEN: 205 ITALIANS 138 JEWS
PERCENT PERCENT
1000 ; 100 >
o OC ; 80 4
ATHEROSCLEROSIS oe ATHEROSCLEROS! $
ALL SITES re ALL SITES
oOo « 4 60 nd A
rd
” = ” 7
a
ae
2 + 20+ <
¢
0 0 45 1) 4h 60 65 70 rT)
A
PERCENT PERCENT wi
60 “ rs)
o 4 60
” 4 40
2 20
7 868
40
PERCENT AGE PERCENT ace
8 * tt) ~
60 « 60 4
ARY ARTERY COROWARY ARTERY
One ISEASE pe DISEASE
tr) - ° o” *
20 a oon el a 20 4 if
a | ——— a
40 “ 50 65 ° @ 65 70 78 o 5 50 66 0 66 7) 76
AGE AGE
Fic, 2. Prevalence of atherosclerosis—ethnic groups. Dotted lines refer to data based on less than
10 cases.
women and 32 per cent of Italian women had greater prevalence than Italians. The over-
elevated blood pressures. The frequency of all prevalence is 17 per cent for Jews and 7
diabetes is the same, 8 per cent, among Italian per cent for Italians, (P< 0.01). The
and Jewish women. theoretical possibility must be kept in mind
There is no consistent ethnic difference in that these differences may be due to selective
the prevalence of coronary artery disease mortality or to differences in attitude toward
among the women, although the number of retirement as the result of illness.
cases are few. The data on the men, how- The results of serum cholesterol and phos-
ever, bear out the general impression, hitherto pholipid determinations are presented in fig-
unsupported by controlled data, that coronary ure 3, which shows the age trends of serum
disease is more common among Jews. From lipid patterns in men and women with and
age 50 on, Jewish men consistently showy a without atherosclerosis in the 4 sites studied.
MENS cee
It wil
men,
jects |
highe
dence
ferent
fifties
to no
phosy
chole
lipid
and \
slight
phos
han
‘eT-
‘he
ind
ive
urd
OS-
im
nd
ATHEROSCLEROSIS AMONG ITALIANS AND JEWS 335
SERUM LIPID LEVELS - AGE
MENS eum 176 WITH ATHEROSCLEROSIS 328 WITHOUT ATHEROSCLEROSIS
CHOLESTEROL - MEN
won
00
290 eeert
at iown cei.
Tr)
100
wo “% 50 $6 0 6 70 7%
AGE
PHOSPHOLIPID - MEN
o 50 56 0 5 7 %
AGE
C/P RATIO = MEN
ov) “5 so 55 Lo) 68 7 76
ace
Fic. 3. Serum lipids—age.
It will be seen from the figure that in the
men, mean serum cholesterol values in sub-
jects with atherosclerosis seem to be slightly
higher than in persons without clinical evi-
dence of atherosclerosis. However, this dif-
ference becomes evident only in the early
fifties and the early sixties where it amounts
to no more than about 15 mg. per cent. For
phospholipids the trend is similar to that for
cholesterol so that the cholesterol-phospho-
lipid ratio is almost identical in those with
and without atherosclerosis. There may be a
slight downward trend for cholesterol and
phospholipids after age 60.
WOMEN: 102 WITH ATHEROSCLEROSIS __ 291 WITHOUT ATHEROSCLEROSIS
wom £ CHOLESTEROL - WOMEN
wo
er od "ee2ne oak ie P
200
130
400 —— —_—___——.
“ “5 Lo) $5 Li) 65 70 7
AGE
PHOSPHOLIPID - WOMEN
wen
em ——— a
20
20
160
100
wo “5 50 $8 60 Ly 7 7S
AGE
C/P RATIO ~ WOMEN
wo “6 50 $5 60 6s 70 %
AGE
Dotted lines refer to data based on less than 10 cases.
For women, the situation is somewhat dif-
ferent. Serum cholesterol and phospholipid
values are higher in those with atherosclerosis
than in those without, in all age groups, the
differences being larger than among the men,
between 30 to 40 mg. per cent for cholesterol.
The cholesterol-phospholipid ratio is slightly
higher in women with atherosclerosis. The
age trend again seems to be downward in
later age groups. Women with atherosclerosis
seem to have higher cholesterol and phospho-
lipid values than men of corresponding ages.
As far as ethnic differences in serum lipid
patterns are concerned, Jewish men are found
336 EPSTEIN AND BOAS
‘TABLE 3, SERUM Lipips, ATHEROSCLEROSIS, AND Erunic Groups,
Men Women
| | |
‘ | - | r | re =
Without | With | With | | Without | With With
Total | Athero- | Athero- Coronary | Total | Athero- Athero- Coronary
| sclerosis | sclerosis* | Disease | sclerosis sclerosis Diseasot
| Mean} No. | Mean! No. | Mean} No. | Mean | No. |Mean| No. |Mean| No. | Mean! No, | Mean! No,
|
Cholesterol
(mg. % ) | | | | | | |
Italians 219} 178 | 219| 129) 220 49 225; 13] 229 204 222; 162 252 | 42 273 5
Jews 237 | 274| 235| 167/ 239/ 107} 239 46} 265] 134] 255] 81! 281 53 | 286 6
Phospholipids
(mg. %) |
Italians... .| 261 | | 259 264 | | 272 | 272 265 297 204
| ! i | | | | |
Jews......| 262 | | 260 | | 265 262 | 295 | | 289 | | 305 | 309
| | | | |
C/P Ratiot | | | |
Italians. | 85 | | .85 | | .83 | | .83 84 | .84 | | .85 93
Jews......| .90 | | 91 | 90 | | 90 | 89 | go 92
*In one cr more of the 4 sites studied,
+With or without other manifestations of atherosclerosis.
tCholesterol:Phospholipid Ratio.
to have higher mean serum cholesterol values Jewish women with atherosclerosis show
than Italian men (table 3). However, within
each of the two ethnic groups, mean serum
cholesterol levels were approximately the
same among those without atherosclerosis,
with atherosclerosis in one or more of the
4 sites studied, or with coronary disease. The
difference between Italian and Jewish men is
small, however, amounting to about 20 mg.
per cent of cholesterol. Mean serum phos-
pholipid values among Italian and Jewish
men are similar so that the cholesterol-phos-
pholipid ratio reflects the trends demon-
strated for serum cholesterol. Thus, the fact
that Jewish men are more prone to coronary
artery disease than Italian men is not ex-
plained by differences in the serum lipids
measured. A tendency toward hypercho-
lesteremia among Jews has been described by
others (2, 6).
Among women, the difference between
Italians and Jews as regards serum cholesterol
is maintained, amounting to about 30 mg. per
cent (table 3). However, both Italian and
values about 30 mg. per cent higher than
those without atherosclerosis, in contrast to
the men. In contrast to the men, Jewish
women also show higher phospholipid values
than Italian women. The cholesterol-phos-
pholipid ratio remains higher among Jewish
women.
DISCUSSION
The data presented bring to mind the ob-
servations of Keys, who found coronary dis-
ease less frequent and serum cholesterol levels
lower in Italy as compared with countries in
which the habitual diet contains larger pro-
portions of fat (9). Dietary studies among
our population groups disclosed no difference
between Italians and Jews in the intake of
calories or fat (4). The proportion of cal-
ories consumed in the form of fat to total
caloric intake is approximately 35 per cent in
both groups, considerably higher than the
habitual fat consumption in Italy as deter-
mined by Keys.
Inasr
the dat
present
We he:
this po
ber of
alysis.
sample
though
to be s
availak
related
the me
Whi
of im
osclerc
other |
bring |
sary tc
presen
bral a
“total |
the ef
preval
clude
who sl
tive of
diseas
would
that <¢
wome
ease.
count
on mi
gens
coron:
ather¢
hancit
the k
mask
distur
seruny
Da
oscle
ing p
coron
is as
show
rosis
oscler
Italia
ethni
Vith
ronary
seaset
1! No,
how
than
t to
vish
lues
hos-
vish
ATHEROSCLEROSIS AMONG ITALIANS AND JEWS 337
Inasmuch as this is a preliminary report,
the data on serum lipid patterns have been
presented without further statistical analysis.
We hesitate to draw definitive conclusions at
this point since a considerably greater num-
ber of data will be available for final an-
alysis. Possible inhomogeneities in smaller
samples can lead to false conclusions even
though tests of significance might show them
to be statistically valid. On the basis of the
available data serum lipid levels seem to be
related to atherogenesis in women. Among
the men, such a relationship is less clear.
While serum lipid patterns are, no doubt,
of importance in the causation of ather-
osclerotic lesions, they should not overshadow
other possible etiologic factors. In order to
bring such factors to light, it may be neces-
sary to include, as was done at times in the
present study, coronary, peripheral, and cere-
bral atherosclerosis under one generic term
“total atherosclerosis.” If one wishes to study
the effect of a given abnormality upon the
prevalence of atherosclerosis, one should in-
clude in the atherosclerotic group all subjects
who show evidence of atherosclerosis irrespec-
tive of site. The use, in our study, of coronary
disease as the sole indicator of atherosclerosis
would have prevented recognition of the fact
that aortic atherosclerosis is as frequent in
women as in men, in contrast to coronary dis-
ease. This demonstration has its experimental
counterpart in the work of Katz and his group
on male and female chickens in whom estro-
gens give protection to cholesterol-induced
coronary atherosclerosis but not to aortic
atherosclerosis (10, 11). Protective and en-
hancing factors are clearly of importance in
the localization of arterial lesions and may
mask or exaggerate the effect of a generalized
disturbance such as the presence of abnormal
serum lipid constituents.
SUMMARY
Data on the prevalence of manifest ather-
osclerosis among a random sample of a work-
ing population are presented. In contrast to
coronary artery disease, aortic atherosclerosis
is as common in women as in men. The data
show the mode of progression of atheroscle-
rosis with age in 4 di:‘erent sites. Ather-
osclerosis is more prevalent among Jews than
Italians in either sex. The effects of age and
ethnic group on serum lipid patterns are
described, but the data from this preliminary
sample are too fragmentary for final conclu-
sions,
Mrs. Rita Simpson coded the data and made the
statistical analyses. Dr. Julian B. Hyman carried
out part of the examinations. Mr. M. Wurm and
Mrs. Emily Nagler were responsible for the chemical
determinations. The roentgen films were taken by
Mr. S. Rubinfeld. Mrs. Elizabeth Dunsay enlisted
the cooperation of those selected for examination.
REFERENCES
1. Abell, L. L., Levy, B. B., Brodie, B. B., and
Kendall, F. E.: A Simplified Method for the
Estimation of Total Cholesterol in Serum and
Demonstration of its Specificity. J. Biol. Chem.,
195: 357-366, 1952.
Adlersberg, D., Schaefer, L. E., and Drachman,
S. R.: The Incidence of Hereditary Hypercholes-
J. Lab. & Clin. Med., 39: 237-245,
bo
teremia.
1952.
3. Boas, E. P., and Epstein, F. H.:
Manifest Atherosclerosis in a Working Population.
Preliminary Report. Arch. Int. Med., 94: 94-101,
1954.
4. Epstein, F. H., Simpson, R., and Boas, E. P.:
Studies on Relations between Diet and Athero-
sclerosis Among a Working Population of Dif-
ferent Ethnic Origins. Am. J. Clin. Nutrition,
in press.
5. Fiske, C. H., and Subbarow, Y.:
metric Determination of Phosphorus.
Chem., 66: 375-400, 1925.
6. Groen, J., Kamminga, C. E., Reisel, J. H., and
Willebrands, A. F.: Cholesterol Content of Blood
Serum from Jewish and Gentile Blood Donors.
Nederl. tijdschr. v. geneesk., 94: 728-738, 1950.
Hawk, P. B., Oser, B. L., and Summerson, W. H.:
Practical Physiological Chemistry. The Blakiston
Company, Philadelphia, 1951, p. 523.
8. Hyman, J. B., and Epstein, F. H.: A Study of
the Correlation between Roentgenographic and
Post-Mortem Calcification of the Aorta. Am.
Heart J., 48: 540-543, 1954.
Prevalence of
The Colori-
J. Biol.
~l
9. Keys, A.: Atherosclerosis: A Problem in Newer
Public Health. J. Mt. Sinai Hosp., 20: 118-139,
1953.
10. Pick, R., Stamler, J., Rodbard, S., and Katz,
L. N.: The Inhibition of Coronary Atheroscle-
rosis by Estrogens in Cholesterol-Fed Chicks.
Circulation, 6: 276-280, 1952.
11. Stamler, J., Pick, R., and Katz, L. N.: Inhibition
of Cholesterol-Induced Coronary Atherogenesis
in the Egg-Producing Hen. Circulation, 10:
251-254, 1954.
. Se Ce GS GS Eek Ee
JOURNAL OF GERONTOLOGY
VoLtuME 10, Number 3
Jury, 1955
Section B
Psychological and Social Sciences,
Social Work and Administration
VoLume 10, SECTION B
Jury, 1955
Number 3
THE DISTRIBUTION ACCORDING TO AGE OF A PSYCHOLOGIC MEASURE
DEPENDENT UPON ORGANIC BRAIN FUNCTIONS®
RALPH M. REITAN, Ph.D.+
(From the Department of Surgery, Division of Neurological Surgery,
Indiana University Medical Center, Indianapolis)
In 1947, Halstead (1) presented results ob-
tained with a battery of psychologic tests
specifically designed for measurement of in-
tellectual impairment associated with brain
damage. His findings indicated marked im-
pairment in patients with frontal as compared
with nonfrontal lobectomies, and fairly con-
sistent impairment in the group with non-
frontal lesions as compared with non-brain-
damaged controls.
The first attempt at cross-validation of the
Halstead battery has been published recently
(3). Fifty patients, heterogeneous with re-
spect to type, extent, and location of brain
damage, were individually matched with 50
control patients on the basis of color, sex,
age, and education. Intergroup comparisons
yielded more striking differences than those
reported by Halstead. The Halstead Impair-
ment Index, for example, differentiated the
matched pairs into their appropriate groups
without error. Six pairs, however, had equal
Impairment Indices.
In consideration of this evidence for the
sensitivity of the Halstead Impairment Index
to the effects of brain damage, an attempt was
made in the present study to determine its
relationship to chronologic age.
POPULATION
One group was composed of 194 subjects
with brain damage of various types. Diag-
noses included brain tumor, subdural hema-
toma, cerebral abscess, cerebral vascular acci-
dent, cerebral atrophy, degenerative cerebro-
vascular disease, penetrating and closed head
injuries, epilepsy, general paresis, multiple
sclerosis, and developmental anomalies of the
brain. Obviously the brain lesions varied in
type, location, and extent. The only specific
Submitted for publication July 28, 1954.
Presented at the Seventh Annual Scientific Meeting of the
Gerontological Society, Inc., Gainesville, Florida, December
28-30, 1954.
*Supported in part by a grant from the James Whitcomb
Riley Memorial Association.
tThe writer is indebted to Dr. Robert F. Heimburger for
reading the manuscript and offering valuable suggestions.
criterion for inclusion of a patient in this
group was unequivocal evidence of brain
damage based upon neurologic and _neuro-
surgical diagnostic procedures.
The group without brain damage was com-
posed of 133 subjects, including some with
various neurotic disturbances as well as some
normal and paraplegic subjects. Each of
these patients had been examined neurologi-
cally, and although the paraplegics had spinal
cord damage, none of the subjects had any
positive indications of brain disease or dam-
age. The neurotic and paraplegic subjects
were hospitalized at the time of testing. This
factor should tend to make the two groups
more comparable, since the brain-damaged
subjects were also hospitalized. However, it
may also make our group without brain dam-
age less representative of a “normal” control
group. The frequency distribution of each
group in 5-year age intervals is presented in
table 1.
TABLE 1. DISTRIBUTION ACCORDING TO CHRONOLOGIC
AGE oF GrouPs WITH AND WITHOUT BRAIN DAMAGE.
Brain No Brain
Age Interval Damage Damage
15-19... spoabaacied 12 10
20-24.... ' 26 15
ae 23 27
CS | ee 30 12
<i 24 15
40-44...... 21 12
45-49...... 19 13
eae 12 10
55-59... : Lo 15 14
60-64... 12 5
194 133
Each subject was interviewed by the writer
before testing was started, and only those
were included in the study who were sufli-
ciently alert, cooperative, and in contact with
reality to be able to give detailed anamnestic
informati
from oth
were inc
damaged
men and
group V
(75 per
women.
administ
had no —
The b
by Hals'
each su
two day
tests. |
after ad
was COr
were CC
The
lected |
ologic
seems t
damage
a comy
which
tive to
for an
the nur
fell in
age. /
istic 0
Impair
damag
Eacl
vals re
65. \
ment
graphi
Hig
(p<.
10 tes
dex w
upon
comp:
elsewl
of the
Fig
pressi
ber 3
E
this
brain
Curo-
com-
with
some
nh of
logi-
inal
any
lam-
jects
This
Ups
ged
r, it
am-
trol
ach
| in
er
se
i-
th
ic
AGE AND ORGANIC BRAIN FUNCTIONS
information which agreed with that obtained
from other sources. No psychotic patients
were included in either group. The brain-
damaged group included 143 (74 per cent)
men and 51 (26 per cent) women, and the
group without brain-damage included 101
(75 per cent) men and 32 (25 per cent)
women. In most instances the tests were
administered and scored by a person who
had no knowledge of the research plan.
PROCEDURE
The battery of psychologic tests developed
by Halstead was individually administered to
each subject. Usually one and one-half to
two days were required for completion of the
tests. The tests were scored immediately
after administration, and before either group
was composed. Mean scores for each group
were compared statistically.
The Halstead Impairment Index was se-
lected for study with relation to the chron-
ologic age continuum, since this measure
seems to be the most valid indicator of brain
damage in the battery (1, 3). This index is
a composite score based upon the 10 tests
which Halstead found to be the most sensi-
tive to frontal lobe damage. It is determined
for an individual subject merely by counting
the number of tests on which his performance
fell in the range characteristic of brain dam-
age. A high Impairment Index is character-
istic of brain-damaged subjects and a low
Impairment Index of subjects without brain
damage.
Each group was divided into 5-year inter-
vals ranging in chronologic age from 15 to
65. Mean scores on the Halstead Impair-
ment Index for each interval were plotted
graphically for both groups.
RESULTS
Highly significant intergroup differences
(p<.0"5) were obtained on each of the
10 tests contributing to the Impairment In-
dex with the exception of two measures based
upon critical flicker frequency. A detailed
comparison of this type has been presented
elsewhere (3), together with a description
of the individual tests.
Figure 1 presents column diagrams ex-
pressing the relationship between the Hal-
339
PROFILE CHART
«x § D
a“ e
ce
i
1
3 .
g 6
8 Id
8 * Level
|é
D
e
c
i
ma 1
e
3 .
ree.
= ,61
CHRONOLOGICAL AGE
Fic. 1. Graphic presentation of mean Halstead Im-
pairment Index for each 5-year interval from ages
15 to 65 for a group with brain damage and a group
without clinical evidence of brain damage. Scores
above the criterion line are characteristic of brain-
damaged subjects and scores below are characteristic
of control subjects.
stead Impairment Index and chronologic age
for each group.
The results are plotted on a profile chart
which permits evaluation with relation to the
results obtained by Halstead. The norms for
the chart were developed in Halstead’s lab-
oratory on the basis of a large group (N =
451) of individually tested brain-damaged
and control subjects. The horizontal mid-
line represents the criterion level for each
test, or the point which Halstead found to
differentiate best his control and frontal-brain-
damaged subjects. Thus, a test performance
above the criterion line is more similar to
those obtained by Halstead’s subjects with
frontal damage than to his controls, whose
scores tended to fall below the criterion line.
Deciles above and below the criterion level
are indicated on the vertical axis.
Mean scores for each 5-year interval in the
brain-damaged group fell well above the
criterion level. Although the scores tend
toward greater impairment with advancing
age, it is apparent that the trend is not pro-
nounced. This is indicated quantitatively by
a Pearson product-moment correlation be-
tween the Impairment Index and age of +.23
and a correlation ratio of .27.
i
i
Wl
:
i
'
7
4
,
w
b
-
*
o
s
we.
340 REITAN
The correlation between age and the Im-
pairment Index for the group without neu-
rologic evidence of brain damage is consid-
erably higher (r = .54; » = .61). Consider-
ing the age range from 15 to 45, no striking
relationship between the variables is ap-
parent. The 45 to 50 age interval, however,
is well above the criterion level and into the
range characteristic of brain damage accord-
ing to Halstead’s norms, and each succeeding
interval obtains a somewhat poorer mean
score. It would seem likely that the age
group from 45 to 65 contributes heavily to
the higher correlation coefficients between age
and test result obtained in this group.
DISCUSSION
The occurrence of only a weak relationship
between the Impairment Index and age in
the brain-damaged group suggests that age
is relatively insignificant in determining the
results when brain damage is clearly pres-
ent. The basis for the distinct relationship
in the group without neurologic evidence of
brain damage cannot be stated. Since previ-
ously obtained evidence indicates the Im-
pairment Index to be a valid and fairly spe-
cific indicator of brain damage, it would seem
possible to hypothesize that the results indi-
cate organic brain changes. These changes
seem to begin, on the average, in the 45 to
50 year age period, although there were some
individuals in each age interval who scored
within the normal range. It is interesting to
note that the 45 to 50 year interval is the
patient-age range in which neurologic sur-
geons become hesitant to perform cerebral
angiography or carotid artery ligations unless
clearly necessary (2).
A detailed understanding of the results
found in this study is dependent upon infor-
mation of the relationship between the Im-
pairment Index and various pertinent bi-
ologic measurements. However, the results
suggest the possibility of reliably differenti-
ating older individuals without positive neu-
rologic signs who show impairment of abil-
ities associated with brain damage from those
who do not.
SUMMARY
The psychologic tests developed by Hal.
stead for the purpose of measuring adaptive
abilities dependent upon organic brain func.
tions were administered to two groups of per.
sons. A group with unequivocal evidence of
brain damage included 194 subjects, and a
group with no neurologic or anamnestic eyi-
dence of brain damage was composed of 133
subjects. Highly significant intergroup dif.
ferences were obtained on the Halstead Im.
pairment Index as well as 8 of the 10 tests
upon which it is based.
The groups were then divided into 5-year
intervals from ages 15 to 65 years, and mean
curves for the Impairment Index were
plotted. The curve for the brain-damaged
group fell in the range characteristic of im-
paired performance consistently over the en-
tire age continuum, and both Pearson product-
moment coefficients and correlation ratios be-
tween test result and age were relatively low.
The relationship between age and test result
was much higher, however, for the group
without neurologic or anamnestic evidence of
brain damage. The correlation was con-
tributed largely by individuals 45 years of
age and older, since the curve showed a
fairly sharp break in the direction of impair-
ment at approximately this age range. The
results indicate that the Halstead Impairment
Index is relatively uninfluenced by age when
brain damage is clearly present. Age, how-
ever, may be a distinctly pertinent variable
in a group without neurologic evidence of
brain damage, particularly in the range from
45 to 65 years.
REFERENCES
1. Halstead, W. C.: Brain and Intelligence, Uni-
versity of Chicago Press, Chicago, 1947.
2. Heimburger, R. F.: Personal Communication.
3. Reitan, R. M.: An Investigation of the Validity
of Halstead’s Measures of Biological Intelligence,
Arch. Neurol. & Psychiat., 73: 28-35, 1955.
HE P
and
with time
Class I m
Aeronaut
tains are
However
meets th
captains
months.
Four s
pose. T'
plete, ar
holders «
years 19
not been
pare the
such co
other da
lation sh
groups ¢
who pas
ing the
qualifiec
tributior
Class I :
dates ar
any mot
a samp!
total nv
holders
it are, th
veal sm
The <
1, whic!
year, it
It can |
tributio
curred
are the
tributio
stituted
’ Hal.
aptive
func.
of per-
ce of
and a
C evi-
of 133
> dif.
1 Im-
tests
)-year
mean
were
aged
f im-
e en-
duct-
s be-
low.
esult
roup
ce of
con-
s of
da
Dair-
nent
yhen
1OW-
able
> of
rom
Uni-
idity
nce,
THE CHANGING AGE DISTRIBUTION OF PILOTS HOLDING FIRST
CLASS MEDICAL CERTIFICATES*
CLAIR R. SPEALMAN, Ph. D., AND PAUL T. BRUYERE, Ph. D.
(From the Medical Division, Civil Aeronautics Administration, Washington, D. C.)
HE PURPOSE of this report is to present
y atl analyze data concerning the change
with time in the age distribution of holders of
Class I medical certificates issued by the Civil
Aeronautics Administration. Only airline cap-
tains are required to possess this certificate.
However, any pilot may obtain one if he
meets the high physical standards. Airline
captains must renew this certificate every six
months.
Four sets of data are available for our pur-
pose. The first two, which are the most com-
plete, are total counts by year of birth of
holders of Class I medical certificates for the
years 1946 and 1949. Unfortunately, it has
not been possible in subsequent years to pre-
pare the detailed punch cards necessary for
such counts. For the year 1952, however,
other data are available. These are: a tabu-
lation showing the distribution by 5-year age
groups of pilots with airline transport ratings
who passed Class I physical examinations dur-
ing the last six months of 1952 (i.e., pilots
qualified to act as airline captains); and a dis-
tribution by year of birth of all holders of
Class I medical certificates on which the birth
dates are recorded as the first or fifteenth of
any month. This latter tabulation represents
a sample of only about 6.57 per cent of the
total number of Class I medical certificate
holders for that year. Estimates based upon
it are, therefore, not sufficiently precise to re-
veal small changes from the preceding years.
AGE DISTRIBUTIONS
The 4 sets of data are summarized in table
1, which shows the age distributions for each
year, in percentage, by 5-year age groups.
It can be seen that a general shift in the dis-
tribution toward the upper age brackets oc-
curred during these years. Most pronounced
are the changes in the two ends of the dis-
tribution. Pilots younger than 30 years con-
stituted 44.5 per cent of the holders of Class
Submitted for publication January 5, 1955.
Published on a grant from the Forest Park Foundation to
the Journal of Gerontology.
views expressed in this report are those of the authors.
The report does not necessarily reflect any policies or con-
clusions of the Civil Aeronautics Administration.
I medical certificates in 1946 as compared with
28.7 in 1949 and an estimated 12.0 per cent
for 1952. At the other extreme, a correspond-
ing change in the opposite direction occurred:
there were only 9.9 per cent of the pilots over
39 in 1946, as compared with 16.0 per cent
in 1949 and 21.3 per cent indicated by the
sample for 1952. Comparison of the 1952
sample data with the distribution of pilots
having both Class I medical certificates and
airline transport ratings reveals that. the lat-
ter are even more heavily concentrated in the
older age groups, 27.8 per cent being over 39
and only 3.9 per cent under 30.
Table 2 shows the numbers of Class I medi-
cal certificate holders by 5-year groups ac-
cording to year of birth for each of the three
years under study. A comparison for 1952
of the estimated numbers of all holders of
Class I medical certificates with the numbers
holding airline transport ratings show little
TABLE 1. PERCENTAGE DISTRIBUTIONS OF PILOTS HOLDING
Crass I MepicaL CERTIFICATES IN THE YEARS 1946,
1949, AND 1952 IN 5- YEAR AGE GROUPS
YEAR OF EXAMINATION
,
Age 1952
Group
1946 1949 |
| Airline Transport
Sample* Rating Onlyt
| |
| | | |
Under 24 | 4.2 1.2 10 =| 0.1
25-29 40.3 | 27.5 | 1.0 | 3.8
30-34 29.1 36.0 42.8 35.2
35-39 16.5 19.4 23.9 33.2
40-44 6.5 11.3 12.8 16.3
45-49 3:1 3.0 5.8 8.2
50-54 igs 1.3 1.8 2.2
55-59 0.1 0.4 0.7 0.9
60-64 0.0 0.0 0.2 0.2
*Sample: Pilots born on ist or 15th day of a month.
tIncludes only pilots with airline transport ratings
who were examined during last six months of the year.
342
difference in the 4 oldest groups. In the
younger groups, however, the number of pi-
lots having Class I medical certificates con-
siderably exceeds the number having airline
transport ratings. The difference is greatest
in the youngest groups. This difference is sig-
nificant statistically only for those born since
1917, but it is probable that among Class I
medical certificate holders born in the years
1908 to 1917, a substantial proportion do not
have airline transport ratings.
A possibly more important finding revealed
in table 2 is that the numbers in the year-of-
birth classes up to about 1912 tend to remain
approximately constant over the 6 years (1946-
1952). Among those born in 1912 and be-
fore, there was very little change from 1946
to 1949, and the estimated, slight increases
from 1949 to 1952 are within the range that
can be attributed to chance sampling fluctua-
tion. The younger groups, however, all show
large increases from 1946 to 1949 and from
1949 to 1952.
TABLE 2.
SPEALMAN AND BRUYERE
The relative constancy of numbers in the
older birth classes from 1946 to 1952 might
be due primarily to the fact that there were
few retirements and deaths in these groups of
pilots and that those few were replaced by
pilots who had not previously held Classs |
medical certificates. However, it is possible
that there was a large turnover (many retire.
ments and deaths balanced by many replace.
ments ) in these birth classes and that the con-
stancy of numbers is largely a chance occur-
rence. For reasons stated previously, this lat-
ter possibility seems unlikely, even though
there was a large increase in the total num-
ber of Class I medical certificate holders dur-
ing this time, from 8,489 in 1946 to 10,019 in
1949 to approximately 13,600 in 1952. These
alternative possibilities were examined by ob-
taining the names of all Class I medical cer-
tificate holders who were 50 years of age or
older in 1949 (year of birth 1899 back to 1889
which was the earliest birth date recorded).
The results of this survey are shown in table
NUMBER OF PiLots HoLpinG CLAss I MEpICAL CERTIFICATES IN THE YEARS 1946,
1949, AND 1952, By YEAR OF BIRTH, IN 5- YEAR GROUPS.
Year of Examination
1946 1949 1952
Year of Birth
All Holders
Airline
All All Transport
Holders Holders Estimated 95% Confidence Rating Onlyf
Number* Interval
SS: ae are 16 11 30 2-85 16
Ss a a eee 120 94 91 18-164 90
Ro yidcs oie bole so cco 209 197 244 125-363 209
| SE 712 719 792 577-1007 788
1908-1912.................. 1533 1562 1737 1419-2055 1567
) USS Ly rae 2789 2919 3245 2812-3678 3191
+ Se ea 3018 3954 5820 5245-6395 | 3389
s.. : a eae res 92 561 1493 1198-1288 363
TONED ioc ob Slices cw 0 2 137 47-227 6
Pe INES soins ose doh b oS Hikes 8,489 10,019 13,589 12,727-14,451 | 9,619
*Estimate based on research sample comprising pilots born on the Ist or 15th day of any month.
year,
tIncludes only pilots with airline transport ratings who were medically examined during the last six months of the
3. TI
cent ¢
Class
year f
plete.
succes
of the
older
is a le
pilots
PRE
Dui
in ea
to 185
tively
in the
stanc}
hold
expec
1889. .
1890. .
1891..
1892. .
1893...
1894. .
1895...
1896. |
1897...
1898. .
1899...
Totals
Ss in the
2 might
Te were
roups of
aced by
Classs |
possible
y retire-
replace-
the con-
e occur-
this lat-
though
al num-
ers dur-
0,019 in
These
| by ob-
cal cer-
age or
to 1889
orded),
in. table
‘line
sport
y Onlyt
209
788
is of the
3. The table further shows that over 70 per
cent of these pilots continued to hold their
Class I medical certificates in 1953, the latest
year for which the medical records are com-
plete. This was determined by examining the
successive individual medical records of each
of these pilots. Evidently, the tendency of
older pilots to retain their medical certificates
is a large factor in stabilizing the number of
pilots in the older birth classes.
