COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX641 34946 QP85 .H88 1 889 Old age; the results ::-;^f>>:v.i- |':ir^'n;i-t':;j;ilv::W':!i ^litf^i^^V ^: >-t o X p 5 to 5 JO I—" CD OX B CD CO Upwards of 80 years j CD •-s CD P< 3' pj O 00 B 00 Ox B CD CO From 30 to 40 ( years j M 99 F 79 8 "^ g Sex. Lbs. oz. 98 5 87 CO 1 Ox Oi o cp --1 ox OX^ to C5S^ w 45-34 39-77 Oz. 48-2 43-09 Encephalon. 30-46 18-22 Oz. 28-47 18-74 J? 24-30 15-23 H-i to OS ION C6 CI- 12-1 10-27 Oz. 11-36 9-45 w CD P >^ 4-99 4-49 Oz. 5-72 5-34 Stomach. 41-01 34-64 Oz. 58-11 53-61 < CD 1^ 4-27 3-46 Oz. 7-12 6-13 SO 2 8-25 6-86 Oz. 1135 10-34 1 CO 2-83 2-37 Oz. 3-47 3-05 CD to o Co" Co I <^ td o $5 5^ crS. CS> 03 CHAPTER YI. REPORT ON THE PRESENT CONDITION, HABITS, CIRCUMSTANCES, ETC., OF PERSONS AGED BETWEEN EIGHTY AND A HUNDRED. The following report, which relates to the present condition of the aged (that is, their condition at the time when the several reports were made), is founded upon the analyses of 824 persons printed at a subsequent page. Of these 824, 340 men and 282 women were between 80 and 90, and 92 men and 110 women were between 90 and 100. Of the total number, 89 per cent, were, or had been, married ; 48 per cent, were poor, 42 per cent, were in comfortable circumstances, and 10 per cent, only were described as being in affluent circumstances. This must not be regarded as representing the relations of poverty and affluence to longevity, because, in the first place, the poor, at all ages and in all districts, bear a large proportion to the affluent ; and, secondly, our returns are largely made from the lower and middle classes, and, in many PERSONS BETWEEN 80 AND 100. Ill instances, from the inmates of union-workhouses, where a good number of aged people are found, and where in- formation respecting them is most easily obtained. The important questions of the relative longevity in different classes and among those following different occu- pations scarcely comes within the range of our inquiry. Indeed, they need carefully collected statistics of varying kinds, and much labour for their solution \ It does not appear that the Shakespearian sequence of the "lean and slippered pantaloon" to that of the "fair round judge" is by any means the ordinary one, for the 'spare' condition and the 'average' condition between 'spare' and 'fat' greatly predominate in our old people at all ages between 80 and 100. The 'average' condition is noted in 47 per cent, of the whole number, the 'spare' in 41 per cent, and the 'fat' only in 11 per cent.^; and the accounts of their condition at earlier periods of life indicate the same, by the far larger proportion having throughout life come under the denomination of 'spare* or 'average.' The average height of the men (67 inches), and of the 1 See Class-Mortality Statistics, by Dr Grimshaw, British Medical Journal, August 13th, 1887; and Influence of Easy Circumstances on Longevity, by Dr Drysdale, Ibid., August 20tli. 2 The round numbers only in the percentages and not the decimals are given, in most instances, which will account for the slight dis- crepancies occasionally observable, such as above, where 47 -f 41 -f 11 = only 99, instead of 100. 112 PRESENT CONDITION OF women (62 inches), if we take into account the lowering of stature attendant upon age, which may be estimated at not less than 2 inches, gives a high standard, the average height of Englishmen at 25 being 67^ inches, and of Englishwomen 62 inches. This, as in the case of the cen- tenarians (p. 56), corroborates the observations of Mr Roberts (British Medical Journal, January 1st, 1887), who found, " on grouping the measurements of a large number of individuals together, that the curve of stature continued to increase up to the age of 70, which was the limit of the statistics;" and he expresses the opinion that "this increasing stature of the population throughout life was due to the greater viability of persons whose stature was up to or above the average; or, in other words, to the weeding out by disease of the smaller and worst developed members of the community." The lowering of stature attendant upon age is due partly to the loss of elasticity of the invertebral substances and other parts of the frame, but chiefly to the inability to attain and maintain the fully erect attitude, which requires a certain effort on the part of the extensor muscles, especially those of the knees and hips, an effort which is fatiguing at all periods of life, and which cannot be successfully made in the case of many aged persons. A lowering of the heads of the thigh-bones, owing to an alteration in the angle of the neck with the shaft, is, PERSONS BETWEEN 80 AND 100. 113 according to my observations, less and of less common occurrence than is generally supposed. Indeed it need not enter into computation as a cause affecting the stature of the aged or as inducing the liability to fracture of this part in old persons. The fair mainten- ance of elasticity and erectness, shown in our list to be one of the attributes of great age, may lead us to infer that the lowering of stature in our old people had taken place to a less extent than is usual ; and I have accordingly estimated it at not more than two inches. The importance of this relation between physical de- velopment and longevity acquires increasing force in pro- portion to the value of the evidence which is being adduced as to the diminishing physique of our people, ascribed to their transfer from rural districts to large towns. In reference to this point I may allude to the words of Sir Thomas Crawford in his recent address at Dubhn {British Medical Journal, August 13th, 1887): "A careful examination," he says of these tables (tables of the causes of rejection of recruits for the army), "leads to the inference that the lower classes, from whom recruits for the army are chiefly taken, are of inferior physique now to what they were twenty -five years ago." If the physique is becoming less good, must we not expect to find a pro- portionate diminution of the instances of great longevity ? Sir Thomas Crawford's statistics have not passed without H. c. 8 114 PRESENT CONDITION OF criticism ; but, at any rate, it is a matter deserving serious attention \ The average weight of 227 men, in whom it is given as under 11 stone, and of 114 women as about 9 stone, is, especially in the women, small in proportion to the height and well- developed forms of these old people, and corre- sponds with the 'spare' condition noticed in so many, and shows that people usually become of less bodily weight as they grow older. These well -developed, and for the most part slender, figures maintain gallantly that erect attitude which is the special feature of the human form, forasmuch as we find 62 per cent, are stated to be 'erect,' and 28 per cent, only to be 'bent.' The 'anaemic' and 'pale' condition of a large proportion 1 Mr Charles Eoberts, for instance (" The Physical Condition of the Masses," in the Fortnightly Review, October, 1887), has been led by a careful examination of the same statistics to conclusions quite opposite to those at which Sir Thomas Crawford has arrived. He finds that improvement in sanitation has not only made the population more healthy, but has materially lengthened the term of life. " Stature and weight of body," he says, " are very much matters of race, and vary in different parts of the country according to the racial origin of the in- habitants. In Scotland and the north of England the men are tall and heavy (from 5 feet 8 to 10 inches, and from 11 to 13 stone), while in the east of England they are tall but less bulky. In the southern parts of England men are much shorter and lighter of weight than in the north and east (5 feet 6 to 7 inches, and 9| to 10 J stone), while in Wales they are also short, but very heavy in proportion to their stature. The adult inhabitants of towns do not fall much below that of the adjoining dis- tricts in either stature or weight. The average stature of the much- abused cockney is 5 feet 7 inches, only half an inch short of that of the whole kingdom, and higher than that of all the home counties." PERSONS BETWEEN 80 AND 100. 115 (respectively 58 per cent, and 30 per cent.) accords with the fact noted in my account of the post-mortem exami- nations of centenarians (p. 103) that the spleen, lymphatic glands, and other blood-making organs are in a compara- tively atrophic state in the aged. Nevertheless, it is to be remarked that a good proportion (63 per cent.) are noted to be 'strong' or of 'average' strength, as against 36 per •cent., who are described as 'feeble.' Among these old people, as in the case of the cen- tenarians, a large number (80 per cent.) retained good SIGHT; and this evidence is confirmatory of the view, derived from the records of the centenarians, that the occurrence, even the early occurrence, of presbyopia (83 per cent, used glasses) does not militate against the con- tinuance of good sight to a very late period of life. It does not appear that much is to be inferred from the presence or absence of the arcus senilis, forasmuch as it is noted to exist in 'considerable' degree in 25 per cent., in 'slight' degree in 37 per cent., and to be 'absent' in 37 per cent. Hearing failed in a larger proportion than sight, being reported as 'indifferent' or 'bad' in nearly half the number of returns under that head. The failure of this sense in a larger number than that of vision is pro- bably due in great measure, as said (p. 152), to the liability of the delicate mechanism of the middle part 8—2 116 PRESENT CONDITION OF of the ear — the tympanum, with its bones, joints, mem- branes, muscles, and lining membrane — to impairment from colds, shocks, and a variety of other causes. The good general condition, the good performance, that is, of the various functions, in a large number of these old people, is, as in the case of the centenarians, a note- worthy fact, and contributes, it need scarcely be said, in very large measure to the comfort and happiness of old age. In 71 per cent, the DIGESTION, and in 62 per cent, the APPETITE, is stated to be 'good.' In only 4 per cent, is the former, and in only 5*4 per cent, is the latter, said to be 'bad.' In 69 per cent, the bowels acted daily; and in few does it appear that they gave trouble. Very few resort to aperients ; and it could be wished that a greater number of the young and middle-aged persons in the upper ranks of life would follow the example of the old people in this respect. The process of micturition is found to be natural in 83 per cent, of the women, and in 58 per cent, of the men. In 20 per cent, of the men, and in less than 3 per cent, of the women, it is noted as being slow; whereas incontinence is said to exist in about 5 per cent, of the women, and in only 3 per cent, of the men. Frequency of micturition appears to be a source of annoyance in not more than 3 per cent, or 4 per cent, in either sex. The evidence of sound brain-condition is furnished PERSONS BETWEEN 80 AND 100. 1J7 by the report of an 'average' amount of intelligence in 74 per cent.; in 15 per cent, it is stated to be 'high/ and in 11 per cent, only to be 'low.' The memory also is in most instances reported to be ' good,' especially (in 78 per cent.) for past events. The recent impressions, as is the case with most of us after youth, are less durable ; still as many as 59 per cent, of these old people are noted to have good memory for recent events. A further evidence of good brain-condition is furnished by the ob- servation that only 9 per cent, are bad sleepers, whereas 64 per cent, are said to be good sleepers, and 27 per cent, to be moderately good sleepers. This does not quite accord with what seems to be a generally received impres- sion that the sleeping faculty of the aged is indifferent. It may be, and it probably is, the case that the work which should go on in sleeping, that is the repair of the ordinary w^ear and tear associated with the exercise of the various functions, and more particularly of the brain- functions, proceeds slowly, and that a proportionately long period is required for it ; so that, although the ' sleeping faculty' may be good, the 'sleeping power' may be less than in earlier life. This sluggishness of the nutritive processes in carrying on renewal after the wear attendant upon functional exercise, and which is an appropriate associate with the sluggishness or diminution of functional activity in the aged, seems at first thought to be scarcely 118 PRESENT CONDITION OF compatible with that good performance, in these same persons, of repair after the greater lesions by wounds and ulcers to which I have before called attention. The ap- parent paradox, however, is probably explained, as men- tioned in the report on the maladies of old people (p. 153)^ by the lower sensitiveness, excitability, and activity of the tissues in the aged, and by the better opportunity thus afforded for the quiet operation of the healing processes. The disappearance of the teeth, as remarked in former reports, does not portend so much as is commonlj^ sup- posed. In 41 per cent, they were all gone, and in some this had been the case for many years. We find, more- over, in these analyses confirmation of the observations before made as a result of our investigation, that the teeth disappear at an earlier period and more commonly in women than in men, though the former are the more long-lived — the proportion in which they were absent being 52 per cent, in the women and 30 per cent, in the men — also that they disappear in the upper jaw earlier than in the lower jaw. Our reports are drawn chiefly from the class of persons who are not able to make amends for natural deficiencies by artificial aids. Thus thirty-seven only oat of the whole number had artificial teeth ; some of these had used them for many years. We can scarcely,, therefore, draw inferences from this information respecting the advantage to health and the prolongation of life which PERSONS BETWEEN 80 AND 100. 119 may be afforded by the dentist's skill ; although it can scarcely be doubted that benefit in these respects, as well as in comfort and other ways, will be found to result from the science and art of dentistry, which is making such great advances. It is interesting to note that the PULSE-KATE between the ages of 80 and 100, which in the whole number of the cases observed averages 77, is about the same as that of middle-life. The slight excess above the average of middle-life may be accounted for by the presence of a certain amount of chest-affection in some of these old people. In the women the average (79) somewhat exceeds that of the men, which is 75. In 80 per cent, it is said to be regular, and in 20 per cent, to be irregular. In the greater number (60 per cent.) the pulse is described as small, and in by far the greater number (81 per cent.) as compressible. Hence the ordinary pulse of the old person may be said to be 77, regular, small, and compressible ; and this may be called the 'pulse of endurance.' It in- dicates that the heart beats quietly and steadily, and that the arterial system is sound. In confirmation of the latter point, we find an absence of evidence of arterial disease noted in 72 per cent.; in 21 per cent, the arteries are described as being ' tortuous,' and in 12 per cent, only as being 'knotty.' I am rather surprised that the men and women are about equal in this respect, for I had supposed 120 PRESENT CONDITION OF calcareous and other like deojenerative chauofes in tlie tissues, especially in the arteries, to be more common in men than in women ; and I think it would be foimd to be so at an earlier period of life (from sixty to eighty). In older people intemperance and other exciting causes of tissue-degeneration, which are most operative among men, have commonly been throughout life in comparative abey- ance, and the natural processes have had more fair and equal play in men and in women. The importance of this will be inferred from what is said on the subject of arterial degeneration at p. 145. The RESPIRATION, avera.ging about 21, is rather less frequent than might have been expected, considering the liability to bronchitis, as well as the diminishing elasticity of the pulmonary tissues and of the chest-walls, which must, to a greater or less extent, form one of the senile changes ; but it accords with the observations that a com- paratively good maintenance of elasticity, that is of good tissue- structure, is one of the features associated with longevity; and our tables indicate that the elasticity of the chest-wall was fairly distinguishable in about one-half of those in whom a return on this point was made. More- over, the chest-measurement, averaging about 36 inches in inspiration and 35 in expiration in the men, and 31 in inspiration and 30 in expiration in the women, is a fair medium, and shows that, considering the time of life. PERSONS BETWEEN 80 AND 100. 121 the range of respiratory movement is well maintained. It is also to be noted that, in a large proportion, the voice is stated to be clear, loud and full, evidencing a sound con- dition, as well probably as a good development, of the vocal apparatus, a point upon which Sir Duncan Gibb is known to have laid much stress. It is very satisfactory to find that nearly a half are reported to be of ' placid ' disposition, and 45 per cent, to be still 'energetic' and brisk, whereas 17 per cent. only are said to be rather 'irritable.' With regard to several it is noted that these qualities are combined. Thus, some are stated to be ' placid ' and ' energetic,' and some to be 'irritable' and 'energetic;' but, on the whole, the placid and energetic dispositions much predominate. With regard to HABITS, 54 per cent, are stated to be ^active,' and taking more or less out-of-door exercise; 31 per cent, to be 'sedentary,' and 14 per cent, to be 'confined to bed.' Though the last is rather a large number, it must be remembered that many solaces attend upon this condition, not the least being the enjoyment of rest, which to the weary body is a real luxury. The need for it is usually, in the first instance, caused by weakness, perhaps rheumatic, in the lower limbs. These parts of the frame, which are the latest to be developed in size and strength, are the most prone to defect, disease, and debility. There is no doubt that in many cases confinement to bed leads 122 PRESENT CONDITION OF to prolongation of life by the immunity it affords from exposures, and by its reservation to the organs essential to life of so much nerve-force and nutritive energy as is economised by the diminution of bodily activity. The greater number (60 per cent.) are ' moderate * EATERS, 30 per cent, are ' small ' eaters, and 9 per cent. only are 'large' eaters. A fair proportion (40 per cent.) are in the habit of taking a little alcohol, which, in the form of beer, whisky, or brandy, they feel to be a comfort and support, alleviating the sense of sinking which many feel ; and perhaps this small quantity, especially if taken in the latter part of the day, does some real good. A smaller proportion take rather more, and are classed as- * moderate ' drinkees. A considerable number, however,. 