PREDICTED INCREASE IN NUMBERS
OF OLDER PILOTS
During 1946 to 1952, the number of pilots
in each of the older birth classes from 1888
to 1892 through 1908 to 1912 remained rela-
tively constant and resulted in a large increase
in the number of older pilots. If this con-
stancy in the older birth classes continues to
hold between the age limits considered, the
expected increase in number of older pilots
TABLE 3.
CHANGING AGE DISTRIBUTION OF PILOTS
343
during the next few years can be calculated
readily. For example, there were 315 Class
I medical certificate holders with airline trans-
port ratings who were 50 years old or older
in 1952 (see last column of table 2). On the
basis of the above premise, in 1957 there will
be an additional 788 pilots (birth classes of
1903 to 1907) in this age group. By 1962, the
still larger birth classes of 1908 to 1912 will
become 50 or older. These additions would
increase the total in the age group to about
1,000 in 1957 and well over 2,000 in 1962.
Very probably pilots in the 65 years and
older brackets will tend to cease professional
flying to a greater extent than was found in
our group of pilots 50 years of age and older.
The oldest pilot in this group was only 64
in 1953, and we do not yet have any basis for
predicting the rate of attrition of pilots aged
65 and older. However, even by 1962, the
number of pilots now flying who will be in
this age group will be relatively small.
Tue NuMBER, ACTIVITY, AND EMPLOYMENT OF PILOTS WHO WERE Firty YEARS OF AGE
oR OLDER AND HELD Crass I MeEpICcAL CERTIFICATES IN 1949 AND THEIR SUBSEQUENT
STATUS IN 1953 AS DETERMINED BY EXAMINING THE MEDICAL RECORDs OF EACH PILOT.
1949 1953 |
| Column 5
Year of Birth Number Number | — x 100
Employed | Number Employed | Number Column 2
Number by Active* | Number | by Active* |
Airlines | Airlines |
|
(1) (2) (3) (4) (5) (6) (7) | (8)
st 1 0 0 0 0 0 0
ee 1 1 1 1 1 0 100
Ne Sc ai aren ess 2 2 2 1 1 1 50
ee 7 4 4 4 1 1 57
BIE ooo. bio se sec 8 S 6 5 3 4 63
os 16 12 12 8 7 7 50
keg ee 18 15 14 15 13 12 83
Eee 32 24 24 25 19 18 78
BE 5 G5 90% o.0-0 ace 19 11 11 12 9 10 63
BE sc e.sGe-siaas & 24 16 18 18 13 14 75
Ss 32 20 23 24 19 19 75
I 25s, sie <csce 1607 | 110 125 113 87 | 86 | 71
|
*150 hours or more flying time in a six months’ period.
+The original tabulation gave a total of 163 for this group. Two of these cases were not found on the second tabu-
lation.
A third case was included by error in the original tabulation.
344
DISCUSSION
One of the objectives of this study was to
establish a basis for predicting how rapidly
the number of older pilots can be expected
to increase. A means of doing this was found
in the fact that the number in each birth class
changed little after the age of about 40. The
detailed examination of the group of pilots
over 50 indicated that although the total num-
ber remained approximately constant during
a 4-year period, there was a turnover of about
30 per cent. It was not possible to assess
the part played by various factors such as
mortality, retirement, recruitment, and the
like.
An incidental finding in this study was the
marked reduction during 1946 to 1952 in the
number of pilots younger than 30. This has
not been commented on elsewhere in this re-
port. Presumably military requirements, the
existence of older pilots in sufficient numbers
to meet the demands of this expanding in-
dustry, and possibly airline policy have all
been responsible in some degree.
SUMMARY
1. The numbers of holders of Class I medi-
cal certificates in the upper age groups (40
years and older) has increased considerably
SPEALMAN AND BRUYERE
and progressively from 1946 through 1952 §
while changes in the opposite direction have
occurred in the lower aye groups (below 30
years ).
2. The increase in numbers of older Class
I medical certificate holders is presumably
due in large measure to the fact that the mid.
dle and upper age groups of Class I medical
certificate holders are made up largely of
pilots who retain their Class I medical cer.
tificates. As time goes on, the larger number
of pilots once in the middle-age groups ap-
pear in the upper age groups. The strong
tendency to retain this certificate and also to
continue active flying was demonstrated by
examining the individual medical records of
pilots in the upper age groups. Of the pilots
who were 50 years old or older in 1949, 70 per
cent still retained their Class I medical certif-
cates in 1953 when they were 54 to 64 years
old.
3. The number of older Class I medical
certificate holders seems to be only slightly
greater than the number of pilots with cur-
rently valid airline transport ratings.
4, On the basis of the data on the age dis-
tributions of pilots in 1946, 1949, and 1952,
it can be estimated that there will be about
1,000 Class I medical certificate holders 50
years of age or older in 1957 and over 2,000 in
1962.
Al
ing |
State
a lar
labor
alysi:
York
clude
discr
the
show
dust:
tiren
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emp’
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Act
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can
This
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195¢
for
pers
men
clud
port
repc
the
ture
wou
old
It te
son
Sul
Sept.
Matu
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gh 1952 §
tion have
below 30
der Class
esumably
the mid.
- medical
irgely of
lical cer.
* number
OUPS ap-
ie strong
1 also to
rated by
cords of
he pilots
9, 70 per
il certifi-
64 years
medical
slightly
‘ith cur-
age dis-
id 1952,
e about
ders 50
2,000 in
JOBS FOR THOSE OVER SIXTY-FIVE
HARVEY C. LEHMAN, Ph.D.
(From the Department of Psychology, Ohio University, Athens, Ohio)
Along with the differential age change tak-
ing place in the population of the United
States there is a growing tendency to exclude
a larger proportion of older people from the
labor market. O’Donnell’s (8) recent an-
alysis of 3,474 jobs advertised in the New
York Times revealed that 1,330 of them in-
cluded age specifications, 97 per cent of which
discriminated against men over age 45, and
the Banker's Trust Survey (10) in 1950
showed that nearly 90 per cent of 289 in-
dustrial pension plans fix 65 as the normal re-
tirement age. Many government bureaus and
agencies help to conventionalize this proce-
dure by maintaining fixed age limits in their
employment practices. The concept of auto-
matic compulsory retirement at a _ certain
specified age, usually around 65, is reflected
in certain laws, including the Social Security
Act itself.
With the gradual acceptance of 65 or 70
as the normal retirement age, what are the
present prospects of employment for Ameri-
can men and women who are 65 or over?
This question is all the more important be-
cause the older person’s personal adjustment
is greatly influenced by his vocational and ec-
onomic adjustment.
METHODS
From the U. S. census reports for 1890 to
1950, with the sole exception of the report
for 1910, which did not isolate age data for
persons 65 and over, we listed separately for
men and for women all occupations which in-
cluded twice or more than twice their pro-
portionate share of workers in the age bracket
65 and over. Data from 6 different census
reports were employed because collectively
the 6 reports yield a much better over-all pic-
ture of the situation than any one of them
would present. This study deals only with
old people who have been in the labor force.
It takes no account of those who for one rea-
son or another have not wanted to work and
Submitted for publication January 31, 1955.
This paper was presented in somewhat different form on
Sept. 3, 1954, in New York City before the Division on
Maturity and Old Age of the American Psychological As-
Sociation.
those who have been idle because of illness,
infirmity, or inability to get a job.
In 1950 men aged 65 and over in the U. S.
labor force comprised 5.4 per cent of the
total number of male workers. If the male
workers 65 and over had been evenly dis-
tributed among all industries and occupations,
old people would have comprised exactly 5.4
per cent of the men of each industrial and oc-
cupational group. However, some occupa-
tions included relatively few and others in-
cluded far more than their proportionate share
of elderly workers. If a particular occupation
included twice or more than twice its propor-
tionate share of workers 65 or over, that fact
will be indicated by saying that the elderly
were over-represented in that specific occupa-
tion.
RESULTS
Between 1890 and 1940 the proportion of
men aged 65 and over in the labor force
dropped from 70 to 43 per cent. It rose some-
what during World War II, when there was
a severe shortage of workers, but at the end
of 1951 it was back at the 1940 level. While
the rate of participation in the labor force for
men in the age bracket 65 and over decreased
greatly from 1890 to 1950, the rate of par-
ticipation for women aged 65 and over de-
creased only slightly, namely, from 8.5 per
cent in 1890 to 8.0 per cent in 1950. The fol-
lowing observations apply, therefore, to only
from 43 to 70 per cent of the men and 8 per
cent of the women 65 and over.
Among older women, keeping house was
the reason most often given for not working
at a paid job. Moreover, a large percentage
of the women who were working at paid jobs
were trying simultaneously to keep house for
their families. Hence, our observations do
not reveal the percentage of elderly women
who were engaged in useful work.
In 1950 the correlation between the total
number of men and the number of men 65
and over engaged in each of 156 occupations
was 0.83. This fairly large positive correla-
tion means that although in general large
345
346
numbers of old people are found in the larger
occupational groups, there are numerous ex-
ceptions to this generalization.
Although older men and women comprise
only a small percentage of the total labor
force (5.4 and 3.2 per cent, respectively, in
1950), the absolute numbers of individuals
concerned are quite large. Thus, in 1950 a
total of 2,470,000 elderly men and 576,000
elderly women were working at paid jobs.
If to these are added the many other persons
who were dependent financially upon these
older workers’ annual wages and if the rel-
atives, friends, and taxpayers who would have
had to support these elderly individuals had
they been without employment are also in-
cluded, it is clear that the annual earnings
of these older men and women were a matter
of personal concern to a very large number
of people. Pertinent in this connection is
the fact that more than one-sixth of those
65 or over are believed to be supported by
children or other relatives (9).
Table 1 is to be read as follows. In 1950
(table 1A, item 5) there were in the United
States 524,697 farmers and farm managers
aged 65 or over, 2.24 timees (or 224 per cent)
as many old people as would have been
found in this group if the men 65 and over
had been distributed evenly among all in-
dustries and occupations.
The marked over-representation of older
men in agricultural pursuits in almost every
census report, as shown in table 1, can be
attributed partly to the fact that many of
them were farm owners who could delay their
retirement as long as they wanted, gradually
tapering off in their work to match their work-
load to their diminishing strength and ambi-
tion, and partly to the fact that the percentage
of the total U. S. population engaged in farm-
ing has been decreasing within recent years.
Although occupations which harbor large
numbers of old persons vary greatly with re-
spect to prestige, wages earned, and the de-
mands made upon them, for a number of dif-
ferent reasons older workers generally are
much out-earned by the working population
as a whole (10). One reason for this is that,
on the average, each successive age group in
the population has received a slightly better
formal education than did its immediate pred-
ecessor. During a short period of time this
difference in formal education is perhaps in-
LEHMAN
consequential but over a 30 or 40 year ip.
terval this difference in schooling is a matter
of very great importance,
The elderly are handicapped by their lim.
ited education and also by their relative lack
of physical strength, agility, and speed. Large
numbers of them must engage, therefore, in
various kinds of custodial or housekeeping
jobs, jobs in which the pay-rate is low (table
1B).
Although old people are much out-earned
by the working population as a whole, there
are some notable exceptions to this general-
ization. We have published data (7) which
reveal that of the American men who re-
ceived earned annual incomes of $50,000 or
more from 1934 to 1938, 17.8 per cent were
65 or over, 3.57 times the number of male
workers 65 or over in the total U. S. labor force
in 1940 (7). Data were also published which
show that in proportion to their numbers
those in the age group 80 to 89 are the most
frequent recipients of annual incomes (not
necessarily earned ) of $1,000,000 or more (7),
Although the absolute number of individuals
in these two affluential groups was not large,
their existence should help avoid a stereo-
typed conception of the older person's eco-
nomic status and earning power. In late ma-
turity individual differences in earning power
are probably greater than at any other time
of life.
It is true also that certain positions which
require a long period of “working up” and
which command great prestige are over-rep-
resented by those over 65. For example, ac-
cording to the last census report there were
253 per cent as many elderly public officials
and inspectors in the United States as there
would have been if the older men had been
spread out evenly among all occupations
(table 1F, item 7).
The census reports give no breakdown for
U. S. congressmen and federal judges, data
for whom were obtained from the World Al-
manac and Who's Who in America. Data
were also assembled for Roman Catholic Car-
dinals. The data in table 2 reveal that 23 per
cent of the U. S. senators in the 83rd Con-
gress were over age 65 and that this was more
than four times what might have been ex-
pected on the basis of the proportion in that
age group in the total population. Another
position in which elderly men are in much
TABLE
CLUD
Agricu
om & ta OD oS
the |
JOBS FOR THOSE OVER SIXTY-FIVE 347
year in. Taste 1. Data From Census Revorts For 1890-1950 (Except 1910) For Men's Occupations Wuicu In-
1 matter chupep Twice OR More THAN Twick ‘THEIR PROPORTIONATE SHARE OF WORKERS 65 YEARS OR OVER.
cir lim. | No.of | Ratio to
ive lack Type of Worker | Census | Men 65 | Expected
q Large | Report | and Over Number
‘fore, in |
keeping Agriculture, Animal Husbandry, and Related Fields, |
V ( table 1. Farmers, planters and overseers gins ahen 1890 469,151 2.12
2, Farmers, planters, and overseers. .. : Zou 1900 | 492,378 2.09
-earned 3. Farmers, owners, and tenants 1930 628 , 243 2.53
e, there 4. Farmers and farm managers 1940 | 592,687 2.59
yeneral- 5. Farmers and farm managers. ss onl 1950 | 524,697 2.24
) which F ea |
yho m 6. Farm laborers (unpaid family workers). | 1900. |} 12,168 2.40
000 or 7, Apiarists | 1920 535 4.31
: 8. Florists | 1920 | 679 2.04
it were 9, Fruit growers ; Thee | 1920. | 9,931 2.96
vf male 10. Gardeners, florists, nurserymen, and vinegrowers. . . 1890 | 9,342 3.09
or force 11. Gardeners, florists, nurserymen, etc 1920. | 8,349 3.18
| which 12, Landscape gardeners. ee 1920 460 2.80
umbers 13. Nurserymen | 1920 | 340 2.91
1 most 14. Poultry raisers | 1920 | 1,776 3.36
s (not ? |
re (7). 15. Stockraisers, herders, drovers , 1890 | 1,985 6.02
viduals 16. Garden laborers os ‘ 1920 | 9,307 2:78
, 17. Buyers and shippers of livestock and other farm products 1930 3,698 2.07
| large, 18. Gardeners. . 1920 | 16, 808 4.00
stereo-
S eCO- B. Unskilled Laborers.
te ma- 1. Charwomen,* janitors, and porters.... . 1940 | 48 ,463 2.11
power 2. Charwomen,”* janitors, and porters... 1950 93,525 2.75
r time 3. Cemetery keepers.... 1920 1,213 4.91
4, Cemetery keepers 1930 2,627 6.33
which 5. Elevator operators. . 1920 | 3,498 2.33
and 6. Elevator operators. . 1950 | 10,015 2.88
Pr -Fep- 7. Guards, watchmen, and doorkeepers 1920 22,202 4.29
le, ac- 8. Guards, watchmen, and doorkeepers 1930 7,905 4.33
> were 9, Guards and watchmen... 1940 34,838 3.61
ficials 10, Guards and watchmen 1950 48,477 3.56
there |
| been 11. Sextons Fe er 1890 | 656 3.08
ations 12. Janitors and sextons. 1900 4,735 2.16
13. Janitors and sextons. . 1920 23,433 3.49
: 14. Janitors and sextons. .. 1930 33,155 3.70
vn for 15. Laborers (street cleaning) 1920 1,777 3.53
data
ld Al- 16. Private household workers. . a's | 1950 8,558 2.09
Data 17. Other specified laborers. . . 1950 | 26,185 2.05
» Car- —-
3 per C. Finance, Insurance, and Real Estate.
Con- Bankers and brokers (money and stocks). . 1890 3,047 2.40
more 2. Bankers and brokers (money and stocks) 1900 21,192 6.59
» oe ee eer ; | 1930 95 2.47
. that 4. Loan brokers and loan company officials. .. . 1920 401 2.09
other ~ —_——_ —— ———__—_—_———— -
much *The word “charwomen” is used here because, although it refers to male workers, this is the term that is used in
the U, 8. census reports. There seems to be no such word ‘‘charmen."
348 LEHMAN
TABLE 1. Data From Census Reports ror 1890-1950 (Excerpt 1910) FoR Men's OccuPations Wuicn Iy. TABLE
CLUDED TWICE OR MoRE THAN TWICE THEIR PROPORTIONATE SHARE OF WORKERS 65 YEARS OR OVER—(Conr), CLUDE
| | No. of | Ratio to
‘Type of Worker | Census | Men 65 | Expected
Report | and Over Number
cafes |
C. Finance, Etc,—Continued |
5. Real estate agents and officials | 1920 | 12,566 2.00 F. P
| ‘
6. Real estate agents....... | 1930 | 20,342 2.%6 ,
7. Real estate agents and Seatesns. ‘ 1940 | 14,482 3.13
8. Real estate agents and brokers i 1950 19,065 2.83 ;
D. Professional Workers. |
1. Clergymen... | 1890 | 9,358 | 3.50
2. Clergymen... | 1900 | 9,988 2.09 ,
3. Clergymen... | 1920 | 12,182 | 2.16 I
4. Clergymen... | 1930 | 15,387 | 2.44 ee
5. Clergymen... | 1940 13,428 2.20 G.
| |
6. Lawyers and judges.... ie | 1940 | 15,859 | 2.00
7. Physicians and surgeons. ; nee | 1890 9,144 | 2.12
8. Physicians and surgeons. . | 1930 14,915 | 2 35
9, Physicians and surgeons. | 1940 18,236 | 2.52
10. Veterinarians....... | 1890 658 | 2.36
11. Veterinarians........ 1930 1,372 | 2.70
12. Veterinarians ; .-| 1940 1,284 | 2.63
13. Authors. . Riches | 1920 344 2.09
14. Authors. . ; .| 1930 624 | 2.07
15. Librarians. . Reiss -| 1920 231 | 2.87
16. Librarians. er | 1930 | 301 2.74
E. Retail Trade, and Independent Hand Trades—Manufacturing. |
1. Retail dealers: books...... Rie ee tote ! ; ...e} 1920 249 2.13
2. Retail dealers: coal and wood. ; ae en 1930 2,921 2.33
3. Retail dealers: flour and feed. . . ; et- : 1930 388 2.47
4. Retail dealers: general stores....... ........ iii, 1930 8,067 2.47
5. Retail dealers: hardware, implements, and wagons... . aoe 1930 2,829 2.19
6. Retail dealers: harness and saddlery...... Me eat re 1920 407 3.38
7. Retail dealers: junk and rags........... ie ee 1930 2,434 2.09 a
8. Retail dealers: rags.... é 4A AL Pe ee Sr - 1920 201 2.24 H.
9. Independent hand trades—manufacturing (unspecified)... ... 1930 18,822 7.37
10. Basket makers..... aii saeeraiesie ats Daten cies Kos 1890 648 3.34
11, Cibbatianker.. Bo ie] age 1930 3,620 2.14
12. Carriage and wagon aishers. re ae anette okits 1890 3,378 2.29
13. Gunsmiths, locksmiths, and bell hameete. = Seer rd Ne eter oe 1890 808 2.07
14. Jewelers and watchmakers (not in factory)...... = cy 1930 2,297 2.00
SS a
F. Public Officials, and Keepers of Charitable and Penal Institutions. |
1. City offucinie and inepectors..... 2... eee cece nee % 1920 3,905 2.71
2. City officials and inspectors............ hae Nien othe a | 1930 6,283 3.23
3. County officials and inspectors... .. eke Tusa. io 1920 1,688 2.00
4. County officials and inspectors........... 5.0.6.0 00 0005. ..| 1930 3,165 3.05
5. Marshalls and constables................ 0.000 e evens ie | 1920 920 2.98 .
6. Marshalls and constables.......... yeaa | 1930 1,270 3.19
JOBS FOR THOSE OVER SIXTY-FIVE 349
Wuicn Iy. TaBLE 1. Data From Census Reports For 1890-1950 (Excert 1910) ror Men’s Occupations Wuicu IN-
(Cont), ctupED Twice OR More THAN Twice THEIR PROPORTIONATE SHARE OF WORKERS 65 YEARS OR OVER (Cont.).
i = Fa | No. of | Ratio to
Nusulied I'ype of Worker | . Census Men 65 Expected
Report | and Over | Number
2.00 F, Public Officials, Etc.—Continued | |
7. Officials and inspectors, state and local 1950 15,709 | 2.53
2.% 8. Postmasters 1920 1,867 | 2.00
3.13 9. Postmasters 1930 | 2,475 2.77
2.83 10. Probation and truant officers.... 1920 | 286 | 3.56
a 11, Probation and truant officers. | 1930 | 954 | 3.58
3.50 12. Sheriffs 1930 | 1,370 | 2.12
2.09 13. Keepers of charitable and penal institutions. .. 1920 | 784 2.20
2 16 14. Keepers of charitable institutions. | 1930 938 | 2.30
>| — tt tichnnectsiinsnnlinn Npaisnicnatil ings
) fo G. Service Workers and Service Industries. |
1. Boarding and lodging house keepers -| 1890 1,241 | 2.46
2.00 2. Boarding and lodging house keepers 1900 | 1,805 | 3.43
2.12 3. Boarding and lodging house keepers | 1920 2,773 | 3.34
2 35 4. Boarding and lodging house keepers. ... | 1930 3,389 4.60
2.52 5. Boarding and lodging house keepers. | 1940 2,200 4.54
6. Hotel keepers and managers. | 1930 | 3,934 2.30
)
Ho 7. Shoemakers and cobblers (not in factory). . 1920 9,631 2.73
) 63 8. Shoemakers and cobblers (not in factory). . 1930 8,351 2.56
09 9, Shoemakers and repairers (not in factory) . 1940 5,577 2.04
07 10. Shoemakers and repairers (not in factory). . . 1950 6,833 2.22
11, ‘Tailors and furriers. . . Rn racked 1950 12,542 2.95
87 12. Engineers and firemen (not locomotive). . . mF 1890 2,561 4.26
Me os 13. Blacksmiths... . pane cot 7,196 4.33
14. Blacksmiths, forgemen, and hammermen.. . : sis eee 1940 9,139 2.76
13 15. Blacksmiths, forgemen, and hammermen........... wars 1950 7,926 2.52
33 16. Harness and saddle industries: semi-skilled operatives ae 1920 2,324 2.93
47 gs Se eae ay ee Seances ; ; 1890 1,077 4.64
47 18. Livery stable keepers and managers....... ; 1920 1,190 2.38
19 19. Umbrella menders and scissors grinders . | 1920 133 3.29
38 20. Whitewashers | 1890 471 2.75
. > (a ae eae
Pe H. Miscellaneous Other Occupations.
1. Hunters, trappers and guides............ ates ; 1920 689 2.11
37 2. Abstractors, notaries, and justices of peace...... es 1930 2,477 5.86
34 3. Abstractors, notaries, and justices of peace... . . sie 1920 2,202 5.96
14 4. Fortune tellers, hypnotists, spiritualists, etc................. 1920 40 3.87
29 5. Healers not elsewhere classified........... Diet begs eis ace 1930 786 2.33
07 6. Auctioneers... bial , 1890 299 2.16
00
ante 7. Commercial travelers.............. Dees sc hike acxpece Hier DERE 1890 754 3.02
8. Millers (grain, flour, feed, etc.)............... ee A 1920 2,224 2.13
71 9. Coal mine owners, operatives, and proprietors... .. a 1930 253 2.07
3 10. Gold and silver mine operatives. . . Ge EP Rea -«| $930 1,951 2.51
0 11. Ship and boat builders........... ex oien 1890 2,306 2.34
5 12. Wheelwrights....... oh ne Rese . 1900 1,779 2.98
8 a peg ee
9
350
TABLE 2, Data FroM THE World Almanac AND Who's
Who in America FoR U.S, CONGRESSMEN, FEDERAL
JupGes, AND ROMAN CATHOLIC CARDINALS,
No, of | Percent-
Men age of | Ratio to
Occupation 65 and Their | Expected
Over Group | Number
|
U.S. Senators, Dec. 1, |
ES | 9 23 4.26
U. S. Circuit Court
Judges, 1953,.....| 30 51 9.44
U.S. District Court
Judges, 1953...... 109 42 7.94
Roman Catholic Car- |
dinals, 1953......| 34 76 14.07
U, S. Supreme Court
Judges, 1953... 4 44 8.15
higher proportion is that of Roman Catholic
Cardinal. The proportion here above age 65
is 76 per cent, 14 times the expected number.
Subsequent to 1900 the census reports give
no separate information for bankers and
brokers (dealers in money and stocks). In-
stead the more recent reports give data for
a category entitled bankers and bank officials,
which probably includes not only bankers
but also bookkeepers in banks, tellers, adding
machine operators, and others. Table 1C re-
veals that in 1900 there were 21,192 bankers
and brokers (money and stocks) aged 65 and
over and that their proportionate ratio was
extremely high, 6.59 (table 1C, item 2).
There were more banks in the United States
in 1950 than in 1900 but because the census
reports for 1900 and for 1950 are not directly
comparable, there is no way of knowing pre-
cisely how many more bankers and _ brokers
there were in 1950 than in 1900.
In 1950 there were 19,065 real estate agents
and brokers 65 or over (table 1C, item 8).
Older men also have been over-represented
in some but not all of the professions (table
1D). Obviously the professional man who
maintains his own office is unlikely to find
himself out of work at an age when he still
wants to go on working.
Lawyers, physicians, and _ veterinarians
(table 1D) who are past 65 and in good
health are likely to find their advanced age
a professional asset rather than a _ liability.
LEHMAN
This fact points up one of the greatest dis.
advantages encountered by wage and salary
workers. Increasingly in the future this
aspect of each vocation will need to be taken
into account by young people who are choos-
ing their occupations.
The ministerial profession has included far
more than its proportionate share of old men
more often than any other professional group
(table 1D). There doubtless are many rea-
sons for this, such as the sedentary nature of
the work, the relation of supply to demand,
and ability of the older clergyman to preach
part-time. Still another reason is that many
clergymen are not paid enough money to live
on and cannot save enough to support them-
selves and their dependents in their old age.
Their pension benefits are also inadequate. It
was recently reported that the pensions of re-
tired Presbyterian clergymen average only
about $700.00 per annum (11). Inadequate
as this sum is, it seems a safe guess that the
pensions of retired Presbyterian ministers are
as large or larger than those of most other re-
tired preachers.
Partly because chain-stores, supermarkets,
and large-scale manufacturing establishments
have developed so rapidly within recent years
older men are over-represented today among
small retailers and workers at the independ-
ent hand trades (table LE). Chain-stores
do not employ old people; therefore the older
retail salesman must work for himself if he
is to work at all. Similarly, the large-scale
manufacturer usually retires his older workers.
For this reason the older man who wants to
continue to manufacture goods must work for
himself it he wants to continue working.
For 16 occupational groups® a coefficient of
correlation of -0.56 was found between the
rate at which the workers within each group
* Architects
Artists and teachers of art
Authors, editors, and reporters
Clergymen
College presidents, professors, instructors
classified ).
(not otherwise
Dentists
Designers and draftsmen
Engineers, civil
Engineers, electrical
Engineers, mechanical
Lawyers and judges
Musicians and music teachers
Pharmacists
Physicians and surgeons
Surveyors
Teachers (not otherwise classified).
were
1950 «
group
negati
new (
attrac’
this ir
numb
neers,
the ce
aeron
were
and t
and «
their
Bet
lege
cent.
and »
propt
per ¢
Ta
now
ders
who
wash
far k
year
old 1
tions
grov
of w
ham
dle |
ager
tion:
and
ing
T
rept
that
you
mer
are
pert
grol
N
met
1H.
stra
193
be
stri
gor
itest dis.
salary
ure this
be taken
© choos.
ded far
old men
il group
iny rea-
iture of
lemand,
preach
t many
to live
t them-
Id age,
late. It
s of re-
e only
equate
iat the
ers are
her re-
arkets,
ments
years
mong
pend-
stores
older
if he
-scale
rkers,
its to
‘k for
ng.
nt of
1 the
roup
erwise
JOBS FOR THOSE
were increasing in numbers from 1940 to
1950 and the percentage of men within each
group in the age bracket 65 and over. This
negative correlation results from the fact that
new occupations and rapidly growing fields
attract large numbers of young people and
this influx tends to decrease the proportionate
number of their elders. Aeronautical engi-
neers, for example, were not even listed in
the census of 1940, In 1950 there were 17,034
aeronautical engineers but only 0.07 per cent
were 65 or over. For a similar reason radio
and television mechanics and repairmen 65
and over comprised less than 1 per cent of
their occupational group in 1950.
Between 1890 and 1950 the number of col-
lege teachers rose enormously, a 2,029 per
cent increase. Partly because of this increase
and partly because of retirement rules, the
proportion over 65 dropped from 6.05 to 3.88
per cent.
Table 1G includes several callings that are
now obsolete. There are few umbrella men-
ders and scissors grinders anymore, but those
who exist are likely to be over 65. White-
washers and hostlers were on the way out as
far back of 1890. Hence, the census for that
year showed a disproportionate number of
old men working at these jobs. Other voca-
tions which are on the wane, stationary, or
growing very slowly in their absolute number
of workers include blacksmiths, forgemen and
hammermen, workers in the harness and sad-
dle industries, livery stable keepers and man-
agers, and tailors and furriers. These voca-
tions find less demand for their services today
and thus relatively few young men are tak-
ing up this work.
The observation that older men are over-
represented among blacksmiths does not mean
that older men are more competent than
young men to work at this trade. It means
merely that today relatively few young men
are becoming blacksmiths, thus increasing the
percentage of older men in the blacksmith
group.
Miscellaneous other callings in which older
men are over-represented are shown in table
1H. The largest group here is that of ab-
stractors, notaries, and justices of peace for
1930. The justices of peace should probably
be classified as public officials and the ab-
stractors perhaps belong in a different cate-
gory than do the justices of peace but here
OVER SIXTY-FIVE
351
they are included in one group in accord-
ance with the census reports.
Because women have a lower mortality rate
than men, age for age, and tend to marry
men older than themselves, relatively more
women than men lose a spouse through death.
Therefore, more than half of the women in
the United States 70 and over are widows
(12).
Many elderly women try to make a living
in such service industries as hotel keepers and
managers, housekeepers and stewards, nurses
and midwives, private household workers, and
dressmakers and seamstresses (table 3A). Al-
though data for boarding and lodging house
keepers were not available in the 1950 census
report, the large proportions of older women
so engaged for the years 1890 to 1940 suggest
that, if the data had been available, a large
proportion of women 65 and over would have
been found working as boarding and lodging
house keepers in 1950 (table 3A, items 1-5).
In proportionate numbers, women agricul-
turists, like men agriculturists, have been
over-represented for a long time (table 3B).
In most instances these elderly women were
probably widows who were left with farms
on their hands. Older women also have been
relatively numerous as self-employed man-
agers, officials, and proprietors engaged in
wholesale and retail trade (table 3C and 3D)
and again it is probable that many of these
were widows whose retail establishments
were left to them by their husbands.
As shown in table 3D some older women
also have worked as canvassers, peddlers,
news vendors, and hucksters. In work such
as this the comparative immunity of the older
women to total unemployment does not neces-
sarily mean that her economic situation is a
fortunate one since she may be earning less
than a bare living and using up a part of her
past savings in order to sustain herself.
No data are available in the 1950 census
report for the number of women who worked
at independent hand trades such as are listed
in table 3E; the most recent figures for such
workers are now 25 years old. However, be-
r~ause of the rapid growth of large-scale manu-
facturing and the low prices at which the
large-scale manufacturer is able to sell his
product, it is likely that today relatively few
young persons of either sex are entering the
independent hand trades. It therefore seems
352 LEHMAN
TaBLe 3. Data From Census Reports For 1890-1950 (Excerpt 1910) FOR WoMEN’s OccuPATIONS Wuicu ly.) TABLE <
CLUDED TWICE OR MORE THAN TWICE THEIR PROPORTIONATE SHARE OF WORKERS 65 YEARS OR OVER CLUDE!
oS —OoO018O00OOO MSS 9050 ee OO a ———__ —
| | No. of Ratio to
Type of Worker | Census | Women 65 Expected
Report | and Over Number
A. Service Workers and Service Industries. a ite
1. Boarding and lodging house keepers... ... 1890 1,881 oe 11
2. Boarding and lodging house keepers... . .. 1900 4,197 2.73 12
3. Boarding and lodging house keepers... . 1920 10,016 3.78
4. Boarding and lodging house keepers... . . 1930 13,593 4.33 13
5. Boarding and lodging house keepers. ... . nee 1940 | 14,004 6.62 14
1s
a). re 1890 | 359 2.72 1¢
7. Hotel keepers...... eet 1900 | 621 2.81 17
8. Hotel keepers and managers........ 1920 840 2.57 1§
9. Hotel keepers and managers... . 1930 1,352 3.16 1'
10. Housekeepers and stewards........... 1890 6,910 3.21 e.3
11. Housekeepers and stewards... . 1900 8,547 22
12. Housekeepers and stewards. . 1920 19,088 4.04
13. Housekeepers and stewards........................ 1930 | 24,924 4.62
14. Housekeepers, stewards, hostesses, exc. private family. 1940 | 4,738 3.62
15. Housekeepers, stewards, exc. private household.......... 1950 | 9,961 3.98
a 1890 | 2,620 2.53
er Os coe Fe Se a Se ails 0 see wind ni | 1920 | 774 7.04
18. Nurses lant nteally..: ERS PTE a a ee TE | 1920 7,650 | 264
19. Midwives. VEIN SOP I ee een ee 1930 18,337 | 7.81
20. Nurses baat perneeny EAS es ap ee ae 1930 10,667 3.08
21. Practical nurses and midwives............ 1940 5,980 3.29
22. Practical nurses and midwives... . 1950 14,867 3.74
23. Private household workers (living in).......... 1950 27,526 4.49
24. Dressmakers and seanistresses (not in factory). . . 1920 12,073 | 2.23
25. Dressmakers and seamstresses (not in factory)........ 1930 14,604 | 3.72 —
26. Dressmakers and seamstresses (not in factory) . 1940 | 11,593 | 4.10 D.
|
27. Laundresses (not in a peaeia isis 2 1920 | 18,835 | 2.13
ES 1920 | 517 4.96
29. Protective service workers. hee ee 1940 | 286 3.14
30. Other domestic and personal 5 service workers Te Naas 1890 | 210 2.44
B. Agriculture, Animal Husbandry and Related Fields. |
1. Farmers, planters, and overseers.................02.000005. | 1890 | 33,981 6.00
2. Farmers, planters, and overseers...................-. 1900 | 51,643 | 6.46
eee 1920 | 37 aes || 6.57
4. Farmers (owners and tenants)... | 1930 | 45,250 | 6.96
5. Farmers and farm managers..................-- ere ee 25,097 7.86
6. Farmers and farm managers....... | 1950 18,125 | 5.15
| |
oo) Sarit toremien, geteraliaems. . 2 ee eset | 1920 | 2,985 | 9.43
8. Farm managers and foremen..... . Cee ees: 1930 | 120 | 5.06
9. Farm laborers (unpaid family eatin)... Pieter tly oe ow a] 1930 7,251. | 3.77
10. Gardeners, florists, nurserymen, and vinegrowers.. .... | 1890 | 309 §.12
|
> WHICH ly.
t OVER
Ratio to
Expected
Number
“Iw
wom
Oe Wh bw
Dw 3 a2 t
m WwW oo
Wr hr te
— © CO =)
“se bw
w
Se & bw
me >
ww em & bo
a
Nm &
on
o
www 8 he =)
“NM SOmoMmMs:
Oe NE Z
TABLE 3.
——————
Data From CENsuUs REPORTs FOR 1890-1950 (Except 1910) FoR WoMEN’s OccuPATIONS WHICH IN-
cLUDED TWICE OR MORE THAN TWICE THEIR PROPORTIONATE SHARE OF WORKERS 65 YEARS OR OVER (Cont.)
JOBS FOR THOSE OVER SIXTY-FIVE
353
|
| No. of Ratio to
Type of Worker | Census | Women 65 Expected
Report | and Over Number
B, Agriculture, Etc.—Continued
11. Gardeners, florists, nurserymen, etc...................0.05. 1900 428 5.77
12. Gardeners... 1920 1,054 9.13
ND Sr aA Sg «86 Rote a Ava awe eRe ee 1920 644 8.78
ES ese ea lid tein wo: ay Sakis 0 GES OSS WD We Pe ON 1920 97 4.48
I 5 ooo saw Sis nective. § S-eiie aa ose hee Sante Sea Se 1920 617 6.78
IS gh nos 30h oA Aah oes + ces vipae a apene <issk | 1900 52 2.23
17. Poultry raisers..... Bg A PROSE re TON OL Ne 1920 318 5.96
18. Stock raisers, herders, and drovers.....................205: 1890 50 2.93
I Oy Es Staite Sa Pe bw Waa has eee | 1920 459 7 S7
C. Miscellaneous Workers and Industries. |
1. Fortune tellers, hypnotists, spiritualists, etc................. 1920 | 95 5.91
2. Healers (except osteopaths, physicians, and surgeons). . . 1920 | 428 2.35
3. Keepers of pleasure resorts, race tracks, etc................. 1930 | 90 3.72
4. Keepers of charitable institutions.......................... 1930 366 2.67
5. Proprietors, managers, and officials, except farm............ | 1940 | 22,977 237
| |
6. Wholesale and retail trade, proprietors, managers, and officials| 1940 | 10,431 2.95
7. Proprietors, managers, and officials (not elsewhere classified) |
ES SAE De Sane EOC TC et Tee ee | 1940 | 771 2.05
8. Proprietors, managers, and officials (not elsewhere classified) |
I IIIS «hes isos not ott es sew Sens a os oe se 1940 | 2,662 4.00
9. Managers, officials, proprietors (not elsewhere classified) self-
employed: wholesale and retail trade, except eating and | |
oe goal Natt: vga nn gn Lee e eR eere | 1950 12,773 2.44
10. Managers, officials, proprietors (not elsewhere classified) self- | |
employed: other industries....................00e0ee | 2950 7,468 2.83
D. Retail Trade, Canvassing, and Peddling. |
1. Merchants and dealers not specified (retail)................. ;} 1890 | 963 2.42
2. Books, music, news and stationery: retail dealers........... | 1930 | 186 ya |
3. Candy and confectionary: retail dealers................... 1920 | 379 2.13
4. Candy and confectionery: retail dealers...................| 1930 520 2.02
5. Merchants and dealers in dry goods (retail)................. | 1890 119 2.18
6. Dry goods, fancy goods, and notions....................... | 1920 | 416 2.35
|
7. Five and ten cent and variety stores....................... | 1930 131 3.44
©. “Goemernl Steen: seta Gentes... .. ws ono os ies oe cheese recs |} 1920 213 2.48
> A GeOTEE SOOMORs: PUNT IIIB, 0 5 as ooo so Se dw oe ee wale owes 1930 402 3.16
10. Merchants and dealers in groceries......................-4: 1890 410 | 52
ee IRS OME ogc or oiets os raicne.kels bv betenncune wie 1920 1,120. | 2.13
a NS | MUNIN oo i a avis nso had nie Sv go biecanpas anew 1930 1,741 2.43
13. Other persons in trade and transportation.................. 1890 57 | 2.84
14. Not specified retail dealers...............0000.000eeceeeeee 1920 339 | = 2.35
Bo.. Sthber quecteett fetadl deslees. oo... 86 cece csc asens 1920 755 | 2.47
16. Not specified retail dealers..............00..cceecceeeeeees 1930 339 | 2.31
Other eneciiied retail demlers «5... 5 kbc eo cc ise tencs |
354 LEHMAN
TABLE 3. Data From Census REPORTS FOR 1890-1950 (ExcePt 1910) FoR WomEN’s OccuPATIONS Wuicu Iy.
CLUDED TwicE OR More THAN Twice THEIR PROPORTIONATE SHARE OF WORKERS 65 YEARS OR OVER (Cont.)
fe | No. of | Ratio to
l'ype of Worker | Census | Women 65 | Expected
Report | andOver | Number
D. Retail Trade, Etc.—Continued
is NNER baci as a Sind Siilosab 54.0.6) o 06 Maria aerate Joeo a a Ad 410
a 4.26
19. Canvassers, peddlers, and news vendors...... Rihteshreys 1940 | 1,027 2.38
20. Hucksters and peddlers.......... Ne AS Ad breatoes | 1890 | 282 4.99
21. Hucksters and peddlers. ..... ey pipet. Wediee a Reioash. se 215 4.91
22. WHucksters and peddlers................. eee rab s aos 1930 | 168 3.81
E. Independent Hand Trades.
1. Independent hand trades—manufacturing.. . . Lee ee! ed 15,726 3.16
2. Carpet makers..... <2 Fn phar NE ae ae Se, 1890 | 632 2.
3. Basket makers... Pld elo ass sic GE's se ¥ee 3 SRS Ae ere 1890 | 64 3.60
F. Unskilled Laborers. |
1. Charwomen, janitors, and porters....................0005. } 1940 | 3,573 2.19
2. Charwomen, janitors, and porters.................... a? 1950 | 10,080 2.59
A Oe ee? Sees. 1,354 | 2.07
ee ae Sa ish are a 1,727 | 2.39
5. Guards, watchmen, and doorkeepers......... PET Nea oe | 1930 | 91 3.85
6. General and not specified laborers. ..............0..0.04.. / 1930 | 650 2.31
G. Professional Workers. | |
ct MINS INT OUNOTIN Sy noo 55 ns eee occerncwn ee vinenns 1890 | 258 2.26
NINE NINE 5 os oo os lace ct die nisisw per ewtewe eer 1900 | 383 | 2.00
Be UCI MU MOTB soci ec cee c cc coewesececeel 1920 | 493 | 2.96
NE UII, oo ooo oo oe ce cre nennesinaee spices | 1930 | 646 | 3.85
ee .| 1940 676 | 4.24
6. Physicians and surgeons......... EE aan Be to | 1950 791 2.24
IEG a AC od, yg ble ibipry vis. sia. eos en ada dea ae | 1930 2,220 3.56
re I a ot el hd oa aso 6A Tet A alld) ie'in ep) ordisgs Bit bio woee 1930 137 3.56
9. Dentists, pharmacists, osteopaths, veterinarians............. 1940 410 | 3.62
oe A ERE Nn rick 9. aie vig) anid 414m WF ¥9,6 AG wie bib mharsee aw 1920 232 | 3.35
Nos sing cig aip aitin nie vase 1930 439 | 3.26
b2, Authors; editera, id reporters... on cee cecce sewn 1940 801 2.05
Ie haioh, (89) aN. § sh ainoo, ldo Hebe. 4 oa he baie 01S. 4)3 lesaleuece 1890 64 2.24
NI pect PEI ea bbc Vip cle eis WH Viet So's Sie die hag ier 1920 120 3.17
15. College presidents and professors. ...............0000.0000. 1930 400 8.04
I a ch AC Cla ace Fegan g olldre 4:4 ane 9/6 bin.v aie ow cree 6A arnaie 1940 1,736 2.§2
IS feel eat Niet SAO ois ey Su Wiki vie siwwieéawaede.s 1950 3,306 2.23
18. Musicians and music teachers.................0.-.e eee eee 1950 5,658 2.41
BN IN ocr ave 50.0 5 solace oie sie els ccsiwie os ewes tines 1930 | 1,508 3.08
H. Finance, Insurance, and Real Estate.
1. Bankers and brokers (money and stocks)................... 1890 74 5.92
2. Bankers and brokers (money and stocks)................... 1900 50 6.46
MM POU NTI PIII ics oie civic ce bac cede cceeeaeenes 1930 56 3.81
4. Insurance agents and brokers. ...........006 0000 c cece ues 1940 742 2.67
5. Insurance and real estate agents and brokers................ 1950 3,384 2.43
6. Realestate agents and brokers..............-.....-ceeeeee 1940 758 3.52
7. Real estate agents and officials................0 000000000, | 1920 579 2.74
solut
over-
trade
In
wom
and |
oF,
for 1
occu
sons
amo’
olde
over
sion:
of e
repr
mus
brar
priv
the
and
wan
pup
olde
twic
gro
it is
phy
the
rent
the
it 5
dou
ope
des
son
to |
res]
lati
son
me
che
adc
Wuicu Iy.
=R (Cont,)
Ratio to
Expected
Number
JOBS FOR THOSE OVER SIXTY-FIVE
safe to assume that regardless of their ab-
solute number older women today are much
over-represented in the independent hand
trades.
In 1950 there were 10,080 female char-
women, janitors, and porters age 65 and over
and their over-representation was 2.59 (table
3F, item 2). Table 3F suggests once more
that older women are often obliged to work
for merely marginal pay, engaging in many
occupations which most capable young per-
sons refuse to enter.
There are enormous individual differences
among older women just as there are among
older men. For example, older women are
over-represented in several kinds of profes-
sional work (table 3G). The largest group
of elderly women professional workers over-
represented in 1950 was that of musicians and
music teachers. The second largest was li-
brarians. If the music teachers were giving
private lessons, they were self-employed in
the sense that they could continue their work
and regulate the amount for as long as they
wanted, provided of course they could find
pupils.
Women physicians and surgeons 65 and
older are listed 6 times in table 3G, more than
twice as frequently as any other professional
group. One possible reason for this is that
it is difficult for young women to qualify as
physicians and surgeons, which tends to raise
the proportion of older women in the group.
Other probable causative factors are the cur-
rent need for the services of physicians and
the sedentary nature of the work which makes
it possible for the older women to continue
medical practice at an advanced age. Un-
doubtedly a great many other factors are also
operative.
DISCUSSION
Although some older people have lost the
desire to work many others have not. To
some of the latter, work is much more than
a way of earning a livelihood. It is a means
to help them keep both their health and self-
respect. Yet today the majority of the popu-
lation must abandon their lifelong occupation
sometime between 60 and 70 (6). Often this
means that the older worker must suddenly
change the habits of a lifetime, an experience
which can be quite traumatic. It should be
added, however, that the prospective em-
355
ployer cannot ordinarily be expected to hire
older people just because they want to work
or the employer feels sorry for them. In the
approach to the entire problem of jobs for
those over 65 realism above all is needed.
At the lower end of the age-scale the com-
pulsory school attendance laws and the in-
creasing demand for a college education are
operating to keep both children and young
adults out of the labor force. And, despite
the fact that people are living longer than
ever before, the retirement ages are moving
downward rather than upward. In many oc-
cupations age becomes a barrier to employ-
ment long before age 65 is attained. In al-
most every occupational category workers
over 45 have fewer employment opportunities
than their numerical representation would
lead one to expect. If the present trend con-
tinues, any further increase in man’s lon-
gevity will add primarily not to his work-life
expectancy but to his years in retirement.
This allegation is based on the fact that be-
tween 1900 and 1940 the expected years in
retirement for an American man of 45 in-
creased over 80 per cent (2).
Compulsory automatic retirement decreases
the contribution that older people are per-
mitted to make to our national output of
goods and services. The larger the number
of workers retired to idleness, particularly if
the retirement ages be lowered much further,
the greater the economic burden placed on
those who remain at their jobs (4).
In 1950 only 43 per cent of the men 65 or
over were in the U. S. labor force and they
comprised only approximately 5 per cent of
the total number of male workers. About 8
per cent of the women 65 and over were in
the labor force and they comprised approxi-
mately 3 per cent of the total number of fe-
male workers. All of these percentages are
declining. Clearly, we should utilize to the
utmost the productive abilities of as large a
proportion of our population as possible. To
be realistic about this matter one must bear
in mind that workers are commonly employed
and paid as a means of making a profit for
their employer. To force prospective em-
ployers to hire older workers under conditions
which might lead to financial losses or even to
bankruptcy is unreasonable (1).
Those over age 65 now comprise about 12
per cent of our voting population and by
1980 they will comprise at least 25 per cent
356
of the qualified electorate, a situation which
is politically unhealthy since these percent-
ages can win national elections. Insecurity in
this large proportion of the population is a
breeding ground for some form of totalitari-
anism such as the Townsend Plan and other
similar movements of the 1930's. If there
should be another depression a resumption of
such movements can be anticipated unless the
problem of the aged is met in some reason-
ably satisfactory manner (4).
Three possible solutions have been ad-
vanced. It has been suggested that the eco-
nomic problem of the older worker can best
be solved by an extension of social security
benefits. This measure is now gradually
being taken and it is being looked upon with
increasing favor in many quarters, but such
means must be used with caution. If pension
payments are so generous that they compare
favorably with wages earned at gainful em-
ployment too many workers may prefer to
leave their jobs and live on their pensions.
It is also a question how far pension pay-
ments can be extended without bankrupting
the national economy. One student of this
subject has concluded that if all eligible em-
ployees were to receive adequate pensions
at age 65 the dollars required, if funded on
an actuarially sound basis, would exceed the
current national debt, now about 274 billion
dollars (5). One need not be a financier to
know that the doubling of our national debt
could do a great deal of harm.
Since there are vast individual differences
in earning power among people aged 65 and
over it is argued that retirement should be
based strictly on the individual worker’s abil-
ity to handle his job and automatic retire-
ment at any specified age should be abolished.
One weakness of this suggestion is that most
large-scale employers refuse to accept it. This
refusal is based on the employers’ conviction
that when decisions are made on an individual
basis 1) many whose continued employment
hinges on such decisions will not believe that
the verdicts have been fair, 2) the ensuing
resentment would make for unfavorable pub-
lic relations, and 3) annual decisions of
whether to retire or retain each individual
employee of 65 or over would entail much
needless trouble and expense. Retirement
strictly on the basis of individual merit is also
opposed on the ground that it fails to provide
LEHMAN
the worker with a face-saving method of re.
tiring.
Much legislation has been enacted and
much more has been proposed for dealing
with the older person's job problem (3, 10),
Over 450 separate legislative bills and resolu.
tions concerned with economic or related
problems of the aged were introduced in the
81st and 82nd Congresses. All of this legis.
lative effort emphasizes the urgent need for
some solution to a very pressing problem. It
does not signify that a satisfactory solution
has been found or that one is likely to be
found soon. Obviously the problems of the
aged in our modern society are not solely vo-
cational and economic. Nevertheless, satis-
factory employment opportunities for those
over 65 who are able and eager to work would
ease the situation for many of them very
greatly.
SUMMARY
By use of the U. S. census reports for the
years 1890 to 1950 (with the exception of
1910) this study seeks to identify those spe-
cific occupations from which older men and
women who work at paid jobs are least likely
to be crowded out by younger ones. It sets
forth those occupations which have included
twice or more than twice their proportionate
share of workers of age 65 or over. The fol-
lowing generalizations have been derived:
1. Larger numbers of elderly people are
found in the larger occupational groups but
the correlation is far from perfect. In 1950
the correlation between the total number of
men engaged in each of 156 occupations and
the number of men of age 65 or over en-
gaged therein was 0.83.
2. Older workers are over-represented in
vocations that are on the wane, stationary, or
increasing only very slowly. They are under-
represented in new and rapidly growing oc-
cupations that require special and newer
skills.
3. Farmers, small businessmen, real estate
agents, bankers and brokers, workers at in-
dependent hand trades, and certain profes-
sional people remain longer in gainful em-
ployment (at least on a part-time basis) than
do most wage and salary workers, probably
because they can control their work-loads,
their hours of work, and their retirement.
4,
ardo
wide
scho
or Sp
in jo
low.
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sent
ing:
at th
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is legis.
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nt.
JOBS FOR THOSE OVER SIXTY-FIVE
4, Older workers engage less often in haz-
ardous occupations and those which demand
wide geographic mobility, much formal
schooling, strenuous physical exertion, agility,
or speed.
5. The elderly are much over-represented
in jobs at which the pay-rate is comparatively
low. However, no stereotyped conception of
either the older person or his occupation is
valid.
6. Although older people are over-repre-
sented both at the top and bottom of the earn-
ing-power scale, they are far more numerous
at the bottom than at the top.
The problem posed by the differential age
changes now occurring in the population of
the United States and the growing tendency
to exclude a larger proportion of older people
from the labor market is discussed.
REFERENCES
1. Brown, J. D.: The Role of Industry in Relation
to the Older Worker, In: The Aged and Society,
edited by Milton Derber. Industrial Relations
Research Association, Champaign, IIl., 1950.
2. Clague, E.: The Gerontological Revolution:
Some Problems and Some Opportunities, J. Am.
Soc. Chartered Life Underwriters, 6: 316-325,
1952.
3. Desmond, T. C.: Age Is No Barrier. The 1952
Report of the New York State Joint Legislative
Committee on Problems of the Aging, Legis-
lative Document (1952) No. 35.
4,
10.
11.
12.
. Ogg, E.: When Parents Grow Old.
357
Desmond, T. C.: Birthdays Don’t Count. The
1948 Report of the New York State Joint Legis-
lative Committee on Problems of the Aging.
Legislative Document (1948), No. 61.
Desmond, T. C.: Growing with the Years. The
1954 Report of the New York State Joint Com-
mittee on Problems of the Aging. Legislative
Document (1954), No. 32.
Havighurst, R. J.: Social and Psychological Needs
of the Aging, Am. Acad. Polit. & Soc. Sci., 1952,
279.
. Lehman, H. C.: Age and Achievement. Prince-
ton, New Jersey, Princeton University Press,
1953.
O’Donnell, W. G.: The Problem of Age Bar-
riers in Personnel Selection, Personnel, 27: 461-
471, 1951.
Public Af-
fairs Pamphlet No. 208. June, 1954. Public
Affairs Committee (22 East 38th Street, New
York 16, N.Y.).
Retirement Policies and the Railroad Retirement
System. Report of the Joint Committee on Rail-
road Retirement Legislation. Part 2. Economic
Problems of an Aging Population. Pursuant to
S. Con. Res. 51 and 56. U.S. Government
Printing Office, Washington, 1953.
Robbins, J. and J.: You're Underpaying Your
Pastor! Coronet, Oct., 61-64, 1954.
Tibbitts, C.: Fact Book on Aging. Federal Se-
curity Agency. Committee on Aging and Geri-
atrics, 1952.
BOOK REVIEWS
GERIATRIC NURSING, Second Edition, by Kath-
leen Newton, C. V. Mosby Company, St. Louis, 1954,
424 pages, $4.75.
Proceeding from her expressed belief that “Nursing
is being recognized as important in almost all activi-
ties dealing with our older population,” Miss Newton
has quite successfully attempted to provide nurses
with a reference book that briefly summarizes some
of the current concepts about geriatrics and high-
lights some of the more important nursing responsi-
bilities in this field. The general background mate-
rial about geriatrics is clearly and interestingly pre-
sented. Numerous specific applications to nursing are
included. The discussions of the nurse’s relationships
with the older person contain many helpful ideas.
The author has condensed a large amount of infor-
mation, emphasizing points of particular significance
to the nurse. Many readers will probably be stimu-
lated to pursue further study among the many source
materials listed.
Having given the nurse a glimpse of the broad
field of geriatrics, Miss Newton goes on to deal more
specifically with the care of the older patient. She
does not limit herself to the hospital situation but de-
scribes the care of the geriatric patient in terms of
his needs regardless of where he happens to be—
at home, in a hospital, in a nursing home, etc. She
clearly shows the value of careful attention to all the
little details so important to the well-being of the
older person. She pictures the nurse as a warm, un-
derstanding person who tries to give the elderly pa-
tient all the independence he can assume and, at
the same time, is unobstrusively vigilant about his
safety and comfort.
The sections of this book devoted to the clinical
specialities such as cancer, cardiovascular diseases,
etc., are necessarily somewhat limited in scope. Some
specialists in these clinical fields have commented
that these sections are too general or, in some in-
stances, give an incorrect interpretation. However,
viewed as background information for the nurse car-
ing for elderly patients with a variety of illnesses, this
material is useful and based on sound principles of
patient care. Miss Newton has especially stressed
the importance of prevention of occurrence and re-
currence of the various disorders and uses pertinent
case illustrations effectively.
The first edition of this book, published in 1950,
was well received by nurses and has been used fre-
quently as reference reading. The changes in the
second edition are few. This book is the only one
of its kind now available. It is to be hoped that
other authors will prepare books specifically addressed
to nurses on various aspects of geriatrics and geriatric
nursing.
JANE WILCOX,
Chief, Heart Nursing Service,
Clinical Center,
National Institutes of Health,
Bethesda, Maryland
358
THE SENILE AGED PROBLEM IN THE UNITED
STATES, (1955 Legislative Problems No. 1) by
Dorothy C. Tompkins, Bureau of Public Administra.
tion, University of California, Berkeley, 1955, 89
pages, paper bound,
The still too little recognized problem of our aging
population is beginning to be considered by our state
legislative bodies in its fundamental social aspect,
New York State’s excellent interpretation is one ex-
ample of work in some 20 states—the name of New
York State Senator Desmond comes to mind—and
now comes a study report for the California legis-
lature on the senile aged.
Against the backdrop of the general facts, the
senile aged in institutions of 11 states are discussed
in more detail. Although the institutionalized senile
are much less than 6 per cent of all the aged, the
majority of them even in institutions require little
more than custodial care. Therefore a_ half-dozen
other types of care are analyzed in this report. Such
sheltered care facilities (11,600 in 1950) serve 5 per
cent of the aged, including a few of the senile. Ex-
pansion and improvement of such facilities might
permit mental hospitals to release many mildly senile
aged to the community, thus freeing scarce space
for the urgently ill of mind. Each of the commu-
nity resources of this kind has its appropriate func-
tion, whether it be nursing home, boarding home,
home for the aged, chronic disease hospital, home
care, day care, or foster home.
Beyond this hopeful area of community planning
is the fact that three-fourths of the aged live in their
own home or with relatives. Then comes the fu-
ture hope: experts on the problem believe senility
can be prevented. It takes a large community or
social effort, but worth it because in future more peo-
ple will spend a longer part of their life span in re-
tirement than ever in history. Approaches must begin
before growing “old,” and they yield wide-spread
benefits. The ways of prevention are “adequate food,
clothing and medical care;” and provision for “nor-
mal living through education, recreation, and stimu-
lation of interests.” One possibility, suggested rather
gingerly in the study, but with stimulating support-
ing data, is a shift in retirement age from the present
arbitrary 65 to an equally arbitrary 70. (It is this
reviewer's ill-founded guess that one handicap to
achieving such a shift is that the majority of its sup-
porters are nearing the age of 65. )
The report includes a selected bibliography (strong
on social aspects, rather weak on the technically medi-
cal); 20 tables of summary information (useful to
the legislator, less probably to the specialist); and
a summary of institutional provisions in state old age
assistance plans (an extraordinary condensation ).
Throughout there is indication of a point of view,
rather roughly summarized like this: medical science
“gives more time,” but society has let its population's
aging creep up on it with no adequate solution to
the range of resulting problems like costly health
conditic
outlets,
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view,
cience
ation’s
ion to
health
conditions, proper housing, creative and recreational
outlets, and employment of the aged person. Rather
more progress has been made in income maintenance
(OASI and various voluntary pension plans ) than in
many other needs, but the income level is insufficient
to allow the aged to meet the other human needs
without more social cooperation. As with most situ-
ations of this sort, leadership and guidance for social
cooperation are generated by legislation framed by
far-sighted legislators.
LOUIS TOWLEY
School of Social Work
Washington University
St. Louis, Missouri
DAS ALTER ALS SCHICKSAL UND ERFOL-
LUNG, third edition, by A. L. Vischer, Benno
Schwabe & Co., Verlag, Basel, 1955, 259 pages,
Fr. 11.50.
At a time when the sociological and pyschological
problems of our ever increasing population of aged
people arouse more and more interest A. L. Vischers
book “Das Alter als Schicksal und Erfiillung” (Old
Age as Destiny and Fulfilment) must be welcomed as
an important contribution to the discussion of these
problems. The book first appeared in 1943 and is
now available in its third and revised edition. The
author, now himself at the threshold of old age, has
BOOKS
359
acquired first hand knowledge of all aspects of old
age in his capacity of physician to the Home of the
Aged in Basel, Switzerland. The first part of the
book deals with the physiological and psychological
aspects of aging, the second with life expectancy,
the third with health and disease and the fourth
with sociological aspects of old age. As the most
important factor in longevity the author considers
heredity. He states that aging of body and mind do
not in most cases go parallel and proves by means
of a large material of historical facts that while the
vigor of the body declines after a fairly early peak
the mind may stay active and productive to the
last and even in cases of very gifted persons may
ascend to new and spectacular heights. However
only persons who have been mentally active all their
lives can expect to keep their mental activity. To
keep old people happier and in consequence also
healthier he advocates to give them work where
they may use their experience and skills without over-
taxing their physical strength. This would not only
lighten the financial burden of the younger genera-
tions but conserve to society valuable specialized
knowledge and at the same time give old people a
productive and socially respected life which they
now lack, thus giving their old age sense and ful-
filment.
GINA HAUROWITZ
Bloomington, Indiana
BOOKS RECEIVED
Books received since April 1 are acknowledged in
the following list:
Everyone Grows Old, Canadian Welfare Council,
245 Cooper Street, Ottawa 4, Ontario, Canada, 1955,
10 pages, paper bound, 25¢ (discounts on quantity
orders ).
One in Ten, Facts about San Francisco’s Older
People, Community Chest of San Francisco, Com-
mittee on the Aged, 1955, 36 pages, paper bound.
Senile Aged Problem in the United States, 1955
Legislative Problems: No. 1, by Dorothy C. Tomp-
kins, Bureau of Public Administration, University of
California, Berkeley, 1955, 82 pages, paper bound
(reviewed in this issue, page 358).
JOURNAL OF GERONTOLOGY
VotuME 10, Number 3
Jury, 1955
Section C
Organization Section and
Index to Current Periodical Literature
VotuME 10, Section C JULY, 1955 NuMBer 3
ee oo = oo = ——— ———— 14059.
NATHAN W. SHOCK
Gerontology Section
National Heart Institute
National Institutes cf Health
The subject categories are those in A Classified Bibliography of Gerontology and 14060
Geriatrics by Nathan W. Shock published by Stanford University Press, Stanford, Cali-
fornia (1951). Only major headings are used and the Roman numerals correspond to
those given in the bibliography. In so far as possible, references are classified according
to organ systems. Thus most of. the material on Geriatrics will be found under the
organ system involved in the disease. Cross references are indicated by number at the
end of each section. When available, abstract references are given (B.A.—Biological Ab- 1406]
stracts; P.A.—Psychological Abstracts; and P. 1.—Population Index). Abbreviations for
journals are those used in A World List of Scientific Periodicals Published in the Years
1900-1933, 2nd Edition. For journals not listed, abbreviations were devised according
to the general rules used in the above source. It is impossible to cover all journals
and list all papers concerned with aging and the aged. Authors and publishers are re-
quested to call attention to publications or to send reprints to the Gerontology Section,
Baltimore City Hospitals, Baltimore 24, Maryland. The assistance of the Forest Park 1406
Foundation, Peoria, Illinois, in the preparation of these materials is gratefully acknowledged.