36 per cent., take none at all, and very few (2*5 per cent.) are described as taking much. It is also observed that a large number (62 per cent.) take but little animal food ; 32 per cent, partake of it moderately; 3 per cent, take none at all ; and I'l per cent, only take it in considerable quantity. It may commonly be observed that as persona advance in years and lessen in activity, the inclination for animal food diminishes. Most of our old people are- content with about three meals a day. We now and then meet with old persons who eat rather ravenously and frequently, thinking perhaps that it is necessary to do so in order to maintain their strength, and that the need for PERSONS BETWEEN 80 AND 100. 12S so doing is indicated by the sense of sinking at the stomach which they experience. These instances however are very exceptional ; and it is probable that a small quantity of cod-liver oil, taken once or twice daily in a little wine or spirit, would relieve the sense of sinking, and would pro- mote digestion and nutrition, and so maintain strength in a safer and better manner than an extra and quickly swallowed amount of food. CHAPTER YII. KEPORT ON THE PAST LIFE-HISTORY OF AGED PERSONS. The folIowiDg account of the past life-history of the 824 aged persons is a sequel to the account of their present condition, and is taken from the same analyses. It may be remarked, in the first place, that nearly a fourth (24 per cent.) were 'first children '\ and at 'least 17 of the number were ' only children,' though the greater number were about the third or fourth in the family. In 196 instances, in which the ages of the fathers and mothers at the time of the birth of the children were included in the returns, the average age of the fathers was 34, and that of the mothers 32. This would indicate the age of about 30 to be, as we might expect, so far as the offspring are concerned, the most favourable for child- producing. Five are stated to have been ' twins.' A gen- tleman of my acquaintance, above 80, himself a twin, married a twin, and has a large family of very healthy ^ See remarks on this point in 'Centenarians' (p. 41). PERSONS BETWEEN 80 AND 100. 125 children and several grandchildren, thus proving that the reproductive as well as the enduring qualities may be fully possessed by twins. Of the 835 who are stated to have been married, the average age at which they were married was 29, the average duration of their married life was forty-five years, and the average number of their children was six. Of the 292 women who are stated to have been MARRIED, the average age at which they married was 26, the average duration of their married life was forty years, and the average number of their children was six. The shorter term of married life of the women as compared with that of the men is explained by the fact that men are, on the whole, somewhat shorter-lived than women,, and also that they marry at a rather later age, the term of the married life of the woman being, therefore, cur- tailed by the earlier deaths of the men. Not much infor- mation has been given respecting the labours of the women ; and it may, therefore, be probably inferred that they did not in most instances present any very remark- able features. One woman is stated to have had severe flooding after a confinement at the age of 42, and to have rallied with difficulty. Two had many miscarriages. In the case of one, each of her fourteen labours was by the aid of instruments, and most of the children were born dead. One had twin daughters, both of whom were alive 126 . PAST LIFE-HISTORY OF at the age of 56, and had large famihes. Fifty-seven of the married women were childless. It appears, therefore, that longevity was about equally shared by the single and the married, by those who had borne children and those who had not. At the same time, among those who had children, fertility, which imports soundness and activity of the generative organs, is indicated to have been an associate of longevity. The greater proportion (55 per cent.) of these old people had lived in comfortable circumstances, 35 per cent, had been ' poor,' and 10 per cent, had been 'affluent.' The greater number had been of average stoutness or of spare habit. Eight per cent, are said to have been ' deli- cate,' whereas 54 per cent, are reported to have been ' robust ' throughout life, and 37 per cent, to have been about ' average ' in this respect. Ninety per cent, had always enjoyed good health with the exception in some, of occasional illnesses, subsequently mentioned, which do not appear materially to have affected their general health. In the category of 'good health' are comprised good digestion, which is reported with regard to 92 per cent.; good appetite, which is noted in 88 per cent.; and good, regular action of the bowels, which had taken place, and in most instances daily, in 85 per cent., costiveness being noted as habitual or frequent in only 10 per cent. With regard to diet we find that the smallest pro- PjERSO^';:^ between 80 AND 100. 127 portion (15 per cent.) had been habitually 'large' eaters, 20 per cent, had been ' small ' eaters, and the largest proportion (61 per cent.) had been 'average' in this re- spect. Five per cent, only had been in the habit of taking ' much ' animal food — that is, more than a pound of meat daily ; 38 per cent, took ' little ' — that is, less than half a pound ; and 53 per cent, had been accustomed to partake of it ' moderately ' — that is, from half a pound to a pound in the day. Fifteen per cent, had taken no alcoholic drink at all throughout the whole or crreater part of their lives ; 40 per cent, had been in the habit of taking a 'little' — that is, less than a pint of beer or two glasses of wine ; 33 per cent, had been accustomed to take it in ' moderation ' — that is, one or two pints of beer ■daily ; and less than 9 per cent, had taken more than this. The last number is composed chiefly of men who lived to between 80 and 90 ; with respect to the men between these ages, of whom there were 298 returns under this head, it is to be observed that 15 per cent, appear to have drank rather freely — 2 or more pints of beer daily — and 10 or 12 had drunk rather heavily for a portion or throughout the greater part of their lives. These excep- tional cases scarcely detract from the value of the im- portant confirmation which our tables afford of that which good sense suggests and which ordinary observation tells — namely, that abstinence from, or a spare or moderate 128 PAST LIFE-HISTORY OF partaking of alcoholic drinks, as well as spare or moderate eating, and spare or moderate meat-eating are most com- patible with health and most conducive to the prolongation of life. In this respect the poor are at some advantage as compared with the rich, for it is quite possible — indeed, very easy — to have too much of good things in the way of food, especially when they are made agreeable to the palate; and out of the abundance of what is good much that is evil is likely to ensue. Persons are apt to forget that limitation in quantity in any article of food is one of the requisites for its wholesomeness and good nutritious effect, and that what is wholesome in moderation becomes unwholesome when the bounds of moderation are exceeded^ those bounds being set by the real requirements of the system and the brisk, complete appropriative powers of the stomach and nutritive organs ; and they need the caution, as I have elsewhere expressed, that " the body quickly finds for idle food some mischief sure to do." In the able and valuable report by Dr Isambard Owen {British Medical Journal, June 23, 1888, p. 1312), on a " Collective Investigation Inquiry into the Connection of Disease with Habits of Intemperance," it is stated that in 4,234 returns made the average duration of life was greatest (62 years) in those who were designated ''tem- perate " — that is, those who drink small amounts and only with meals, and rarely take spirits — and that a gradual PERSONS BETWEEN 80 AND 100. 129 diminution, amounting in all to rather more than ten years, was found to take place in passing down the scale to the decidedly intemperate ; further, that the average duration of life reported in the case of the 'total-ab- stainers ' was less than that reported in the ' temperate.' Some considerations, such as the preponderance of early ages among living total abstainers and the consequent greater opportunities for early death among the members of this class who were reported on in comparison with others, prevent our drawing any absolute conclusion from the last part of the statement. Still, allowance for such, considerations being made, it does appear from the tables given by Dr Owen that length of life on the whole per- tains to the temperate — or rather it should be said to the very temperate — as much as, perhaps even more than, to the total abstainers. A greater number and a wider range of statistics would be needed to give trustworthy information respect- ing the influence of different occupations, modes of life, and places of dwelling upon the duration of life ; but we find that by far the greater number (94 per cent.) of those included in our tables had been ' active ' persons, and had led active lives, only 6 per cent, being described as * sedentary.' The greater proportion (77 per cent.) of the men had been occupied much out of doors ; this being the case, as might be expected, to less extent (33 per cent.) with H. c. 9 130 PAST LIFE-HISTOBY OF the women. Of several it is remarked that they were good walkers, athletes, sportsmen, etc. Nothing, perhaps, more surely than good enduring power in walking, run- ning, or similar exercise, indicates that soundness of frame and that nutritive energy and good balance of organs w^hich lead to longevity. Moreover, the opportunity for nutrition to do its restorative work was in nearly all pro- vided by the faculty of 'good sleeping,' to which was com- monly added its appropriate attendant, the habit of ' early rising.' I say 'appropriate attendant' for 'good' sleeping is, for the most part ' quick ' sleeping, that is, the reparative work which has to be done in sleep is done briskly and well. Good sleepers, in the prime of life, do not usually sleep very long, especially when they are well and actively and happily employed during the day ; and we are some- times surprised at the small amount of sleep which those who are actively employed seem to require, the fact being that activity and energy of the will and the volitional system induce activity and energy in the sleeping or restorative operations, and, conversely, a dawdling day is commonly followed by dawdling sleep or drowsiness at night. When we speak of early rising, it must be observed that the word ' early ' has a relative significance with re- ference to the time of going to bed. A person who retires to rest four hours after midnight and gets up at 10 A.M., may be strictly regarded as an ' early riser.' PERSONS BETWEEN 80 AND 100. 131 As we found in the case of centenarians with regard to the HAIR, so in the old people we are considering it had held its ground and its colour well, the proportion of those who were bald ' early ' being about 26 per cent, whereas those in whom it was noted that this had not taken place amounted to 72 per cent. Those who were grey ' early ' are 24 per cent., whereas in 75 per cent, this change is said to have been ' late.' Sixty-nine per cent, had been of ' energetic ' tem- perament, giving us the satisfaction of finding energy thus associated with the qualities that promote longevity, and that good working and good wearing qualities are oommonly linked together. Thirty-six per cent, are re- ported to have been of 'placid' temperament, and 13 per cent, to have come under the designation of 'irritable.' In a few (5 per cent.) only is the intellect described as having been ' low; ' in 21 per cent, it is said to have been ^ high ;' and 73 per cent, are said to have possessed an ' average ' amount of intelligence. It may seem somewhat remarkable that nearly one- half had suffered ILLNESSES, more or less severe, at some period or periods of life. Of these illnesses many were caused by some external influences or poisons, such as those of fever, small -pox, or scarlatina, and they therefore had no special relation to weakness, disorder, or defect in the body. Though often directly destructive of life and 9—2 132 PAST LIFE-HISTORY OF seriously damaging to organs, they do not infrequently^ even when severe, pass away like a cloud and leave the body quite unscathed, the only remaining vestige of in- complete recovery, that is, of incomplete restoration to the previous condition, being perhaps the change, whatever it be, which renders the system insensible to the influence of the poison, and so confers an immunity from the recur- rence of the particular disease. Moreover, certain local in- flammatory affections, those of the lungs, for instance, and some other parts, erysipelas, and a variety of affections, are in like manner engendered by, or are attributable to, poisonous or malarial agencies introduced from with- out, while some, of which gout may be taken as a type^ are the result of noxious materials engendered within the body. Whatever view may be taken of the causes and nature of the illnesses which had been undergone by these old people — and they were of various kinds — it is interesting to learn that in so many instances illness, though severe, did not prevent the sufferer from reaching- old age. Doubtless the qualities which lead to old age are those which best promote complete recovery from ill- ness as well as complete nutritive reparation under other circumstances ; and, in relation to this subject, I may refer, especially with regard to aifections of the nervous system, to the remarks on the Maladies of Old People (p. 147). The minor AILMENTS with which a small proportion PERSONS BETWEEN 80 AND 100. 133 had been troubled at various periods in their lives may not have been altogether without their compensating ad- vantages, forasmuch as these disorders not infrequently olear away slight accumulations of evil which would other- wise have increased and festered into graver maladies. These ailments, moreover, often serve as kindly warnings against indiscretions and exposures which, if continued, might prove disastrous. Though it is better not to err at all, it is a saving thing to be stopped or recalled in time. Thirty-nine of the whole number (824) had suffered occa- sional attacks of bronchitis ; 41 had been troubled with dyspepsia; and 30 with rheumatism. A few gave ac- counts of skin-eruptions — eczema or psoriasis — more or less troublesome; others of gout, varix, or sore leg. Still, more than 50 per cent, appear to have passed their lives in freedom from these and other maladies. Our statis- tics, therefore, are confirmatory of the view that the qualities which lead to old age are those which for the most part give immunity from ailment and disease, and which also promote recovery from them when they occur. With regard to family history, this subject has been so much dwelt upon and so worked out in connection with life-insurance that little remains to be said. In many of our cases no sufficient information respecting it could be obtained. Still, 406 are reported to have be- longed to long-lived families, those only being included 134 PAST LIFE-HISTORY OF in this number in the case of whom four of the immediate relatives (grandparents, parents, brothers or sisters) had attained to the age of 70, or three to the age of 80. In. six instances the families are stated to have been " short- lived." It should be added that in more than 20 per cent, the families, on one or both sides, are stated to have been consumptive (see also page 13), and in the families of IT per cent, there is said to have been cancer or some form of malignant disease. In 367 instances, in which returns on BLOOD-RELA- TIONSHIP are given, it is stated that none such existed between the grandparents or between the parents in 35 7» In four instances the grandparents were said to have been cousins ; and in six instances the parents are said to have been cousins; and it is probable that in all these the rela- tionship was that of first cousin. I do not know the pro- portion which the marriages of cousins bear to those in which no such relationship exists, or what is the nume- rical proportion of the children of cousins to the popula- tion generally; but the fact that 10 out of 367, with respect to whom a return on this point was made, or rather more than 2*7 per cent., were the children of cousins, seems to place the offspring of cousins in a very fair position with regard to the prospects of longevity. The results of this collective investigation respecting aged people have not been such as to evolve anything PERSONS BETWEEN 80 AND 100. 