GERONTOLOGY 14046. Havighurst, R. J., and R. Albrecht: Older
14034. Bastai, P., and G. C. Dogliotti: Die geron- — Longmans, Green, N. Y., 1058, a¥5
, cheat . pp. Abstr: P. 1., 21: No. 1134, 1955.f 1406
tologischen Studien in Italien. Z. Alters- 14047. Hetti : ‘ .
. Hettig, R. A.: Some physiologic mechanisms
foreoh., 8: S7C-988, 1065. of aging. Tex. St. J. Med., 50: 581-584
14035. Bortz, E. L.: Stress and aging. Geriatrics, nti 8: Picadas ilar:
10: 93-99, 1955. f
~ 14048. Ingrah . es riews 1406
14036. Brito, A., and R. Da: (To be and not to be apne, 3 s Modern +s ently heal
‘ s problems of aging. Conn. St. med. J., 18:
old.) J. Soc. Sciénc. méd., 118: 243-279, 963-970. 1954
1954. Saghey 3 ‘ .
14049, Lancaster, H. O.: A the Australis 1406
14037. Canadian Welfare Council: Bibliography on pene oT Med. J poe oa (2) eaaae
old age; books in the library of the Canadian 1954 i il pn awh Big .
pot Segoe eer ag yong 14050. Mahan, B. E. (Editor): Jowa Conference
rod ee ’ pp. str: BP. i, 21: No. on Gerontology, October 11-12, 1954. State
272, / : Univ. Iowa, Iowa City, February 1955, Bull.
14038. Carey, J. W.: Gerontological study tour. #703, 16 pp.
Geriatrics, 10: 144-146, 1955. 14051. Mars, G.: III Congresso Internazionale di
14039. Coyle, H.: Growing older. Amer. J. Nurs., Gerontologia. (Londra, 19-24, Inglio 1954).
54; 1104-1106, 1954. Gior. Geront., 2: 623-634, 1954.
14040. Del Corral Saleta, J. M.: Fisiologia de la 14959 Mason-Hohl. E.: We are the aging. J. 1406
vejez. Clin. Labor., Zaragoza, 57: (339), Amer. med. Women’s Ass., 9: 365-367, 1954.
401-412, 1954. 14053. Roe, M. A.: Public Health aspects of the
14041. Dorsey, J. M.: The benefits of senectitude. aging population. Tex. St. J. Med., 50: 593- 140)
(Editorial). Geriatrics, 10: 147, 1955. 595, 1954.
14042. Fisher, M.: The neurological aspects of ag- 14054. Torresini, A.: La sociologia della vecchiaia
ing. Canad. Serv. med. J., 10: 23-39, 1954. al congresso di Londra. Gior. Geront 2: | 140
14043. Fleming, C.: Gerontology as an applied 635-646, 1954.
science. Brit. J. phys. Med., 17: 207-209, 14055. Torresini, A.: Organizzazioni gerontologiche
1954. inglesi. Gior. Geront., 2: 711-715, 1954. 140
14044, Greppi, E.: Commento-radio al III Congresso 14056. Visher, A. L.: Probleme der Gerontologie.
Internazionale di Londra. Gior. Geront., 2: Schweiz. med. Wschr., 84: 1305, 1954.
621-622, 1954, 14057. Webster, R. C.: Old age. J. R. sanit. Inst, 4 14
14045. Greppi, E.: Invecchiamento e vecchiaia. Pro- 74: 951-957, 1954.
fiol generale di diagnosi e terapia. Gior. 14058. Zakon, S. J.: Toward the autumn of life.
Geront., 3: 5-15, 1955. Ibid., (2), 51-64, Quart. Bull. Nthwest. Univ. med. Sch., 28: 1“
1955. 429-494, 1954.
360
—=—=:_
NUMBER 3
JRE
ht: Older
1953, xvi,
134, 1955.
echanisms
581-584,
on health
d. J., 18:
Australian
, 548-554,
‘onference
54. State
955, Bull.
‘ionale di
lio 1954).
ging. J.
67, 1954.
ts of the
50: 593-
vecchiaia
ront., 2:
tologiche
954.
mntologie.
54.
nit. Inst.,
of life.
sch., 28:
INDEX OF CURRENT PERIODICAL LITERATURE
14059. Zubek, J. P., and P. A. Solberg: Human
development. McGraw-Hill Co., N. Y., 1954,
vii, 476 pp. Abstr: P. A., 29: No. 573, 1955.
BIOLOGY OF AGING
1. CELLULAR BroLoGy AND PHYSIOLOGY
(includes plants )
14060. Fedorov, M. V., and V. F. Nepmiluev:
(Basic forms of roots of Phleum pratense and
modification of the quantity of cells in roots
according to phases of development and
years of life of the plants.) Mikrobiol.,
Moscow, 23: 166-171, 1954.
14061. Terzian, L. A., and N. Stahler: The effect
of age and sex ratio on the mating activity
of Anopheles quadrimaculatus Say. Naval
Medical Research Institute, Bethesda, Mary-
land, Res. Rep. Vol. 12, Proj. NM005
048.06.06, June 1954, pp. 261-268.
Ziffren, S. E.: Management of the burned
elderly patient. J. Amer. geriat. Soc., 3:
36-42, 1955.
14062.
II. CLIMATE
Binaghi, A. C., and M. Angel Nores: Influ-
encia de la actividad solar sobre el desar-
rollo de epidemias y mortandad. Sem méd.,
B. Aires, 104: 547-554, 1954.
. Kosambi, D. D., and S. Raghavachari: Sea-
sonal variation in the Indian death rate.
Ann. human Genet., 19: 100-119, 1954.
Reiter, R.: Wetter und Todeshiufigkeit; die
tiigliche Todesziffer Siidbayerns und_ ihre
Beziehung zu _ bio-meteorologischen Indika-
toren. Dtsch. med. Wschr., 79: 1113-1117,
1954.
14063.
14065.
IV. LoNGEvitTy
(case reports, drugs, heredity, marriage,
occupation, and sex differences )
14066. Freudenberg, K.: Die Manager-Sterblichkeit
und die Methodik der Mortalititsstatistik.
Off. GesundhDienst., 16: 153-162, 1954.
Lhermitte, J.: La mort du point de vue de
la biologie. Progr. méd. Paris, 82: 427-432,
1954.
Logan, W. P.: Social class variations in mor-
tality. Brit. J. prev. soc. Med., 8: 128-137,
1954.
Metrop. Life Insur. Co.: Widows increas-
ing in number. Statist. Bull. Metrop. Life
Insur. Co., 36: 6-8, Jan. 1955.
Roberts, C. G., and D. D. Reid: Premature
disablement and death among post office
workers. Brit. J. prev. soc. Med., 8: 147-
152, 1954.
Sauvy, A.: Factores sociales de la mortalidad.
14067.
14068.
14069.
14070.
14071.
361
Rev. int. Sociol., 11: (42), 349-373, 1953,
Abstr: P. 1., 20: No. 1879, 1954.
Takahashi, E.: The sex ratio of neonatal
deaths in Japan. Hum. Biol., 26: 143-155,
1954.
Walden, P.: How to attain great age and
not become old. Sci. Counselor, 18: 7-10,
1955.
See also No. 14073.
14072.
14073.
IV-C. Lonceviry: Comparative Physiology
14074. Boyd, E. M., and E. J. Huston: The distri-
bution, longevity and sex ratio of Trichinella
spiralis in hamsters following an initial in-
fection. J. Parasit., 40: 686-690, 1954.
Crowell, S.: The regression-replacement cycle
of hydranths of obelia and campanularia.
Physiol. Zool., 26: 319-327, 1953.
Crozier, W. J.: Growth and duration of life
in Chiton tuberculatus. Proc. nat. Acad.
Sci., Wash., 4: 322-325, 1918.
Demuth, G. S.: Duration of life of the
worker bee. Gleanings in Bee Culture, 54:
106, 1926.
Hecht, S.: Form and growth in fishes. J.
Morph., 27: 379-400, 1916.
Jackson, C. H. N.: The analysis of tsetse-fly
population. Ann. Eugen., Camb., 10: 332-
369, 1940.
Lee, R. M.: A review of the methods of age
and growth determination in fishes by means
of scales. Min. Agri. Fish., 4: (Series 2),
1-32, 1920.
Milum, V. G.: The honeybee’s span of life.
30th Ann. Rep. Illinois State Beekeeper’s
Ass., 1931, pp. 94-107.
Oakberg, E. F., and A. M. Lucas: Variations
in body weight and organ; body-weight ra-
tios of inbred lines of white Leghorn chick-
ens in relation to mortality, especially from
lymphomatosis. Growth, 13: 319-337, 1949.
Peterson, C. G. J.: Eine Methode zur Bes-
timmung des Alters und Wuchses der Fische.
Mitt. dtsch. Seefisch. Ver., 11: 226-235, 1891.
Phillips, E. F.: The effect of activity on the
length of life of honeybees. J. econ. Ent.,
15: 368, 1922.
Riley, C. V.: Longevity in insects.
ent. Soc. Wash., 3: 108-125, 1895.
Rockstein, M.: Longevity in the adult worker
honeybee. Ann. ent. Soc. Amer., 43: 152-
154, 1950.
Senger, C. M.: Notes on the growth, de-
velopment, and survival of two echinostome
trematodes. Exp. Parasit., N. Y., 3: 491-496,
1954.
Stunkard, H. W.: The life history and sys-
14075.
14076.
14077.
14078.
14079.
14080.
14081.
14082.
14083.
14084.
14085. Proc.
14086.
14087.
14088.
362
14089.
14090.
14091.
14092.
14093.
14094.
14095.
14096.
14097.
14098.
14099.
14100.
14101.
14102.
JOURNAL OF GERONTOLOGY
tematic relations of the Mesozoa. Quart.
Rev. Biol., 29: 230-244, 1954.
Van Cleave, H. J., and L. G. Lederer: Studies
on the life cycle of the snail Viviparus con-
tectoides. J. Morph., 53: 499-522, 1932.
Van Oosten, J.: Life history of the lake her-
ring (Leucichthys artedi Le Sueur) of Lake
Huron as revealed by its scales; with a cri-
tique of the scale method. Bull. U. S. Bur.
Fish., 44: 265-428, 1929.
See also Nos. 14155, 14156.
IV-H. Loncevity: Mortality Rates
Anderson, O.: Statistik iiber Langlebigkeit.
Allg. statist. Arch., 30; 368-379, 1941-1942,
Abstr: P. I., 12: No. 1153, 1946.
Canada. Dominion Bureau of Statistics:
Canadian life table 1951. Queen’s Printer,
Ottawa, 1953, 14 pp. Abstr: P. I., 21: No.
1063, 1955.
Ceylon. Department of Census and Statis-
tics: Life, births and deaths; 1920-1952.
Govt. Press, Colombo, 1954, 38 pp. Abstr:
P.1., 21: No. 1328, 1955.
Ceylon. Department of Census and Sta-
tistics: Life table values. Quart. Bull. Sta-
tist., 5: (2), 6-8, 1954. Abstr: P. I., 21:
No. 1064, 1955.
Denmark. Sundhedsstyrelsen: (Causes of
death in the Kingdom of Denmark, 1951
and 1952.) I Kommission hos H. Hagerup,
Copenhagen, 1954, 122 pp. Abstr: P. I., 21:
No. 1307, 1955.
Finland. _Tilastollinen Piiitoimisto: (Life
tables 1946-50.) Suomen Virallinen Tilasto,
VI. Viaestétilastoa A 108, Helsinki, 1954, 23
pp. Abstr: P. I., 21: No. 1065, 1955.
France. Ministére de la Santé Publique: Mor-
talité par tuberculose en France en 1951.
Bull. Inst. nat. Hyg., 8: 1-8, 1953. Abstr:
P. I., 20: No. 1866, 1954.
Hart, H.: Expectation of life; actual versus
predicted trends. Soc. Forces, 33: (1), 82-
85, 1954. Abstr: P. I., 21: No. 1053, 1955.
Iskrant, A. P., and A. B. Kurlander: Dia-
betes mellitus mortality in the continental
United States—1950. J. chronic Dis., 1: 368-
380, 1955.
James, G., R. E. Patton, and A. S. Heslin:
Accuracy of cause of death statements on
death certificates. Publ. Hlth. Rep., Wash.,
70: 39-51, 1955.
King, M. B., et al.: Mississippi life tables,
1950-51; by sex, race and residence. Univ.
Miss., Bur. Publ. Admin., 1954, Sociol. Study
Series #4, 21 pp. Abstr: P. I., 21: No. 1066,
1955.
Lancaster, H. O.: The mortality in Australia
14103.
14104,
14105,
14106.
14107.
14108,
14109.
14110.
14111.
14112,
14113.
14114,
14115.
14116.
14117.
14118.
14119.
from cancer. Med. J. Aust., 41: (2), 100.
102, 1954.
Linford, R. J.: Abridged life tables and their
construction. Med. J. Aust., 41: (2), 588.
593, 1954.
Metrop. Life Insur. Co.: Cardiovascular.
renal mortality in western countries. Statist,
Bull. Metrop. Life Insur. Co., 35: 8-11, Dee,
1954.
Metrop. Life Insur. Co.: All-time low mor.
tality in 1954, Statist. Bull. Metrop. Life
Insur. Co., 36: 1-6, Jan. 1955.
Metrop. Life Insur, Co,; The increasing
chances of survival. Statist. Bull. Metrop,
Life Insur. Co., 36: 1-3, March 1955.
Metrop. Life Insur. Co.: Recent trends in
leukemia. Statist. Bull. Metrop. Life Insur,
Co., 36: 3-6, March 1955.
Moine, M.: Apercu des causes de décés en
1952 et 1953. Rev. Path. gén., Paris, 54:
892-899, 1954.
Moriyama, I. M.: Recent mortality trends
in areas of low mortality. Publ. Hlth. Rep.,
Wash., 69: 963-969, 1954.
Phillips, A. J.: Mortality from cancer of the
lung in Canada 1931-52. Canad. med. Ass.
J., 71: 242-244, 1954.
Ravina, A.: Tabagisme et taux de mortalité.
Pr. méd., 62: 1529, 1954.
Sablinski, J.: (Method of calculation of mor-
tality according to data on known and specu-
lated causes.) Zdrowie Publ., 70: 119-123,
April 1954. Abstr: P. I., 21: No. 1243,
1955.
Shepard, W. P.: Does the modern pace really
killP J. Amer. geriat. Soc., 3: 139-145, 1955.
Smyth, G. H.: The Tudor death rate. Med.
World, Lond., 81: 552-559, 1954.
Swartout, H. O., and R. G. Webster: To
what degree are mortality statistics depend-
able? Amer. J. publ. Hith., 30: 811-815,
1940.
U. S. Department of Health, Education and
Welfare. Public Health Service. National
Office of Vital Statistics: Abridged life ta-
bles United States; 1952. Vit. Statist., Spec.
Rep., Nat. Summaries, 40: (9), 196-205,
1955.
Winfield, G. A., and L. Wellwood: Analysis
of morbidity and mortality statistics, treat-
ment services, department of veterans af-
fairs. Canad. Serv. med. J., 10: 198-211,
1954.
Anonymous: Additional data on expectation
of life (a table). Population Index, 8: (1),
74, 1942.
Anonymous: Additional data on expecta-
tion of life (a table).
(4), 319, 1942.
Population Index, 8:
14120.
14121
14122
1412
1412,
1412
1412
1415
141
141
14]
14]
(2), 100.
s and their
(2), 588.
iovascular-
S. Statist,
8-11, Dee,
low mor-
trop. Life
increasing
|. Metrop,
55.
trends ip
fe Insur,
décés en
Paris, 54:
ty trends
Ith. Rep,
‘er of the
ned. Ass,
mortalité,
1 of mor-
id specu-
119-123,
o. 1243,
ce really
15, 1955.
e. Med.
ter: To
depend-
811-815,
‘ion and
National
life ta-
t., Spec.
196-205,
Analysis
;, treat-
ans af-
98-211,
ectation
8: (1),
xpecta-
dex, 8:
14120.
14121.
14122.
14123.
14124.
14125.
14126,
14127,
14128.
14129,
14139).
14131,
INDEX OF CURRENT PERIODICAL LITERATURE
Anonymous: Needs for birth and death sta-
tistics in the USA. Bull. World Hlth. Org.,
11: 283-291, 1954.
See also Nos. 14063, 14065, 14716.
Loncevity: NATIONAL Groups
IV-I.
Almado, C. A.: La estadistica y su relacién
con la proteccién de la infancia. Bol, Of.
Sanit. Panamer., 35: 690-709, 1953. Abstr:
P. I., 20: No. 1859, 1954.
Argentina, Direccién General de Estadistica:
(Anurio estadistico, afio 1936) Biffignaidi,
Cordoba, 1940, 528 pp. Abstr: P. I., 8: No.
1082, 1942.
Brazil. Conselho Nacional de Estatistica:
A mortalidade da populagado natural do Rio
Grande do Sul. Demographic Studies, Rio
de Janiero, 1953, No. 77, 16 pp. Abstr:
P. 1., 20: No. 1747, 1954.
Brazil. Conselho Nacional de Estatistica:
A mortalidade de populacdo natural do Es-
tado do Rio de Janeiro. Demographic Stud-
ies, Rio de Janeiro, 1953, No. 77, 16 pp.
Abstr: P. 1., 20: No. 1747, 1954.
Brazil. Conselho Nacional de Estatistica: A
mortalidade da populagdéo mineira. Demo-
graphic Studies, Rio de Janeiro, 1953, No.
78, 15 pp. Abstr: P. I., 20: No. 1747, 1954.
Central African Statistical Office. Federation
of Rhodesia and Nyasaland: Vital statistics.
Federation of Rhodesia and Nyasaland.
Mon. Dig. Statist., U. K., 1: 1-3, 1954.
Abstr: P. I., 20: No. 1831, 1954.
Ceylon. Department of Census and Sta-
tistics: Statistical abstract of Ceylon, 1954.
Ceylon Govt. Press, Colombo, 1954, xiv, 336
pp. Abstr: P. I., 21: No. 1329, 1955.
Contraloria general de la Re-
publica: (La tabla de mortaildad en Co-
lombia.) An. Econ. Estadist., 6: 11, 1943.
Abstr: P. I., 9: No. 1112, 1943.
Germany. Federal Republic. Bavaria. Sta-
tistiches Landesamt: Alter und Familien-
stand der iiber die bayerische Landesgrenze
Abgewanderten. Bayern Zahl., 8: 205-206,
1954. Abstr: P. I., 21: No. 1121, 1955.
Germany. West Berlin. Statistisches Lan-
desamt: Die Sterbefille nach Todesursachen
in Berlin 1946 bis 1951. Berliner Statistik,
Sonderheft 36, Ergiinzungsheft zu den Son-
derheften 11, 22, und 35. Berlin, 1954, 35
pp. Abstr: P. I., 20: No. 1868, 1954.
Gibraltar. Chief Medical Officer: Annual
medical and sanitary report for the year
ending 3lst December 1952. The Officer,
Gibraltar, 1953, 47 pp. Abstr: P. 1., 20:
No. 1773, 1954.
Colombia.
14132.
14133.
14134,
14135,
14136.
14137.
14138.
14139.
14140.
14141.
14142.
14143.
363
Great Britain. Board of Trade: Age and
occupation analysis of migrants, 1953; migra-
tion of Commonwealth citizens between the
United Kingdom and other countries by the
long sea routes. The Board, London, 1954,
9 pp. Abstr: P. I., 21: No. 1324, 1955.
India. Registrar General: Census of India,
1951. Part 4. Age tables—1951 census.
The Registrar, New Delhi, 1954, 172 pp.
Abstr: P. 1., 21: No 1331, 1955.
India. Registrar General: Census of India,
1951. Part 4. Distribution by age and
livelihood classes. The Registrar, New Delhi,
1954, 176 pp. Abstr: P. 1., 21: No. 1332,
1955.
India. Registrar General: Census of India,
1951. Part 6. Estimation of birth and death
rates in India during 1941-1950. The Reg-
istrar, New Delhi, 1954, 64 pp. Abstr: P. I.,
21: No. 1333, 1955.
Italy. Instituto Centrale di Statistica: An-
nuario di statistiche demografiche, 1951.
Azienda Beneventana Tipografica Editoriale,
Roma, 1953, 331 pp. Abstr: P. I., 20: No.
1778, 1954.
Japan. Ministry of Welfare. Division of
Health and Welfare Statistics: (Trends in
the nation’s health; 1953.) The Ministry
Tokyo, June 25, 1954, Spec. Issue No. 1,
Vol. 1, 96 pp. Abstr: P. I., 20: No. 1814,
1954.
Lindhardt, M.: The changes in the im-
portance of certain causes of death in the
Scandinavian countries. Danish med. Bull.,
1: 179-185, 1954.
Mauritius. Central Statistical Office: Year-
bood of statistics, No. 7, 1952. The Office,
Port Louis, 1954, 192 pp. Abstr: P. I., 20:
No. 1833, 1954.
Panama, Republic of. Contraloria General
de la Republica: Poblacién activa de la
ciudad de Panama que trabajaba en la Zona
del Canal, por occupacién y sexo, censo de
1940. Causas principales de la muerte, por
grupo de edad y sexo, ciudad de Panama,
1941. Estadist. Panamefia, 2: (1), 4-6, 1942.
Abstr: P. 1., 9: No. 1426, 1943.
Southern Rhodesia. Central African Statis-
tical Office: Vital statistics. Econ. statist.
Bull. S. Rhodesia, 21: (24), 19-22, 1954.
Abstr: P. I., 20: No. 1841, 1954.
Surinam, ———: Report of the number of
citizens in Paramaribo in the month of Oc-
tober, 1942. Official Gedeelte, Ao. Dec. 8,
1942, No. 103. Abstr: P. I., 9: No. 1476,
1943.
Switzerland. Eidgenossiches statistisches Amt.:
Schweizerische Sterbetafeln 1929-32 fiir die
Stadt- und Landbeviélkerung, nach Zivil-
364
14144.
14145.
14146.
14147.
14148.
14149.
14150.
14151.
14152.
14153.
14154.
14155.
JOURNAL OF GERONTOLOGY
standsgruppen, fiir Lungentuberkulose und
Krebs. Z. schweiz. Statist. Volkswirtsch.,
—: (4), 1941. Abstr: P. 1., 9: No. 1547,
1943.
Tanganyika. East African Statistical De-
partment: Report on the census of the non-
African population taken on the night of
February 13, 1952. Dar es Salaam, Govt.
Printer, 1954, iv, 51 pp. Abstr: P. 1., 21:
No. 1347, 1955.
Trindad and Tobago. Government: Annual
statistical digest No. 2, 1935-1952. The Gov-
ernment, Trinidad, 1953, x, 158 pp. Abstr:
P.1., 21: No. 1292, 1955.
United Nations. Population Division: Méi-
grations internationales selon le sexe et
lage; statistiques pour les années 1918-1947.
Pop. Studies, ST/SOA/Ser. A/No. 11, N. Y.,
1953, viii, 282 pp. Abstr: P. I., 21: No. 1112,
1955.
U. S. National Office of Vital Statistics:
Analysis and summary tables with supple-
mental tables for Alaska, Hawaii, Puerto Rico
and Virgin Islands. Vit. Statist., 1951, Govt.
Print. Off., Wash., 1954, Vol. 1, lii, 434 pp.
Abstr: P. I., 21: No. 1298, 1955.
Vila Coro, A.: Natalidad, mortalidad, mor-
bilidad y desarrollo del nifio pamue en la
Guinea continental espafola. Rev. Sanid.
Hig. publ., Madr., 26: 239-300, 1952. Abstr:
P. I., 20: No. 1842, 1954.
Anonymous: Schweizerische Sterbetafel,
1933/37. Z. schweiz. Statist. Volkswirtsch.,
76: 420-439, 1940. Abstr: P. I., 8: No. 679,
1942.
Anonymous: Complete expectation of life
at various ages in selected countries (a table).
Population Index, 8: (3), 244-245, 1942.
Anonymous: Complete expectation of life
at various ages in selected countries (a
table). Population Index, 9: 221-223, 1943.
See also No. 14064.
V. METABOLISM
Borisov, D.: (Water and electrolyte metabo-
lism in aged). Med. glasn., 8: 167-171,
1954.
Fuqua, M. E., and M. B. Patton: Effect of
three levels of fat intake on calcium metabo-
lism. J. Amer. diet. Ass., 29: 1010-1013,
1953.
Horanyi, B.:
nervous system in old age.)
arch., 7: 17-25, 1954.
Rockstein, M.: Some aspects of physiologi-
cal aging in the adult worker honey bee.
Biol. Bull., 105: 154-159, 1953.
(Tissue modifications in the
Magy. belorv.
14156.
14157.
14158.
14159.
14160.
14161.
14162.
14163.
14164.
14165.
14166.
14167.
14168.
14169.
Rockstein, M., and P. W. Herron: Phos.
phatase in the adult worker honey bee. J,
cell. comp. Physiol., 38: 451-467, 1951.
Sekla, B.: Esterolytic processes and duration
of life in Drosophila melanogaster. Brit. J,
exp. Biol., 6: 161-166, 1929.
Slack, H. G.: Metabolism of elastin in the
adult rat. Nature, Lond., 174: 512-513, 1954,
Watson, B. A.: The hypometabolic state; a
clinical entity. N. Y. St. J. Med., 54: 2045,
1954.
Williams, C. H., L. A. Barnes, and W. H.
Sawyer: The utilization of glycogen by flies
during flight and some aspects of the physio-
logical ageing of Drosophila. Biol. Bull,
84; 263-272, 1943.
See also Nos. 14153; 14265; 14295; 14299.
14450.
VI. Nurtririon
Babcock, M. J., H. N. Church, and L. 0.
Gates: Nutritional status of industrial work-
ers. I. Dietary, blood and physical findings,
Milbank mem. Fd. quart., 32: 323-342, 1954.
Chope, H. D.: Relation to nutrition of health
in aging persons. A four-year followup of a
study in San Mateo County. Calif. St. J.
Med., 81: 335-338, 1954.
Chow, B. F.: Vitamin By and aging.
atrics, 10: 31-33, 1955.
Kirk, J. E., and M. Chieffi: Hypovitaminemia
A. J. clin. Nutrit., 1: 37-43, 1952. Abstr:
P. A., 29: No. 274, 1955.
Martin, J. D., Jr.: Nutrition in the elderly
surgical patient. Amer. Surg., 20: 966-970,
1954.
Shea, J. A., M. L. Jones, and F. J. Stare:
Nutritional aspects of aging. Med. Clin.
N. Amer., (Boston). —: 1485-1492, Sept.
1954.
Geri-
See also No. 14285.
ORGAN SYSTEMS
I. BLoop
Berlin, N. L., J. H. Lawrence, and H. C.
Lee: The pathogenesis of the anemia of
chronic leukemia; measurement of the life
span of the red blood cell with glycine—
2-C14. J. Lab. clin. Med., 44: 860-874, 1954.
Berlin, N. I., C. Reynafarje, and J. H. Law-
rence: Red cell life span in the polycythemia
of high altitude. J. appl. Physiol., 7: 271-
272, 1954.
Blaustein, A.: Clinical trials with a new an-
tianemic agent—acidiron. J. Amer. geriat.
Soc., 3: 120-124, 1955.
14170.
14171.
14172.
14173.
14174.
14175.
14176
14177
14178
14179
1418(
1418)
1418
1418
on:
1951.
id duration
'. Brit. J.
tin in the
513, 1954,
ic state; q
54; 2045,
id W. H.
n by flies
1e physio-
iol. Bull,
9; 14299,
id L. O.
ial work-
findings,
42, 1954,
of health
vup of a
y. BJ
z. Geri-
minemia
Abstr:
- elderly
966-970,
. Stare:
l. Clin.
, Sept.
H.. G
mia of
he life
ycine—
, 1954.
, Law-
themia
: 271-
‘Ww an-
geriat.
Phos.
*y bee. J,
14170.
14171.
14172.
14173.
14174.
14175.
14176.
14177.
14178.
14179,
14180.
14181,
14182.
14183,
INDEX OF CURRENT PERIODICAL LITERATURE
Bottner, H., and B. Schlegel: Die Lebens-
dauer iibertragener Erythrocyten bei Kranken
mit Tuberkulose. Beitr. Klin. Tuberk., 111:
155-157, 1954.
Garrow, J. S.: Some haematological and
serum protein values in normal Jamaicans.
W. Ind. med. J., 3: (2), 104-107, 1954.
Ottesen, J.: On the age of human white
cells in peripheral blood. Acta physiol.
scand., 32: 75-93, 1954.
Read, R. C.: A simplified procedure for the
measurement of red cell volume and turnover
with Cr". Surg. Forum, 4: 169-172, Oct.
1953.
Weber, F. P.: Case of achlorhydric anaemia
in a male followed up for 20 years. Brit.
med. J., 2: (4903), 1529-1530, 1954.
See also No. 14191.
I-A. BLoop: Chemistry
Antonini, F. M.: Glicolipoproteine del siero,
polisaccaridi e sostanze eparinoidi nell’eta
senile e nell’aterosclerosi. Gior. Geront., 2:
647-648, 1954.
Barr, D. P.: Influence of sex and sex hor-
mones upon the development of atherosclero-
sis and upon the lipoproteins of plasma. J.
chronic Dis., 1: 63-85, 1955.
Cottet, J., A. Mathivat, and J. Redel: Etude
therapeutique d’un hypocholesterolemiant de
synthése: l’acide phényl-ethyl-acetique. Pr.
méd., 62: 939-941, 1954.
De Bellis, L.: La potassiemia durante Il’eta
senile. Boll. Soc. ital. Biol. sper., 30: 370-
372, 1954.
Deveze, M.: La cristalografia determinativa
y las modificaciones humorales ocasionadas
por el envejecimiento. Med. esp., 32: 42-44,
1954.
Eiber, H. B., A. A. Goldbloom, L. J. Boyd, I.
Chapman, and O. Deutschberger: Newer
clinical and laboratory studies in the aged.
II. Correlated serum lipid partitions. and
lipoprotein molecules (SF 0-400) in patients
80-100 years of age; preliminary report.
Bull. N. Y. Acad. Med., 30: 719-720, 1954.
Fazio, B., U. Costa, and G. Assereto: Com-
portamento dello iodio organico serico nella
vecchiaia. Arch. Maragliano pat. clin., 9:
511-516, 1954.
Garry, R. C., A. W. Sloan, J. B. De V Weir,
and M. Wishart: The concentration of
haemoglobin in the blood of young adult
men and women; the effect of administering
small doses of iron for prolonged periods.
Brit. J. Nutrit., 8: 253-268, 1954.
Gillum, H. L., and A. F. Morgan: Nutri-
tional status of the aging. I. Hemoglobin
14184.
14185.
14186.
14187.
14188.
14189.
14190.
14191.
14192.
14193.
14194.
14195.
365
levels, packed cell volumes and sedimentation
rates of 577 normal men and women over
50 years of age. J. Nutrit., 55: 265-288,
1955.
Gillum, H. L., A. F. Morgan, and R. I. Wil-
liams: Nutritional status of the aging. II.
Blood glucose levels. J. Nutrit., 55: 289-
303, 1955.
Hawkins, W. W., E. Speck, and V. G.
Leonard: Variation of the hemoglobin level
with age and sex. Blood, 9: 999-1007, 1954.
Herbeuval, R., G. Cuny, and M. Manciaux:
Etude chez le vieillard des électrolytes K et
Na et de la pression osmotique du plasma par
le delta cryoscopique. Pr. méd., 62: 1555-
1556, 1954.
Johnson, E. C., R. B. Dube, H. A. Louhi, H.
H. Yii, V. C. Wilmot, and C. A. Storvick:
Thiamine metabolism of women on controlled
diets. VI. Comparison of the daily levels
of thiamine in the blood and urine. J. Amer.
diet. Ass., 29: 41-43, 1953.
Rafstedt, S., and B. Swahn: Studies on
lipids, proteins and lipoproteins in serum from
newborn infants. Acta paediat., Uppsala,
43; 221-234, 1954.
Scott, E. M., R. C. Wright, and B. T. Hanan:
Anemia in Alaskan Eskimos. J. Nutrit., 55:
137-149, 1955.
Wadsworth, G. R.: Haemoglobin levels of
normal men and women living in a tropical
climate. Brit. med. J., 2: (4893), 910-911,
1954.
Wehmeyer, P:: On the influence of age on
plasma protein concentration, blood cell
volume, and sedimentation rate in the ox.
Acta physiol. scand., 32: 69-74, 1954.
See also No. 14261.
I-B. Bioop: Coagulation
Capaldo, A., and G. Del Buono: Ricerche
sull’attivita tromboplastinica dei varii organi
e tessuti. V. Cervello; suo comportamento
nelle varie eta. Riv. Biol., 46: 253-259, 1954.
Innerfield, I.: | Trypsin given intra-muscu-
larly in chronic, recurrent thrombophlebitis.
J. Amer. med. Ass., 156: 1056-1058, 1954.
Prosperi, P.: Comportamento del tempo di
Quick e del tempo di Howell dalla nascita
all’adolescenza. Riv. Clin. pediat., 53: 167-
172, 1954.
Zuckermann, R., T. Valazquez, A. Bisteni,
and J. Ortiz Marquez: Flebotrombosis y
tromboflebitis coronarias. IV. Estudio ana-
tomoclinico. Arch. Inst. Cardiol. México,
20: 610-643, 1950.
366
(blood
14196.
14197.
14198,
14199,
14200.
14201.
14202.
14203.
14204.
14205.
14206.
14207.
14208.
14209.
14210.
JOURNAL OF GERONTOLOGY
III. CarpiovAscULAR SysTEM
vessels, blood pressure, hypertension, blood
volume, veins, and arteriosclerosis )
Antonini, F. M., and G. Mininni: Metabo-
lismo dei mucopolisaccaridi nell’aterosclerosi
sperimentale de colesterolo. Gior. Geront.,
2: 649-652, 1954.
Blanchard, W. O., W. J. Zukel, E. M. Morris,
M. A. Smith, and D. A. Sullivan: Screening
for cardiovascular disease in a community.
New Engl. J. Med., 25: 550-555, 1954.
Chang, Y. O., T. J. S. Laursen, and J. E.
Kirk: The total nicotinic acid and pyridine
nucleotide content of human aortic tissue.
J. Geront., 10: 165-169, 1955.
Dubey, V. D.: A study of blood pressure
amongst industrial workers of Kanpur. J.
Indian Med. Ass., 23: 495-498, 1954.
Gonzales Cruz, A.: Modificaciones de la
presién venosa con el esfuerzo en personas
sanas de edad geriatrica. Med. esp., 32: 124-
129, 1954.
Greppi, E., and F. M. Antonini: Differenze
cliniche ed umorali tra aterosclerosi e arterio-
sclerosi senile. Gior. Geront., 2: 660, 1954.
Griep, A. H., G. R. Barry, W. C. Hall, and
S. W. Hoobler: The prognosis in arterial
hypertension; report on 117 patients under
53 years of age followed 8 to 10 years.
Amer. J. med. Sci., 221: 239-249, 1951.
Guard, H. R., and Y. M. Bhende: Changes
due to ageing in the abdominal aorta. In-
dian J. med. Res., 41: 267-276, 1953.
Guillaume, A. C.: Quelles sont les limites
tensionnelles normales? Biol. méd., 43: 292-
326, 1954.
Hagen, H., and H. Jensen: Blutstrémungs-
zeit bei Gesunden. Z. Kreis. Forsch., 43:
484-487, 1954.
Hamilton, M., G. W. Pickering, J. A. Roberts,
and G. S. C. Sowry: The aetiology of essential
hypertension. I. The arterial pressure in
the general population. Clin. Sci., 13: 11-
35, 1954.
Hamilton, M., G. W. Pickering, J. A, Fraser
Roberts, and G. S. C. Sowry: The aetiology
of essential hypertension. II. Scores for
arterial blood pressures adjusted for differ-
ences in age and sex. Clin. Sci., 13: 37-49,
1954.
Hamilton, M., G. W. Pickering, J. A. Fraser
Roberts, and G. §. C. Sowry: The aetiology
of essential hypertension. IV. The role of
inheritance. Clin. Sci., 13: 273-304, 1954.
Hevelke, G.: Beitrige zur Funktion und
Struktur der Gefisse. Z. Altersforsch., 8:
219-234, 1955.
Kirk, J. E., T. J. S. Laursen, and R. Schaus:
Studies on the succinic dehydrogenase of
human aortic tissue. J. Geront., 10: 178-18]
1955.
14211. Ledbetter, P. V., and E. J. Morrow: Thirty.
three years’ experience in the management
of arterial hypertension. J. Amer. geriat,
Soc., 3: 172-180, 1955.
14212. Luke, J. C.: Management of segmental
occlusion of major arteries. Geriatrics, 10: 5.
11, 1955.
14213. McGoey, P. F.: The choice of amputation
in senile gangrene. Canad. med. Ass. J., 71:
469-472, 1954.
14214. McGovern, V. J., and J. M. Greenaway: Hy-
pertension; a survey of autopsy findings from
patients over and under the age of forty
years. Med. J. Aust., 41: (2), 10-12, 1954,
14215. Michel, D.: Kurze Mitteilung: Zur Allters-
abhingigkeit des I. Teiles der Schellong-
schen Regulationspriifung. Z. Altersforsch.,
8: 275-277, 1955.
14216. Perera, G. A.: Hypertensive vascular dis-
ease; description and natural history. J.
chronic Dis., 1: 33-42, 1955.
14217. Schaus, R., J. E. Kirk, and T. J. S. Laursen:
The riboflavin content of human aortic tissue.
J. Geront., 10: 170-177, 1955.
14218. Semisch, C. W., III, and D. W. Lewis;
Cardiovascular disease in the aged. Med.
Clin. N. Amer., ..: 1767-1784, 1954.
14219. Vega Diaz, F.: Algunos problemas clinicos
de la cardiopatologia senil. If Congreso Na-
cional de la Sociedad Espafiola de Geron-
tologia y Geriatria, Valencia, July 1954, Part
ii, 475 pp.
14220. Volynskii, Z. M., I. I. Isakov, S. I. Iakovlev,
and S. A. Keizer: (Charasteristics of arterial
pressure in inhabitants of Leningrad during
the post-war years and normal blood pres-
sure). Terap. Arkhiv., 26: 3-9, 1954.
14221. Wadsworth, G. R.: The bleod volume of
normal women. Blood, 9: 1205-1207, 1954.
14222. Wakefield, H.: High blood pressure in older
women. Post Grad. med. J., 16: 175-177,
1954.
14223. Wayne, E. J.: Treatment of peripheral
vascular disease in old age. Brit. med. J., 2:
(4890), 718-720, 1954.
See also No. 14176.
III-G. CarpiovAscuLAR SystEM: Heart
(heart, anatomy and physiology, heart disease,
coronary artery disease, and myocardial disease )
14224, Bassani, A., and S. Fantini: Cuore senile.
Acta geront., 4: 115-127, 1954.
14225. Benton, J. G., and H. A. Ruski: The rela-
tion of physical activity and occupation to
14226.
14227.
14228.
14229
14230
14231
14232
1423¢
1423
1423:
1423
1423
1423
1423
1424
1424
142
genase of
): 178-18],
Thirty.
anagement
er. geriat.
segmental
ics, 10; 5.
mputation
iss. EB 71;
yay: Hy-
lings from
of ‘forty
-12, 1954,
ur Alters.
schellong-
ersforsch.,
cular dis-
story. J,
Laursen;
tic tissue.
. Lewis;
J. Med.
i.
s clinicos
reso Na-
e Geron-
954, Part
Iakovley,
yf arterial
d during
od pres-
lume of
17, 1954.
in older
175-177,
eripheral
iM. Jom
art
disease,
ease )
» senile.
he rela-
ation to
14226.
14227.
14228.
14229.
14230.
14231.
14232.
14233.
14234.
14235.
14236.
14237.
14238,
14239.
14240.
14241.
14242.
INDEX OF CURRENT PERIODICAL LITERATURE
coronary artery heart disease. Ann. intern.
Med., 41: 910-917, 1954.
Berconsky, I.: Afecciones cardiovasculares
de la vejez. Dia méd., 26: 1181-1189, 1954,
Calazel, P., J. Cassagneau, M. Esclavissat, R.
Bollinelli, J. Ducuing, and P. Meriel: Etude
du débit coronaire. I. Premiers résultats
chez homme normal. Arch. Mal. Coeur,
47: 289-303, 1954.
Corti, L., and R, Gallini:
atriale senile ed il suo trattamento.
Geront., 2: 577-588, 1954.
Edington, G. M.: Cardiovascular disease as
a cause of death in the Gold Coast African.
Trans. roy. Soc. trop. Med. Hyg., 48: 419-
425, 1954.
Franco, S$. C.: Clinical ballistocardiography;
value and limitations of the portable ballisto-
cardiograph in the detection of heart disease.
Industr. Med., 21: 197-205, 1952.
Gibson, T. C.: Electrocardiography; the
normal electrocardiogram. Med. Illustr., 8:
547-549, 1954.
Hebbert, F. J., and J. Rankin: Mitral valve
disease over the age of 50. Acta med. scand.,
150; 101-118, 1954.
Kattus, A. A., A. U. Rivin, A. Cohen, and
G. S. Sofio: Cardiac output and central
volume as determined by dye dilution curves;
resting values in normal subjects and patients
with cardiovascular disease. Circulation, 11:
447-455, 1955.
Kazmeier, F., and W. Schild: Die Altersver-
iinderungen des Ballistokardiogramms. Z.
Altersforsch., 8: 212-218, 1955.
Kowalski, H. J.. W. H. Abelmann, W. F.
McNeely, N. R. Frank, and L. B. Ellis: The
cardiac output of normal subjects determined
by the dye injection method at rest and dur-
ing exercise. Amer. J. med. Sci., 228: 622-
625, 1954.
Lohmann, D.: Chemische Untersuchungen
iiber Altersveriinderungen des Herzens. Z.
Altersforsch., 8: 234-244, 1955.
Michel, D.: Der Altersgang der Stehver-
inderungen des Elektrokardiogramms. Z.
Altersforsch., 8: 201-211, 1955.
Morgan, H. J.: Senile heart disease.
Amer. climat. Ass., 65: 64-70, 1953.
Qamada, K.: Untersuchungen iiber Wasser
und Kaliumgehalt des Herzmuskels im Alter.
Acta geront., 23: 1, 1952. :
Richardson, J. L.: Does exertion precipi-
tate coronary thrombosis? J. med. Ass. Ga.,
42; 89-91, 1953.
Rozanova, V. D.: (Age factor in resistance
of the heart to atropine.) Fiziol. Zh. S.S.S.R.,
40: 453-457, 1954.
Russek, H. I., and B. L. Zohman:
La fibrillazione
Gior.
Trans.
Chances
14243,
14244,
14245.
14246.
14247.
14248.
14249.
14250.
14251.
14252.
14253.
14254.
367
for survival in acute myocardial infarction;
survey of the acute phases in 1,318 patients.
J. Amer. med. Ass., 156: 764-768, 1954.
Shearer, M. C., S. H. Sikkema, and L. W.
Holden: Prevalence of heart disease in uni-
versity students. Amer. J. publ. Hlth., 42:
1103-1110, 1952.
Slattery, R. V.:
chest microfilms.
1595-1596, 1953.
Sorribes-Santamaria, V.: La atipia clinica
del infarto de miocardio en las edades avan-
zadas de la vida. Med. esp., 32: 157-160,
1954.
Stampfli, K.: Zur Herztherapie mit Recosen
bei iilteren Patienten. Ther. Umschau, Bern,
11: 112-114, 1954.
Taylor, H. L., W. F. Maloney, and A. Keys:
Factors affecting the low-frequency, critically-
damped ballistocardiogram, with special ref-
erence to age, body size, and body composi-
tion. Amer. Heart J. 48: 864-880, 1954.
Testori, E.: Osservazioni sull’azione degli
estratti lipoidei miocardici e diencefalici nelle
sindromi d’alterata regolazione di tipo ipos-
figmico e ipotensivo del soggetto senile.
Gior. Geront., 2: 597-608, 1954.
Tormo Alfonso, V., R. Baguena Candela, and
J. Baguena Candela: La heparina en el tra-
tamiento de la angina de pecho. Med. esp.,
32: 161-165, 1954.
Wafer, J. G., Jr.:
of heart disease.
106: 450-454, 1954.
Yater, W. M., A. H. Traum, W. G. Brown,
R. P. Fitzgerald, and M. A. Geisler: | Coro-
nary artery disease in men eighteen to thirty-
nine years of age. Report of eight hundred
sixty-six cases, four hundred fifty with
necropsy examination. Amer. Heart J., 36:
683-722, 1948. Abstr: B. A., 23: No. 15046,
1949.
Anonymous: Direzioni terapeutiche nella
patologia vascolare degenerativa: L’estratto
di cuore embrionael di miko e téré. Acta
geront., 4: 135-168, 1954.
See also No. 14330.
Heart disease discovered on
J. Amer. med. Ass., 152:
A study of the incidence
J. Louisiana med. Soc.,
IV. CoNNECTIVE TissUE AND CARTILAGE
Eichelberger, L., and M. Roma: Effects of
age on the histochemical characterization of
costal cartilage. Amer. J. Physiol., 178: 296-
304, 1954.
Morettini, A., S. G. Neri Serneri, and A.
Sciagra: Modificazioni istologiche del con-
nettivo nell’artrite sperimentale del coniglio
dopo somministrazione per via endoarteriosa
di acetilcolina e colina. Reumatismo, Milano,
6: (Suppl.), 53-54, 1954.
368
14255.
14256.
14257.
14258.
14259.
14260.
14261.
14262.
14263.
14264.
14265.
14266.
14267.
14268.
14269.
14270.
JOURNAL OF GERONTOLOGY
Pieroni, P. F.: El tejido conjuntivo y el
laboratorio en las enfermedades reumiaticas.
Sem. méd., B. Aires, 105: 154-157, 1954.
V. ENDpDOcRINE SysTEM
(includes sex glands and climacteric )
Blumenthal, H.: The aging process in the
endocrine glands of the guinea pig. I. The
influence of age, sex and pregnancy on the
mitotic activity and the histological structure
of the thyroid, parathyroid and adrenal
glands. Arch. Path., Chicago, 40: 264, 1945.
Bonnin, M., and W. R. Adey: Investigations
of muscular weakness in middle life; the so-
called menopausal dystrophy. Australas.
Ann. Med., 3: 171-181, 1954.
Bredland, R.: Menopause. Nord. Med.,
Stockholm, 52: 1009-1012 1954.
Bruni, B.: La terapia antispastica nelle sin-
dromi vascolari particolarmente in meno-
pausa. Acta geront., 4: 128-134, 1954.
Collett, M. E., G. E. Wertenberger, and V.
M. Fiske: The effect of age upon the pat-
tern of the menstrual cycle. Fert. & Steril.,
5: 437-446, 1954.
De Bellis, L.:
ed attivita ovarica.
1954.
De Bellis, L.: Ricerche sperimentali sulla
determinazione qualitativa delle sostanze ad
azione gonadostimolante presenti nelle urine
di donne vecchie. Boll. Soc. ital. Biol. sper.,
30: 372-374, 1954.
Freeman, H., G. Pincus, F. Elmadjian, and
L. P. Romanoff: Adrenal responsitivity in
aged psychotic patients. Geriatrics, 10: 72-
77, 1955.
Gondim, J. C.: Rutura vaginal sub-coitu em
multipara no climaterio. Rev. Gynec. Obst.,
Rio de J., 48: 290-294, 1954.
Kalant, O. J., and E. A. Sellers: The in-
fluence of age and sex on the succinoxidase
activity of the adrenal gland of the rat.
Endocrinology, 55: 777-781, 1954.
Kinsell, L. W.: Hormones, growth and
senescence. J. Amer. geriat. Soc., 3: 31-35,
1955.
Loube, S. D., and L. K. Alpert: Evaluation
of screening procedures in a diabetes detec-
tion drive; a follow-up survey of individuals
found to have positive urine tests. Diabetes,
3: 274-278, 1954.
Masters, W. H., and J. W. Ballew: The
third sex. Geriatrics, 10: 1-4, 1955.
Rapporti tra calcemia, eta
Riv. Ostet., 9: 458-465,
Mines, J. L.: Female endocrine physiology
from puberty to the climacteric. J. Amer.
osteop. Ass., 54: 144-145, 1954.
Novak, E. R.: The menopause. J. Amer.
med, Ass., 156: 575-578, 1954.
14271.
14272.
14273.
14274,
14275.
14276.
14277.
14278.
14279.
14280.
14281.
14282.
14283.
14284.
14285.
Panella, I., and G. Messina: La _ tubercolosi
genitale nelle donne in menopausa. Arch,
ital. Anat. Istol. Patol., 28: 169-188, 1954,
Pupi, R. E., and J. F. Raffaele: Aspectos
geriatricos en el tratamiento de la diabetes
y sus complicaciones. Sem. méd., B. Aires
105: 289-302, 1954.
Rossitto, G.: Sindrome menopausale, dos.
aggi e terapia ormonali. G. Sci. med., 8;
143-147, 1953.
Sannazzari, P., and G. Assereto: Studi sulla
pregnandioluria. II. Compartemento della
pregnandioluria nell’unoma sano ed eucrinico
nelle varie eta della vita. Arch. Maraglinao
pat. clin., 9: 763-768, 1954.
Sannazzari, P., and L. Zinolli: Comporta-
mento della gonadostimolinuria nelle varie
eta della vita in soggetti sani ed eucrinici,
Arch. Maragliano pat. clin., 9: 369-389, 1954,
Silberberg, R., and M. Silberberg: Skeletal
effects of radio-iodine induced thyroid def-
ciency in mice as influenced by sex, age and
strain. Amer. J. Anat., 95: 263-289, 1954.
Tyler, F. H., K. Eik-Nes, A. A. Sandberg,
A. A. Florentin, and L. T. Samuels: Adreno-
cortical capacity and the metabolism of corti-
sol in eldery patients. J. Amer. geriat. Soc.,
3: 79-84, 1955.
Ufer, J.: Uber die Behandlung klimak-
terischer Beschwerden mit protrahiert wirken-
den Hormonestermischungen. Geburt. Frau-
enheilk., 14: 650-655, 1954.
See also Nos. 14099, 14181, 14625.
VI. Gastro-INTEsTINAL SysTEM
Alifio Testor, J. A.: Frecuencia y caracter-
isticas clinicas de las colecistopatias en los
viejos. Med. esp., 32: 14-19, 1954.
Cate, W. R., Jr.: The incidence of choleli-
thiasis in the older age groups. J. Tenn. med.
Ass., 47: 102-104, 1954.
De Biasio, B., G. Mazzi, and L. Dal Ri:
Contributo allo studio della diagnostica fun-
zionale epatica nei vecchi; le modificazioni
dell’ attivita protrombinica dopo carico di
vitamina K. Gior. Geront., 2: 653-656, 1954.
Erb, P.: Ulcera ventriculi et duodeni_ bei
Menschen iiber 65 Jahren. Z. Altersforsch.,
8: 255-267, 1955.
Font, J.: Gerestomatologia. Med. esp., 32:
45-57, 1954.
Font, J.: La periodontoclasia o piorrea
alveolodentaria, vejez prematura de la apofisis
alvéolar de los maxilares. Med. esp., 32:
113-118, 1954.
Ginzberg, R., and W. C. Brinegar: Studies
of appetite and of constipation in advanced
life; psychological and statistical evaluation
1428
1428
1428
1428
142¢
1426
1426
1426
1429
142¢
1429
1429
1430
ubercolosi
a. Arch,
3, 1954.
Aspectos
i diabetes
B. Aires,
sale, dos-
med., 8:
tudi sulla
nto della
eucrinico
faraglinao
Somporta-
elle varie
eucrinici,
389, 1954,
Skeletal
roid defi-
, age and
, 1954.
Sandberg,
Adreno-
| of corti-
riat. Soc.,
klimak-
t wirken-
rt. Frau-
caracter-
is en los
f choleli-
nn. med.
Dal Ri:
tica fun-
jificazioni
varico di
56, 1954.
deni_ bei
rsforsch.,
esp., 32:
piorrea
2 apofisis
osp., 32:
Studies
\dvanced
valuation
14286.
14287.
14288.
14289.
14290.
14291.
14292.
14293.
14294.
14295.
14296.
14299.
14300.
INDEX OF CURRENT PERIODICAL LITERATURE
of a county home survey in Iowa. Amer. J.
digest. Dis., 21: 267-272, 1954.
Hayes, M. A.: Biliary-tract surgery in pa-
tients past 60 years of age. J. Amer. geriat.
Soc., 3: 146-171, 1955.
Hays, D. M., and F. Glenn: The fate of
the cholecystostomy patient. J. Amer. geriat.
Soc., 3: 21-30, 1955.
Priest, R. J., B. E. Brush, and L. J. Gregory:
Medical and surgical management of diverti-
culitis in geriatric patients. J. Amer. geriat.
Soc., 3: 55-63, 1955.
Rafsky, H. A., and L. J. Honig: Changes
in the colonic function and use of laxatives
in the aged. Ann. N. Y. Acad. Sci., 58: 513-
519, 1954.
Ratnoff, O. D., and A. J. Patek, Jr.: Post-
necrotic cirrhosis of the liver; study of forty-
five cases. J. chronic Dis., 1: 266-291, 1955.
Renaud, M.: Sur les cirrhoses tardives et
les facteurs des inflammations sclerosantes.
Bull. Acad. nat. Méd. Paris, 138: 255-256,
1954.
Szemzo, G.:
tic ulcer in advanced aged. )
arch., 7: 1-6, 1954.
Tauchi, —., —., Hisashi, and T. Morikawa:
On the nature of senile atrophy of liver and
spleen in comparison with non-senile atrophy.
Nagoya med. J., 2: 1-12, 1954.
Wist, G.: Zunahme und Altersverteilung
der Ulkuskomplikationen am _ Sektionsgut
(14300 Sektionen), zugleich ein Beitrag zur
Frage der Ulkusgenese. Z. Altersforsch., 8:
267-274, 1955.
Zorzoli, A.: The influence of age on phos-
phatase activity in the liver of the mouse.
J. Geront., 10: 156-164, 1955.
Anonymous: Da queratinizacdo da mucosa
oral de homens idosos. Rev. brasil. Odont.,
12: 40-44, 1954.
(Statistical aspects of the pep-
Magy. belorv.
VIII. Lympuatic SystEM
Kelemen, G.: The tonsils in advanced age.
Eye, Ear, Nose Thr. Mon., 33: 723-726, 1954.
King, J. T.: Senile tonsillar gigantism; re-
port of a case. Sth. med. J., Birmingham,
47: 1155-1156, 1954.
X. Nervous SystEM
(neurology )
Aprison, M. H., and H. E. Himwich: Rela-
tionship between age and_ cholinesterase
activity in several rabbit brain areas. Amer.
J. Physiol., 179: 502-506, 1954.
Barbareschi, G.: Arteriosclerosi
Gior. Geront., 3: 77-87, 1955.
cerebrale.
14301.
14302.
14303.
14304.
14305.
14306.
14307.
14308.
14309.
14310.
14311.
14312.
14313.
14314.
14315.
369
Brain, R.: Cerebral vascular disorders. Ann.
intern. Med., 41: 675-681, 1954.
Brunetta, A.: Accidenti vascolari cerebrali;
diagnostica differenziale—importanza del re-
perto liquorale. Gior. Geront., 3: 65-76,
1955.
Cooper, I. S.: Chemopallidectomy; an in-
vestigative technique in geriatric Parkin-
sonians. Science, 121: 217-218, 1955.
Crain, S. M., H. Grundfest, F. A. Mettler,
and T. J. Flint: Five year follow-up of
artane treatment; the outcomes in 461 Parki-
son cases. Trans. Amer. neurol. Ass., (78th
Meet. ), —: 236-239, 1953.
Dickmann, G. H.: El tratamiento quirir-
gico de la enfermedad de Parkinson: valora-
cién de su estado actual. . Prensa méd.
argent., 41: 2048-2063, 1954.
Doring, H., P. Seulberger, and H. Peters:
Vegetative Tonuslage in Abhiangigkeit vom
Lebensalter und ihre Beeinflussung durch
Geschlecht und Krankheit. Chirurg, 25: 198-
202, 1954.
Ferey, D.: Le traitement chirurgical des
hémorragies cérébrales spontanées. Concours
méd., 72: 1235-1236, 1950.
Gayral, L., and L. Fourny: Les accidents
cérébraux au cours des traitements par les
antibiotiques. Toulouse méd., 55: 183-193,
1954.
Guidi, G.: Problemi di patologia vascolare
cerebrale. (Editorial). Gior. Geront., 3:
88-94, 1955.
Hahn, T.: Die Elektroenzephalographie bei
zerebralen Thrombophlebitiden und Throm-
bosen. Schweiz. Arch. Neurol. Psychiat., 73:
57-99, 1954.
Hopkins, B., and R. Martin: Psychological
test performance in patients over sixty. II.
Paraphrenia, arteriosclerotic psychosis and
acute confusion. J. ment. Sci., 99: 451-463,
1953. Abstr: P. A., 28: No. 4655, 1954.
Huber, H.: Uber Zirkluationsstérungen im
sklerotischen Gehirn und deren Beinflussung
mit Nicovasen. Wien. med. Wschr., 104:
773, 1954.
Jaffe, N. B.: Coma senile; a new concept
in diagnosis. Miss. Valley med. J., 76: 202-
203, 1954.
Kaplan, H. A., S. Machover, and A. Rabiner:
A study of the effectiveness of drug therapy in
Parkinsonism. J. nerv. ment. Dis., 119: 398-
411, 1954.
Liéken, A. C., and K. Cyvin: A case of
clinical juvenile amaurotic idiocy with the
histological picture of Alzheimer’s disease.
J. Neurol., Neurosurg. Psychiat., 17: 211-
215, 1954.
ace Te hte cA
370
14316.
14317.
14318.
14319.
14320.
14321.
14322.
14323.
14324.
14325.
14326.
JOURNAL OF GERONTOLOGY
Luzes, P.: Tratamento do parkinsonismo;
com especial referencia a um novo anti-
parkinsénico. J. méd., Pérto, 25: 487-493,
1954.
Miiller, O. H., A. A. Jaworski, A. C. Silver-
man, and M. J. Elwood: The effect of age on
the protein concentration of cerebrospinal
fluid of normal individuals and patients with
poliomyelitis and other diseaases. Amer. J.
med. Sci., 228: 510-519, 1954.
Neu, H. N., and H. A. Ladwig: Rehabili-
tation of the hemiplegic. Neb. St. med. J.,
39: 415-416, 1954.
Poppen, J. L.: Chronic subdural hematomas.
Geriatrics, 10: 49-51, 1955.
Rand, R. W., W. E. Stern, and J. K. Orr:
Parkinsonism; early results of occlusion of
the anterior choroidal artery. Calif. Medi-
cine, 81: 276-278, 1954.
Shirkova, G. I.: (Modifications of the higher
nervous function in aged Rhesus monkeys. )
Zh. vysshei nerv. deiat., 4: 194-205, 1954.
Sulkin, N. M.: The properties and distribu-
tion of PAS positive substances in the ner-
vous system of the senile dog. J. Geront.,
10: 135-144, 1955.
Thomson, J. L.: Thrombosis of major cere-
bral arteries . Brit. J. Radiol., 27: 553-564,
1954.
Winn, J. A:
masquerading as functional disorder.
St. J. Med., 55: 110-112, 1954.
Wright, I. S.: Cerebral vascular diseases:
their significance, diagnosis and present treat-
ment, including the selective use of anti-
coagulant substances. Lancet, 2: 825-830,
1954.
Wyse, D. M., and C. J. Pattee: The effect
of diet on the metabolic alterations of para-
plegia. Canad. med. Ass. J., 71: 235-238,
1954.
Chronic progressive chorea
N. Y.
See also Nos. 14042, 14154, 14160, 14639,
14798.
XI. REACTIONS OF THE Bopy As A WHOLE
(allergy, anoxia, anesthesia, anthropometry, drugs,
exercise, immunity, sleep, and temperature
14327.
14328.
14329.
regulation )
Alcalé Llorente, E.: Nuestra experiencia con
el suero de Bogomoletz. Med. esp., 32: 101-
107, 1954.
Armstrong, D., L. I. Dublin, G. M. Wheatley,
and H. H. Marks: Obesity and its relation
to health and disease. J. Amer. med. Ass.,
147: 1007-1014, 1951. Abstr: B. A., 26:
No. 5683, 1952.
Brezina, E.: Verdinderungen der Leistungs-
14330.
14331.
14332.
14333.
14334.
14335,
14336.
14337.
14338.
14339.
14340.
14341.
14342.
14343.
14344.
fiihigkeit ilterer Jahrginge in Osterreich,
Arch. Hyg., Berl., 138: 227-234, 1954.
Chapman, C. B., and R. S. Fraser: Studies
on the effect of exercise on cardiovascular
function. I. Cardiac output and mean circu-
lation time. Circulation, 9: 57-62, 1954,
Clements, E. M., and K. G. Pickett: Body
weight of men related to stature, age, and
social status; weight of Scotsmen measured
in 1941. Brit. J. prev. soc. Med., 8: 99-107,
1954.
Clements, E. M., and K. G. Pickett: Chest
girth of men related to stature, age, body
weight and social status; chest girth of Scots-
men measured in 1941. Brit. J. prev. soc.
Med., 8: 108-116, 1954.
Conrad, S. W.: Resistance of the obese to re-
ducing. J. Amer. diet. Ass., 30: 581-586,
1954.
Conrad, S. W.: The psychologic implica-
tions of overeating. Psychiat. Quart., 28:
211-214, 1954,
Copello, F., and G. Vallarino: Alcuni dati
sull’impiego del siero antireticolo citotossico
de Bogomoletz in cingque casi di ipotrofia
grave del lattante. Minerva nipiol., Torino,
4: 46-47, 1954.
De Gennes, L.:
traitement des obésités.
494, 1954.
Depaoli, M.: Influenza della terapia_ siero-
antireticolare citossica (siero di Bogomoletz)
sulla reazione Wassermann della sifilide siero-
resistente. Minerva derm., Torino, 29: 90-
101, 1954.
Dole, V. P., I. L. Schwartz, J. H. Thaysen,
N. A. Thorn, and L. Silver: Treatment of
obesity with a low protein calorically unre-
stricted diet. Amer. J. clin. Nutrit., 2: 381-
391, 1954.
Drefus, G.: L’obésité et la maigreur; en-
quéte etiologique 4 conduire devant une obés-
ité chez adulte. Vie méd., 35: 467-472, 1954.
Eisfelder, H. W.: Treatment of obesity. The
role of the doctor, drug and diet in weight
loss. Amer. Practit., 5: 778-780, 1954.
Erlendsson, F., and A. Nielsen: (Age and
other factors in military adaptability and
training.) Militaerlaegen, 60: 37-58, 1954.
Goodman, J. I.: The relationship of obesity
to chronic disease. Geriatrics, 10: 78-82,
1955.
Hadorn, W.: Behandlungsméglichkeiten der
Fettsucht. Schweiz. med. Wschr., 84: 575-
587, 1954.
Hammer, G., J. Hiller, and A. Jakob: Ein
Beitrag zur Begutachtung des sogenannten
chronischen _Strahlenschadens. Strahlen-
therapie, 94: 64-71, 1954.