185 very novel or startling, or to give rise to any fresh theo- ries with regard to longevity and the means of attaining it, but rather to dissipate certain ideas which are more or less current though founded upon too limited observation, and to show that the maxims and laws which common sense and sound reason would dictate hold good, that the real elixir vitce is to be found in the observance of them, and that, as a general rule, those persons live the longest who might be expected to do so. Thus : — 1. The prime requisite is the faculty of age in the blood by inheritance ; in other words, that the body has been wound up, as it were, and sent into the world with the initial force necessary to carry on the living processes through a long period, that this is the case with every organ, and that the several organs are so adjusted to one another as to form a well-balanced whole. The various functions will then be equably and harmoniously performed, and there will, consequently, throughout life, be little cognisance of imperfection or ailment of any kind. 2. The body is usually well developed and well proportioned and rather spare, and, though there are many exceptions to this, rather exceeds the average standard of height. It is capable of much endurance and of quick and complete restoration after fatigue, this latter faculty giving the habit of, and probably the desire for, early rising; and with it also is associated a good power of 136 PAST LIFE-HISTORY OF recovery from the disturbances caused by accident or disease. The cerebral or intellectual powers accord with the general good quality, and the whole nervous system is active and energetic without being irritable. The chest is broad, breadth of chest be it remarked being one of the peculiarities of the human form ; it is capable of much expansion and therefore of drawing and holding a long breath. Hence the work of breathing, which has to be repeated some twenty times in a minute throughout life, takes place easily and quietly and, therefore, with com- paratively little wear and tear. The heart also does its work quietly, steadily, and at moderate rate. With regard to these points it may be observed that at birth the head is large in proportion to the rest of the body, first, because it is important for the brain to be early cased in and protected by bone, and, secondly, because when it is so cased in growth takes place with difficulty. The brain therefore in early life is large and rather soft and, as years go on, it becomes firmer but not much larger. Hence one of the factors in development after birth is to bring up the rest of the frame into due proportion to the brain and head. When this does not take place, owing either to the head being too large or to the growth of the rest of the person being insufficient, the standard of health and strength, especially in the former case, is liable to be defective. Also, when the growth of PERSONS BETWEEN 80 AND 100. 137 the rest of the body is in excess, causing a disproportion in the opposite direction, namely a lankiness of limb with relative smallness of head, the health-standard is liable to be low. It will commonly be found that the form of body which to the eye gives the best proportions between head, chest, abdomen and limbs, is the one in w^hich the health- standard is highest and the prospect of longevity greatest. 3. Owing to the inherent good quality of the nutritive processes, those degenerative changes which, in advancing years, always more or less diminish the elasticity of the arterial coats and of other parts, are slow to occur, so that the pulse retains, in great measure, its softness and the thorax its vital capacity, while stiffness of limb and general feebleness are late in their manifestation. The decadence of the teeth, which in the animal world generally sounds a death-knell, inasmuch as it deprives the body of the means of obtaining its subsistence, does not seem to augur much in the case of civilised man, to whom the teeth are less directly needed for his maintenance ; while another cuticular appendage, the hair, seems to share, to some extent, the enduring quality of the rest of the system. 4. To this natural long-livedness must be added the fair opportunities for the career of the body through the ascending and descending stages of the course assigned to it. That course will not be exceeded, but it may be, and usually is, curtailed. Indeed, as we know, even in those 138 PAST LIFE-HISTORY OF endowed with the greatest perfection of physique, the natural life-period is, owing to a variety of circumstances more or less unfavourable and often unavoidable, rarely completed, and the normal processes of decay and dis- solution are seldom allowed to have their regular course. In the domain of Nature, as I have before said, these processes are not suffered to advance very far, for the simple reason that the weakness associated with them causes the animal to fall a victim to some one of the various methods of killing which may, hence, be said to constitute the natural manner of death. Under the saving influences of civilisation, by which the rough and ready law of killing is modified, that which most contributes to the proloncration of life and the consummation of the inherited period, is "temperance in all things," especially in eating and drinking, and above all in alcoholic drinking,, and to a large extent also in meat-eating. If the world did but realise, and would have the good sense and self- restraint to act upon the knowledge, that a large pro- portion of the ills to which man is regarded as the heir,, and which are therefore looked upon as inevitable, are simply the result of excess in eating and drinking, a great addition would be made to the average term of human life and health, as well as a great economy in the consumption of the materials — the food-stuffs — by which life is sus- tained. This saving would probably more than compen- PERSONS BETWEEN 80 AND 100. 139 sate for the additional requirement made by the addition to life. Under the term "excesses" must especially be included those small day-by-day superfluities which attract little attention and are thought little of, but the in- sinuating evil of which accumulates surely, inducing often,, in the first instance, a sense of weakness; and this is thought to imply a need for more of that food or stimulus which is in reality the cause of the weakness. Thus are gradually sown the seeds of disease the true cause of w^hich is overlooked and which is therefore attributed to some other cause. "Temperance" is the great lesson under this head which our tables teach ; and its import- ance, overshadowing as it does all others, is a reason for not now diverting attention from it by mentioning them. I would not restrict temperance in drinking to tem- perance in alcoholic drinks alone, but to the consumption of fluids of all kinds, which should be limited to the requirements indicated by natural thirst. By ^natural thirst' I mean the thirst of the natural or healthy body, which gives the true indication of the amount of fluid that is required to maintain the softness, suppleness, and func- tional activity of the tissues as well as to supply the loss by the kidneys and skin incurred in the processes of draining away effete materials and regulating temperature. In the ordinary working of the healthy body thirst is slight, and healthy persons are scarcely conscious of it. 140 PAST LIFE-HISTORY OF But it is liable to be increased by indulgence, and may become a dominating sensation, or an irresistible craving, in those who yield frequently to the desire to assuage it ; and the passage of too much liquid through the system is injurious in a variety of ways, producing waste of material, weakening of the nutritive processes, and causing excess of wear in various organs. For this reason I have never regarded with an altogether favourable eye the ' drinking fountains ' and ' temperance stalls ' which well-meaning people place in our streets, having some apprehension that the facilities for drink thus afforded will promote thirst which in itself is no good omen and which probably will not always be satiated with w^ater and other so-called 'temperance' drinks. 5. To the recovering power — the good and often the quick recovering power — of the aged after operations, fractures and other accidents, ulcers, inflammatory and other affections, manifested in many of the returns, I have already, and perhaps sufficiently, directed attention. In confirmation of these observations, many cases have been published in the Medical Journals, and others have been privately communicated to me by medical men living in various parts of the kingdom. 6. Our returns give general evidence of the comfort and happiness of old age and of quiet enjoyment of the faculties and opportunities that remain, without the pain PERSONS BETWEEN 80 AND 100. 141 of remorse at those which are lost. Xot unfrequently there is much cheerfulness and merriment, and often much, even increased, enjoyment of the beauties of nature. One friend writes to me that this grows with him year by year: and I have often observed that this applies rather to limited scenery, to appreciation of the charms of a garden, the green landscapes of England, the quiet nooks and dells of the Lake district, such as Wordsworth in his later time loved, rather than to the big hills and the grand outlines which fascinate younger eyes and offer irresistible, too often dangerous, temptations to younger limbs. The former, especially when cheered and warmed by sunshine, are more in harmony with the feelings of the aged, whose thoughts, divested of the stress of life's work, are free for their appreciation. Indeed, when the body remains sound, and when the aspirations are, as commonly is the case, toned into relation with its diminishing capabilities, when the surroundings are favourable, and the mind, freed from the struggle of the world, can enjoy calm reflection on the past and the future, and by a genial sympathy with others can fulfil the mission which remains to it here of promoting peace on earth and good will among men, the declining days are often the happiest ones of the long life. Finally, when the developmental processes have carried the body through the stages of its allotted span, the gradually thinning thread of life yields without a snap,, and the aged one passes contentedly and gently away. CHAPTEE VIII. THE MALADIES OF OLD PEOPLE. The following remarks, like the reports in the two pre- ceding Chapters, are based upon the analyses derived from the accounts of 824 persons, between eighty and a hundred (340 men and 282 women between eighty and ninety, and 92 men and 110 women between ninety and a handred). I may first observe that, with regard to Diseases and Failures of Particular Organs, the proportion of immunities from them was in favour of the women, amounting to 55 per cent., as compared with 35 per cent, in the case of the men. The affections of the urinary organs especially preponderate, as we might expect, in the men. They are, indeed, more than twice as frequent in the men than in the women, amounting to 42 per cent., whereas in the women they were only 20 per cent. In the women, brain- affections are more frequent than in the men, being in the proportion of 16 per cent, in the women to 7 per cent, in the men. But the failures in the heart and THE MALADIES OF OLD PEOPLE. 143 in the lungs are about equal in the two sexes. It is worthy of note that 85 per cent, of the whole number are reported to be free from any evidence of rheumatic affec- tions of the hands. The hands were selected for observa- tion because their condition is readily ascertained and because that is a fair gauge of the rest of the system. Of the various maladies, Bronchitis is the domina- ting one, and, superadded to debility, it is oftener than any •other assigned as the cause of death. It is, indeed, in- cluding the common winter-cough, a very frequent malady in this climate at all times of life. In the aged it is liable to become persistent ; and a slight increase coming upon the enfeebled circulation and general weakness of the old person often produces a fatal result. The demands on the activity of the respiratory functions are, it is true, diminishing in the aged in proportion to the diminished activity of the nutritive and other processes ; but the respiratory capacity, which depends much upon the elasti- city of the thoracic walls and of the pulmonary tissue, is liable to diminish in still greater ratio. Hence the res- piratory movements, which are in great measure (the movement of expiration more particularlj'') the resultants of elasticity, are performed incompletely and with effort, the chest as a consequence permanently maintains more and more of the expanded or i?2spiratory state, and the expulsion of mucus from the air-passages is effected 144 THE MALADIES OF OLD PEOPLE. with difficulty. Thus a continual source of irritation is provided, which, on slight provocation, extends into the smaller bronchial tubes, and is reluctant to quit its hold there. In a few of our old people the affection was habitual, and had been so for years. In some there had been recurrences of attacks of considerable severity, with complete recovery, at a very advanced time of life. It will probably accord with general experience that some combination of sedative with stimulant medicines affords more relief in these cases than any other treat- ment. Bronchitis being thus one of the chief enemies of aged people, it is by guarding against the exposures which induce it, by keeping indoors or even in bed in bad weather, by residence in mild climates and by various suitable precautions, that the span of life may be much prolonged. Common observation proves this in the case of those who are in comfortable circumstances ; and the experience of the union-houses, where much kindly care is taken of the aged, shows it in the case of the poor. With regard to the HEART we do not get much evidence of disease. Some irregularity or intermission of pulse was noted in about a fifth of the cases observed. In a few there were stethoscopic indications of valvular disease without any other symptoms. Whether the oedema of the legs observed in certain cases, and which we are familiar THE MALADIES OF OLD PEOPLE. 145 with as an occasional temporary affection in old people, is attributable to an imperfection in the heart, or to some other cause, I do not know. A knotty condition of the Arteries, indicative probably of calcareous degeneration, is reported in 12 per cent. The large proportion in which the arteries are stated to be soft and compressible, in other words to have un- dergone little or no change, is important in relation to the view that it is in morbid change of the arterial coats that the seeds of disease and early decay are so commonly laid. This indeed appears to constitute, in many cases, one of the earliest, the most notable, and the most im- portant, of the senile degenerative changes, and it has been said with some truth, that a man is as old as his arteries. The thickening and loss of elasticity of the arte- ries, still more the atheromatous and calcareous changes in them, and the consequent interference with the blood- current through the affected vessels, necessarily lead to impaired nutritive conditions in the various tissues, with liability to atrophic, fatty, inflammatory, hsemorrhagic, can- cerous, gangrenous, and other sequences, and thus consti- tute, directly or indirectly, the most common cause of premature death in those who have passed the middle period of life. If these changes in the arterial walls are attributable, as they are regarded by some pathologists to be, and as they in some measure probably are, to direct H. c. 10 146 THE MALADIES OF OLD PEOPLE. contact with and irritation by morbid constituents in the blood flowing through the vessels, this cause of senile decay must be referred back to imperfection in the blood- making and digestive processes, — those processes, that is to say, which commencing in the mouth are continued in the stomach, the intestinal canal, in the lymphatic system and in the blood itself, and to which the salivary glands, the pancreas and the liver, as well as the kidneys and skin, and indeed all the secretory and excretory organs contribute their share. Further, the practical point is that these digestive and blood-forming imperfec- tions are, in no small measure, engendered by our indis- cretions in subjecting the organs concerned to undue trial by the quality, and no less by the quantity, of the food and drink with which they are expected to cope. The confirmation of all this is found in the fact that so many of our aged people are stated to have been moderate in their demands on these organs and, in other words, to have been temperate in eating and drinking, and thus to have retained these organs, as well as the arterial system, in a sound, healthy condition throughout their long lives. True, as years go on, the nutritive force of all the tissues slowly fades, and, in the normal condition, this takes place in all alike, that is, in equal degree. But it seems that the blood-vessels are liable to take the lead in this failure, induced thereto probably, as just said, by THE MALADIES OF OLD PEOPLE. 147 morbid states of the blood and inducing in their turn a lowered vitality, with predisposition to disease, in the parts supplied by them. The Brain-affections, and the recoveries from them in old people, are among the most remarkable of their maladies. We are all familiar with the fact that passing attacks of unconsciousness, whether they depend upon temporary congestion or other circulatory disturbances, or upon mere suspension of cerebral activity, or other cause, are by no means uncommon, and, though sometimes very alarming, leave often no permanent diminution of mental power. The impairment or loss of motor power in some part, as a limb, is, of course, a serious addi- tion, forasmuch as it commonly indicates a lesion or decided failure in some locality of the brain, probably of the same nature as that which we find in similar attacks in less advanced age; and a paralytic seizure not infre- quently ends the long but not necessarily strange or eventful history. But we are surprised to find how even these attacks in the aged are not infrequently more or less recovered from. Thus 25 cases are given in which brain-attacks associated with paralysis, in most instances hemiplegic, and in some also with convulsions and uncon- sciousness, were in greater or less degree recovered from. In some the recovery was complete. One man had three attacks of paralysis, at 82, 85, and 86 ; and one woman, 10—2 148 THE MALADIES OF OLD PEOPLE. in addition to several attacks of unconsciousness, had left hemiplegia and convulsions at 78, paralysis of the left hand at 82, and severe apoplexy at 89, after which she was able to get about again, though with weakened mind and a liability to epilepsy. While considering this point we do not forget (as mentioned at p. 20) that in the aged person the brain is gradually and progressively shrinking, and the interspace between it and the skull caused by this shrinkage is being filled by fluid-effusion in the subarachnoid or pia mater-tissue ; and there may be temporary irregularities and imperfections in this compensating adjustment of pressure of fluid on the surface and of the blood circulat- ing in the interior, which would, to some extent, account for these cerebral attacks and also for the recoveries from them. The senile alterations in the coats of the cerebral arteries must also be an important item ; but our knowledge of the physiology of the cerebral circulation is at present scarcely sufficient to enable us to make clear deductions respecting its pathology. In only 11 out of the 340 returns of men between 80 and 90, and in only 1 of the 92 returns between 90 and 100, is Prostatic Disease said to have existed. In one of these it had existed several years, and in others two, three, and four years respectively. In one the affection is said to have given less trouble than formerly. The THE MALADIES OF OLD PEOPLE. 149 condition of retention relieved by frequent use of the catheter may be extended with care over many years; but the enlargement of the prostate, with its associated bladder-symptoms, is, I fear, a malady from which re- covery, even in old age, is scarcely to be expected. It is something to find that our reports confirm the view (p. 25) that it is a malady from which age gives, after 70, a gradually-increasing exemption. The enlargement of the prostate gland is apparently the result of a degenerative change, resembling the senile thickening of the arterial coats, consisting, that is to say, like it in a substitution of a continuous increment of a low fibroid tissue in place of the natural structures and occurring in this instance in and about the walls of the ducts, while the calibre of the ducts, like that of the arteries, becomes increased and their terminal parts, or acini, become dilated and sacciform. What may be the real relation, as cause or effect, between the two pheno- mena — the thickening of the duct- walls and the enlarge- ment of the duct-calibre — is not easy to say. The change further resembles that in the arteries and probably also other degenerative changes, such as calcification of the costal cartilages, with respect to the period of life at which it most commonly takes place, viz. about 60, the liability diminishing after 70. Again, as in the case of the arteries, the ill effects of the change are chiefly manifested, not so 150 TEE MALADIES OF OLD PEOPLE. much in the part primarily affected, as in parts somewhat distant and dependent on or associated with it. Thus the enlargement of the prostate may go on long and to consider- able extent without deleterious consequences, provided the bladder and kidneys are not injuriously influenced by it. Fifty-two were troubled with Rheumatism in some of its many forms, which include pains in the limbs, aching in the bones, etc., for which, I suppose, a remedy is not very easily to be found. Indeed, it is difficult to define precisely, or clearly account for, the various pains, rheumatic and other, which old people often complain of, and which disturb their comfort without materially affect- ing their health. The women suffer from these even more than the men, probably in consequence of the nervous system in them being more on the alert. These various pains are included here under the head of ' rheumatism ' because they are so described, the \yord covering as we know a multitude of pains, rather than because they are rightly so classified. Probably the term "senile pains" would be more appropriate. They, as well as the stiffness of joints associated with old age, are not unlikely due to the deficiency of moisture and consequent want of sup- pleness in the joints and various tissues. Possibly also there may be some degenerative changes in the nerves. Five of the men and six of the women had GoUT, all these being between 80 and 90. THE MALADIES OF OLD PEOPLE. 151 Two cases of Senile Gangrene were noted. They w^ere in men above 90. The severe forms of Malignant Disease are not fre- quent. One man, above 80, had rapidly advancing sarcoma of the shoulder ; 5 women, between 80 and 90, had cancer of the breast ; 5 men and 1 woman had epitheli- oma; and 1 man and 1 woman had rodent ulcer. None of these maladies are mentioned in the men or women above 90. Still, although the very aged appear to be less liable to some of the more severe diseases, such as cancers and diseases of the urinary organs, they are, on the whole, rather more liable to a variety of ordinary and slight maladies, the proportion of those above 90 who were altogether exempt from malady being 84 per cent., while the proportion of those between 80 and 90 was 43 per cent. With regard to the Eyes, 8 per cent, are stated to suffer from cataract, 80 per cent, are said to have good sight, although 83 per cent, use glasses. Some have used glasses for many years, which is confirmatory of what I said in the account of the centenarians (p. 45), that "the occurrence of presbyopia does not seem to be associated with, or to be a prelude to, inconvenience or impairment of sight beyond that which may be corrected by glasses." The more frequent failure of the organ of Hearing, 152 THE MALADIES OF OLD PEOPLE. which is noted in more than one-half (56 per cent.) of the returns, is probably due in great measure to the liability to impairment of the delicate mechanism of the middle ear — the tympanum with its membrana tympani, its ossicles with their joints, its muscles, its Eustachian tube, and its lining membrane — in consequence of colds, shocks, and a variety of causes. But in comparing the organ of hearing with that of sight, in this respect, we must not forget that the lessening of elasticity and muscular activity — which we must assume to induce defects in hearing in old persons corresponding with the visual defects classed under the term presbyopia — does not, like the latter, admit of alleviation by an easily applied physical apparatus. At least, nothing corresponding to the portable and convenient lenses for presbyopia has yet been adapted to meet the auditory defects which may be attributed to a presbyotic condition. This doubtless causes the instances of notable deafness to be out of due proportion to those of notable deficiency in vision. To make a fairer estimate between the two conditions we should compare the instances in which slight deafness occurs with those in which glasses are required. In 4 per cent, only is the Digestion said to have been bad. In 71 per cent, it is reported as good, and in the remainder moderate. Very few were troubled with con- stipation. In 62 per cent, the appetite is reported to THE MALADIES OF OLD PEOPLE, 153 be good ; and by far the greater number are stated to be good sleepers. I am continually seeing and hearing of instances con- firmatory of the inference as to the good reparative POWERS of the aged after fractures, wounds, and ulcers, which were based upon the returns furnished in reply to Collective Investigation inquiries, and which I have already published \ These inferences are so contrary to preconceived notions, indeed, to probabilities, that it takes some time and effort and frequent repetition to obtain for them a fair measure of acceptance ; but I think the reparative powers of age are becoming more ac- credited, and that we shall ere long cease to have age adduced as a reason against the hopeful, and therefore careful, treatment of fractures, wounds, and sores in the octogenarian, the nonagenarian, and even in the cen- tenarian. What is still more remarkable than the healing powers of the aged after local lesions is the reparative powers often evinced by them after illnesses, as shown by numerous examples of those between 80 and 100, and also by some of the centenarians, which have been already given (page 50). Indeed, the recoveries from severe attacks of bronchitis, pneumonia, apoplexy, and paralysis^, indicate the reparative powers after illness as well as| 1 British 3Iedical Journal of July 12tb, 1884. 154 THE MALADIES OF OLD PEOPLE. after accident to be among the most interesting of the senile features. It is certainly strange that, when the other nutritive forces are failing — wearing out, as it were — those which are concerned in the work of repair, which may be regarded as, next to development, the highest effort of nutrition, should hold their ground so well. I have already instanced some other conditions in which the same contrast is observed, notably that of the healing of the stump after separation of a part following gangrsena senilis, where the structures next to those which were unable to maintain their vitality at all often evince so much granulating and cicatrising energy. As an illus- tration of this, I have at the present time, in Adden- brooke's Hospital, a man, aged 77, with calcified arteries, in whom the right great toe and the left second toe have mortified and separated, and the parts left have healed well and soundly, the head of the metatarsal bone of the hallux being covered by a large cicatrix, which must have formed with difficulty at any period of life ; and cicatrisation is now going on rapidly on the surface left by sloughing and ulceration on the inner side of the left great toe. Attention has quite recently been drawn by Dr Harley (see Lancet of June 18th) to certain facts which seem to have a bearing upon this point. He observes that high breeding in most animals conduces to a marked diminution in the bodily recuperative capacity; THE MALADIES OF OLD PEOPLE. 155 also that the higher bodily recuperative capacity shown to be possessed by all men living in a rude state, whether as savages or gipsies or tramp-wanderers among ourselves, arises from the fact that the refining influences of civilisation materially diminish the animal recuperative capacity. We are familiar also with the great reparative powers exhibited in some of the lower animal forms as compared with those in the higher animals. It would seem that the greater sensitiveness — that is, irritability or suscepti- bility of the nervous system and of the tissues generally — which is associated with higher organisation, where we may suppose the balances of nutrition to be most delicately swung, are, in a measure, unfavourable to reparative work. We can quite conceive that the calm, quiet processes upon which it depends are less likely to proceed in an orderly and uninterrupted manner under conditions of high ex- citability, where stimulus easily engenders disorder, as in infants or children, than under lower vitality and less susceptible circumstances. Herein, possibly — namely, in the lower and slower excitability of their tissues — may be found an explanation of those recuperative powers of the aged to which I have referred, and of which it is practically important that we should take due account. I cannot close this record without bearing testimony 156 THE MALADIES OF OLD PEOPLE. to the comfort and kindness which the old people receive in the various union-houses that I have visited. They are well fed, kept warm and free from exposures, walk out when they can, and lie in bed when it suits them to do so ; and great attention is paid to their cleanliness. It was obvious that mutual attachment had grown up, in (^ most instances, between them and the master and mistress N^f the house and the medical and other attendants. It would, I think, tend to soothe the feelings of the un- willing ratepayer if he occasionally visited the poor-house and witnessed the comfort which the aged and infirm are deriving from that largest charity ever known — the English poor-law system — to which he, perhaps unwill- ingly, contributes. CHAPTER IX. ANALYSES OF RETURNS RESPECTING THE PRE- SENT CONDITION AND PAST HISTORY OF PERSONS BETWEEN EIGHTY AND A HUN- DRED YEARS OLD. For the following analyses of the returns respecting the present condition, including the habits and circumstances, also respecting the past history, including the family history, of 824 persons between the ages of 80 and 100, I am indebted to A. Francis, M.R.C.S., who also assisted me in making the tables from which the analyses were worked out. Of these persons, 340 were males and 282 were females, between the ages of 80 and 90 j and 92 were males and 110 were females between the ages of 90 and 100. The analyses are derived from the Reports sent, chiefly by medical men, in reply to the inquiries of, and upon the forms issued by, the Collective Investigation Committee of the British Medical Association. The analyses of their Present Condition and of their Past Life-History are given separately ; and, for purposes of com- parison, the analyses of the returns of the Men and Women are given separately, and each is given respectively in the decades from eighty to ninety and from ninety to a hundred. The analyses of the returns of persons over a hundred (the Cen- tenarians) were given at a pi'eceding page. 158 PRESENT CONDITION OF NO. I. ANALYSIS OF KETURNS RELATING TO PRESENT CONDITION, HABITS, CIRCUMSTANCES, ETC. Of Males, from 80 to 90. 340 Returns. Single : Married : Widowed. — 335 returns; S. 36, M. 80, W. 219. Affluent : Comfortable : Poor. — 337 returns ; A. 40, C. 138, P. 159. Fat: Spare: Average. — 333 returns; F. 37, Sp. 114, A. 182. Full-Blooded : Pale: Average. — 321 returns; F. 54, P. 57, A. 210. Strong : Feeble : Average. — 329 returns ; S. 106, F. 100, A. 123. Height. — 313 returns; average, a little over 5 feet 7 inches. Weight. — 188 returns; average, a little over 11 stone. Figure. — 299 returns ; erect 198, bent 101. YoiCE. — 325 returns. Weak, 31 ; loud 57; clear, 81 ; full, 16 ; loud and clear, 77 ; clear and full, 44 ; clear and weak, 11 ; loud and full, 7 ; loud, clear, and full, 1. Sight. — 267 returns; good, 224; cataracts (both sides), 19; cataract (one side), 3 ; failure of sight, apparently independent of presbyopia, 21; one of them had been "blind for ten years," and one had had "opaque cornese for twenty years." Glasses. — 259 returns ; none, 42 ; one of these used them formerly; 217 used glasses. In some of them the number of years during which glasses had been used was given: "All MEN FROM 80 TO 90. 159 life," 3; "many years," 17; "occasionally," \\ "for small print," 1 ; "not long," 1 ; "none till 80," 1 ; 1 year or less, 3; 2 to 3 years, 11 ; 4 to 5 years, 13 ; 6 to 7 years, 10 ; 8 to 10 years, 20; 12 to 15 years, 20; 16 to 20 years, 39; 21 to 25 years, 6; 26 to 30 years, 23; 31 to 35 years, 4; 36 to 40 years, 19; 41 to 45 years, 4; 46 to 50 years, 7; ^"l years, 1 ; €5 years, 1. Hearing. — 329 returns; good, 188; indifferent, 98; bad, 43. Joints of Hand. — 330 returns; natural, 287; stiff, 17; deformed,15; stiff and deformed, 9; Dupuytren's contraction, 2. Digestion. — 337 returns; good, 253; moderate, 72; bad, 12. Appetite. — 335 returns; good, 224; moderate, 95; bad, 16. Eater. — 320 returns; large, 24; moderate, 211 ; small, 85. Number of Meals. — 275 returns; average rather over three daily. Alcohol. — 320 returns; none, 120; little, 120; moderate, 67 ; much, 13. Animal Food. — 304 returns; none, 9; little, 182; moderate, 109; much, 4. Bowels. — 313 returns ; daily, 219; alternately, 23; irregular, 68; relaxed, 1 ; costive, 1; 3 to 4 times daily, 1. Aperients. — 294 returns; never, 85; occasionally, 1; rarely, 149 ; frequently, 59. Disposition. — 328 returns; placid, 140; irritable, 33; lethargic, 7; energetic, 100; placid and lethargic, 6 ; placid and energetic, 25 ; irritable and energetic, 17. Intellect. — 322 returns ; high, 55 ; average, 242 ; low, 25. Memory. — Past Events. — 307 returns; good, 253; moderate, 34; bad, 20. Recent Events. — 260 returns; good, 166; moderate, 56 ; bad, 38. 160 PRESENT CONDITION OF Habits. — 327 returns; active, 202; sedentary, 93; one of these "could work, but for deafness;" bedridden, 32 ; of these, one for 5 weeks, two for 6 months, one for 5 years. OuT-OF-DooR Exercise. — 306 returns ; none, 45 (including 32 who were bedridden) ; little, 81 ; moderate, 65 ; of these one works still ; short walks, 44; much, 71 ; of these one "in river daily," "two still work," one "worked until stopped by an accident 4 months ago," one "gardens," one "walks much," three "walk 3 miles," one "walks for 2 hours," one "walks and rides," two "walk 8 to 10 miles," one "walks 12 miles a day," two "hunt," one of them twice a week. Sleep. — 326 returns; good, 230; moderate, 78; bad, 18. Number of Hours. — 213 returns; average, 7f hours. Hour of Going to Bed. — 275 returns; average, about 9 o'clock. Hour of Rising. — 271 returns; average, about 7.10 a.m. Chest-Girth in Inspiration. — 167 returns; average, iittle over 36 inches. Chest-Girth in Expiration. — 167 returns; average, little over 35 inches. Only those cases are here included in which the chest-girth both in expiration and in inspiration were re- turned. Elasticity of E.ib Cartilages. — 209 returns; distinct, 106; indistinct, 103. Pulse. — 280 returns ; average, about 74 per minute. This average is rather high, owing to the frequent occurrence of chest-affections; a large number had pulse-rate below 70 per minute. Regular, Irregular. — 262 returns; E,. 201, I. 61. Large, Small. — 237 returns; L. Ill, S. 126. Compressible, Incompressible. — 261 returns; C. 208, I. 53. Arteries. — 252 returns; even, 144; visible, 7; tortuous, 19 ; tortuous and even, 9 ; tortuous and visible, 20 ; visible and MEN FROM 80 TO 90. 161 €ven, 22; tortuous, visible, and even, 2; knotty, 12; visible and knotty, 6 ; tortuous and knotty, 7 ; tortuous, visible, and knotty, 4. So that they were even in 177 cases, knotty in 29 cases, visible in 61 cases, tortuous in 61 cases. Respiration. — Number, 237 returns. Average, 20 to 21 per minute. The average is high, owing to the frequent occurrence of chest affections. Regular, Irregular. — 252 re- turns. E. 242, I. 10. ' Arcus Senilis. — 266 returns. Absent, 94; little, 98; much, 74; one of these had had arcus senilis since 44 years of age. Teeth. — 300 returns; average about 6 each; but 87 had no teeth, and one of these not for 20 years. In 282 cases the teeth were specified. Upper incisors, 235; canines, 147; molars, 249 ; lower incisors, 438 ; canines, 221 ; molars, 330. Artificial Teeth. — 195 returns. 158 did not use them, and of these 46 had not any teeth, and one had not had any teeth for 20 years, another not for 30 years ; besides these 46 cases, many others had very few teeth. 