L’obésité et la maigreur;
Vie méd., 35: 485-
14345
14346
14347
14346
14346
1435
1435.
1435
1435
1435
143°
143°
143)
143
143
143
143
Osterreich,
54.
Studies
liovascular
ean circu-
1954,
tt: Body
age, and
measured
: 99-107,
t: Chest
ge, body
of Scots-
TEL. soc.
ese to re-
581-586,
implica-
art., 28:
‘uni dati
totossico
ipotrofia
Torino,
\aigreur;
35: 485-
a siero-
moletz )
le siero-
29: 90-
haysen,
nent of
y unre-
2: 381-
ur; en-
e obés-
, 1954.
. The
weight
re and
y and
1954.
»besity
78-82,
mn der
: 575-
Ein
innten
ahlen-
14345.
14346.
14347.
14348.
14349.
14350.
14351.
14352.
14353.
14354.
14355.
14356.
14357.
14358.
14359,
14360.
14361.
INDEX OF CURRENT PERIODICAL LITERATURE
Hartstein, M.: The decline of vaccination
in different age-groups in a London borough.
J. roy. Inst. pub. Hlth., 17: 255-263, 1954.
Herrmann, K. O.: El tratamiento de la con-
mocién cerebral con el suero antirreticular
citotéxico (SAC) o suero de Bogomoletz.
Arch. Méd. Cuba, 5: 138-139, 1954.
Howes, D. W.: Studies of Coxsackie viruses.
I. Comparison of age-susceptibility relation-
ships in mice. Aust. J. exp. Biol., 32: 253-
264, 1954.
Janz, D., and F. Bahner: Die medikamen-
tise Behandlung der Fettsucht mit einem
neuartigen Hydantoin. Dtsch. med. Wschr.,
79: 846-849, 1954.
Kemsley, W. F.:
from 1943-1950.
22-42, 1953.
Keriorgant, Y.: A la recherche des incon-
nues de lobéstité. Sem. Hédp. Paris, 30:
2489-2490, 1954.
Kotsovsky, D.: Zur medikamentésen Be-
handlung der Schlaflosigkeit im Alter. Med.
Klinik, 49: 1043-1044, 1954.
Lestradet, H.: L’obésité et la maigreur;
quelques notions élémentaires sur les mé-
tabolismes organiques et la nutrition. Vie
méd., 35: 461-464, 1954.
Mariani, M.: II siero citotossico antireticolo-
endoteliale umano in stomatologia. Minerva
stomat., Torino, 3: 26-32, 1954.
Nowy, H.: Uber die Altersabhiingigkeit der
tédlichen Strophanthindosis bei der Ratte.
Arch. exp. Path., Pharmak., 223: 165-168,
1954.
Pende, N.: L’insuffisance du mésenchyme et
des hormones mésenchymotropes dans la
sénéscence. Gior. Geront., 2: 703-708, 1954.
Plauchu, M., E. Pommatau, and R. Vottero:
Facteurs étiologiques, conceptions patholo-
géniques et traitement des obésités. J. Méd.
Lyon, 35: 389-398, 1954.
Rostalski, M.: Fortschritte in der Behand-
lung der Fettsucht. Medizinische, Stuttgart,
—: (33-34), 1110-1112, 1954.
Schmalbach, K.: Eine Familie, in der man
mit 40 Jahren dick wird; Untersuchung zur
Psychosomatik der Fettsucht. Schweiz. Arch.
Neurol. Psychiat., 72: 258-277, 1953.
Spiegl, F. V.: Beitrag zur Therapie der Fett-
sucht. Med. Klinik, 49: 888-890, 1954:
Walker, H. C., Jr.: Obesity; its complica-
tions and sequelae. Arch. intern. Med., 93:
951-966, 1954.
Wasmuth, C. E., and C. C. Higgins: Anes-
thesia for the aged and poor-risk candidate
for genitourinary surgery. Geriatrics, 10: 100-
104, 1955.
Changes in body weight
Ann. Eugen., Lond., 18:
14362.
14363.
14364.
14365.
14366.
14367.
14368.
14369.
14370.
14371.
14372.
14373.
14374.
14375.
14376.
14377.
371
Nutrition and adult body di-
Nutrit. Rev., 12: 296-297, 1954.
Estimated prevalence of over-
Publ. Hlth.
Anonymous:
mensions,
Anonymous:
weight in the United States.
Rep., 69: 1084-1086, 1954.
See also No. 14241.
XII. RepropuctivE SystEM
(ovaries, testes, see Endocrine System )
DeTorres, M.: La primiparidad afiosa. Rev.
esp. Obstet. Ginec., Valencia, 13: (73), 8-13,
1954.
Foti, M.: II trattamento anticoagulante nella
geriatria ginecologica. .Q. clin. ostet., 9: 267-
278, 1954.
Hirvonen, L., and K. Niemineva: Cesarean
section in elderly primiparas. Quart. Rev.
Surg., 11: 187-200, 1954.
Hirvonen, H., K. Niemineva, and L. Hir-
vonen: Uber die Fertilitét der schnittent-
bundenen alten erstgebirenden. Gynecolo-
gie, 33: 394-393, 1954.
Kosmak, G. W.: Gynecologic and other im-
plications which relate to an ageing female
population. Amer. J. Obstet. Gynec., 44:
897-910, 1942.
McBride, J. M.:
pausal endometrium.
691-697, 1954.
Millis, J., and Y. P. Seng: The effect of age
and parity of the mother on birth weight
of the offspring. Ann. human Genet., 19:
58-73, 1954.
Mufioz Ferrer, F.: El aparto genital de los
anencéfalos. Rev. esp. Obstet. Ginec., Va-
lencia, 12: (69), 143-150, 1953.
Schauffler, G. C.: Significance and manage-
ment of genital prolapse in the aged. J.
Amer. geriat. Soc., 3: 43-49, 1955.
U. S. Department of Health, Education, and
Welfare. Public Health Service. National
Office of Vital Statistics: Births by age of
mother, race, and birth order; United States,
1952. Vit. Statist., Spec. Rep., 40: (10),
209-220, 1955.
Wolfle, D.: Differential fertility and the in-
telligence of new generations. Science, 119:
675-676, 1954. Abstr: P. I., 21: No. 1086,
1955.
The normal post-meno-
J. Obstet. Gynaec., 61:
XIII. Resprratory SystEM
Abeles, H.: Age distribution of tuberculous
pleural effusions. .Amer. Rev. Tuberc., 70:
901-902, 1954.
Arnett, J. H.: Vital capacity of the lungs in
the middle age. Arch. intern. Med., 67:
1129-1131, 1941.
Avogaro, P.: Contributo anatomo-patologico
372
14378.
14379.
14380.
14381.
14382.
14383.
14384.
14385.
14386.
14387.
14388.
14389.
14390.
14391.
14392.
14393.
14394.
JOURNAL OF GERONTOLOGY
alla conoscenza dei rapporti tra eta e tu-
bercolosi. Arch. tisiol., Napoli, 9: 432-441,
1954.
Azzario, P.: Considerazioni sul tubercolotico
anziano in relazione alla toracoplastica. Gaz.
med. ital., 113: 254-256, 1954.
Barach, A. L.: Diaphragmatic breathing in
pulmonary emphysema. (Editorial). J.
chronic Dis., 1: 211-215, 1955.
Bellini, E.: La pressione intrapleurica nell’
enfisema polmonare cronico. Gior. Geront.,
3: 16-21, 1955.
Beltran Baguena, M.: Enfisema senil. II
Congreso Nacional de la Sociedad Espafola
de Gerontologia y Geriatria, Valencia, July
1954, Part I, 261 pp.
Bickerman, H. A., and A. L. Barach: The
effect of breathing 100 per cent oxygen in
pulmonary emphysema; correlation of clin-
ical improvement with changes in pulmonary
ventilation. J. chronic Dis., 1: 111-120, 1955.
Brantigan, O. C.: The surgical treatment of
pulmonary emphysema. W. Ind. med. J.,
3: 283-285, 1954.
Carifiena, J.: Frecuencia e importancia social
de la tuberculosis en los viejos. Med. esp.,
32: 95-100, 1954.
Cohn, J. E., D. G. Carroll, and R. L. Riley:
Respiratory acidosis in patients with em-
physema. Amer. J. Med., 17: 447-463, 1954.
Cornet, H. A.: Inhalations-und Baderbe-
handlung bei chronischer Bronchitis. Arch.
phys. Ther., 6: 120-125, 1954.
Crenshaw, G. L.: Surgical management of
degenerative lung disease. J. Amer. med.
Ass., 156: 1561-1563, 1954.
Epifanio, C., and R. Burgos: Aspecto
clinico y anatomorradiolégico de la tubercu-
losis pulmonar en el adulto. Térax, Monte-
video, 2: 245-254, 1953.
Fernandes, J.: A entidade denominada bron-
quite crénica. J. méd., Pérto, 24: (594),
357-363, 1954.
Franke, K.: Die Anionen-Wasserstaub-be-
handlung in der Bronchitistherapie und- pro-
phylaxe. Arch. phys. Ther., Lpz., 6: 130-
132, 1954.
Friend, J.:
function in emphysema.
495, 1954.
Giaquinto, M., and G. Mauro: Tubercolosi
ed eta; forme cliniche ricorrenti nell’eta in-
oltrata della vita, da 50 anni ed oltre. Min-
erva med., Torino, 45: 167-173, 1954.
Haebisch, H., L. G. De S. Azul, and J. M.
Cardoso: Padronizacao da funcao ventilatéria
em individuos normals. Rev. Paulista Med.,
S. Paulo, 45: 85-92, 1954.
Heiskell, C. L., Jr., J. B. Belsky, and B. F.
The variability of ventilatory
Clin. Sci., 13: 491-
14395.
14396.
14397.
14398.
14399.
14400.
14401.
14402.
14403.
14404.
14405.
14406.
14407.
14408.
14409.
14410.
Klaumann; Treatment of chronic emphysema
of lungs with diamox (carbonic anhydrase
inhibitor). J. Amer. med. Ass., 156: 1059.
1063, 1954.
Israel, R.: Les bronchites chroniques at leurs
complications. Rev. prat., Paris, 4: 565-57),
1954.
Leech, E. L.: Problems presented by pul-
monary tuberculosis in patients over fifty,
Ann. intern. Med., 33: 321-332, 1950.
Llopis Llorente, R.: Actualizacion del prob-
lema de la tuberculosis senil.
32: 130-144, 1954.
Maconi, G.: L’azione della penicillina cruda
somministrata per via aerosolica nelle forme
cronicizzanti polmonari. Gaz. med. ital., 113:
254-256, 1954.
Mars, G., and S. Ragaini: Sulle emottisi ter-
minali nella tubercolosi dell’eta
Gior. Geront., 2: 661-673, 1954.
Mars, G., aim? S. Ragaini: Aspetti anatomo-
patologici de'la tubercolosi senile. — Gior,
Geront., 2: 674-698, 1954.
Martinez Ramoén, E.: ‘Tratamiento de los
procesos neuménicos agudos en la senectud.
Med. esp., 32: 72-76, 1954.
Martinez Ramon, E.: Algunos aspectos his-
topatologicos de la medula osea en los anci-
anos tuberculosos. Med. esp., 32: 150-156,
1954.
Martuzzi, M., and P. Ricci: Le forme ana-
tomische dei processi tubercolari nelle diverse
eta della vita con particolare riguardo alleta
senile. Arch. ital. Anat. Istol. patol., 27:
223-254, 1954.
Miller, W. F.: A physiological evaluation of
the effects of diaphragmatic breathing train-
ing in patients with chronic pulmonary em-
physema. Amer. J. Med., 17: 471-477, 1954.
Moreau, L.: A propos de la bronchite chro-
Med. esp,
avanzata,
nique. Concours méd., 76: 2283-2286, 1954.
Press, P.: A propos de la morbidité tuber-
culeuse en Suisse. Bibl. tuberc., Basel, 7:
67-73, 1954.
Riley, R. L., R. H. Shepard, J. E. Cohn, D. G.
Carroll, and B. W. Armstrong: Maximal dif-
fusing capacity of the lungs. J. appl. Phy-
siol., 6: 573-587, 1954.
Salzberg, A. M., and B. Blades: Surgical
management of emphysematous blebs and
bullae. J. Amer. geriat. Soc., 3: 15-20, 1955.
Schubert, R., and B. Schobel: Gerontologische
Betrachtungen zur Diagnostik und Therapie
des Asthma bronchiale. Medizinische, Stutt-
gart, —: (35), 1137-1141, 1954.
Sharp, C. M., S. D. Doff, E. H. Williams, Jr.,
and R. M. Thorner: A reappraisal of tuber-
culosis in Florida. Publ. Hlth. Rep., 70:
271-276, 1955.
14411
14419
1441<
1441:
1441.
1441
144]
144.
144
144
144
14
14¢
14:
14
14
14
mphysema
anhydrase
56: 1059.
es at leurs
- 565-57],
1 by pul.
ver fifty,
». a
del prob-
led. esp.,
ina cruda
lle forme
ital., 113:
ottisi ter-
avanzata,
anatomo-
Gior.
» de los
senectud,
ctos_his-
los anci-
150-156,
me ana-
» diverse
o alleta
tol., 27:
ation of
g train-
ary em-
7, 1954.
te chro-
3, 1954.
» tuber-
asel, 7:
1, D. G.
nal dif-
1. Phy-
surgical
ys and
, 1955.
ogische
herapie
- Stutt-
ns, Jr.,
tuber-
»., 0%
14411.
14412.
14413.
14414.
14415.
14416.
14417.
14418.
14419.
14420.
14421.
14422.
14423.
14424,
14425,
14426,
14427,
INDEX OF CURRENT PERIODICAL LITERATURE
Spina, G.: Il decorso di alcune forme ema-
togene della tubercolosi polmonare in rap-
porto alle varie eta della vita. Ann Inst.
Carlo Forlanini, 14: 113-125, 1954.
Towers, R. P.: Post-menopausal endometrial
tuberculosis; an unusual case with a review
of previous reports. J. Obst. Gynaec., 61:
657-660, 1954.
Wilde, H.: Uber die Altersabhingigkeit des
Pilzbefalles bei Bergleuten. Derm. Wschr.,
130: 793-794, 1954.
Ziskind, M. M.: Some clinical patterns of
bronchitis. Ann. Allergy, 12: 585-591, 1954.
Zorkendorfer, W.: Elekirosoleinhalation bei
Bronchitis. Arch. phys. Ther. Lpz., 6: 128-
129, 1954.
See also No. 14591.
XIV. SENsE ORGANS AND PERCEPTION
Ancetti, A.: Studio sulla porzione fibrocarti-
laginea della tuba uditiva nel vecchio. Arch.
ital. Otol., 65: 447-466, 1954.
Bartlet, J. E. A.: A case of organized visual
hallucinations in an old man with cataract,
and their relation to the phenomena of the
phantom limb. Brain, 74: 363-373, 1951.
Berens, C.: Aging process in eye and adnexa.
Arch. Ophthal., 29: 171-209, 1943.
Burn, R. A.: Senile changes in the eye. In:
Systemic Ophthalmology, A. Sorsby, (Edi-
tor), C. V. Mosby Co., St. Louis, 1951, pp.
699-710.
Callahan, A.: Senile ectropion; analysis of
types and surgical correction. Amer. J. Oph-
thal., 38: 787-790, 1954.
Doerfler, L. G., and C. T. McClure: The
measurement of hearing loss in adults by gal-
vanic skin response. J. speech hear. Disord.,
19: 184-189, 1954.
Feldstein, M.: Correction of senile atrophy of
eyelid and blepharochalasis. Eye, Ear, Nose,
Thr. Mon., 33: 605, 1954.
Kulczycka, B.: (Ascorbic acid and its relation
to pigmentary changes in senile lenses.)
Folia. biol., Warszawa, 2: 53-60, 1954.
Kumnick, L. S.: Pupillary psychosensory res-
titution and aging. J. Optic., Soc., 44: 735-
741, 1954.
Pendse, G. S., L. S. Bhave, and V. M.
Dandekar: Refraction in relation to age and
sex. Arch. Ophthal., 52: 404-412, 1954.
Silliato, F.: Sulla degenerazione senile dis-
ciforme della macula; contributo clinico e
patogenetico. Ann. Ottalm. clin. Ocul., 80-
229-240, 1954.
Tower, P.: The aging retina.
10: 12-16, 1955.
Geriatrics,
14428.
14429.
14430.
14431.
14432.
14433.
14434.
14435.
14436.
14437.
14438.
14439.
14440.
14441,
14442.
14443.
373
Wilson, R. H., and W. E. McCormick: Visual
acuity; results of a survey of 10,000 per-
sons. Industr. Med. & Surg., 23: 64-72, 1954.
XV. SKELETAL SysTEM
Costa Bertani, G.: Reumatismos vertebrales.
Prensa méd. argent., 38: 131-139, 1951.
Eptsein, J. A., and L. M. Davidoff: Recog-
nition and management of spinal cord and
nerve root compression caused by osteo-
phytes. Bull rheumat. Dis., 3: 47-48, 1953.
Haas, L. L.: The size of the sella turcica
by age and sex. Amer. J. Roentgenol., 72:
745-761, 1954.
LaCapeére, J.:
générescence discale.
99-109, 1954.
Neuwirth, E.: Neurologic complications of
osteoarthritis of the cervical spine. N. Y. St.
J. Med., 54: 2583-2590, 1954.
Schoger, G. A.: Die Coccygodynie im Rah-
men der rheumatischen Wirbelsiulenerkrank-
ungen. Med. Klinik, 49: 1211-1213, 1954.
Seyss, R.: Uber Schulterschmerzen im hé-
heren Alter und ihre Ursachen. Klin. Med.,
Wien, 9: 225-227, 1954.
Silberberg, M., and R. Silberberg: Athyroid
Rhumatisme vertébral et dé-
Rhumatologie, —: (3),
joint disease in mice of various ages. Arch.
Path., Chicago, 58: 227-235, 1954.
Stecher, R. M., and A. Ausenbachs: Heber-
densche Knoten; die Besonderheit der Osteo-
arthrose der Finger. Z. Rheumaforsch., 13:
65-86, 1954.
XV-A. SKELETAL SysTEM: Bone
Blumenfeld, I.: Afecciones
traumaticas de la _vejez.
1806-1815, 1954.
Carimati, A.: Il cranio di Ugo Foscoolo
(1778-1827) a cenni storici sul malum senile
biparietale. Minerva med., Torino, 45: 880-
885, 1954.
ortopédicas y
Dia méd., 26:
Casati, A.: Le alterazioni presenili del cranio
nel radiogramma. Radiolog. med., 40: 872-
880, 1954.
Faleg, G.: Alterazioni olfattorie e nasali
nell’osteite deformante di Paget. Oto-rino-
laryng Itali., 22: 226-232, 1954.
Forcella, I. G., and A. M. Castellaro: Ac-
corgimenti e risultati nella cura dell’osteo-
mielite cronica. Minerva ortop., Torino, 5:
258-260, 1954.
Gershon-Cohen, J., and J. F. McClendon:
Roentgenographic studies of osteoporosis. II.
The inhibitive effect of dietary phosphate
fertilizer on dental caries and skeletal de-
calcification in the rat. Amer. J. Roent-
genol., 72: 247-249, 1954.
SANS RNID
374
14444,
14445.
14446.
14447.
14448.
14449.
14450.
14451.
14452.
14453.
14454.
14455.
14456.
14457.
14458.
JOURNAL OF GERONTOLOGY
Heck, C. V.: Management of hip fracture
in the geriatric patient. J. Amer. geriat. Soc.,
3: 113-116, 1955.
Hirsch, W.: Die Ostitis deformans Paget.
VEB Georg Thieme, Leipzig, 1953.
Keen, J. A.: Age determination; conflicting
evidence presented by anatomical and radi-
ological data of the skeleton. S. Afr. med. J.,
24: 1086-1089, 1950.
Key, J. A., and L. T. Ford: Compression and
extension fractures at the wrist. Geriatrics,
10: 17-25, 1955.
Leriche, R.: Prophylaxie des _ raideurs,
oedémes, raréfactions osseuses qui persistent
aprés consolidation des fractures speciale-
ment chez les gens agés. Pr. méd., 62: 1223-
1224, 1954.
Morpurgo, M., G. Mars, C. Bonessa, and A.
Boselli: Sul metabolismo protidico-minerale
e sulla funzione corticosurrenalica nelle osteo-
patie senili. Gior. Geront., 2: 699-702, 1954.
Neal, W. M., L. S. Palmer, C. H. Eckles,
and T. W. Gullickson: Effect of age and nu-
trition on the calcium phosphate/calcium
carbonate ration in the bones of cattle. J.
agric.- Res., 42: 115-121, 1931.
Picchio, A. A.:
stotiche del Paget.
126: 289-308, 1954.
Rechtman, A. M., and M. W. Yarrow: Os-
teoporosis. Amer. Proctit., 5: 691-696, 1954.
Roversi, A. S., and G. Mars: Sull’auto-
nomia nosologica e patogenetica dei noduli
di heberden. Gior. Geront., 2: 709-710,
1954.
Soto-Hall, R., and H. Lillo: New trends
in the treatment of fracture of the hip in the
aged. J. Amer. geriat. Soc., 3: 106-112,
1955.
Thiebaut, F., D. Philippides, and F. Rohmer:
Maladie de Paget compliquée de paraplégie;
guérie par laminectomie. Rev. neurol., 90:
238-241, 1954.
Van Demark, G. E., and R. E. Van Demark:
Hip nailing in patients of eighty years or
older; experiences in 104 consecutive per-
sonal cases. Amer. J. Surg., 85: 664, 1953.
Van Demark, R. E.: Two successful hip
nailings in one patient at ages of 93 and 95
years. S. Dak. J. Med., 7: 431-433, 1954.
Zimmerman, S. P.: Hyperparathyroidism
simulating Paget’s disease. Ann. intern.
Med., 30: 675-681, 1949. Abstr: B. A.,
24: No. 12411, 1950.
See also No. 14276.
Sulle forme iniziali e mono-
Bull. Sci. med., Bologna,
14459.
14460.
14461.
14462.
14463.
14464.
14465.
14466.
14467.
14468.
14469.
14470.
14471.
14472.
14473.
XV-E. SKELETAL System: Arthritis and
Rheumatism*
Baader, E. W.: Rheumatismus als Berufs-
krankheit, Dtsch. med. J., 5: 339-341, 1954,
Bayer, F., and H. Wagner: Ubergegeu.
seitige Beziehungen von Schmerz, Gelenksch-
wellung und Beweglichkeit bei chronischem
Rheumatismus unter Beriicksichtigung von
Witterungseinfliissen. Z. Rheumaforsch., 13:
86-97, 1954.
Bonnet, P., and H. Thiers: Les manifesta-
tions oculaires du rhumatisme chronique.
Rev. Rhumat., Paris, 21: 476-488, 1954.
Boylston, B. F.: Basic orthopedic principles
in rheumatoid arthritis. Tex. St. J. Med., 50:
616-619, 1954.
Bunin, J. J., L. Sokoloff, R. R. Williams, and
R. L. Black: Rheumatoid arthritis; a review
of recent advances in our knowledge con-
cerning pathology, diagnosis, and treatment.
J. chronic Dis., 1: 168-210, 1955.
Chilov, K., and L. Stanchev: (Clinical as-
pects of rheumatoid arthritis; data on 15
years of clinical follow-up.) Izv. med. inst.,
Sofia, 9-10: 191-218, 1954.
Hartfall, S. J.: Stress factors in the aetiology
of the rheumatic diseases. Physiotherapy,
40: 339-342, 1954.
Henning, M. P.: (Climate and rheumatism.)
Svenska Lékartidn., 51: 2937-2938, 1954.
Hunt, T. E., and J. A. Trew: Zone electro-
phoretic studies of plasma proteins in rheu-
matoid arthritis and ankylosing spondylitis,
Ann. rheumat. Dis., 13: 201-210, 1954.
Jeffrey, M. R., and D. Watson: Free ery-
throcyte porphyrin and plasma copper in
rheumatoid disease. Acta. haemat., 12: 169-
176, 1954.
Kalbak, K.: Seroreaktionen bei rheuma-
tischen Krankheiten. Dtsch. med. J., 5: 315-
320, 1954.
Kellett, C. E.: Complementary activity of
the blood in rheumatism and certain allied
disorders. Ann. rheumat. Dis., 13: 211-218,
1954,
Laine, V. A., K. J. Vainio, and T. E. Holo-
painen: Effect of thyroidectomy in rheuma-
toid arthritis. Ann. rheumat. Dis., 13: 250-
251, 1954.
Lehtinen, M., and A. Telkka: Skinfold
thickness of the hand in rheumatoid arthri-
tis. Ann. Med. intern. Fenniae, Helsinki,
43; 109-114, 1954.
McEwen, C., H. Wilson, and M. Ziff:
Studies on the metabolism of adrenal cortical
steroids in the synovial cavity in rheumatoid
*Selected references.
14474.
14475.
14476
14477
14478
1447!
1448
1448
1448
XV-
144)
144
144
and
S Berufs.
41, 1954,
bergegen..
elenksch-
onischem
ung von
sch., 13:
1anifesta-
hronique,
54.
rinciples
fed., 50:
ms, and
a review
ge con-
eatment.
tical as-
on 15
d. inst.,
etiology
therapy,
1atism. )
954.
electro-
n rheu-
ndylitis,
4.
ee ery-
per in
2: 169-
=heuma-
: 315-
vity of
allied
1-218,
Holo-
euma-
: 250-
cinfold
arthri-
lsinki,
Ziff:
ortical
natoid
14474.
14475.
14476.
14477.
14478.
14479.
14480.
14481.
14482.
XV-E.
14483.
14484,
14485.
INDEX OF CURRENT PERIODICAL LITERATURE
arthritis. Trans. Ass. Amer. Phys., 67: 97-
102, 1954.
Mandl, F., and W. Gyri: Influencia de la
implantacién de tejido tiroideo sobre las en-
fermedades articulares reumaticas y otras.
Dia méd., 26: 989-993, 1954.
Payne, R. W., M. R. Shetlar, J. A. Bullock,
D. R. Patrick, A. A. Hellbaum, and W. K.
Ishmael: The serum _ polysaccharideprotein
ratio (PR) as a measure of rheumatoid
arthritis activity. Ann. intern. Med., 41:
775-779, 1954.
Sanes, S., V. Scamurra, and H. M. Robins:
Laboratory aids in diagnosis of the collagen
diseases. Geriatrics, 10: 59-66, 1955.
Seifert, H., and H. Tichy: Zur serologischen
Differentialdiagnostik einzelner Formen des
chronischen Rheumatismus. Z. Rheuma-
forsch., 13: 133-151, 1954.
Shetlar, M. R., J. A. Bullock, C. L. Shetlar,
and R. W. Payne: Comparison of serum
C-reactive protein, glycoprotein and seromu-
coid in cancer, arthritis, tuberculosis and
pregnancy. Proc. Soc. exp. Biol., N. Y., 88:
107-109, 1955.
Sokoloff, L., S. L. Wilens, and J. J. Bunim:
Arthritis of striated muscle in rheumatoid
arthritis. Amer. J. Path., 27: 157-173, 1951.
Abstr: B. A., 25: No. 17313, 1951.
Teilum, G., and A. Lindahl: Frequency and
significance of amyloid changes in rheuma-
toid arthritis. Acta. med. scand., 149: 449-
455, 1954.
Wager, O., and E. Alameri: Studies of
agglutination in rheumatoid arthritis. I. At-
temps to purify the factor causing agglutina-
tion of sensitized erythrocytes. Ann. Med.
exp. Biol. Fenn., 31: 361-370, 1953.
Ziff, M.: (A hemagglutination test for rheu-
matoid arthritis with enhanced sensitivity
using the euglobulin fraction.) Bull. rheu-
mat. Dis., 5: 75-76, 1954.
See also Nos. 14792, 14817.
SKELETAL SystEM: Arthritis and Rheumatism
Therapy*
Aron, E., and J. L. Neel: Traitement du
rhumatisme articulaire aigu par la phénylbu-
tazone (Butazolidine). Pr. méd., 62: 1192-
1193, 1954.
Arsov, D.: L’adrénaline
microdoses en rheumatologie.
34: 1731-1744, 1954.
Barbier, J.: Adrenalinotherapie 4 minima
réalisée par diélectrolyse dans le traitement
des algies chez les arthrosiques; considéra-
intraveineuse en
Brux. méd.,
*Selected references.
14486.
14487.
14488.
14489.
14490.
14491.
14492.
14493.
14494.
14495.
14496.
14497.
14498.
14499.
14500.
375
tions sur l’utilisation thérapeutique par di-
électrolyse des intermédiaires chimiques.
Rev. méd. Nancy, 79: 484-492, 1954.
Bunim, J. J., M. Ziff, and C. McEwen:
Cortisone therapy in rheumatoid arthritis; a
four-year appraisal. Bull. rheumat. Dis., 5:
73-74, 1954,
Décourt, L., J. M. Fernandes, M. C. Lima,
E. Chiorboli: Considerazoes sobre 0 uso do
acido ascorbico na artrite reumatoide. Rev.
Paulista Med., S. Paulo, 44: 281-285, 1954.
Fenner, K.: Uber Erfahrungen mit der
neuartigen Arzneimittelkombination Glutisal
bei rheumatischen Erkrankungen. Med.
Mschr., 8: 318-319, 1954.
Forestier, J., and F. Thevenoz: Le sulfure
d’or colloidal dans la thérapeutique de la
polyarthrite chronique évolutive. Pr. méd.,
62: 1056-1057, 1954.
Furtenbach, W.: Erfahrungen mit Final-
gonsalbe bei Behandlung rheumatischer Er-
krankungen. Wien. med. Wschr., 104: 853-
854, 1954.
Harris, S. B., and R. Klein: Hematologic
observations in short and long-term treatment
of rheumatic diseases with phenylbutazone.
N. Y. St. J. Med., 55: 95-98, 1954.
Hindley-Smith, J. D.: The treatment of the
osteoarthritic hip-joint by means of intra-
articular injections of irgapyrin and butazo-
lidin. Brit. J. phys. Med., 16: 137-139, 1953.
Hollander, J. L.: The local effects of com-
pound F (hydrocortisone) injected into
joints. Bull. rheumat. Dis., 11: (2), 21-22,
1951.
Hurlburt, F. W., and C. E. Robinson: Long-
term cortisone therapy in rheumatoid arthri-
tis. Canad. med. Ass. J., 70: 645-650, 1954.
Kuzell, W. C., and R. W. Schaffarzick:
Phenylbutazone (Butazolidin). Bull. rheu-
mat. Dis., 3: (3), 41-42, 1952.
Mease, J. A., Jr.: Blood extract therapy in
the intractable arthritic. Med. Times, N. Y.,
82: 750-752, 1954.
Miller, R. D., R. W. Centry, H. H. Zinsser,
and F. E. Schlueter: Total adrenalectomy
in rheumatoid arthritis. Lancet, 2: 598,
1954.
Pilz, A.: Die Behandlung rheumatischer
Krankheitsbilder mit Gentamidon. Wien.
med. Wschr., 104: 751-752, 1954.
Prévot, A. R.: Résultats du traitement de la
polyarthrite -chronique évolutive par I’auto-
vaccinotherapie totale. Bull. Acad. nat. Méd.,
Paris, 138: 120-123, 1954.
Puig Leal, J., —., P. Del Fernandez, and P.
Vallado: El ultrasonido en el tratamiento
de las enfermedades reumaticas. Rev. clin.
esp., 54: 9-13, 1954.
376
14501.
14502,
14503,
14504,
14505.
14506,
14507.
14508,
14509,
14510.
14511.
14512,
14513.
14514.
14515.
JOURNAL OF GERONTOLOGY
The present-day management of
arthritis. J. chronic Dis., 1: 253-265, 1955.