37 used artificial teeth ; for many years, 3 ; 35 years, 1 ; 32 years, 1 ; 30 years, 2 ; 28 years, 1 ; 20 years, 10; 17 years, 1 ; 15 years, 4; 12 years, 1; 10 years, 5; 9 years, 1; 6 years, 2; 4 years, 2; "yes," 3. Evidences of Failure. — 285 returns. None, 102 ; heart, 16; heart and lungs, 5; heart, lungs and brain, 1; heart, lungs, and urinary organs, 4 ; heart, brain, and urinary organs, 1; heart and urinary organs, 12; heart, lungs, brain, and urinary organs, 3 ; iTings, 29 ; lungs and brain, 2 ; lungs and urinary organs, 18; brain, 11; brain and urinary organs, 7; urinary organs, 74. In 22 cases the heart-sounds are returned as "normal." So that the heart was affected in 42 cases, the lungs in 62 H. C. 11 162 PRESENT CONDITION OF cases, the brain in 25 cases, the urinary organs in 119 cases. In the case of the urinary organs the failure was in many cases very slight, not affecting the general health (vide Micturition). Micturition. — 267 returns. Natural, 157; frequent, 14; 1 occasionally; slow, 56: incontinence, 7; one of these "for years," one for 3 months, and one "nocturnal;" quick, 1; difficult, 2 ; slow and difficult, 11, one of them "for 30 years," another used a catheter twice daily ; difficult and painful, 1 ; frequent and painful, 2 ; slow and frequent, 6 ; frequent and incontinence, 1 ; slow and painful, 2 ; slow, difficult and pain- ful, 2 ; catheterised, 6, of these, one twice daily, one 4 time& daily, one 6 times daily, one for 3 years, one daily for 40 years {vide Present Maladies). Present Maladies. — The returns are very incomplete ; in many cases only symptoms have been returned, in others failure of some organ was returned, but the nature of the failure was not stated ; in hardly any cases have details of the malady been given; the maladies have therefore been grouped in relation to the organ which appeared most affected. 278 returns ; none 89. Bronchitis. — 43 cases ; 1 frequently, 1 occasionally ; 9 chronic, and one of these for 2 years. Asthma. — 3 cases ; 1 chronic. Cough. — 5 cases. Dys'pnoe,a. — 4 cases. Emphy- sema. — 8 cases; one for 2 years. Congestion of Lungs. — 3 cases ; 1 died. PneuTUonia. — 1 case ; died. Chronic Naso- pharyngeal Catarrh. — 1 case. Debility. — 24 cases ; one for 6 months. Weak Heart. — 12 cases, 1 with giddiness and fainting. Syncope. — 1 case, occasionally. Vertigo. — 1 case. Palpitations. — 2 cases; one occasional and severe for 20 years. Dilated R^ Heart. — 1 case. MEN FROM 80 TO 90. 163 Murmurs. — 7 cases; one for 2 years; systolic at base in 2, mitral in 2 (in one of these for 10 years), mitral systolic in 1, aortic in 1. Intermittent Heart. — 2 cases; in 1 every fourth beat, in the other occasionally. Ancemia. — 1 case, for a year. Dyspepsia. — 5 cases. Diarrhoea. — 6 cases ; two occasionally, one for 3 months, one for 16 years, one for 4 days, with death. Files. — 2 cases. Fistula. — one case for 30 years. Prolajysus Ani. — 2 cases; one for 15 years. Enlarged Liver, — 1 case. Hernia. — 8 cases ; 1 double, one for 10 years, one for 55 years. Inguinal Hernia. — 15 cases; 1 double, 1 large, one large for 12 years, one large for 30 years, one for 50 years, one for 60 years. Umbilical Hernia. — 1 case. Headaches. — 1 case. Enlarged Prostate. — 11 cases; 1 for several years, three for 2, 3, and 4 years respectively, and one gives less trouble now than formerly. Cystitis. — 2 cases ; 1 died. Pus in Urine. — 1 case. Irritable Bladder. — 4 cases; one for 18 months, 1 for a few years. Atony of Bladder. — 2 cases. Gravel. 1 case. Hematuria. — 3 cases; 1 occasionally prostatic, 1 three attacks in last 6 months. Retention. — 2 cases ; 1 occasionally, 1 with death. Rheumatism. — 19 cases; one for 12 months, one of hip for 4 years. Sciatica. — 4 cases. Lwmbago. — 1 case. Gout. — 7 cases ; 1 of them in foot. Pains in Bones, — 1 case. Lame. — 1 case. Paralysis Agitans. — 3 cases. Delusions. — 1 case. Mental Depression. — 1 case. Insane, — 1 case for 60 years. Epileptic Fits. — 1 case recently, 1 fit every 2 months. Occasional Fits, — 1 case from "brain congestion." Cerebral Hcemorrhage, — 4 cases, all died; one was the "third attack at 86." Partial Hemiplegia. — 2 cases, one for 13 months, one for 4 years. Paralysis of Face and Voice, — 1 case for 6 months. 11—2 164 PRESENT CONDITION OF MEN FROM 80 TO 90. Epithelioma. — 5 cases ; three of lip ; in one of these re- moved at 84, wound healed by first intention ; one of finger, removed; one of penis and prepuce, operated on two months ago. Rodent Cancer. — 1 case, of ear. Nasal Polypi. — 1 case. Fibrous Tumour. — 1 case, size of hen's egg, over orbit, removed at 81 after 3 years' duration. Sarcoma. — 1 case of shoulder, 15 months' duration, increasing rapidly, with, little effect on general health. (Edema of Legs. — 5 cases, one for 14 weeks. Enlarged Legs. — 1 case, hard and brawny. Inflamed Legs. — 1 case. Sore Leg. — 1 case. Varicose Ulcers. — 4 cases ; one for 6 months, one for 2 years, one for 20 years, now healing; one for 6 years. Eczema. — 4 cases; one of ankle, one for 5 years. Psoriasis. — 1 case. Lupus. — 1 case, from stroke of whip. Bedsores. — 1 case. Senile Gangrene. — 4 cases, one of these of toe. Ophthal- mia. — 2 cases. • Erysipelas. — 1 case with death. One died after "4 days' feverish illness." Fracture of Femur. — 2 cases, one "impacted, one month ago." NO. n. ANALYSIS OF EETUENS EELATING TO PAST HISTOEY, INCLUDING FAMILY HISTOEY. Of Males, from 80 to 90. 340 Returns. Age when Married. — 273 returns. Average a little over 28 years of age. Duration of Married Life. — 260 returns. Average about 43|^ years. Nuniher of Children. — 269 returns; average about 6 each, but 34 had no children. Affluent, Comfortable, Poor. — 326 returns; A. 33, C. 190, P. 103. First, or Child of Parents. — 303 returns; average 3rd to 4th child. In 50 cases the number in the family was also given; in these the average position was 2nd to 3rd child, and the average number in the family was 6 to 7 children ; 72 were "1st child," and of these 10 at least were "only child ; " one was a twin, his twin sister dying at the age of 6 months ; another had twins, who were both alive at 56; years of age. Fat, Spare, Average. — 317 returns; F. 69, Sp. 100; average, 148. 166 PAST HISTORY OF Delicate, Robust, Average. — 311 returns; D. 12, E,. 189, A. 110. Health, Good, Moderate. — 315 returns; G, 304, M. 11. Often, Rarely, Ailing. — 14 returns; O. 7, K. 7. Digestion. — 325 returns; good, 307; indifferent, 17; bad, 1. Bowels. — 307 returns ; good (daily), 266 ; irregular, 12 ; costive, 25 ; relaxed, 4. Baldness. — 191 returns; early, 55; late, 135; not bald, 1. Greyness. — 248 returns; early, 58; late, 189; not grey, 1. Disposition. — 308 returns; placid, 98; irritable, 19; lethar- gic, 2; energetic, 133; placid and energetic, 35; placid and lethargic, 2 ; irritable and energetic, 19. Intellect. — 308 returns; high, 68; low, 16; average, 224. Habits. — 308 returns; active, 293; sedentary, 15. Out-of-Door Exercise. — 298 returns; little, 31; (of these one "could walk 50 miles," and one "always worked indoors"); moderate, 39 ; one of these travelled much in Germany and America; much, 228; of these 13 were great walkers, 1 walked 20 to 30 miles a day, one " 30 miles on 4 days a week," one 5 to 20 miles daily, one "50 miles, many a day;" two 10 miles daily. Besides these, six had much walking, riding, or driving, or worked hard; one was an "athlete, walked 20 miles;" one "great athlete, runner, and jumper;" two were pugilists; one "active in boyish and manly exercises;" one "much hunting;" one "hunting since 8 years old;" one "hunt- ing and shooting all his life;" one "hunting, drinking, shoot- ing, fishing;" one "in saddle as doctor for 50 years;" one "led an irregular gipsy life;" one was at sea; one "much exposed in India for over 25 years;" one was "engaged in whaling, and in India, leading an adventurous life." Hours in Bed. — 243 returns. Average. — Nearly 8 hours. MEN FROM 80 TO 90. 167 Hours of Rising. — 253 returns. Average. — A little before 6 A.M. Sleeper. — 311 returns. Good, 278; average, 26; bad, 7. Appetite. — 295 returns. Good, 289 ; indifferent, 6. Ea-TEr. — 305 returns. Large, 52; average, 194; small, 59. Alcohol. — 298 returns. None. — 28; besides these, one "never till 30," and another "none after 60." Little. — (under 1 pint) 95 ; of these, one took a quarter and one half a pint of beer daily. Moderate (1 to 2 pints). — 112; of these, six took 1 to 2 pints of beer or porter daily, one 4 glasses of wine, one half a pint of claret, one was an abstainer till 40, one "little in early life," one "much in early life," one took a little rum, one had "tendency to drink," one "much at times," one " did not take alcohol daily, but occasionally to excess; 4 pints of beer made him tipsy." Much (more than 2 pints). — 45; of these, two were "free livers," two ''much beer, free livers," one " very much beer," one " much beer regularly," two 2 to 3 pints of beer, one "2 to 4 pints of beer all his life," one 4 pints of beer daily, one 6 pints of beer often, three 3 to 5 pints of beer, one "in early life, never intemperate," one "drank heavily in early life," one "heavy drinker, able to stand large quantities," one "much of all kinds," one "much port," one "three-fourths of a bottle of Marsala for years," one "often drunk," one "freely never too much," one took 5 ounces of rum daily, one "a pint and a half of wine and spirits daily for years," one "three glasses of whisky and wine," one "6 ounces of whisky," one "drank all he could get," three "much when they could get it," one was a pub- lican, one "drank freely of rum (1 pint daily) till 46, none since," one "took 6 pints of beer and much spirits, was a great drinker till 6 years ago, never went to bed sober if he 168 PAST HISTORY OF could get beer," one "often drank a bottle of rum before breakfast when in Australia." Animal Food. — 272 returns. None. — 1. Little (under half a pound).— 107 ; one of these was "almost a vegetarian.'^ Moderate (half a pound to a pound). — 143. Much (more than 1 pound). — 21. Illnesses Undergone. — "i^ever."^ — 16 cases; one "young," one "40 years ago, severe," one "a year ago," and nine at 16, 20, 25, 34, 35, 40, 40, 50, and 74 respectively. Typhus Fever. — 1 6 cases ; one severe, one in childhood, and eight at 14, 20, 24, 25, 37, 40, 45, and 46 respectively, one in 1827, one at 40, severe, two 40 and 50 years ago respectively. Typhoid Fever. — 8 cases ; two severe at 27 and 67 respectively, five at 15, 40, 50, 55, and 60 respectively. Yellow Fever. — 1 case, twice. Scarlet Fever. — 6 cases; one "young," four at 18, 40, and 40, severe, and 65, severe. Influenza. — 1 case^ at 50. Whooping-cough. — 1 case, at 56. Small-pox, — 9 cases ; one in childhood, one slightly, one at 16, severe, one at 74, one "confluent at 19," one 77 years ago, one twice, one "in 1825 after vaccinia." African Fever. — 1 case. Ague. — 5 cases; one "prolonged" at 20, three at 40, 44, and 68. Intermittent Fever. — 1 case. Erysipelas. — 5 cases ; one "of leg often," one at 81 recovered, one severe 50 years ago. Cellulitis. — 2 cases ; one at 82 with incisions, one three times at 65, 75, and 80. Cholera. — 3 cases, one at 30. Dysentery. — 2 cases, one at 82, one in 1883. Syphilis. — 1 case. Carhuncle. — 5 cases, one had two, one 20 years ago, three at 60^ 74, and 75, the last with incisions and quick recovery. ^ Probably many of the cases designated ''Fever" and ''Typhus Fever" were " TypJioid Fever." MEN FROM 80 TO 90. 169 Brain Fever. — 2 cases at 30 and 46. Sunstroke. — 1 case at 50. Adder Bite. — 1 case. '^Cerebral Affection.'' — 1 case, 30 years ago. Rheumatic Fever. — 14 cases, two "young," two 30 and 40 years ago, nine at 20, 34, 40 (severe), 42 (severe, with complete recovery), 45, 58, 60, 63, and 65. Chorea. — 1 case. Rheumatism. — 6 cases, one twice, one 12 years ago, one for 12 years. Rheumatic Gout. — 1 case at 37. Gout. — 10 cases, one occasionally, one frequently, one frequently for 10 years, one for 17 years, one since 21 years old, with chalk stones in fingers. Sciatica. — 3 cases, one at 69. Lumbago. — 1 case. Neuralgia. — 3 cases; one at 55, one in legs with insomnia at 55 and with issues for 8 years. — Rheumatic Iritis. — 1 case, 25 years ago. Lithotomy. — 1 case, 15 years ago, removal of large uric acid calculus. Lithotrity. — 1 case, 24 years ago. Lithuria. — 1 case. Renal Colic. — 1 case, 50 years ago. Hmmatemesis. — 1 case. Jaundice. — 3 cases; one at 84 severe, one at 81 recovered. Gall-stones. — 4 cases ; one for 34 years. Hepatic Abscess. — 1 case bursting into colon at 43. Hepatitis. — 2 cases, in one two attacks at 30 and 35. Bilious Attacks. — 1 case occasionally. Hepatic Congestion. — 1 case occasionally. Colic. — 2 cases; one severe a year ago. Dropsy. — 1 case, 5 years ago, tapped 6 quarts, recovered. Diarrhoea. — 1 case at 85. Typhlitis. — 1 case at 40. Inflammation of Bowels. — 2 cases, one at 21. Hcematuria. — 1 case, 3 attacks in 6 months. Albumi- nuria. — 2 cases; one 4 years ago, one 1 year ago for a few days. Irritable Bladder. — 2 cases; one a few years ago, one from 50 to 60. Retention. — 1 case, catheterised twice daily for one month, with recovery. Difficult Micturition. — 1 case at 68, catheterised then and occasionally since. Disease of 170 PAST HISTORY OF Bladder and Prostate. — 1 case, severe, from 72 to 78, now quite well. Stricture. — 1 case when young. Diseased Hip. — 1 case in infancy, lame. Syncope. — 1 case at 74. Bled. — 2 cases; one for illness at 40, one for trans- fusion. Epistaxis. — 2 cases; severe at 30 and 73; one was thought to be dying 15 years ago. Fistula. — 1 case 50 years ago. Sarcoma of Eye. — 1 case. Abscess. — 4 cases ; one of thigh 50 years ago, one "strumous when young;" one of "shoulder at 76, recovery;" one in "side at 30, in bed 8 weeks." Bronchitis. — 23 cases; one "severe," three "severe" at 47, 60, and 84 ; two at 65 and 68 ; four 6 months, 6 months, 10 years, and 17 years ago; one "several attacks since 80;" one "3 attacks severe, with recovery at 50, 83, and 84;" one "5 acute attacks in successive winters from 77 to 82 years;" one " two attacks at 50 and 75 ;" one "several severe attacks ;" one " severe 2 years ago, recovery." Broncho-pneumonia. — 1 case at 82, recovery. (Edema of Lungs. — lease. Asthma. — 1 case for 10 years. Pulmonary Congestion. — 2 cases, at 30 and in 1875 respectively. Bronchitis and Pleuro-pneum,o- nia. — 1 case, three times in last 7 years, last at 84, good recovery. Pneumonia. — 4 cases, one "two attacks at 45 and 50," one severe 10 years ago, two at 66 and 79. Pneumonia and Pleurisy. — 1 case at 78. Pleurisy. — 6 cases; five at 16, severe, 28, 60, 72, 82 respectively. Phthisis. — 3 cases; two had " slight symptoms when young ;" a third had " haemoptysis at 40, in bed 8 weeks;" one was "delicate in early life;" one had "breakdown from anxiety, with diplopia and inter- mittent pulse at 64, with recovery;" one had "irregular heart 10 years ago, from study ; recovering with change." Epilepsy. — 2 cases ; one 20 to 30, fits in last two years, MEN FROM 80 TO 90. 171 failure of memory. Insane. — lease. Apoplexy and Paralysis. — 16 cases; one "20 years ago, partial paralysis of right arm for 5 years, recovery;" one "in 1850, with right hemiplegia;" one "convulsions on right side with unconsciousness, a year ago with recovery ; " one " fit at 79, with hemiplegia, complete recovery except of voice;" one "hemiplegia a year ago," one "left hemiplegia at 76," one "3 attacks at 82, 85, and 86;" one "paralysis at 65;" one "slight stroke at 85, slight paralysis after;" one "slight stroke lately, weak after;" one "paralysis of both legs and left arm, not unconscious, quite recovered;" one "paralysis at 84, partial recovery, died of apoplexy;" one "hemiplegia at 45, recovery;" one "hemiplegia at 84, nearly recovered ;" one "right hemiplegia and aphonia at 84, recovered." Congestion of Brain. — 1 case at 62. Slight Ailments. — 256 returns; none, 156. One was "ailing till 50," one had "feeble childhood and youth, health and appetite better after 80." Bronchitis. — 16 cases; one "several times," four chronic. Cough. — 2 cases ; one frequently. Catarrh. — lease. Asthma. — 1 case, 28 years. Dyspepsia. — 16 cases; one lately, one at 70, recovery. Bilious Attacks. — 3 cases. Giddiness. — 2 cases; one occasion- ally, one "after meals." Flatulence. — 1 case. Gall-stones. — ■ 1 case. Palpitations. — 3 cases; one occasionally, one "for 20 years." Headaches. — 3 cases ; of these one " sick headaches every 3 months," one "sick headaches frequently." Constipation. — 4 cases. Diarrhoea. — 8 cases; one "in summer," two occasionally, one has "tendency to diarrhoea," one "for 15 years, since injury to abdomen." Piles. — 3 cases. Epistaxis. — 1 case. 172 PAST HISTORY OF BheumatisTn. — 16 cases; one at 68, one *' lately, in bed 3 months." Gout. — 7 cases ; one slight, one annually for 30 years, two occasionally. Sciatica. — 2 cases. Neuralgia. — 1 case. Angina. — 1 case rarely. Ague. — 1 case. Orchitis. — 1 case occasionally. Hernia. — 6 cases ; one double, one " from infancy," one for 30 years, one "inguinal," one "right inguinal," and one "inguinal for 30 years." Dijfficult Micturition. — 1 case, few years ago, from stricture. Eczema. — 7 cases; one "of legs," one at 46, one "30 years of leg," two for 2 and 4 years, one "grocer's eczema all his life till lately." Psoriasis. — 1 case, alternating with asthma. Varix. — 1 case, many years. Ulcer of Leg. — 4 cases; one "20 years, now healed," one "for 30 years," one "from 60 to 80, now healed." Accidents. — 175 returns. None, 128. Concussion of Brain. — 3 cases; one at 62 and one at 70; the third "four times, was bled each time." Spinal Concussion. — 1 case at 34. Severe Railway Accident. — one case at 56. — Knocked Down. — 1 case at 76. Severe Fall. — 1 case, three weeks ago, scalp wound healed rapidly. Run Over. — 1 case, by a cab at 80. Severe Bruising. — 1 case at 64. Kick on Head. — 1 case when young, large depression of right frontal bone. Fracture of Skull. — 1 case at 49. Injury to Chest. — 1 case at 16, with repeated haemoptysis and venesection. Injured Abdomen. — 15 years ago, diarrhoea since. Dislocation : Shoulder. — 6 cases ; two at 65 and 79 ; three 1, 8, and 40 years ago. Ankle. — 2 cases; one at 50, one 50 years ago. Hip. — 1 case, 20 years ago. Injured Hip. — 1 case at 71, lame since. Fracture : Patella. — 2 cases ; one 8 months ago, one "mus- MEN FROM 80 TO 90. 173 cular at 78, with bony union." Ar^n and Leg. — 1 case at 45. Arm. — 1 case at 83. Leg and Thigh. — 1 case at 86; Right Humerus. — 1 case at 85. Rihs. — 5 cases; three at 64, 70 and 70, one a year ago with recovery in 3 weeks, one " 3 ribs at 58." Sternum,. — 1 case at 30. Shoulder. — 1 case, "com- pound, after 70." Leg. — 2 cases; one at 45. Thigh. — 6 cases ; one 5 years ago, one "in 1880, close to knee," one "left, at QQ^''^ one " at 83, in bed nine weeks with perfect union," two of neck of thighbone, one of them in January, 1883, the other " at 79, recovered after being in bed nine weeks." Arnpufation : Arm. — 1 case at 47. Leg. — 2 cases; one for "diseased ankle at 25," one from "accident at 46." Longevity in Family. — Taking as a standard of a long-lived family one in which of the near relations (grandparents, parents, brothers, sisters, and subject of inquiry) 4 attained the age of 70, or 3 the age of 80, we have at least 182 cases ; two of them were on mother's side only; one was returned as short- lived family. Blood-eel ATiONSHip between Parents or Grandpaeents. — 163 returns. None, 157. In two cases "grandparents were cousins," in one "maternal grandparents were first cousins," in one "paternal grandparents were cousins," in one "parents were cousins," in one "parents were first cousins." Age of Father at Birth of Subject of Inquiry. — 96 returns. Average, about 36 years of age. Age of Mother at Birth of Subject of Inquiry. — 96 re- turns. Average, about 31 years of age. Only those cases are included in which both age of father and mother are given. Diseases in Family. Cancer (malignant growths). — 44 families. 174 PAST HISTORY OF MEN FROM 80 TO 90. Consumption. — 65 families. Scrofula. — 1 family. Gout. — 30 families. Apoplexy and Paralysis after 40. — 42 families. Rheumatis'ni. — 59 families. Epilepsy. — 5 families. Insanity. — 13 families. None. — 40 families. NO. III. ANALYSIS OF EETUENS EELATING TO PEE SENT CONDITION, HABITS, CIRCUMSTANCES, ETC. Of Males, from 90 to 100. 92 Returns. Single, Married, Widowed. — 76 returns; S. 4, M. 18, W. 54. Affluent, Comfortable, Poor. — 77 returns; A. 6, C. 42, P. 29. Fat, Simre, Average. — 78 returns; F. 8, Sp. 35, A. 35. Full-Blooded, Pale, Average. — 73 returns; F. 12, P. 16, A. 45. Strong, Feeble, Average. — 76 returns; S. 31, F. 31, A. 14. Height. — 70 returns; average, 5 feet 6f inches; one, now 5 feet 6 inches, was 5 feet 9 inches; another, now 5 feet 5 inches, was 5 feet 7|^ inches. Weight. — 39 returns; average, 10 stone 9 pounds. Figure. — 70 returns ; erect, 40 ; bent, 30. Voice. — 76 returns; loud, 10; clear, 10; loud and clear, 33; clear and full, 7; full, 3; loud and full, 2; weak, 5; clear and weak, 6. Sight. — 61 returns; good, 50; Cataract (both eyes), 4, in one case at 88 years. Cataract (one eye), 1. Failure, ap- 176 PRESENT CONDITION OF parently independent of presbyopia, 6 ; in one case " blind for 20 years." Glasses. — 49 returns; none, 10; 39 wore them; of those in which period was given, many years, 3 ; 2 to 3 years, 1 ; 8 to 10 years, 5 ; 12 to 15 years, 4; 16 to 20 years, 6 ; 26 to 30 years, 5 ; 40 years, 3 ; 50 years, 2. In two cases " can read for five minutes without spectacles, and then ' goes all of a piece.' " Hearing. — 77 returns; good, 38; indifferent, 20; bad, 19. Joints. — 77 returns ; natural, 64 ; deformed, 7 ; stiff, 4 ; stiff and flexed, 1 ; stiff and deformed, 1. Digestion. — 74 returns; good, 57; moderate, 14; bad, 3. Appetite. — 74 returns; good, 52; moderate, 17; bad, 5. Eater. — 71 returns; large, 12; moderate, 46; small, 13. Number of Meals. — 55 returns; average rather over 3 each daily. Alcohol. — 73 returns; none, 21 ; little, 26 ; moderate, 26 ; 1 ^' takes occasionally a little too much." Animal Food. — 69 returns ; none, 1 ; little, 41 ; moderate, 26 ; much, 1. Bowels. — 74 returns ; daily, 49 ; three times daily, 1 ; alter- nately, 8 ; every third day, 1 ; irregular, 1 3 ; costive, 2. Aperients. — 72 returns; never, 24; occasionally, 1; fre- quently, 10 ; rarely, 37. Disposition. — 76 returns; lethargic, 1; energetic, 28; placid, 28; irritable, 12; placid and energetic, 3; irritable and energetic, 4. Intellect. — 72 returns; high, 12; average, 51; low, 9. Memory^ Past Events. — 70 returns ; good, 58 ; moderate, 5 ; bad, 7. MEN FROM 90 TO 100. 177 Memory i Recent Events. — 60 returns; good, 34; moderate, 14; bad, 12. Habits. — 75 returns ; active, 46 ; sedentary, 21 ; bedridden, 8, one for 1 year, one for 2 years. Out-of-Door Exercise. — 68 returns; none, 17, of which 8 were bedridden, 1 not out for years, 1 not for 9 years; little, 7 ; moderate, 2, one travels by train alone ; much, 3, one of these attended Norwich market as a cattle dealer a few days before death, another works in garden 3 hours daily ; short walks, 23 ; walk and drive, 2 ; walks 1 hour, 1 ; walks 2 to 3 hours, 1 ; walk one mile, 3, one of these could do so "easily at 94;" walk 2 miles, 2; walk 3 miles, 3; rides on horseback, 1; "work as labourers," 2; "works on farm," 1; one "at work in hayfield 3 days before death." Slee2o. — 70 returns; good, 47; moderate 16; bad, 7. Sleep, Numher of Hours. — 39 returns; average, 8^ hours. Hour of Going to Bed. — 54 returns; average, 8.30 p.m. Hour of Rising. — 56 returns; average, 8 a.m. Chest Girth in Inspiration. — 30 returns; average, 35|^ inches. Chest Girth in Expiration. — 30 returns ; average, 35 inches. Only those cases are included in which chest girth in both inspiration and expiration are given. Elasticity of Rib Cartilages. — 41 returns; distinct, 16; indistinct, 25. Pulse. — 57 returns; average, little over 75 per minute. Regular, Irregular. — 51 returns; E,. 38, I. 13. Large, Small. — 49 returns; L. 20, S. 29. Compressible, Incompressible. — 51 returns, C. 42, I. 9. Arteries. — 55 returns ; even, 38 ; visible, 1 ; visible and even, 2 ; tortuous, 1 ; tortuous and even, 2 ; tortuous and H. C. 12 178 PRESENT CONDITION OF visible, 5 ; knotty, 3 ; visible and knotty, 2 ; tortuous and knotty, 1. So they were visible in 10 cases, even in 42 cases, tortuous in 9 cases, knotty in 6 cases. Respiration Number. — 48 returns; average, about 23 per minute. Regular, Irregular. — 48 returns ; R. 43, I. 5, Arcus Senilis. — 55 returns; much, 13; little, 22; absent, 20. Teeth. — 69 returns; average, 4 to 5; but 27 had none, and two had "several," one had a "third set of bicuspids at 89 years of age^;" in 62 cases the teeth are specified. Upper Inci- sors, 44; canines, 23; molars, 57. Lower incisors, 60; canines, 40 ; molars, 58. Artificial Teeth. — 71 returns; ^^ did not use them, and of these 26 had no teeth, and several others very few; 5 used them ; one for 3 years, one for 10 years, one for 20 years. Evidences of Failure. — 58 returns; none, 18; heart, 1; heart and brain, 1 ; heart and urinary organs, 2 ; lungs, 9 ; lungs and urinary organs, 2 ; lungs, brain, and urinary 'organs, 1; brain, 4; brain and urinary organs, 1; urinary organs, 19; so the heart was affected in 4 cases, the lungs in 12 cases, the brain in 7 cases, the urinary organs in 25 cases. Heart sounds returned ^^ "normal" in 7 cases. Micturition. — 58 returns; natural, 32; slow, 8; frequent, 5; incontinence, 4, one partial for 18 years; difficult, 3, in one case catheter used occasionally, in one from contraction of urethra after amputation of penis. Slow and difficult, 4 ; slow and frequent, 1 ; slow, difficult, frequent, and painful, 1 ; in this case " micturition has been frequent for several years, sometimes a quarter of an hour before he can make water." 1 Probably, as in other instances in which a similar statement has been made, some stumps of old teeth, which had become covered up by the gums, reappeared. MEN FROM 90 TO 100. 179 Present Maladies. — 63 returns; none, 25. Debility. — 10 cases. Weak Heart. — 1. Mitral Bruit. 1, Senile Decay. — 1 ; died. Cardiac Dropsy. — 1. Bronchitis. — 8 cases; three slight, one for 8 years, one fatal. Cough. — 2 cases, one chronic. Emphysema. — 1. Con- gestion of Lungs. — 1 case for 2 weeks. Indigestion. — 1. Ulcer. — 1 from injury. "Gouty erysipelas and eczema." — 1 case. Hernia. — 1 case. Dementia. — 2 cases; one for a few years, one since 1847 in St Luke's. Hemiplegia. — 1 case. Brain impaired. — recently in 1, from anxiety. Senile Gangrene. — 2 cases ; 1 of foot, 1 of toe ; both died. Hheumatism. — 4 cases; 1 often, 1 of hip. Enlarged Prostate. — 1 case. Albuminuria. — One case for 6 months. Atony of Bladder. — One case for 14 years, with occasional retention. Uraemia and death, 1 case, difficult mic- turition from contraction of urethral orifice after amputation of penis for epithelioma 24 years previously. Temperature. — 3 returns; one of 95*0°, two of 96*0°; one of these "under the tongue." 12—2 NO. IV. ANALYSIS EELATING TO PAST HISTOKY, INCLUDING FAMILY HISTOEY. Of Males, from 90 to 100. 92 Beturns. Age when Married. — 62 returns ; average, 30 to 31 years of age. Duration of Married Life. — 54 returns; average, little- over 47 years. Number of Children. — 68 returns ; average, little over 7 each. Affluent J Comfortable, Foor. — 72 returns; A. 6, C. 42,. P. 24. First or Child of Parents. — 64 returns ; 18 are marked " first child," and of these one at least was " only child." In 19 cases the number in the family was also returned ; of these, the average position was about third, and the average number of the family was 7 to 8 children. One was a twin, the second born of the two, the other being a girl. Delicate, Robust, Average.— 69 returns ; D. 2, R. 47, A. 20. Health: Good, Moderate.— 70 returns ; G. 79, M. 9. Digestion. — 74 returns ; good, 72 ; indifierent, 2. Bowels. — 68 returns ; good (daily), 58 ; irregular, 3 ; cos- tive, 6 ; loose, 1. PAST HISTORY OF MEN FROM 90 TO 100. 181 Baldness. — 38 returns; early^ 12; late, 26. Greyness. — 50 returns; early 13; late, 37. Disposition. — 68 returns; placid, 18; irritable, 5; lethargic, 1; energetic, 32; irritable and energetic, 6; placid and ener- getic, 6. Intellect. — 59 returns; high, 13; average, 44; low, 2. Habits. — 72 returns; active, 70; sedentary, 2. Out-qf-Door Exercise. — 68 returns; little, 5; moderate, 6. One "worked hard, often late at night;" one was a "good walker," Much, 57; of these, six were great walkers, one *' walking four to five miles daily till 87;" one "ten to twenty miles daily, at 80 could run two miles without stopping ;" one " on horseback till 85 ; " one a " sportsman," one had "laborious occupation;" one "worked hard, often late at night;" one "had a good deal of night-work;" one "often had night-work as a coastguard;" one "a cattle-dealer, often twelve hours without food." Hours in Bed. — 44 returns ; average, 8^ hours. Hour of Rising. — 53 returns; average, 6 a.m. Sleeper. — 67 returns; good, 61; average, 4; bad, 2. Appetite. — 67 returns ; good, 65 ; indifferent, 2. Eater. — 66 returns; large, 13; average, 48; small, 5. Alcohol. — '67 returns; none, 1; little, 27; moderate, 32; one of these "took much when he had the chance;" much, 7; of these two were "free eaters and drinkers," one "took two glasses of beer and four glasses of wine daily," one " took three glasses of whisky a day," one was " often drunk and in gaol," one was " drunk about once a week," one " boasted that he smoked and drank more than any man in the town, and was most irregular in every way." Animal Food. — 58 returns; none, 1; little, 14; one of them "once a week;" moderate, 41 ; much, 2. 182 PAST HISTORY OF Illnesses TJndeegone. — 69 returns ; none, 32. "i^ever"' (typhoid?).— 6 cases; at 18, 21, 33 severe, 40, 65, and 76. Typhoid Fever. — 4 cases; one young, three at 45, 50, and 67. Yellow Fever. — 1 in West Indies. Typhus Fever. — 4 cases; one at 15, one at 45, one when young in the Peninsular war, one at 65. Ague. — 1. Erysipelas. — 4 cases; one at 60, one severe at 80, one severe, with recovery at 89, Brain Fever. — 1 underwent much venesection. Bronchitis. — 8 cases; three at 80, 88, and 96, one had twa attacks in last four years, one severe at 94 with ultimate recovery, one at 98 severe with recovery. Pneumonia. — 2 cases ; one at 75, one within last 4 years. Phthisis. — 1 had symptoms, and at 15 was at Brompton Hospital. Abscess. — 1 in back at 45. Jaundice. — 2 cases; one at 60, one when young. Fistula, —1 at 48. Epithelioma of Penis. — 1 with amputation at 70. RheuTnatism. — 2 cases, one as a boy. Glaucowja. — 1 case, in left eye. Strangulated Hernia. — 1, with operation at 84. Gangrene, — 1 of left foot at 77. Venesection. — 1, several times when young. Eczema. — 2 cases ; one acute at 90, with complete recovery. Dementia. — 1 case since 1847, in St Luke's. One had slight paralysis at 72, one slight apoplexy and hemiplegia at 89, one 3 " strokes " with temporary paralysis, one of these during last 15 years also had occasional loss of consciousness and use of left side, with quick recovery. Retention. — One 4 years ago. Atony of Bladder. — One for 14 years from over-distension, occasionally catheterised ; one ^ Those designated '■'•Fever'''' and ^'Typhus" were probably in some cases '^Typhoid." MEN FROM 90 TO 100. 183 for several years has had frequent micturition, sometimes a quarter of an hour before he can make water. Slight Ailments. — 63 returns ; none, 38. Bronchitis. — 3 cases; one slight, one chronic for 8 years. Asthma. — 1 case. Rheumatism. — 5 cases ; one slight, one at 80, unable to walk since. Gout. — 4 ; one for 20 years. Diarrhoea. — 1 lately. Piles. — 1 for 70 years. Bilious. — 1. Ague. — 1. Gravel. — 1. Renal Hcemorrhage. — one case, copious 4 times in last 20 years. Dizziness. — 2 cases; one occasionally for 10 years. Hernia. — 3 cases ; one '' all life," two for 20 and 50 years. Ulcer of Leg. — 1 case, healed at 98. Eruption on Legs. — 1. Eczema. — 1. Ailing in Youth. — 1. Accidents. — 49 returns ; none, 35. Concussion. — 1 at 84 from fall of 10 feet. Dislocated Thumb. — 1 from fall from scaffold at 81, recovered. Sprained Ankle. — 1 at 98, quick recovery. Scalp Wound. — 2 cases; one severe lately with quick recovery, one from fall at 89, healed quickly. Fracture: Ribs. — 3 cases; one at 84 with speedy recovery, one at 93 healed well. Clavicle. — Spontaneous at 90 in raising himself from chair, united. Thigh. — 1 at 82. Humerus. — 1 at 92, perfect union. Neck of Thighbone. — 2 cases; one 87 not united, one at 20 at Quatre Bras. Leg. — 4 cases ; one at 85, one compound, one both bones at 80 with recovery, one at 80 in middle, "leg slipped off fender as he sat, he did not fall, not united, quite flexible, in bed 7 weeks." Family Longevity. — Taking as a standard of a long-lived family, one in which of the near relations (grandparents, parents, brothers, sisters, and subject of inquiry) 4 attained the age of 184 PAST HISTORY OF MEN FROM 90 TO 100. 70, or 3 the age of 80, we have at least 40 cases ; one was returned as of "short-lived family." Blood Relationship between Parents or Grandparents. — 29 returns; none, 29. Age of Father at Birth of Subject of Inquiry. — 11 returns; average, 35 years of age. Age of Mother at Birth of Subject of Inquiry. — 1 1 returns ; average, nearly 32 years of age. Only those cases are included in which the ages of both father and mother are returned. Diseases in Family. — Cancer (malignant growths). — 8 families. Consumption. — 13 families. Scrojula. — families. Gout. — 8 families. Apoplexy and Paralyses after 40. — 9 families. Rheumatism. — 10 families. Epilepsy. — families. Insanity. — 5 families. None. — 5 families. In one case almost every member of family except the subject terribly addicted to drink ; in another case his son, daughter, and 4 nephews and nieces were deaf mutes. NO. V. ANALYSIS OF EETUENS KELATING TO PEE SENT CONDITION, HABITS, CIECUMSTANCES, ETC. Of Women from 80 to 90. 282 Returns. Single, Married, Widowed.— 2^0 returns; S. 32, M. 26, W. 222. Affluent, Comfortable, Poor. — 280 returns; A. 23, C. 112, P. 145. Fat, Spare, Average.— 211 returns; F. 36, S. 119, A. 122. Full-hlooded, Pale, Average. — 275 returns; F. 18, P. 104, A. 153. Strong, Feeble, Average. — 274 returns; S. 58, F. 110, A. 106. Height. — 218 returns; average, a little over 5 feet 2 inches. Weight. — 86 returns; average, about 8 stone 10|^ pounds. Figure. — 242 returns; erect, 146 ; bent, 96. Voice. — 268 returns; clear, 103 ; loud, 40; weak, 32; full, 11 ; clear and weak, 9; clear and full, 23; loud and clear, 49; loud and full, 1. Sight. — 220 returns; good, 184; cataracts, 15; failure ap- parently independent of presbyopia, 21. Glasses. — 227 returns; none, 32; 195 wore them. In some the number of years during which they were worn was 186 PRESENT CONDITION OF given ; many years, 19; 2 to 3 years, 2 ; 4 to 5 years, 6 ; 6 to 7 years, 4; 8 to 10 years, 14; 12 to 15 years, 10; 16 to 20 years, 31; 21 to 25 years, 10; 26 to 30 years, 34; 31 to 35 years, 6; 36 to 40 years, 28; 41 to 45 years, 3; 46 to 50 years, 10; 54 years, 1; 58 years, 1; 60 years, 1; 65 years, 1. Hearing. — 279 returns; good, 175; indifferent, 77; bady 27. Joints. — 278 returns; natural, 243; stiff, 12; deformed^ 13; stiff and deformed, 10. Digestion. — 280 returns; good, 169; moderate, 94; bad, 17, Appetite. — 278 returns; good, 144; moderate, 115; bad, 19. Eater, — 275 returns; large, 22; small, 105; moderate, 148, Number of Meals. — 225 returns; average, 3 to 4 daily. Alcohol. — 270 returns; none, 105; little, 117; moderate,. 44; much, 4. Animal Food. — 249 returns; none, 10; little, 164; moderate^ 72; much, 3. Bowels. — 266 returns; daily, 183; irregular, 51; alternately,, 30; costive, 1; once a week, 1. Aperients. — 265 returns; never, 58; rarely, 150; frequently, 52; daily, 3; occasionally, 2. Disposition. — 267 returns; placid, 119; irritable, 28; lethar- gic, 4 ; energetic, 93 ; placid and energetic, 14 ; irritable and energetic, 9. Intellect. — 266 returns; high, 33; low, 36; average, 197. Memory, Past Events. — 258 returns; good, 186; moderate,. 41; bad, 31. Recent Events. — 221 returns; good, 120; mode- rate, 58; bad, 43. Habits. — 275 returns; active, 128; sedentary, 100; bed- ridden, 47; of these five for 2, 3, 4, 4, 15 years respectively,, and two for 3 weeks and 3 months respectively. WOMEN FROM 80 TO 1)0. 18T Out-of- Door Exercise. — 252 returns; none, 88 (of these 47 were bedridden); little, 102; moderate, 34; much, 14; short walks, 18 (of these one walks 2 miles). Besides these, three walk 3, 4 and 6 miles respectively. Sleep. — 267 returns; good, 146; moderate, 89; bad, 32. Number of Hours. — 147 returns; average, a little over 7 hours. Hours of Going to Bed. — 204 returns ; average, a little past 9 o'clock p.m. Hour of Rising. — 202 returns; average, 7.45 a.m. Chest Girth in Inspiration. — 73 returns; average, about 31;^ inches. Expiration. — 73 returns; average, about 30^ inches. Only those are included where both inspiration and expiration are given. Elasticity of Bih Cartilages. — 139 returns; distinct, 65; indistinct, 74. Pulse. — 228 returns ; average, nearly 79 per minute ; high, owing to chest affections in many cases. Regular, Irregular. — 201 returns; R. 164, I. 37. Large, Small. — 194 returns; L. 60, S. 134. Compressible, Incompressible. — 221 returns; C. 181, I. 40. Arteries. — 211 returns; even, 138; visible, 13; tortuous- and even, 8; visible and even, 11; tortuous, 13; tortuous and visible, 6 ; knotty, 6 ; visible and knotty, 2 ; tortuous and knotty, 1 2 ; tortuous, visible, and knotty, 1 ; tortuous, visible, and even, 1; so that they were even in 158 cases, tortuous in 41 cases, visible in 34 cases, knotty in 21 cases. Respiration. — Number, 204 returns ; average, nearly 22 per minute; rather high, owing to chest complaints in many cases. Regular, Irregular. — 212 returns ; R. 198, I. 14. Arcus Senilis. — 224 returns; much, 48; little, 80; absent, 96. 