Rossing, P., and H. Lutterbeck: Hyaluroni-
dase therapy of inflammatory and degenera-
tive joint diseases. Rheumatism, 10; 76-84,
1954.
Small, J. C., and J. C. Small, Jr.: Treat-
ment of the rheumatic diseases by desensiti-
zation with an aqueous extract of strepto-
cocci, III. Rheumatoid arthritis. Ann.
Allergy, 12: 409-418, 1954.
Tufts, M.: Use of placental serum in the
Ragan, C.:
treatment of rheumatoid arthritis. Wis.
med, J., 53; 615-616, 1954,
XV-E. SKELETAL System: Gout®
Boger, W. P., and R. T, Smith; (Probenecid
in therapy of gout.) Svenska Lékartidn.,
51; 2021-2039, 1954.
Hartung, E. F.: History of the use of col-
chicum and related medicaments in gout;
with suggestions for further research. Ann.
rheumat. Dis., 13: 190-200, 1954.
Marson, F, G.; Sodium salicylate and pro-
benecid in the treatment of chronic gout;
assessment of their relative effects in lower-
ing serum uric acid levels. Ann. rheumat.
Dis., 13: 233-245, 1954.
Ross, D. N.: Treatment of gout with
H.P.C. Brit. med. J., 2: (4891), 782-786,
1954,
Talbott, J. H.: Clinical
effects of enemid in gout.
Dis., 11: (1), 19-20, 1951.
Traut, E. F., A. A. Knight, P. B. Szanto, and
E. W. Passerelli: Specific vascular changes
in gout. J. Amer. med.’ Ass., 156: 591-593,
1954.
Weissenbach, R. J., and P. Pizon: Rhuma-
tismes chroniques et goutte chronique des
mains. Pr. méd., 62: 1-4, 1954.
Wilson, D., A. Beyer, C. Bishop, and J. H.
Talbott: Urinary uric acid excretion after
the ingestion of isotopic yeast nucleic acid
in the normal and gouty human. J. biol.
Chem., 209; 227-232, 1954.
and_ metabolic
Bull, rheumat.
XVI. Skin AND INTEGUMENT
Castellani, A.: Superficial cutaneous mycoses
and trichomycoses in old age. Geriatrics, 10:
86-88, 155.
Fivaz, L.: Untersuchungen zur Atiologie der
Alopecia areata. Dermatologica, 108: 352-
360, 1954.
Garn, S. M., S. Selby, and R. Young: Scalp
thickness and the fat-loss theory of balding.
Arch. Derm. Syph., N. Y., 70: 601-608, 1954.
*Selected references.
14516,
14517,
14518,
14519,
14520,
14521,
14522.
14523.
14524,
14525.
14526,
14527.
14528.
14529.
14530.
Holman, D. B., and E, Schultz: Popliteal vein
ligation for chronic leg ulcer. West J. Surg,
62: 493-497, 1954.
Kiihnan, —: Die Hypophysenimplantation
als neue Behandlungsmethode chronischer
Dermatosen. Derm. Wschr., 129; 600-602,
1954,
Lambrev, Zh.; (Grafting as a method of
prolongation of life in old animals.) Suv-
rem. med.,, 5: 35-40, 1954.
Lenggenhager, R.: Alopecia areata. Der.
matologica, 108: 441-444, 1954,
Montagna, W., H. B. Chase, and P, J,
Brown; The skin of hairless mice. II. Aging
changes and the action of 20-methylcholan-
threne. J. investig. Dermat., 23: 259-269,
1954,
Walther, H.: Zur Pruritusbehandlung in
Abhiingigkeit vom Lebensalter insbesondere
mit der Kombination Nebenschilddriisenex-
trakt und ionisiertem Kalzium, Derm. Wschr.,
130; 795-797, 1954.
XVII, UnocenrraL SystEeM®
(includes prostate )
Arcadi, J. A.; Role of the ground substance
in atrophy of normal and malignant prostatic
tissue following estrogen administratio.a and
orchiectomy. J. clin. Endocrinol. Metab.,
14; 1113-1125, 1954.
Burkert, S.: Endothelium der Prostata. Z.
Urol., 47: 371-374, 1954.
Darget, R., and R. Ballanger: Sur un cas de
néoplasme prostatique traité par surrenalec-
tomie totale en deux temps. J. Urol. méd.
chir., 60; 241-244, 1954,
Eckerstrém, S.: Urinary incontinence in old
persons. Geriatrics, 10: 83-85, 1955.
Flocks, R. H., and L. J. Prendergast: Treat-
ment of carcinoma of the prostate. Geriatrics,
10: 52-58, 1955.
Gibba, A.: Studio sul comportamento dei
17-chetosteroidi urinari nel carcinoma pro-
statico in rapporto all’impiego di vari metodi
terapeutici. Arch. ital. Urol., 27: 240-253,
1954,
Gibson, E. C.: Carcinoma of the prostate
in Jews and circumcised Gentiles. Brit. J.
Urol., 26: 227-229, 1954.
Goldstein, A. E., and T, Weinberg: The im-
portance of correct pathologic diagnosis of
carcinoma of the prostate; clinical applica-
tion. Amer. Surg., 20: 971-980, 1954.
Gunn, S. A., J. E. Ayre, M. M. Coplan,
F. M. Woods, and P. D. Melvin: Clinical ap-
plication of cytology to prostatic cancer. J.
Urol., 72: 722-728, 1954.
*Selected references.
14531.
14532.
14533.
14534.
14535.
14536.
14537.
14538,
14539.
14540
14541
14542
14546
1454
1454:
14541
1454
liteal vein
t J. Surg,
plantation
hronischer
600-602,
iethod of
.) Suv.
a. Der.
d Pz
II. Aging
ylcholan-
259-269,
lung in
esondere
lriisenex-
Wschr,,
ibstance
>rostatic
ioa and
Metab,,
ita. = Z,
cas de
renalec-
l. méd,
in old
Treat-
riatrics,
to dei
a pro-
metodi
(0-253,
rostate
rit. J.
he im-
sis of
yplica-
oplan,
al ap-
ee he
14532.
14533,
14534.
14535,
14536,
14537,
14538.
14539.
14540,
14541.
14542.
14543,
14544.
14545.
14546.
14547.
. Jentzer, A.:
INDEX OF CURRENT PERIODICAL LITERATURE
Un progrés dans le traitement
du carcinome de la prostate au moyen d’hor-
mones naturelles. Schweiz. med. Wschr.,
84; 1088-1092, 1954.
Jewett, H. J.: Radical perineal prostatectomy
for carcinoma; an analysis of cases at Johns
Hopkins Hospital, 1904-1954, J. Amer. med.
Ass., 156; 1039-1041, 1954,
Kaufman, J. J., M. Rosenthal, and W. E.
Goodwin: Methods of diagnosis of carcinoma
of the prostate; a comparison of clinical im-
pression, prostatic smear, needle biopsy, open
perineal biopsy and transurethral biopsy. J.
Urol., 72: 450-465, 1954.
Lich, R., Jr.:
review of 678 patients.
438, 1954,
Lich, R., Jr.: Prostatitis.
82; 594-603, 1954,
MacDonald, S$. A.: Prostatectomy, mortality
and morbidity, J. Urol., 72: 439-442, 1954,
Obé, G., and G.
phoretische Untersuchungen
plasma, Ejakulat und Prostataexprimat. — Z.
Urol., 47; 393-399, 1954.
Prior, C.; Le mastzellen nella ipertrofia della
prostata. Riv. anat. Patol., 7; 963-978, 1953.
Riches, E. W.: The management of enlarged
Retropubic prostatectomy; a
J. Urol., 72; 434-
Med. Times, N. Y.,
Hermann: Papierelektro-
am Sperma-
prostate. Ann. roy. Coll. Surg., 15; 120-134,
1954.
Trautner, K.: Prostatitis. Ugesk. Laeg., 116:
1535-1537, 1954.
Vogel. M. T., T. H. MecGavack, and H.
Kammandel; The urethral smear in the nor-
mal human male. J. clin. Endocrinol., 8:
967-981, 1948. Abstr: B. A., 23: No. 14893,
1949.
GERIATRICS
I, GENERAL ORIENTATION
Alcala Llorente, E.: Bases para una_espe-
cializacién geriitrica. Med. esp., 32: 108-112,
1954.
Buendia, R.; Ul poco de geriatria para los
médicos de A.P.D. Bol. cult. Cons. gen.
col, méd. Esp., 16: (79), 67-68, 1954.
Hammond, W.: A geriatric orientation. N. Y.
St. J. Med., 54: 3387-3395, 1954.
Petranyi, G.: (Problems of aging and old
age in internal medicine.) Magy. belorv.
arch., 7: 33-40, 1954.
Snabl, P.: (Present day problems of geri-
atrics.) Prakt. lék., Praha, 34: 319-322, 1954.
Anonymous: Preventive geriatrics. J. Michi-
gan med. Soc., 53: 507-536, 1954.
Il.
14548,
14549.
14550.
14551.
14552.
14554.
14555.
14556.
14557.
14558.
14559.
14560.
14561.
14562.
14563.
14564.
14565.
14566.
377
and III.
Adams, G. F.;
covery home for the old,
488, 1954.
Callan, J. R., and W. L. Starnes: Analeptic
action of oral metrazol in geriatric practice;
a preliminary report. Dis. nerv. Sys., 15:
121, 1954.
Castillo de Lucas, C.: La hidroclimatologia
en la vejez. Med. esp., 32: 37-41, 1954.
Cherkasky, M.: Hore care of chronic ill-
ness. Changing illness requires changing
philosophy and facilities. (Editorial). J.
chronic Dis., 1; 346-349, 1955.
Densen, P. M., C. A. D’Alonzo, and M. G.
Munn: Opportunities and problems in the
study of chronic disease in industry. J.
chronic Dis., 1; 231-252, 1955.
Despeyroux, L., and P, Gassan:
générales de la physiotherapie dans les af-
Toulouse méd., 55:
MepicaL CarE AND DIAGNOSIS
Betwixt and between; a re-
Lancet, 2: 486-
Indications
fections rhumatismales,
605-613, 1954.
Dos Reis, F. M.:
patologia do enveihecimento.
Med., 11; 105-110, 1954.
Hanssen, P.: (Hospital care of aged.) Nord.
med., 52: 1522-1524, 1954.
Hanssen, P.: (Hospitalization of aged in
Oslo; statistical study.) Nord. med., 52: 1524-
1526, 1954.
Heeres, P. A.: (The shortage of nurses and
the nursing of chronically diseased patients. )
Ziekenhuiswezen, 27: 183-186, 1954.
Hoffmann, M.: Ein Beitrag zur Uberwiir-
mungsbehandlung chronischer Krankheiten.
Dtsch. Gesundhwes., 9: (8), 236-241, 1954.
Howell, T. H.: Problems of the aged and
chronic sick. Med. Pr., 232: 3-19, Dec. 1954.
Med.
A terapeutica tissular na
Rev. brasil.
The care of old people.
294-296, 1954.
Physical medicine and _re-
Ohio St. med.
Hughes, T.:
World, Lond., 81:
Krusen, F. H.:
habilitation for chronic illness.
J., 50: 929-934, 1954.
Nealis, C. H., and A. R. Kilgore:
tive and postoperative care of the aged.
Surg. Clin. N. Amer., 99: 1473-1477, 1954.
Phillips, H. T., and H. D. Cohn: The domi-
ciliary care of sick persons as part of a com-
prehensive health and medical care pro-
gramme. S. Afr. med, J., 28; 613-617, 1954.
Quadri, A.: La terapia fisica nei ricoveri per
vecchi. Longevita, 4: (2-3), 30, 1954.
Roberts, D. W.: Hospital unit for the long-
term patient. Mod. Hosp., 83: 69-72, 1954.
Rogers, A. M.: Home care, rehabilitation and
placement in industry of patients with cardio-
vascular disease. Med. Clin. N. Amer., 38:
1785-1788, 1954.
Preopera-
378
14567.
14568.
14569.
14570.
14571.
14572.
14573.
14574.
14575.
14576.
14577.
14578.
14579.
14580.
14581.
14582.
14583.
JOURNAL OF GERONTOLOGY
Solomon, W. M.: Progress in physical medi-
cine and rehabilitation. J. Amer. med. Ass.,
156: 753-755, 1954.
Stevenson, I.: The nurse and her patient in
long-term cases. Amer. J. Nurs., 54: 1462-
1464, 1954.
Williams, H. N.: Prescribing for the chronic;
the challenge for homeopathy. Hahnemann.
Mon., 69: 267-270, 1954.
Anonymous: Flexible nursing unit for chronic
patients. Mod. Hosp., 83: 77, 1954.
Anonymous: The care of old people in gen-
eral practice. Med. World, Lond., 81: 345-
363, 1954.
See also Nos. 14100, 14618.
IV. DiIsEAsE
(chronic, infectious, and mental )
Alcala Llorente, E., and E. Martinez Ramén:
Estadistica de morbilidad senil, segun datos
del dispensario nacional de la “obra de pro-
teccién a la vejez”, durante el quinquenio;
1949-1954. Med. esp., 32: 2-13, 1954.
Anglem, T. J., and M. L. Bradford: The
prognosis of major surgery for cancer in the
aged. Cancer Res., 7: 988-990, 1954.
Atkinson, S., S. P. Fjeld, and J. G. Freeman:
An intensive treatment program for state
hospital geriatric patients. II. Further prog-
ress and results. Geriatrics, 10: 111-117,
1955.
Balaguer-Vintré, I.: Relaciones entre la ater-
osclerosis y la involucién senil. Med. esp.,
32: 20-27, 1954.
Berry, G. P.: Who are the chronically ill?
Texas Rep. Biol. Med., 12: 575-577, 1954.
Brown, T. M.: The doctor-patient relation-
ship in chronic illness. Texas Rep. Biol.
Med., 12: 577-582, 1954.
Cavalieri, U.: Aspetti di fisio-patologia della
vecchiaia. Gior. Geront., 2: 573-576, 1954.
Chafetz, M. E.: An active treatment pro-
gram for chronically ill mental patients. J.
nerv. ment. Dis., 119: 428-436, 1954.
Charache, H.: Longevity in cancer. Amer.
J. Surg., 88: 521-522, 1954.
Chatagnon, P., P. Jeanneau, —. Nicolas-
Charles, and C. Chatagnon: Role de |’émo-
tion et de l’anxiété morbide dans |’apparition
de manifestations somatiques chez deux
séniles; etude clinique et biologique. Ann.
méd.-psychol., 112: (2), 183-191, 1954.
Ciocco, A., and M. D. Ring: Experience in
providing care for the long-term patient and
the light it throws on additional research
needed. J. chronic Dis., 1: 392-411, 1955.
Clemmesen, J., and A. Nielsen: The social
14584.
14585.
14586.
14587.
14588.
14589.
14590.
14591.
14592.
14593.
14594.
14595.
14596.
14597.
14598.
14599.
14600.
14601.
distribution of cancer in Copenhagen; 1943
to 1947. Brit. J. Cancer, 5: 159-171, 195],
Cobbs, B.: Questions confronting the psy.
chologist investigating chronic illness. Texas
Rep. Biol. Med., 12: 738-742, 1954.
Collins, S. D.: <A review of illness from
chronic disease and its variation with age,
sex, and season, with some trends.
Dis., 1: 412-441, 1955.
Cooper, M. J.: Psychiatric aspects of care
of the aged. Tex. St. J. Med., 50: 585-589,
1954.
Cutler, S. J., M. A. Schneiderman, and S. W,
Greenhouse: Some statistical considerations
in the study of cancer in industry. Amer. J.
publ. Hith., 44: 1159-1166, 1954.
Forster, W., S. Schultz, and A. L. Hender-
son: Combined hydrogenated alkaloids of er-
got in senile and arteriosclerotic psychoses,
Geriatrics, 10: 26-30, 1955.
Geill, T.: (Principal features of geriatric dis-
eases.) Mskr. prakt. laegegern., 31: 405-422,
1953.
Geill, T.: (Therapy in geriatric disease.)
Mskr. prakt. laegegern., 31: 445-462, 1954,
On the age distribution of
Acta Unio int. Contra.
J. chronic
Glemmesen, J.:
cancer of the lung.
Canc., 10: 101, 1954.
Goldfarb, A. I.: Psychiatric problems of old
age. N. Y. St. J. Med., 55: 494-500, 1955.
Graberg, E.: (Impressions of psychiatric care
of aged in England.) Soc. med. Tidsk., 31:
325-330, 1954.
3reenblatt, R. B.: Hormones, carcinogenesis,
and geriatrics. (Editorial). Geriatrics, 10:
46-47, 1955.
Greppi, E.: Horton senile.
2: 657-659, 1954.
Grinschpun, S.: Algunas
neuro-psiquiatricas en geriatria.
Chile, 82: 237-252, 1954.
Grosse, H.: Krebs und Alter.
forsch., 8: 244-254, 1955.
Hilleboe, H. E.: Public health trends in New
York State; chronic diseases and disabilities.
N. Y. St. J. Med., 54: 3264-3272, 1954.
Hollister, L., and W. F. Fitzpatrick, Jr.:
Oral metrazol in the psychoses associated
with old age. J. Amer. geriat. Soc., 3: 197-
200, 1955.
Jacobsen, C.:
confronting the medical educator.
Rep. Biol. Med., 12: 672-674, 1954.
Kiefer, L., B. H. Sullivan, Jr., and W. Little-
field: The Huggins cancer test on 700 nor-
mal persons. Proc. Soc. Exp. Biol., N. Y.,
73: 29-30, 1950. Abstr: B. A., 24; No.
15686, 1950.
Gior. Geront.,
consideraciones
Rev. méd.
Z. Alters-
Questions on chronic illness
Texas
14602.
14603.
14604.
14605.
14606.
14610.
14611.
14612.
14613.
14614
14615
1461€
14617
1461
1461
1462
fen; 1943
71, 1951,
the psy-
Ss. Texas
ess from
vith age,
|. chronic
of care
585-589,
nd S. W.
derations
Amer, J.
Hender-
ds of er-
sychoses,
tric dis-
4105-429,
lisease. )
2, 1954,
ution of
Contra.
; of old
), 1955.
ric care
sk., 31:
genesis,
ics, 10:
zeront.,
aciones
. méd,
Alters-
n New
bilities.
.
k, Jr.:
ociated
}: 197-
illness
Texas
Little-
0 nor-
N. Y.,
: No.
14610.
14611.
14612.
14613.
14614,
14615,
14616.
14617,
14618.
14619.
14620.
. Kubie, L. S.:
. Leake, C. D.:
. Leake, C.
INDEX OF CURRENT PERIODICAL LITERATURE
Kohn, L. A.: Chronic illness from the point
of view of the teaching internist. . Texas Rep.
Biol. Med., 12: 662-665, 1954.
Kubie, L. S.: Chronic illness and hidden
neurotic difficulties. Texas Rep. Biol. Med.,
12: 608-610, 1954.
The complex scientific chal-
lenge in chronic illness. Texas Rep. Biol.
Med., 12: 742-744, 1954.
. Leake, C. D.: The prevention of the focus-
ing of frustration in chronic illness. Texas
Rep. Biol. Med., 12: 627-631, 1954.
Factors in teamwork in car-
ing for the chronically ill. Texas Rep. Biol.
Med., 12: 632-633, 1954.
D.: Communication with the
chronically ill patient. Texas Rep. Biol.
Med., 12: 775-777, 1954.
. Long, E. R.: The decline of chronic infec-
tious disease and its social implications. Bull.
Hist. Med., 28: 368-384, 1954.
. McCartney, J. L.: Electroshock treatment in
involutional and senile psychoses. J. Amer.
geriat. Soc., 3: 50-54, 1955.
McDanald, E. C., Jr.: Anxiety, chronic dis-
ease and the psychologist. Texas Rep. Biol.
Med., 12: 619-622, 1954.
May, R.: Anxiety in chronic illness. Texas
Rep. Biol. Med., 12: 622-624, 1954.
Merrell, M., and L. E. Shulman: Determina-
tion of prognosis in chronic diseases, illus-
trated by systemic lupus erythematosus. J.
chronic Dis., 1: 12-32, 1955.
Comment on devaluation in
Texas Rep. Biol. Med., 12:
Meyers, R.:
chronic illness.
613-619, 1954.
Meyers, R.: The role of the communicative
and general semantic disciplines in coordi-
native efforts to fashion a medical and psy-
chological program for the chronically ill.
Texas Rep. Biol. Med., 12: 778-784, 1954.
Moore, J. E.: The natural history of chronic
illness. (Editorial). J. chronic Dis., 1: 335-
337, 1955.
Orthner, F.: Lebensalter, Altern und Krebs.
Hippokrates, 25: (11), 342-343, 1954.
Peck, H. B.: The role of the patient and
patient-groups in the study of chronic ill-
ness. Texas Rep. Biol. Med., 12: 744-746,
1954.
Peters, J. J., J. H. Peers, S. Olansky, J. C.
Cutler, and G. A. Gleeson: Untreated syph-
ilis in the male negro; pathologic findings in
syphilitic and nonsyphilitic patients. J.
chronic Dis., 1: 127-148, 1955.
Polonio, P.: Involutional schizophrenia. Dis.
nerv. Syst., 15: 310-311, 1954.
Robbins, C. L.: The role of natural sur-
14621.
14622.
14623.
14624.
14625.
14626.
14627.
14628.
14629.
14630.
14631.
14632.
14633.
14634.
14635.
14636.
14637.
379
roundings in treating the chronically ill.
Texas Rep. Biol. Med., 12: 586-588, 1954.
Roberts, D. W.: Care of the long-term pa-
tient; a summary of the national conference.
J]. chronic Dis., 1: 51-62, 1955.
Roberts, D. W.: The over-all picture of long-
term illness. J. chronic Dis., 1: 149-159,
1955.
Sill, H.: (Morbidity statistics.) Svenska
Lédkartidn., 51: 1782-1792, 1954.
Scheele, L. A.: Planning and organizing for
care of the chronic patient; the job of the
community. Mod. Hosp., 83: 65-68, 1954.
Seidenfeld, M. A.: Chronic illness as a prob-
lem in adaptation to life. Texas Rep. Biol.
Med., 12: 605-608, 1954.
Shinfuku, N.: Mental disorders of the aged
in Japan. Yonago acta Med., 1: 115-123,
1954.
Shock, N. W.: Criteria for the design of re-
search studies on chronic disease. (Edi-
torial). J. Amer. geriat. Soc., 1: 224-226,
1955.
Simonds, W. H., and A. Stewart: Old peo-
ple living in Dorset; a socio-medical survey
of private households. Brit. J. prev. soc.
Med., 8: 139-146, 1954.
Sjogren, H.: (Presenile and senile neuro-
psychiatric diseases; preliminary survey of
600 cases.) Nord. méd., 52: 1083-1091, 1954.
Sjogren, H.: (Decreta medica de senectute;
critical analysis of the concepts of involu-
tion and atrophy in psychiatric-geriatric lit-
erature.) Nord. méd., 52: 1505-1511, 1954.
Sorribes-Santamaria, V.: El sincope mani-
festacién “princeps” de los procesos infec-
ciosos del anciano. Med. esp., 32: 83-85,
1954.
Steiner, P. E.: The endemiology of cancer by
organ systems. Brit. J. Cancer, 8: 215-222,
1954.
Walther-Biiel, P. D.: Das Alter in klinisch-
psychiatrischem Licht. Schweiz. Arch. Neurol.
Psychiat., 73: 425-430, 1954.
Wright, B. A.: Devaluation in chronic ill-
ness. Texas Rep. Biol. Med., 12: 610-613,
1954.
Wright, M. E.: The period of mourning in
chronic illness. Texas Rep. Biol. Med., 12:
624-627, 1954.
Anonymous: The commission on the care
and treatment of the chronically ill, aged and
infirm; administrative policies governing
grants-in-aid for programs of physical medi-
cine and rehabilitation within hospitals pro-
mulgated July 14, 1954. Conn. St. med. J.,
18: 782-784, 1954.
Anonymous: Morbilidad de las enfermedades
de declaracién obligatoria en 1953; estudio
380
14638.
14639.
14640.
14641.
14642.
14643.
14644.
14645.
14646.
14647.
14648.
14649.
14650.
14651.
JOURNAL OF GERONTOLOGY
comparativo. Rev. Sanid. Hig. publ., Madr.,
28: 110-118, 1954.
See also Nos. 14552, 14557, 14703.
V. HycIrENE
Bond, B. W.: Health education for organ-
ized groups of older adults; a governmental
health agency program. Geriatrics, 10: 89-
91, 1955.
Potter, H. W., and G. V. Freiman: The ef-
fect of life problems and cerebral pathology
on the mental health of aging persons. N. Y.
St. J. Med., 54: 2826-2830, 1954.
Repond, A.: Psychologie, psychopathologie
et hygiéne mental de la senescence et de la
vieillesse. Schweiz. Arch. Neurol. Psychiat.,
73: 406-422, 1954.
Treuting, W. L.: Aging and health.
Tulane med. Fac., 12: 54-56, 1953.
See also No. 14586.
Bull.
VII. SurcERY
Elman, R.: Surgical experience in the aged
as an aid to surgery in the young. J. Amer.
geriat. Soc., 3: 85-92, 1955.
Goode, J. V.: Surgery of the aged. Tex. St.
J. Med., 50: 596-599, 1954.
Hunnicutt, A. J.: Physiologic reserves in the
aged; application to operability. J. Amer.
geriat. Soc., 3: 93-105, 1955.
Lazzarini, L.: L’assistenza chirurgica nelle
comunita di geronti. Longevitd, 4: (2-3),
37-39, 1954.
Mithoefer, J., and J. C. Mithoefer: Studies
of the aged. Arch. Surg., Chicago, 69: 58-
65, 1954.
Raven, R. W.: Surgery in octogenarians.
Brit. J. Med., 1: 266-268, 1955.
Stewart, J. D., and G. S. Alfano: Surgery of
the elderly. J. Amer. med. Ass., 154: 643-
646, 1954.
See also No. 14165.
PSYCHOLOGICAL PROCESSES
Austria. Statistisches Zentralamt: (Suicides
in Austria since 1913.) Statist. Nachr., 8:
415-417, 1953. Abstr: P. I., 21: No. 1071,
1955.
Billig, O., and R. Adams: Emotional prob-
lems of the middle-aged man. Psychiat.
Quart., 28: 442-452, 1954.
Brozek, J.: Personality changes with age; an
item analysis of the Minnesota multiphasic
personality inventory. J. Geront., 10: 194-
206, 1955.
14652.
14653.
14654.
14655.
14656.
14657.
14658.
14659.
14660.
14661.
14662.
14663.
14664.
14665.
14666.
14667.
14668.
Caldwell, B. McD., and R. I. Watson: An
evaluation of sex hormone replacement jn
aged women. J. genet. Psychol., 85: 18]-
200, 1954.
Eder, A.: Wenn ich dreissig Jahre alt sein
werde; Auswertung eines Aufsatzes vierzehn-
jahriger Buben. Wien. Arch. Psychol., 4:
107-113, 1954.
Forgus, R. H.: The effect of early perceptual
learning on the behavioral organization of
adult rats. J. comp. physiol. Psychol., 47:
331-336, 1954.
Howell, R. J.: Sex differences and educa-
tional influences on a mental deterioration
scale. J. Geront., 10: 190-193, 1955.
King, H. F.: The response of older rural
craftsmen to individual training. J. Geront,
10: 207-211, 1955.
Landscheide, M.: Die Selbstmorde in Nord-
rhein-Westfalen und ihre Motive. Statist.
Rundchau Land Nordrhein-Westfalen, 6: 173-
176, 1954. Abstr: P. I., 21: No. 1073, 1955.
McIntyre, C. J.: Sex, age and iconicity as
factors in projective film tests. J. consult.
Psychol., 18: 337-343, 1954.
Mowbray, R. M.: Disorientation for
J. ment. Sci., 100: 742-752, 1954.
Pressey, S. L., and A. W. Jones: 1923-1953
and 20-60 age changes in moral codes, anxi-
eties, and interests, as shown by the “X-O
Tests”. J. Psychol., 39: 485-502, 1955.
Révész, G.: Héheres Lebensalter und geistige
Lesitungskraft. Universitas, 8: 685-690, 1953.
Abstr: P. A., 29: No. 642, 1955.
Sahanek, O., and V. Vrzal: (Case of fetish-
ism with manifestations of transvestism in ad-
vanced age.) Lék. Listy, 9: 355-358, 1954.
Schwab, R. S., M. E. Chafetz, and S. Walker:
Control of two simultaneous voluntary motor
acts in normals and in Parkinsonism. Arch.
Neurol. Psychiat., 72: 591-598, 1954.
Singleton, W. T.:
timing with age.
166-172, 1954.
Stoll, W. A.: Wert und Unwert psychischer
Altersverinderungen. Schweiz. med. Wschr.,
84: 922-923, 1954.
Watson, R. I.: Training the psychologist for
work with the chronically ill. Texas Rep.
Biol. Med., 12: 659-661, 1954.
Wesman, A. G.: Standardizing an individual
intelligence test on adults; some problems.
J. Geront., 10: 216-219, 1955.
Zanoli, R.: La senescenza fisiologica e pa-
tologica dell’apparato motore. Minerva med.,
Torino, 45: 1409-1415, 1954.
age.
The change of movement
Brit. J. prev. soc. Med., 8:
See also No. 14311.
Watson: An
placement jn
ol., 85: 18].
ahre alt sein
zes vierzehn-
Psychol., 4:
ly perceptual
ganization of
Psychol., 47:
and _ educa-
deterioration
1955.
older rural
J. Geront.,
de in Nord-
ve. Statist.
alen, 6: 173-
1073, 1955.
iconicity as
J. consult.
m for age.
4,
1923-1953
codes, anxi-
y the “X-O
1955.
und geistige
9-690, 1953.
e of fetish-
stism in ad-
~358, 1954.
S. Walker:
atary motor
ism. Arch.
54.
* movement
c. Med., 8:
psychischer
ed. Wschr.,
hologist for
Texas Rep.
_ individual
problems.
gica e pa-
lerva med.,
14669.
14670.
14671.
14672.
14673.
14674.
14675.
14676.
14677.
14678.
14679.
14680.
INDEX OF CURRENT PERIODICAL LITERATURE
SOCIAL & ECONOMIC ASPECTS
I. AccIDENTS
Malboysson Correcher, E.: Accidentes del
trabajo en personas de edad. Med. esp.,
32: 67-71, 1954.
U. S. Department of Health, Education, and
Welfare. Public Health Service. National
Office of Vital Statistics: Accident fatalities
United States; 1952. Vit. Stat., Spec. Rep.,
Nat. Summaries, 40: (11), 223-247, 1955.
III. DeEmMoGRAPHY
Anderson, O. W.: A suggested single index
for a measure of changing age distributions
in general populations. Soc. Forces, 33:
(1), 86-87, 1954. Abstr: P. I. 21: No. 1232,
1955.
Australia. Parliament: Report of the Gen-
eral Assembly of the United Nations on the
administration of the Territory of Nauru from
July 1, 1952, to June 20, 1953. Govt. Printer,
Canberra, 1954, 69 pp. Abstr: P. I., 21: No.
1019, 1955.
Dublin, L. I.: Population trends and their
impact on life insurance. In: Insurance Lec-
tures Series, Sch. Business Admin., Univ.
Conn., Storrs, Spring 1952, pp. 20-32. Abstr:
P. 1., 21: No. 1194, 1955.
Federici, N.: Aspetti della situazione demo-
grafica italiana in base ai primi risultati del
censimento del 1951. Banca nazi. Lavoro,
6: 373-386, 1953. Abstr: P. I., 20: No. 1777,
1954.