188 PRESENT CONDITION OF Teeth. — 253 returns; average, little over 3 each; but 122 tad no teeth; of these, two had not had any for 40 and 55 years respectively. In 241 cases the teeth were specified. TJ'p'per incisors, 103; canines, 75; molar s^ 96. Lower incisors, 201; canines, 112; molars, 121. Artificial Teeth. — 208 returns; none, 176; of these, 89 had not any teeth, and 4 had not had any for 4, 30, 40, and 40 years respectively, and 3 had not had any "for years," and many others had very few teeth ; 32 used artificial teeth, in .some cases the number of years during which they had been worn was given. Many years, 5; 5 years, 1; 7 years, 1; 10 years, 2; 12 years, 1; 15 years, 1; 20 years, 4; 21 years, 1; 25 years, 3 ; 30 years, 4 ; 36 years, 1 ; 40 years, 1 ; 55 years (full set), 1. Evidences of Failure. — 2 28 returns; none, 117; heart, 11; heart and lungs, 6; heart and brain, 5; heart and urinary organs, 5; heart, lungs, and urinary organs, 2; heart, brain, and urinary organs, 2; heart, lungs, brain, and urinary organs, 5; in 14 cases heart-sounds returned as normal; lungs, 21; lungs and brain, 3; lungs and urinary organs, 7; brain, 18; brain and urinary organs, 3; urinary organs, 23; so that the heart was affected in 36 cases, the lungs in 44 cases, the brain in 36 cases, the urinary organs in 47 cases ; in the case of the urinary organs, the failure was often slight {vide Micturi- tion). Micturition. — 207 returns; natural, 166; incontinence, 1 3 ; slow, 1 1 ; slow and difficult, 3 ; frequent, 8 ; painful, 1 ; difficult 1 ; hsematuria, 1 ; difficult and painful, 1 ; slow, difficult, and painful, 2. Present Maladies. — 248 returns; none 91. Debility. — 34 •cases. Weak Heart.— ^. Syncope. — 2. Paljntations. — 3. Yer- WOMEN FROM 80 TO 90. 189- tigo. — 3. Angina. — 1, occasionally. '■'■Aortic Disease.''^ — 1. Murmur at Base. — 2 cases, one of them systolic. Dyspe2:)sia. — 9. Diarrhoea. — 5, one slight, one occasion- ally. Piles. — 3. Flatulence. — 2. Constijjation. — 1. Hernia. — 5, one for 40 years, one strangulated, with death three days- after herniotomy, one umbilical. Bronchitis. — 32 cases, 6 of them chronic. Cough. — 2. Emphysema. — 2. Pneumonia. — 1. Rheumatism, Rheumatic Gout. — 26 cases. Gout. — 6. Swelled Knee. — 1. Uterine Haemorrhage. — 1. Polypus Uteri. — 1. Prolapsus Uteri. — 4, one for 30 years. Irritahle Bladder. — 2. Retention of Urine. — 1. Intermittent Hcematuria. — 1, for 20 years. Caries of Rib. — 1. Lame {Hi})). — 1. Diseased Ankle. — 1, for many years. Fracture of Neck of Femur. — 2. Cancer of Breast. — 5. Epithelioma of Face. — 1. Rodent Cancer. — 1. Carbuncle. — 1, large. Periostitis. — 1. Eczema. — 3. Erythema of Leg. — 1. Sore Eyes. — 3. Sore Mouth. — 1. Eczema of Nipple. — 1 (no cancer). Ulcer of Leg, — 1. Inflamed Legs. — 1. Neuralgia {Face). — 3. Sciatica. — 2. Licmbago. — 1. Hys- teria. — 1. Paralysis Agitans. — 2. ^'Lunatic." — 1. Dementia. — 13 cases. Besides these, one with epileptic attacks, and occasional delusions and excitement, and one "light-headed for one year." Epilepsy. — 1, occasionally. Mania. — 1, chronic; well for 17 years, recurring at 57. Hemiplegia. — 6. Paraplegia. — 1. Paralysis of Left Arm, — 1. Senile Fits. — 1. Temperature. — 6 returns; in two cases "normal;" in three, 98-0°; in one, 98-2°. NO. VI. ANALYSIS OF KETUENS RELATING TO PAST HISTOEY, INCLUDING FAMILY HISTOEY. Of Females, from 80 to 90. 282 Returns. ■of age. Age when Married. — 220 returns ; average, about 26 years ige. Duration of Married Life. — 199 returns; average, nearly oyg. . Number of Children. — 228 returns ; average, 5 to 6 each, "but 43 had no children; one had "prostration at 41, from child-bearing," one " often ailing since a bad labour 46 years ;ago," one "had severe flooding at 42, with difficulty rallying," one " nursed 8 children for a year each," two *' many miscar- riages," one "7 miscarriages out of 10 conceptions," one had ^'only one child, still-born," one "early profuse catamenia, menopause at 48," one "catamenia commencing at 16, mode- rate," one "catamenia from 17 to 40, moderate." Affluent., Comfortable, Poor. — 263 returns; A. 23, C. 138, P. 102. First or — Child of Parents. — 249 returns ; average about 4th child. In 70 cases the number in the family was re- turned ; in these the average position was 3rd to 4th, and the average number in the family 7 to 8 children; 58 were "first PAST HISTORY OF WOMEN FROM 80 TO 90. 191 child," and of these 4 at least were "only child;" three were twins, and two twin brothers of one of the subjects both died over 80 years old ; the mother of one not included in above had 22 children, and the maternal grandmother of one in- cluded above had 22 children, of whom 20 grew up. Delicate, Robust, Average. — 240 returns ; D. 37, K,. 100, A. 103. Health. — 232 returns; good, 207; moderate, 25. Often Ailing, Rarely Ailing. — 26 returns; O. 25, K. 1. Digestion. — 248 returns; good, 211; indifferent, 37. Bowels. — 226 returns; regular, 184; irregular, 9; costive, 29; relaxed, 3; twice daily, 1. Baldness. — 80 returns ; early, 17; late, 61 ; none, 2. Greyness. — 210 returns; early, 53; late, 155; none, 2. Disposition. — 242 returns ; placid, 74 ; irritable, 20 ; leth- argic, 2; energetic, 128; irritable and energetic, 13; placid and energetic, 5. Intellect. — 238 returns; high, 43; average, 180; low, 15. Habits. — 234 returns ; active, 215; sedentary, 19. Out-of-Door Exercise. — 206 returns ; little, 64 ; moderate, 72, one a moderate walker; much, 59, one hard, working. Besides these, eleven others : one worked hard, one walked daily, one "good walker," one "walked 3 hours," five "took walks," one " could walk 30 to 40 miles when young," one was "never very active." Hours in Bed. — 171 returns ; average a little over 8 hours. Hour of Rising. — 196 returns; average a little past 6 a.m. Sleeper. — 232 returns; good, 188; average, 33; bad, 11. Appetite. — 233 returns ; good, 209 ; indifferent, 24. Eater. — 230 returns; large, 29; small, 63; average, 138. Alcohol. — 232 returns; none, 54; very little, 2; little, 109, one of these "none till 35;" moderate, 60, one of these "none 192 FAST HISTORY OF till 40;" much, 7, one of these was a "notorious drinker, locked up 200 times for being drunk, father died aged 90, and brother died aged 70, both heavy drinkers." Illnesses Undergone. — 231 returns; none, 111. "i^ever." ^ — 19 cases; three "young," two severe at 20 and 60, eight at 28, 30, 50, 60, 40, 60, 63, and 70 respectively. Measles. — 1 case. Tonsillitis. — 1 case. Typhus Fever. — 10 cases; 1 "young," five at 15, 20, 28, 30, and 46 respectively. Scarlet Fever. — 5 cases; two severe at 40 and 42; one at 72. Typhoid Fever. — 6 cases ; one at 42 severe, five at 1 2, 1 9, 30, 47, and 70 respectively. Influenza. — 1 case at 68. Group. — 1 case at 16, was bled excessively. Whooping-cough. — 1 case. Erysipe- las. — 5 cases ; "frequently" one and severe at 57, three of face at 20, 57, and 62 respectively. Diphtheria. — 1 case at 68. Rheu- matic Fever. — 14 cases; one twice, one prolonged at 74, one at 26, deaf since; five at 21, 24, 26, 30, and 72 respectively. Rheutnatism. — 3 cases. Gout. — 3 cases; at 31, 73, and 81. Sunstroke — 1 case at 52. Gholera. — 1 case at 30. Dysentery. — 1 case, severe, at 50. Jaundice. — A cases; three at 12, 81, and 83; all recover- ing. Enteritis. — 4 cases ; two at 44 and 80, one severe at 34. Hcematemesis. — 1 case at 60. Diarrhoea. — 2 cases ; one at 88 severe, recovered. Bilious Attacks. — 2 cases; one at 60, with gall-stones; one "severe to point of sinking." Gall-stones. — 2 cases ; one " badly when young." Gall-stones and Jaundice. — 1 case at 66. Inflammation of Liver. — 1 case at 73. Stran- gulated Hernia. — 2 cases, at 50 and 85, with death in latter. Intestinal Obstruction, 1 case at 76. Pneumonia. — 7 cases; one at d)2, recovered; one at 72, with pleurisy; one severe at 69, and four at 57, 67, 79, and ^ Some of those designated "■Fever'" and ''Typhus" were probably " Typhoid:' ^YOMEN FROM 80 TO 90. 193 80. Congestion of Lungs. — 1 case at 83. Pleurisy. — 6 cases; five at 20, 40, 50, 60, and 72. Bronchitis. — 26 cases; five at 25, 81, 86, "86 for four months," and "after 80" respectively; four severe at 62, 74, 80, and 88 respectively; two died; one 6 months ago; three "winter bronchitis" (one of them for 5 years); one 15 years ago, one at "80 with complete recovery," one 3 severe attacks at 76, 77, 78 ; one with pneumonia at 86 recovering; one had "two attacks in last 2 years." Uterine Fibroid. — 1 case. Nephritis. — 1 case at 77. Phle- bitis. — case at 75 recovering. Gangrene. — 1 case at 75 re- covering. Herpes. — 1 case at 77 never completely recovering. Glaucoma, with removal of eye. — 1 case. Feeble Heart and Anasarca. — 1 case for several years. Poisoned Hand. — 1 case, 12 years ago; laid up several months. ^^ Inflammation.^^ — 1 case at 30. Abscess. — 1 case in thigh at 57. Eczema. — 1 case for 2 years at 78; one "three years at 50." Insanity. — 1 case. Paralysis Agitans. — 1 case at QQ. Para- lysis. — 2 cases at 79 recovering, and 82. Hemiplegia. — 8 cases; one 2 years ago, one 3 years ago for a week, two at 81 and 82, both recovering; two at 77 and 78, with "partial recovery;" and two at 72 and 81. Cancer of Breast. — 3 cases; two doubtful and removed, one of them at 50, the third, "from injury 16 years before death, did not trouble her until ulcer of leg healed one year before her death." Slight Ailments. — 218 returns. None, 119. Dyspepsia. — 21 cases; one for 5 years, 1 "all her life." Bilious Attacks. — 3 cases. Piles. — 4 cases. "Spasms." — lease. Congestion of Liver. — 2 cases. Costive. — 1 case, since typhoid fever at 47. Diarrhoea. — 2 cases; one occasionally. H. c. 13 194 PAST HISTORY OF Headaches. — 7 cases; one "all her life," one "terrible from 20 to 50 years of age." Pruritus. — 1 case for 40 years. Neur- algia. — 1 case. Palpitations. — 4 cases; 1 "all her life," 1 for many years. Menorrhagia. — 1 case. Amenorrhcea. — 1 case. Hysteria. — 1 case. Prolapsus Uteri. — 2 cases. Hernia. — 5 cases; three for many, 20, and 40 years; one "femoral" for 15 years; one large umbilical. Gout. — 5 cases; one frequently, one "for 15 years." Eheumatism. — 16 cases; one for 20 years, one since 76 years of age. Bronchitis. — 14 cases; one "slight, occasionally," one "not for 10 years," one "for 10 years." Coughs. — 2 cases; one for many years. Catarrhs. — 1 case. Eczema. — 1 case. Sore Leg. — 1 case. (Edema of Legs. — 1 case, recently. Ulcer of Leg. — 4 cases; one for 8 years. Hematuria. — 2 cases; one in " 3 successive springs," one "intermittent for 20 years." Lame. — 1 case "from birth." Melancholy. — lease. Debility. — lease. Delicate. — 2 cases; one "throughout life," one "in early life." Lateral Curva- ture. — 1 case. One took |th grain of morphine daily for many years. Accidents. — 188 returns. None, 150. Burn. — 1 case, "when a child." Concussion of Brain. — 1 case at 36. Head injury. — 1 case at 79. Jarred by railway accident. — 1 case, 30 years ago. Injury to Back.— "2. cases; one at 35; one from fall, bedridden since. Fall Downstairs. — 3 cases; one at 88, one 2 years ago; her pulse, previously 60, has been 120 per minute since. Amputation: Leg. — 1 case at 50, for accident. Breast. — 2 cases; for doubtful cancer, one at 50; one recovered in 14 WOMEN FROM 80 TO 90. 195 days (Za?ice<, June, 1885). ^^ Operation for Tu7nour of Womb." — 1 case at 53. Herniotomy. — 1 case; death, 3 days later. Dislocation of Shoidder. — 3 cases, two at 70 and 79. Fracture : Neck of Femur. — 6 cases ; one 4 years ago, one "3 years ago, bedridden since;" four at 70, 81, 81, and "77 with recovery \" Thigh. — 3 cases; two at 40 and 74, one 9 months ago (Lancet, April, 1884). Arm. — 5 cases, at 6, 60, 78, 80, "70, with quick recovery." Forearm. — 2 cases; at 84, and "82, with firm union in 25 days." Wrist. — 1 case; in one wrist at 60 and in the other at 78. Rihs. — 5 cases; three at 25, 60 and 81. Patella. — 1 case at 25. Hi]). — 1 case at 57, on crutches since. Both Legs. — 1 case at 78. Com'pound Frac- ture of Leg. — 1 case 10 years ago, no lameness. Ijongevity in Family. — Taking as a standard of a long-lived family one in which of the near relations (grandparents, parents, brothers, sisters, and subject of inquiry), 4 attained the age of 70, or 3 the age of 80, we have at least 135 cases. Five families were returned as "short-lived." Relationship between Parents or Grandparents. — 134 re- turns. ISTone, 139. Parents, first cousins, 1. Parents, second cousins, 1. Age of Father at Birth of Subject of Inquiry. — 70 returns; average, rather over 33|^ years of age. Age of Mother at Birth of Subject of Inquiry. — 70 returns; average, about 29|^ years. Only those cases are included in which the ages of both the father and mother are returned. Diseases in Family. — Cancer (malignant growths). — 30 1 In this, and other cases, where recovery is mentioned, it is stated in the return to have taken place; but it is not necessarily to be inferred that recovery did not take place in the instances in which mention of it is omitted. 13—2 196 PAST HISTORY OF WOMEN FROM 80 TO 90. families. Consumption. — 75 families. Scrofula. — 1 family. Gout. — 24 families. Apoplexy and Paralysis after 40. — 45 families. Rheumatisf)!. — 53 families. Epilepsy. — 3 families. Insanity. — 28 families. None. — 21 families\ 1 This scarcely enables us to form an estimate respecting the absence of disease in the families, forasmuch as no return will have been made in many cases in which disease did not form part of the family-history. NO. VII. ANALYSIS OF KETUKNS RELATING TO PRESENT CONDITION, HABITS, CIRCUMSTANCES, ETC. Of Women, from 90 to 100. 110 Returns. Single, Married, Widowed. — 108 returns; S. 15, M. 10, W. 83. Affluent, Comfortable, Poor. — 110 returns; A. 12, C. 46, P. 52. Fat, Spare, Average. — 109 returns; F. 10, S. 62, A. 37. Full-hlooded, Pale, Average. — 104 returns; F. 7, P. 56. A. 41. Strong, Feeble, Average. — 106 returns; S. 28, F. 45, A. 33. Height. — 92 returns; average, 5 feet ^\ inches. Weight. — 28 returns; average, 8 stone 7 J pounds nearly. Figure. — 93 returns; erect, 54; bent, 39. Voice. — 105 returns; clear, 25; full, 5; loud and clear, 33; weak, 11 ; clear and full, 14; loud, 11; clear and weak, 6. Sight. — 93 returns; good, 58; cataracts, 12; one at 85, and two for 1 and 4 years respectively. Failure, apparently independent of presbyopia, 23; one blind for 2 years. Glasses. — 77 returns; none, 16; 61 wore them. In many cases the number of years during which they were worn was given. Few years, 1 ; many years, 9 ; 4 to 5 years, 2 ; 8 to 198 PRESENT CONDITION OF 10 years, 2; 12 to 15 years, 1; 16 to 20 years, 6; 21 to 25 years, 2; ^^ to 30 years, 6; 31 to 35 years, 3; 36 to 40 years, 10; 41 to 45 years, 3; 46 to 50 years, 6; 60 years, 2; 57 years, 1 ; 63 years, 1; 75 years, 1; 83 years, 1. Of those who use no glasses, two can thread a needle without; one used them from 40 to 80, but reads well without them now; one used them from 40 to 60, but reads well without them now. Hearing. — 110 returns; good, 48; indifferent, 34; bad, 28. Joints. — 107 returns; natural, 90; deformed, 7; stiff, 5; stiff and deformed, 4; slight Dupuytren's contraction, 1. Digestion. — 107 returns; good, 84; moderate, 21; bad, 2; one can "live on anything, and eat anything." Appetite. — 108 returns; good, 71; moderate, 34; bad, 3. Eater. — 101 returns; large, 10; moderate, 62; small, 29. Nuniber of Meals. — 77 returns; average, 3 to 4 daily. Alcohol. — 105 returns; none, 32; moderate, 24- little, 48; much, 1. Animal Food. — 98 returns; none, 4; moderate, 38; little, 56. Bowels. — 103 returns; once a week, 1; twice daily, 1 ; alter- nately, 8; irregular, 22; daily, 71. Aperients. — 97 returns; daily, 2; frequently, 20, in one case the "bowels never acted without;" rarely, 48; never, 27. Disposition. — 105 returns; placid, 37; irritable, 13; leth- argic, 2; energetic, 32; irritable and energetic, 14; placid and energetic, 7. Intellect. — 102 returns; high, 18; average, 71; low, 13. Memory, Fast Events. — 105 returns; good, 80; moderate, 11; bad, 14. Memory, Fecent Events. — 93 returns; good, 55; moderate, 17; bad, 21. WOMEiV FROM 90 TO 100. 199 Habits. — 108 returns; active, 48; sedentary, 33; bedridden, 27, 2 for a year, 1 for 6 months. Out-of-door Exercise. — 104 returns; none, 50, of whom 27 were bedridden; little, 25; moderate, 2; short walks, 21; one of these "walked 4 miles last week;" walk much, 4; of these, one "able to walk some miles," one "walked 3 miles within a month of her death, and walked a third of a mile to moi-n- ing service and back on the day before death ; died from a cold." Drives out, 1. Sleep. — 103 returns; good, 69; moderate, 24; bad, 10, one of these kept awake by rheumatic pains. Sleep, Nurtiher of Hours. — 59 returns ; average, about 7f hours. Hour of Going to Bed. — 71 returns ; average, little past 8.30 P.M. Hour of Rising. — 70 returns; average, about 8.45 a.m. Cliest-girth, in Inspiration. — 27 returns; average 31^ (about). Expiration. — 27 returns ; average 30|^ (about). Only those cases are included in which chest-girth in both inspiration and expiration are returned. Elasticity of Rib-cartilages. — 53 returns ; distinct, 28 ; in- distinct, 25. Pidse Number. — 78 returns ; average, nearly 80 per minute; high from chest affections in many cases. Regidar, Irregular. — 70 returns; R. 60, I. 10. Large, Small. — 72 returns; L. 20, S. 52. Cojnpiressible, hicompressible. — 75 returns ; C. 63, 1. 12. Arteries. — 71 returns; even, 54; tortuous, 1; visible, 1; visible and even, 6 ; tortuous and visible, 4 ; tortuous and even, 2 ; knotty, 1 ; tortuous and knotty, 1 ; visible and knotty, 1. So they were even in 62 cases, tortuous in 8 cases, visible in 12 cases, knotty in 3 cases. 