France. Direction de la Statistique Générale:
Population présente totale. Imprimerie Na-
tionale, Paris, 1953, Vol. 2, 436 pp. Abstr:
P. I., 21: No. 1310, 1955.
Germany. Federal Republic. Statistisches
Bundesamt: Die Bevélkerung der Bundes-
republik Deutschland nach der Zahlung vom
13.9.1950. Heft 1. Die Bevélkerung nach
Geschlecht, Alter und Familienstand. Dtsch.
Statist. Bundesrep., 35: 1-43, 1952. Abstr:
P. I., 19: No. 132, 1953.
Germany. West Berlin. Statistisches Landes-
amt: Die vorausgeschitzte Entwicklung der
West-Berliner Bevélkerung bis zum 1. Januar
1975. Berl. Statist., 7: 364-370, 1953. Abstr:
P. I., 20: No. 1770, 1954.
Gold Coast. Government Statistician: Popu-
lation. Digest Statist. 3: (1), 1-2, 1954.
Abstr: P. I., 20: No. 1832, 1954.
Gould, C. A.: Population age structure.
Lancet, 1: 1020, 1954.
Lorimer, F.: Dynamic aspects of the rela-
ation of population to economic development.
Bull. Inst. int. Statist., Madrid, 33: 243-254,
1954. Abstr: P. I., 20: No. 1693, 1954.
14681.
14682.
14683.
14684.
14685.
14686.
14687.
14688.
14689.
14690.
14691.
14692.
14693.
381
Madeira, J. L.: Aspectos econdmicos de al-
gunas_ caracteristicas demograficas. Rev.
brasil. Estatist., 14: 325-349, 1953. Abstr:
P. I., 20: No. 1694, 1954.
Mauldin, W. P., and D. S. Akers: The pop-
ulation of Poland. Govt. Print. Off., Wash.,
1954, vi, 198 pp. Abstr: P. I., 20: No.
1785, 1954.
Metrop. Life Insur. Co.: Future population
trends. Statist. Bull. Metrop. Life Insur.
Co., 36: 6-8, March 1955.
Myers, R. J., and E. A. Rasor: Proyecciones
a largo plaza de la poblacién de los Estados
Unidos para fines de estimar el costo del
seguro social. Estadistica, 12: 242-258, 1954.
Abstr: P. I., 21: No. 1048, 1955.
New Zealand. Census and Statistics De-
partment: Population projections by age
groups; non-Maori population. Mon. Abstr.
Statist., (Suppl.), 1-6, Oct. 1953. Abstr:
Abstr: P. I., 21: No. 1050, 1955.
New Zealand. Census and Statistics Depart-
ment: Population census, 1951. Vol. 4. In-
dustries, occupations and incomes. The De-
partment, Wellington, 1954, 112 pp. Abstr:
P. 1., 21: No. 1050, 1955.
Nougier, L. — R.: Essai sur le peuplement
préhistorique de la France. Population, 9:
241-274, 1954. Abstr: P. I., 21: No. 1007,
1955.
Paraguay. Direccién General de Estadistica
y Censos: Censo nacional de poblacién y
viviendas, 28 de octubre de 1950. Boletin
Informativo, Asuncién, 1954. Abstr: P. L.,
21: No. 1304, 1955.
Podder, K. C.: On the punched card method
in smoothing for age bias in census returns.
Sankhya, 13: 261-266, 1954. Abstr: P. L.,
21: No. 1241, 1955.
Smith, T. L.: The changing number and
distribution of the aged population. J.
Amer. geriat. Soc., 3: 1-14, 1955.
Southern Rhodesia. Central African Statisti-
cal Office: Census of population; 1951.
Govt. Printer, Salisbury, 1954, 122 pp.
Abstr: P. I., 20: No. 1840, 1954.
Sweden. Statistiska Centralbyran: (Census
of the population on December 31, 1950.
Vol. III. Total enumeration; population by
age and sex in communes, parishes and popu-
lation clusters). | Statistiska Centralbyran,
Stockholm, 1954, 6°, 322 pp. Abst: P. I.,
21: No. 1319, 1955.
Switzerland. Ziirich Canton. Statistisches Bu-
reau. (Fliichmann, F.): Die Bevélkerung-
struktur des Kantons Ziirich. Ergebnisse
der Volkszihlung vom 1 Dezember 1950.
Ziircher Wirtsch., 10: 1-72, 1954. Abstr:
P. I., 21: No. 1135, 1955.
382
14694.
14695.
14696.
14697.
14698.
14699.
IV-B. Economic PROBLEMs:
14700.
14701.
14702.
14703.
14704.
14705.
JOURNAL OF GERONTOLOGY
Tanganyika. East African Statistical Depart-
ment: Statistical abstract; 1938-1951. Dar
es Salaam, 1953, iv, 48 pp. Abstr: P. I., 20:
No. 1844, 1954.
U. S. Bureau of the Census: Estimates of
the population of the United States, by age,
color and sex, July 1, 1954. Current Pop.
Repts., Wash., Pop. Estimates, Series P-25,
Aug. 29, 1954, No. 101, 6 pp. Abstr: P. I.,
21: No. 1294, 1955.
U. S. Bureau of the Census: Provisional
estimates of the population of the United
States; January 1, 1950 to August 1, 1954.
Current Pop. Repts., Wash., Pop. Estimates,
Series P-25, Sept. 10, 1954, No. 102, 1 pp.
Abstr: P. I., 21: No. 1294, 1955.
U. S. Bureau of the Census: Provisional
estimates of the population of the United
States; January 1, 1950 to September 1,
1954. Current Pop. Repts., Wash., Pop.
Estimates, Series P-25, Oct. 11, 1954, No.
103, 1 pp. Abstr: P. I., 21: No. 1294, 1955.
Anonymous: ‘Types of vital statistics avail-
able in different countries; Demographic and
Social Statistics Branch, Statistical Office of
the United Nations. Bull. World Hlth. Org.,
11: 177-199, 1954.
IV. Economic PrRoBLEMS
California. University of. Institute of In-
dustrial Relations: Economic problems of
the aged. The University, Berkeley, 1954,
No. 58, 36 pp.
Employment
Brazil. Consehlo Nacional de Estatistica: A
duracio média da vida economicamente
activa. Rev. brasil. Estatist., 15: 91-96,
1954. Abstr: P. I., 21: No. 1143, 1955.
Cohen, A.: Job finding for the older plus
hard to place; Detroit project. Personnel &
guid. J., 33: 148-151, Nov. 1954.
Cook, M. W. J.: The employment of older
men and women. (The Nottingham and Dis-
trict Employment Committee Conference on
problems of training or retraining of the older
workers.) Ministry of Labor and National
Service, Great Britain, Nov. 1954, 10 pp.
Fisk, G. H.: Sickness absentee rate in
younger and older workers in a small manu-
facturing plant. Arch. industr. Hyg. & occup.
Med., 10: 223-225, 1954.
Johnstone, R. T.: The importance of geri-
atrics in industrial medicine. J. Amer. geriat.
Soc., 3: 117-119, 1955.
Mathiasen, G.: The continued employment
of older people. Geriatrics, 10: 137-140,
1955.
14706.
14707.
14708.
14709.
14710.
14711.
14712.
14713.
14714.
14715.
IV-C. Economic PrROBLEMs:
14716.
14717.
14718.
14719.
14720.
Metrop. Life Insur. Co.: Women in the
labor force. Statist. Bull. Metrop. Life Ingur.
Co., 30: 7-10, Oct. 1949. Abstr: P. 1., 16:
No. 441, 1950.
Peterson, R. L.: How competent are older
workers? Off. Execut., Phil., 29: 17-20, Noy,
1954.
Peterson, R. L.: Older workers and their job
effectiveness. Geriatrics, 10: 34-38, 1955.
Sivadon, A.: Le probléme des travailleurs
agés ou inadaptés. Méd. d’Usine, 16: 399-
403, 1954.
Stanton, J. E.: Some factors affecting em-
ployment in relation to age. Doctoral Diss,,
Ohio State Univ. Press, 1955, No. 66, pp.
337-343.
United Nations. Secretary-General: Eco-
nomic opportunities for women; older women
workers. U.N., Econ. & Soc. Counc., 1954,
53 pp.
U. S. Department of Commerce, Civil Aero-
nautics Administration, Office of Aviation
Safety: The changing age distribution of
holders of class I medical certificates. The
Office, Wash., Nov. 1954, 9 pp.
U. S. Department of Health, Education and
Welfare, Social Security Administration:
Quarterly summary of earnings employment
and benefit data. Bur. Old-Age and Surv.
Insur. Div. Prog. Anal., 14: 1-20, Nov. 1954.
Vernon, H. M., and T. Bedford: A study
of absenteeism in a group of ten collieries.
Med. Res. Counc., Indus. Fatigue Res. Board,
1928, Rept. No. 51.
Anonymous: Services for older workers—the
need for developing work opportunities.
Empl. sec. Rev., Wash., 21: 3-28, Nov. 1954.
See also No. 14656.
Retirement and
Pensions
(See also Social Security )
McMahan, C. A., and T. R. Ford:
the first five years of retirement.
10: 212-215, 1955.
Surviving
J. Geront.,
Myers, R. J., and J. A. MacDougall: The
railroad retirement act in 1954. Soc. Sec.
Bull., 18: 7-12, 1955.
Political and Economic Planning: Providing
for pensions. Planning, 20: 93-116, May 24,
1954. Abstr: P. I., 21: No. 1192, 1955.
Princeton University. Department of Eco-
nomics and Sociology. Industrial Relations
Section: Industrial pensions and retirement
procedures; a selected annotated bibliography.
The Section, Princeton, 1954, 20 pp.
Vallejo, A.: Jubilacién en torno a un prob-
‘omen in the
Op. Life Insur,
str: P. 1, 16:
tent are older
): 17-20, Noy.
and their job
4-38, 1955,
eS travailleurs
ine, 16; 399-
affecting em.
octoral Diss,
No. 66, pp.
neral: Eco-
older women
Zounc., 1954,
, Civil Aero-
of Aviation
tribution of
icates. The
lucation and
ministration:
employment
2 and Surv.
Nov. 1954.
I: A study
n collieries.
Res. Board,
vorkers—the
portunities,
Nov. 1954,
ent and
Surviving
J. Geront.,
gall: The
Soc. Sec.
Providing
, May 24,
955.
| of Eco-
Relations
retirement
liography.
un prob-
14721.
14722.
14723.
14724.
14725.
14726.
14727.
14728.
14729.
14730.
14731.
14732.
14733,
14734,
INDEX OF CURRENT PERIODICAL LITERATURE
lema. Bol. cult. Cons. gen. col. méd. Esp.,
17: 53-54, 1954.
V. EpucaTION
Hewitt, D., and K. F. Mather: Adult educa-
tion; a dynamic for democracy. Haskell Ltd.,
N. Y., 1937.
Kaplan, O. J.: Evaluation of health educa-
tion activities by opinion-poll techniques.
Amer. J. publ. Hlth., 41: (2) 31-36, 1951.
Rancati, A.: L’azione dell’educare. Longe-
vita, 4: (2-3), 3-4, 1954.
J. S. Bureau of the Census: Sixteenth
Decennial Census of the United States:
1940. Population. Series 15. Marital status
and years of school completed, by age, for
the white population by nativity and parent-
age: 1940. The Bureau, Wash., June 9, 1942.
Abstr: P. 1., 9: No. 551, 1943.
U. S. Bureau of the Census: Sixteenth
Decennial Census of the United States: 1940.
Population. Fourth Series. Characteristics
by age, marital status, relationship, education,
and citizenship. Govt. Print. Off., Wash.,
1943. Abstr: P. I., 9: No. 547, 1943.
VI. Hovusinc AND CARE
Beria, L.: Nuovi orizzonti al pio albergo
trivulzio di Milano. Longevitd, 4: (2-3),
43-44, 1954.
Denti, N., and C. Rasori: La casa di riposo
per vecchi di fidenza. Longevitd, 4: (2-3),
27-28, 1954.
Gabba, A., and M. Massa:
torio dell’E.C.A. di Milano.
(2-3), 49-51, 1954.
Haylett, R. R.:
with special reference to rural areas.
sanit. Inst., 74: 1021-1026, 1954.
Johansen, G. F.: (Medical considerations
on institutional care of aged). Ugesk. Laeg.,
116: 1119-1121, 1954.
Knudsen, H. L.: Minnesota’s facilities for
care of the chronically ill and the aged.
Minn. Med., 37: 747-748, 1954.
McInnes, R. J.: Maple Crest—Boone County
nursing home. Publ. Aid. Ill., 22: (2), 12-
13, 1955.
Mattioni, C.: La casa di invalidita e vec-
chiaia di udine. Longetiva, 4: (2-3), 31,
1954.
National Social Welfare Assembly. National
Committee on the Aging: Standards of care
for older people in institutions. Section III.
Bridging the gap between existing practices
and desirable goals in homes for the aged
and nursing homes. The Assembly, N. Y.,
1954, 112 pp.
Il nuovo dormi-
Longevita, 4:
Housing for old people;
J. &.
14735.
14736.
14737.
14738.
14739.
14740.
14741.
14742.
14743.
14744.
14745.
14746.
14747.
14748.
14749.
14750.
383
Piédrola Gil, G.: Problemas sanitarios y
medicos de las residencias de ancianos. Med.
esp., 32: 77-82, 1954.
Vincenzi, M.: La casa intercommunale di
riposo di rodigo. Longevitd, 4: (2-3), 40,
1954,
See also No. 14548.
VIII. Mepicat Care
Berlioz, C.: De certains problémes posés par
Yassurance de la longue-maladie. Rev. Hyg.
Méd. soc., 2: 150-154, 1954.
Busnelli, C.: I problemi della
Longetivd, 4: (2-3), 54-58, 1954.
Gaustad, *V.: (Hospital care
Nord. med., 52: 1518-1522, 1954.
Hitt, H. L., and P. H. Price: . . Health in rural
Louisiana at mid-century. Louisiana State
Univ. & Agric. & Mich. Coll., 1954, Louisiana
Bull. No. 492, 64 pp. Abstr: P. I., 21: No.
1054, 1955.
Lee, R. V.:
chronically ill.
584-586, 1954.
Perrini, F.: Esclusioni e limitazioni del-
lassicurazione contro le malattie in riferi-
mento alle esigenze del vecchi. Minerva
med., Torino, 45: 1660-1661, 1954.
Phillips, O. M.: Medical care and social and
economic problems of the aged. Texas St. J.
Med., 50: 590-593, 1954.
Torresini, A.: Il problema della cronicita al
Quinto Congresso della Societa Italiana di
Medicina Sociale. (Editorial). Gior. Geront.,
3: 22-26, 1955.
See also No. 14582.
miseria.
of aged.)
A program of care for the
Texas Rep. Biol. Med., 12:
IX. SocraL PROBLEMS
(includes social adjustment )
Arndt, H. C. M.: Personal adjustment in old
age. Publ. Aid Ill., 22: (2), 1-3, 1955.
Cavalieri. U.: Alcoolismo e vecchiaia.
Longevita, 4: (2-3), 45-48, 1954.
Hiscock, I.: Opportunities for the aged; past
and future. Conn. St. med. J., 18: 836-839,
1954.
Kaplan, J.: Effect of group activity on
psychogenic manifestations of older people.
Geriatrics, 9: 537-539, 1954.
Kern, R. A.: Our growing responsibilities
to the aged in our midst. Maryland med. J.,
3: 393-401, 1954.
The National Council of Social Service:
Living longer; some aspects of the problems
of old age. The Council, London, 1954, 72
Pp.
384
14751.
14752.
14753.
14754,
14755.
14756.
14757.
14758.
14759.
14760.
14761.
JOURNAL OF GERONTOLOGY
New York City. Mayor’s Advisory Com-
mittee for the Aged: New York City’s
senior citizens. Vol. 13, in: Mayor's Ad-
visory Committee for the Aged, N. Y., Dec.
1953. Abstr: P. I., 21: No. 1276, 1955.
Pan, J. S.: Method of prediction of personal
adjustment in old age. Sociol. soc. Res., 38:
113-119, 1953. Abstr: P. A., 29: No. 641,
1955.
Spinley, B. M.: The deprived and the priv-
ileged. Routledge & Kegan Paul, London,
1953, 208 pp. Abstr: P. I., 21: No. 1140,
1955.
See also No. 14384,
X. SocraL Groups
Godwin, W. L.: The sociology of small
groups, with special reference to age status.
(Abstract). Univ. N. C. Rec., 520: 281-282,
1953. Abstr: P. A., 29: No. 671, 1955.
U. S. Bureau of the Census: Marriage statis-
tics. Marriages by racial type and by age of
resident groom; by age of bride; collection
areas; 1940, Vit. Statist., Spec. Rep., 17:
Nov. 28, 1942. Abstr: P. I., 9: No. 1007,
1943.
U. S. Bureau of the Census: Sixteenth De-
.cennial Census of the United States: 1940.
Population. Series P-16. Marital status of
persons in the labor forces, by employment
status, age, and sex, and for regions; 1940.
The Bureau, Wash., Dec. 6, 1942. Abstr:
P. 1., 9: No. 552, 1943.
U. S. Bureau of the Census: Sixteenth De-
cennial Census of the United States: 1940.
Population. Series P-16. Marital status of
men and women in each occupation, by age,
for the United States; March 1940-February
15, 1943. The Bureau, Wash., Feb. 15,
1943. Abstr: P. I., 9: No. 552, 1953.
XI. Socrar Securiry
Addicks, I. S.:
labor.
1954.
Berlin Landesversicherungsanstalt: Geschaefts-
bericht; 1953. The Office, Berlin, 1954, 138
pp.
Canada. Department of National Health and
Welfare. Research Division: Social security
expenditures in Australia, Canada, Great
Britain, New Zealand, and the United States,
1949-50; a comparative study. The Depart-
ment, Ottawa, 1954, 42 pp.
Delaware. Old Age Welfare Commission:
Annual report; 1949-1950. The Commission,
Dover, 1950, 11 pp.
New federal laws affecting
Mon. Labor Rev., 77: 1102-1104, Oct.
14762.
14763.
14764,
14765.
14766.
14767.
14768.
14769.
14770.
14771.
14772.
14773.
14774.
14775.
14776.
14777.
14778.
14779.
Kuhle, A. A.: The 1954 amendments to
the Federal Social Security Act. Publ. Aid
Ill., 22: (1), 6-9, 1955.
Lehmann, A.: L’assurance-vieillesse et in-
validité du personnel infirmier
Veska-Z., 17: 678-681, 1953.
Lesage,—.: L’évolution des dépenses de
sécurité sociale en 20 années, de 1932 a 1951,
Concours méd., 76: 3719-3722, 1954.
Marquis, J. E.: Old-age and survivors in-
surance; coverage under the 1954 amend-
ments. Soc. Sec. Bull., 18: 3-10, Jan., 1955,
Massa, M.: Le rubriche. Longevitd, 4; (2-
3), 41-42, 1954.
Massa, M.: L’ordinamento
assistenziali. Longevita, 4:
1954.
Mexico. Instituto del Seguro Social:
ico y la seguridad social. Tomo III.
strucciones y sistemas de protecién
The Institute, Mexico, 1953. Abstr:
21: No. 1214, 1955.
Radosavljevié, _D.: (On the
changes of the social security
Naradno zdrav., 10: 93-98, 1954.
féminin,
dei
(2-3),
servizi
52-53,
Méx-
Con-
social.
PT
proposed
system. )
Royer, M.: Réflexions sur la réforme de la
Sécurité Sociale. Concours méd., 74: 2710,
1952.
Triib, C. L. P.: Das Sozialgerichtsgesetz
(SGG) vom 3.9.1953 und die Mitwirkung
des Arztes in der neuen Sozialgerichtsbarkeit.
Med. Mschr., 8: 324-329, 1954.
Anonymous: Reorganization of a social se-
curity scheme for Cuban workers. Industr.
Labour, 12: 489-491, 1954.
Anonymous: Physicians and the amend-
ments to the Social Security Act. J. Amer.
med. Ass., 156: 500, 1954.
XII. Soctat SERVICE AND SociAL Work
(recreation and rehabilitation )
Allen, E. N.: Connecticut’s interest in the
problems of aging. Conn. St. med. J., 18:
751-753, 1954.
Beyers, M. F.: Homecraft for the handi-
capped. J. Rehabilit., 20: (4), 7-10, 1954.
Brock, J. F.: Rehabilitation: medical as-
pects with special reference to rehabilitation
by feeding. S. Afr. med. J., 28: 719-722,
1954.
Campironi, E.:
ricreativo per vecchi.
25-26, 1954.
Cavalieri, U.:
malati_ cronici.
1954.
Coe, M. H.: The nurse and rehabilitation.
II. The cardiac patient. Amer. J. Nurs., 54:
1355-1356, 1954.
Programma per un centro
Longevita, 4: (2-3),
La riabilitazione degli am-
Longevita, 4: (2-3), 7-9,
147
14
14
nendments to
t. Publ. Aid
illesse et in.
ier féminin,
dépenses de
1932 a 195].
1954.
survivors jn.
1954 amend.
), Jan., 1955,
evita, 4; (9.
dei
2-3),
Servizi
52-53,
»cial:
» III,
cion
\bstr:
Méx-
Con-
social.
P: =
> proposed
yY system.)
3
forme de la
, 74: 2710,
richtsgesetz
Mitwirkung
chtsbarkeit.
1 social se-
. Industr.
ie amend-
J. Amer.
A
ORK
est in the
dd. J., 18:
he handi-
10, 1954,
edical as-
abilitation
719-722,
mm centro
4; (2-3),
legli am-
-3), 7-9,
bilitation.
Vurs., 54:
14780.
14781.
14782.
14783.
14784.
14785.
14786.
14787.
14788.
14789.
14790.
14791.
14792.
14793.
14794.
14795.
14796.
INDEX OF CURRENT PERIODICAL LITERATURE
Die Wiederherstellungstherapie
Wien. med. Wschr., 104: 237-
Ehalt, W.:
im Heilbad.
238, 1954.
Feldman, M. B.:
habilitation. S.
1954.
Fisher, M.:
tion; some simple apparatus and its use.
J. phys. Med., 17: 145-149, 1954.
Gilbertson, E.: The nurse and rehabilitation.
III. Mental health aspects. Amer. J. Nurs.,
54: 1358-1359, 1954.
Gingras, G., M. Mongeau, and M. Bergeron:
A study of lower extremity amputation in
Brit. J. phys. Med.,
Psychiatric aspects of re-
Afr. med. J., 28: 714-716,
Mechanotherapy in rehabilita-
Brit.
geriatric rehabilitation.
17: 265-269, 1954.
Great Britain. The National Corporation for
the Care of Old People: Sixth annual re-
port for the year ended September 30, 1953.
Daniel Greenway & Sons, Ltd., London, Sept.
1953, 34 pp.
Hess, E.: Rehabilitation and what it means.
J. Amer. med. Women’s Ass., 9: 394-395,
1954.
Hoge, E. B.: Developing clubs for older
people. In: How Public Welfare Serves
Aging People, Amer. Publ. Welf. Ass., Chi-
cago, 16 pp.
Hossack, J. R., and R. Sofin: The relation-
ship of occupational therapy and vocational
counseling in rehabilitation. Canad. J. occup.
Ther., 21: 19-23, 1954.
Hugo, A. J.: Rehabilitation; the hospital
point of view. S. Afr. med. J., 28: 722-724,
1954.
Landau, G.: Restoration of
Geriatrics, 10: 141-148, 1955.
Levin, M. L.: Action areas in rehabilitation;
developing rehabilitation services. Amer. J.
publ. Hlth., 44: 741-743, 1954.
Lowman, E. W., P. R. Lee, S. Miller, R.
King, and H. Stein: The chronic rheuma-
self-esteem.
toid arthritic; psychosocial factors in re-
habilitation. Arch. phys Med., 35: 643-647,
1954.
McCarthy, H. L.: Day centers for older
people. In: How Public Welfare Serves
Aging People, Amer. Publ. Welf. Ass., Chi-
cago.
Mannes, M.:
the Hodson Center.
35, Dec. 16, 1954.
Michaud, M.: Les problémes posés a I’assist-
ante sociale par l’assurance invalidité. Rev.
Hyg. Méd. soc., 2: 47-51, 1954.
Miedema, J. J.: Bezigheidstherapie/arbeids-
therapie. Ziekenhuiswezen, 27: 159-161,
1954.
Coming of age. Report on
The Reporter, 11: 32-
14797.
14798.
14799.
14800.
14801.
14802.
14803.
14804.
14805.
14806.
14807.
14808.
14809.
14810.
14811.
14812.
14813.
14814.
14815.
14816.
385
The nurse and rehabili-
Amer.
Morrissey, A. B.:
tation. I. The role of the nurse.
J. Nurs., 54: 1354-1355, 1954.
Moskowitz, E.: Human salvage-rehabili-
tation of a severe hemiplegic. Post Grad.
med, J., 16: 238, 1954.
National Old People’s Welfare Committee:
Progress report, 1953-54, The Committee,
London, 1954, p. 35.
Nelson, R.: “Over 65” Club keeps ‘em
young at heart. Publ. Aid Ill., 22: (2), 18-
19, 1955.
Origlia, D.:
di socialita.
1954,
Perkins, V.: The Golden Age program. E.
D. Farmer Foundation for the Aged, Dallas,
Jan. 1954, Bull. #1, 5 pp.
Perkins, V.: A manual for organizing Golden
Age Clubs. E. D. Farmer Foundation for
the Aged, Dallas, Jan. 1954, Bull. #2, 10 pp.
Perkins, V.: Friendly visiting. E. D. Farmer
Foundation for the Aged, Dallas, Jan. 1954,
Bull. #3, 3 pp.
Pinkerton, A. C., and E. J. Desjardine: Com-
munity rehabilitation centre. Canad. Hosp.,
31: 40-45, 1954.
Redkey, H.: The community rehabilitation
center. J. Rehabilit., 20: 14-20, 1954.
Reimer, D.: Rehabilitation program for
chronically ill elderly patients in a neuro-
psychiatric hospital. Arch. phys. Med., 35:
754-759, 1954.
Rivero Arrarte, P.:
sional del reumatico invalido.
Med., 44: 1-12, 1954.
Robertson, M. A.: The general practitioner's
view on rehabilitation. S. Afr. med. J., 28:
724-726, 1954.
Rodriquez, A. A., and J. L. Koczur: Inte-
grated plan returns patients to community
life. Arch. phys. Med., 35: 580-586, 1954.
Rusk, H. A., and E. J. Taylor: Economic
values of rehabilitation. (Editorial). J.
Amer. geriat. Soc., 1: 222-223, 1955.
La ricreazione come strumento
Longevitad, 4: (2-3), 23-24,
La rehabilitacién profe-
Arch. urug.
Sanger, W. T.: Factors in rehabilitation
needs. Texas Rep. Biol. Med., 12: 582-583,
1954.
Savage, C. L.: Rehabilitation from the view-
point of a physician in industry. Virginia
med. Mon., 81: 226-227, 1954.
Schmitt, R. C.: Old age in Hawaii; a study
of the older population of Oahu. Geriatrics,
10: 39-42, 1955.
Schoger, G. A.; Der Rehabilitation-Gedanke
bei der Behandlung von Rheumakranken.
Z. Rheumaforsch., 13: 22-27, 1954.
Silhol, P.: La rehabilitation en Grande-Bre-
tagne. Marseille chir., 6: 154-167, 1954.
386
14817,
14518,
14819,
14820,
14821,
14822,
14823,
14824,
14825.
14826,
14827,
14828,
14829,
JOURNAL OF GERONTOLOGY
Tichy, H.; Rehabilitation chronischer Rheu
matiker, Dtsch, med, J., 5: 341-342,
Worden, BR. E.; Rehabilitation centers; plan
ning, administration, personnel, finance, J,
Amer, med, Ass,, 156; 1483-1486, 1954,
Worden, BR, E,; Civilian hospitals as rebabili
tation centers, Ohio St. med, J., 56; 935
936, 1054,
See also Nos, 14318, 14561, 14567, 14748,
MISCELLANEOUS
Carp, L.: Cleero speaks on old age, Gert
atries, 10; 43-45, 1055,
Gosselin, M, G., and C, W. Bauer; The effect
of age and of heat on the ferment in cascara
sagrada, J, Amer, pharm, Ass, (Set, Ed,
43; 569-573, 1054,
Piédrola Gil, G.:
la organizacién nacional de los servicios de
gerocultura y geriitria, Med. esp,, 32: 145-
149, 1954,
Rackemann, I’, M., and M, ©, Edwards; A
follow-up study of 688 patients after an in-
terval of twenty years, New Engl. J. Med.,
246; 815-823, May 1952,
Sinclair, J.: The code of health and lon-
gevity, Arch, Constable & Co., London, 1807,
Vol, 1, 609 pp.
Sinclair, J.: The code of health and longevity.
Arch, Constable & Co,, London, 1807, Vol.
L1, xvii, 283 pp.
Sinclair, J.; The code of health and longevity.
Arch, Constable & Co., London, 1807, Vol.
IIT, xi, 485 pp.
Sinclair, J.; The code of health and longevity.
Arch, Constable & Co., London, 1807, Vol.
IV, vii, 564 pp.
Souza Santos, P., A. Vallejo-Freire, and H, L,.
Souza Santos; Elektronenmikroskopische Stu-
dien tiber das Altern von amorphem_ kol-
loidem Aluminiumhydroxyd, Kolloidny Zh.,
133; 101, 1953. Ibid., 135; 56, 1954,
Anonymous: Methods in long-term studies,
Amer. J. publ, Hith., 41; 85-113, 1951.
Necesidad y esquema de
1054,
14830,
14831,
14832,
14833,
14834,
14835,
14836,
14837,
14838,
14839,
14840,
14841,
14842,
14843,
14844,
14845,
14846,
14847,
14848,
IV, Miscennanvous: Popular Articles
Baer, M. Fy; Age and employment—olde
worker, Personnel & guid, J., 33; 317, Feb,
1955,
Blivin, B.: Retired people should be ep.
couraged to earn, Saturday Evening Post,
297; 10, Nov, 13, 1954,
Crampton, C, W.; How U, 5S,
longer, This Wk, =: 7;
20, 1955.
Desmond, T, C.; Lengthening the life span
Today's Uth., 33; 26-28, March 1955,
Dunne, A.; Feature X;
men can live
25-26; 30, Feb
apostolate for te.
tired professional lay Catholics, America,
92; 501-592, March 5, 1955,
Longwell, M.; We are where we belong
Farm J., 79; 111, March 1955,
Morrow, A, E.; Old-timer,
J., 44; 100, Feb, 1955,
Paepper, P.; Occupation;
Home, 53; 42, March 1955,
Simerville, C. L., and RB. BR. Reichart: Pre
retirement expectancy and retirement reality
Personnel & uid. J., 33: 344-346, Feb
1955,
Anonymous:
Nat, educ, Ass
retired, Amer
Hollywood evolves $20,00 4
month, Business Wk., —: 176, Oct. 16, 1954,
Anvaymous; Listener, not adviser, best role
for oldsters. Sei. News Lett. Wash., 66:
259, Oct, 23, 1954,
Anonymous; 20,000 pension funds. Time,
64; 92, Nov. 22, 1954,
Anonymous: Shelved at seventy, Business
Wk., —: 119, Feb. 5, 1955,
Anonymous: Those pension billions, News
week, 45; 22, Feb. 7, 1955.
Anonymous: Retiring farmers, New Repub
lic, 132: 5, Feb, 14, 1955.
Anonymous: Unions raising pension rights
U.S, News, 38; 105, Feb, 25, 1955.
Anonymous: Going like sixty, Time, 65: 64,
Feb, 28, 1955.
Anonymous: Cure for getting old.
week, 45; 54, March 7, 1955.
Anonymous: After seventy-five you get
healthier, Sci, Digest, 37: 51, March 1955
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