200 PRESENT CONDITION OF Respiration Number. — 62 returns; average, 21 to 22 per minute ; higher from chest affections in many cases. Regular , Irregular. — 67 returns ; R. 65, I. 2. Arcus Senilis. — 77 returns ; much, 23; little, 25 ; absent, 29. Teeth. — 95 returns; average, a little over 2 each, but 58 had no teeth, one "none for 20 years;" one "lost teeth when young, but can eat a beefsteak as well as anyone." In 92 cases the teeth are specified. Upper incisors, 26; canines, 23; Tnolars^ 25. Lower incisors, 49 ; canines, 26 ; molars, 41. Artificial Teeth. — 96 returns; none, 85; 11 used artificial teeth, and another did so formerly. Of these for many years, 4; "from early life," 1; 10 years, 1; 30 years, 1; 45 years, 1; 50 years, 2. Evidences of Failure. — 83 returns ; none, 43 ; heart, 4 ; heart and lungs, 1 ; heart and brain, 1 ; heart and urinary organs, 2 ; heart, lungs, and urinary organs, 1 ; lungs, 3; lungs and urinary organs, 2 ; brain, 15 ; urinary organs, 11 ; so that the heart was affected in 9 cases, the lungs in 7 cases, the brain in 16 cases, the urinary organs in 16 cases. Micturition. — 79 returns; natural, 63; slow, 6; frequent, 3 ; difficult, 2 ; incontinence, 1 ; slow and diJSScult, 1 ; slow, difiicult, and painful, 1 ; difficult and painful, 1 ; difficult and frequent, 1. Heart Sounds returned as "normal" in 13 cases. Present Maladies. — 86 returns ; none, 39. Bronchitis. — 6 cases; 3 slight. Chronic Cough. — 1. Weak Heart. — 1. Syncope. — 1, slight. Anasarca. — 1, few months. (Edema. — 3 cases, of legs, ankles, and feet respectively. Valvu- lar Disease. — 1, long-standing disease; carried up and down stairs for years; breath short. Murmurs. — 4 cases, 2 "systolic," 1 "basic," 1 " basic systolic. " WOMEN FROM 90 TO 100. 201 Debility. — 13. General Decay and Death. — 2 cases. Rheu7iiatisni. — 5. Abdominal Tumour. — 1 case, dying semicomatose soon after. Tumour of Right Hypochondrium. — 1 case, for many years. Diabetes. — 1. Bilious. — 1. Constipation. — 1. Neuralgia. — 2 cases after herpes, 1 of arm after herpes a year ago, 1 for 9 months. Gastralgia. — 1. Varix of Leg. — 1. Ulcer of Leg. — 1, for 2 years. Tremors. — 1 . * ' Wanders. " — 1 . " Excitement and Illusions. ' ' — 1. '■'■Childish." — 2. Senile Dementia. — 1. Imbecile. — 1. Slight Paralysis. — 1. Senile Paralysis. — 1, for 5 years. Epi- lejytic Convulsions. — 1. Partial Left Hemiplegia. — 1. Apo- plexy and Left Hemiplegia, 1. NO. VIII. ANALYSIS OF EETUENS EELATING TO PAST HISTOEY, INCLUDING FAMILY HISTOEY. Of Women, from 90 to 100. 110 Returns. Age when Married. — 72 returns ; average, 26 to 27 years of age, and 1 married again at 81 years of age. Duration of Married Life. — 64 returns ; average, 4:2 to 4:3 years. Number of Children. — 83 returns; average, nearly 6 each, but 14 had no children, 1 of these having been married 3 times; in 1 case all labours (14) instrumental, killing most of children; 1 had 7 children, and of these 2 were twin daughters, both alive at 57 had large families, and 1 had twin boys. Affluent, Comfortable, Poor. — 102 returns; A. 14, C. 50, P. 38. First or — Child of Parents. — 80 returns ; average, fourth child ; 20 were " first child," and of these at least 1 was an "only child." In 24 cases the number in the family was also given ; of these the average position was third to fourth, and the average number in the family 7 to 8. Delicate, Robust, Average. — 95 returns ; D. 10, E.. 48, A. 37. Health : Good, Moderate. — 95 returns ; G. 90, M. 5. „ Often, Rarely Ailing. — 12 returns; 0. 10, R. 2. Digestion. — 99 returns ; good, 94 ; indifferent, 5. PAST HISTORY OF WOMEN FROM 00 TO 100. 203 Bowels. — 88 returns ; good, 77 ; costive, 9 ; irregular, 2. One " took much aperient medicine till 70 ; " another "all her life." Boldness. — 27 returns; early, 5, 1 "from eczema;" late, 22. One had much hair on chin. Greyness. — 71 returns; early, 18; late, 53. Disposition. — 97 returns; placid, 26; irritable, 9; energetic, 41; irritable and energetic, 12; placid and energetic, 8; placid and lethargic, 1. Intellect. — 92 returns ; high, 23 ; low, 3 ; average, 66. Habits. — 140 returns; active, 132; sedentary, 8. Out-of-door Exercise. — 87 returns; little, 19, one a laun- dress till 92; moderate, 28, one a bad walker; great walkers, 2 j much, 38, of these 2 were good walkers and 1 a great walker ; 1 " walked barefoot all her life, and does so all the year round;" 1 a "noted tobacco smuggler, many hardships, slept in chair 50 years without undressing." Hours in Bed. — 60 returns ; average, about 8^ hours. Hour of Rising. — 74 returns; average, about 6.15 a.m. Sleeper. — 83 returns; good, 75; average, 11; bad, 3. Appetite. — 89 returns ; good, 85 ; indifferent, 4. Eater. — 87 returns; large, 10; average, 56; small 21. Alcohol. — 92 returns; none, 22; very little, 1; little, 43; m.oderate, 24; rather free, 1 ; much, 1. Animal Food. — 82 returns; little, 38; moderate, 43; much, 1. Illness Undergone. — 93 returns; none, 42. ^' Fever \" — 2 cases; one severe at 30, one "many years ago." Scarlet Fever. — 1 case, severe at 19. Typhus Fever. 1 Some of those designated " Fever " and " Typhus Fever " were prob- ably " T^/p/ioicZ i^ever. " 204 PAST HISTORY OF — 2 cases at 27 and 42. Typhoid Fever. — 1 case at 27. Croup. — 1 case at 50. English Cholera. — 1 case at 80. Small- pox. — 1 case. Erysijoelas. — 3 cases; one severe, one of head. Chorea. — 1 case twice, at 7 and 10. Rheumatic Fever. — 6 cases; three at 18, 40, 40, two at -50, severe. Rheumatism. — 3 cases ; one at 82 for six months. Gout. — 2 cases ; one occasionally for 16 years. Diarrhoea. — 1 case. Enteritis. — 2 cases; one at 76, one at 71, with complete recovery. Hcematemesis. — 1 at 78 ; no return. Jaundice. — 3 cases; one at 60, one severe at 40. Congested Liver. — 1 at 88. Poisoned Hand. — 1 at 95. Sloughing Ulcer of Foot. — 6 months ago, quite healed. Inflammation in Side. — 1 case, twice. Pelvic Abscess. — 1 case at 45. Herpes. — 2 cases : one at 92, one of right side of head and neck at 95. Bronchitis. — 13 cases; three at 75, 78, and 96 respectively, one "several times," one "lately, severe, with recovery," one "3 times in 20 years," one "severe at 67," one "3 times, at 75, 76, and 89, with recovery from each in 3 months," one "severe at 95, with complete recovery." Pneumonia. — 5 cases ; two at 60 and 78, one " double, severe, at 94, with recovery in 6 weeks." Congestion of Lungs. — 1 at 93. SpasmodiQ Asthma. — 1 case, severe from 50 to 70, circumstances then suddenly reduced her from affluence to penury, and the asthma ceased. Valvular Disease of Heart. — 1 case, long standing, short breath, carried up and down stairs for years. Paralysis. — 2 cases; 1 at 60, complete recovery, one twice, at 85 and 90, with partial recovery. Apoplexy. — 2 cases ; in one 3 attacks, two at 83, the third at 90 with death. Paraplegia. — 1, two years ago. Hemiplegia. — 3 cases; one WOMEiV FROM 90 TO 100. 205 right, at 89, recovered use of leg, not of arm ; one had several attacks and recoveries, namely, left hemiplegia and convulsions at 78, with good recovery, paralysis of left hand at 82, severe apoplexy at 89|^ ; got about again, but mind weakened and with occasional epileptic attacks. One was "out of her mind" for a few days a short time ago, slept 14 hours, and awoke well. Slight Ailments. — 79 returns; none, 52. Bronchitis. — 3 cases. Coughs. — 2 cases; one slight, one for 20 years. Winter Cough. — 1 case. Indigestion. — 1 case, " all her life." Gastralgia. — 1 case. Bilious Attacks. — 2 cases. Bilious Headaches. — 2 cases; one when young. Headaches. — 6 cases; one of "sick head- aches," one " severe every month," one " till 60 years old," one " severe till 50 years old." Diarrhoea. — 1 case occasionally. Gravel. — 1 case, slight, lately. Eczema. — 1 case, slight. Delicate. — 2 cases; one when young. Neuralgia. — 1 case. Rheumatism. — 2 cases. Syncope — 2 cases ; one occasionally. Conjunctivitis. — 2 cases. Varix of Leg. — 1 case. Pro- lapsus Uteri. — 2 cases. Polypus Uteri. — 1 case. Iri'itahility of several Mucous Membranes. — 1 case, from 40 till death. Issue for 60 Years. — 1 case, closed 3 years ago, with gain in weight after. Frequently in Bed, and Bled because FulVblooded. — 1 case. Accidents. — 71 returns; none, 57. Falls. — 3; one "downstairs at 94, sedentary since," and two at 87 and 90 respectively. Burn. — 1 at 92, perfect healing. Contusion. — 1 severe at 34. 206 PAST HISTORY OF WOMEN FROM 90 TO 100. Fracture: Ribs. — 1 at 84. Arm. — 1, 6 years ago, rapid recovery. Thigli. — 1 at 90. Colles's. — 1 at 89, rapid union. Xeck of Femur. — 4 cases; one at 93, one died in 3 months, one "10 years ago," one "at 80, not united." Injury to Hip. — 2 cases, one at 88 with lameness since, one 6 months before death. Blood-Relationship between Parents or Grandparents. — 41 returns; none, 38. Parents, distant relations, 1 ; cousins, 1 ; first cousins, 1. Age of Father at Birth of Subject of Inquiry. — 19 returns; average, 32|^ years old. Age of Mother at Birth of Subject of Inquiry. — 19 returns; average, nearly 29 years old. Only those cases are included in which the ages of both father and mother are returned. Diseases in Family. — Cancer (malignant growths). — 15 families. Consumption. — 16 families. Scrofula. — 1 family. Gout. — 9 families. Aj^oplexy and Paralysis after 40. — 16 families. Rheumatism. — 18 families. Epilepsy. — 2 families. Insanity. — 8 families None. — 11 families. Longevity in Family. — Taking as a standard of a long-lived family one in which, of the near relations (grandparents, parents, brothers, sisters, and subject of inquiry), 4 attained the age of 70, or 3 the age of 80, we have at least 49 cases. APPENDIX. The accompanying photographs of Benjamin Atkins and Elizabeth his wife, each aged 101, are from a negative taken by the Rev. J. E,. Smith, and kindly lent by him. In March, 1889, Mr Amyot of Diss was so good as to send me photographs and some particulars of this old couple. The man died on May 9th ; and on August 2nd Dr Barnes of Eye, in Suffolk, kindly drove Mr Amyot and myself a distance of seven miles over to Brockdish to see the survivor. Both she and her husband had taken to bed at the beginning of the winter, rather for the warmth than from inability to get up, and she was still there ; a pale, thin, healthy woman with good features and healthy complexion, brisk in movement, quick of hearing, with good sight, very good appetite and digestion, daily action of bowels, pulse 80, arteries firm, breathing quick (40), perhaps increased in rate by the excitement from our visit; heart's sounds natural, teeth all gone ; a good covering of grey hair on the" head ; entirely without ailment except that she is troubled with frequency of micturition, often getting out of bed for the purpose and, on this account, getting very little sleep. Mentally she is in her dotage and could give scarcely any account of herself. She often indulges, her attendant says, who is worn out by her ministrations, loudly in language M^hich 208 APPENDIX. is far from the most becoming, and which appears formerly to have been by no means habitual to her. She has been twice married, lived forty years with her recently deceased husband, and had four children, who are all alive. Had been an industrious, good kind of woman, a spare eater, much more so than now, used to take a little beer or wine, but none latterly, never had any illness so far as the attendant, who had known her well for forty years, is aware ; was rather short and thin, but robust, strong and active. The Kev. F. R. Smith, the curate of Brockdish, informed me that the following are copies from the parish register of Syleham, in Suffolk : " Elizabeth Barber, daughter of George and Sarah Barber, baptized Feb. 1, 1789." — "Elizabeth Barber married to George Duncombe 30th June, 1816." — "Married to Benjamin Atkins Sept. 30th, 1849," the last from the Brockdish register. Mr Smith remarks that her birthday was always kept on the 6th January, and that it is therefore probable that she was a year old at the time of her baptism, as it is scarcely probable that the ceremony would have taken place when she was only three weeks old. He adds that her niece always heard that she was born in 1787. Mr Smith further told me that Benjamin Atkins, whose baptism was dated May 11, 1788 \ was of moderate height, was toothless, had good sight, hearing indifferent ; good appetite and digestion, had been three times married, first to a woman older than himself, on the second occasion to one younger, and 1 The entry to this effect in the register of the parish church of Bressing is attested by the rector of the parish: — "Benjamin Atkins used to say that he remembered his mother telling him that he was born on Whitsunday. Now in the year 1788 Easter-day was March 23, there- fore Whitsunday would be May 11th. If B. A. was not baptized on the day of his birth he must have been a year old on May 11, 1788." F. K. S. APPENDIX. 209 lately to one of the same age; that he used to go about and get up his potatoes till last winter, when he and his wife, as before mentioned, being poor, took to bed as the best mode of keeping themselves warm. A week before his death he took the holy communion, entering heartily into the service. Three days before death his appetite failed ; but, with that exception, he seemed well up to the day of his death. August 22, 1889. I went to-day to Oundle to see Stephen Coal, whose baptismal entry in the vestry of the church I saw, "March 7th, 1787, Stephen son of James and Mary Coal." He had always understood that he was more than six months old when he was baptized ; and if that be so he is now at least 103. He is reputed to be 105, and is an inmate of Laxton Hospital, where he has been for 20 or more years. He is a short, small man, about 5 ft, in height, spare and rather bent; enjoys very good health, and has no maladies except a pruriginous skin-eruption on his forearms and arms, which he has had for some time, and which keeps him awake very much at night. He takes salts (half-an -ounce) once or twice a week. He has a remarkably good appetite and digestion, eats more than any other inmate of the hospital, " nothing comes amiss to him and nothing hurts him." His voice is clear and strong, but he hears with one ear only and that imperfectly ; is of cheerful, placid disposition ; is brisk in his manner and in his answers to questions; goes out every day for short walks, and goes to church on Sundays, often staying for the evening communion. His pulse is between 60 and 70, small and soft, the artery being apparently healthy ; but the heart's action is irregular and weak, and there is a distinct systolic bruit heard over its base. Respiration is 20, regular and very gentle, attended with little expansion of the chest, which measures H. c. 14 210 APPENDIX. about 30 inclies, and the walls of which distinctly preserve their elasticity. Scarcely any arcns senilis. One upper molar remains. No evidences of failure in any organ except the heart; and micturition is "very fair." He was the youngest of five children, has lived in Oundle all his life ; was a gardener, therefore much in the open air ; led a very regular quiet life, was up early, often at three o'clock fishing ; was not a large eater ; took about a pint of beer a day, and " occasionally made himself comfortable " when with friends. Never smoked or took snufi". Was never confined to bed by illness. His father lived to 84. His mother died after a confinement. A brother lived to near a hundred, and a sister to over 90. He married at 29 and had six children. A son, set. 76, who came to see him a few weeks ago, was scarcely as vigorous as himself; and the old man is said to have given "the boy" a penny with which to buy some sweets. There is probably a little mistake as to the age of his son or his own age at the time of his marriage.^ The following remarkable statement respecting twin cente- narians is quoted in the Lancet, August 17, 1889: "On the 12th instant, at Coosat, a village near Athlone, Margaret Mulochill, 100 years of age, gave evidence at a coroner's inquest relative to the death of Honora, her twin sister. The old women lived together, and on Saturday, when Margaret went to the market, she left Honora at home in good health. On returning she found her dead on the sofa. Death had resulted from failure of the heart's action." The following scarcely less remarkable was a saying, as I am informed by his widow, of the Rev. Mr Williams of Godmanchester : "my Great Aunt sat at the head of her own table for 100 Christmas days ; she was married at 15.'' 1 He took his daily walk Oct. 10, and died Oct. 12, 1889, after one day's illness. APPENDIX. 211 PosT-MoRTEM Examination (No. 10) of a centenarian. Professor Cunningham of Trinity College Dublin has kindly sent me the following account of the Post-Mortem Examination of "James Conway ^t. 106, born 30th January 1783, died 18th April 1889. " Dr Kenny who attended him certified his death as being due to the exhaustion following an acute attack of Cystitis. ^^ Appearance of Body. Well built man of low stature — spare biit muscular. Height 5 ft. \\ in. Limbs clean and straight : chest- wall perfectly resilient. Sternitm and Costal cartilages showed none of the signs we are in the habit of associating with old age. Manubrio-gladiolar joint open ; no ossification of costal cartilages. — Lymphatic glands in axilla, groin, chest and mesentery fairly well marked — not enlarged but certainly not atrophied. — Heart small: walls thinner than usual: still they were firm and the cavities were not dilated. Valves healthy. — Lungs healthy and elastic. — Intestines with thin walls due to atrophy of muscular coat. Peyer's patches somewhat wasted. In Stomach muscular layers better marked. Liver small, 2 lbs. 1 oz., healthy. — Spleen very much reduced in size. — Pancreas very small. (N.B. Spleen, pancreas, and entire length of injected splenic artery were unfortunately all weighed together when I was in London. They weighed not quite 4 oz.) — Kidneys and Suprarenal capsules normal in appearance, size and weight. — Bladder, muscular coat greatly hypertrophied. — Prostate, size of a small orange and so soft that it broke down when the capsule was removed in the dissection of the perineum.— Coi^^er's glands very distinct and of normal size and appearance. — Prostatic and Vesical plexuses of veins not more marked than usual. — Urethra wide and healthy. — Arteries throughout the entire body slightly dilated but with no decided signs of atheroma and little loss of 212 APPENDIX. elasticity. — Muscles firm and red — very different from the oily muscles of my other centenarian [mentioned at p. 103]. — Sigmoid lateral curvature of the spine. This in a measure accounts for low stature.— -4 or ^(X showed a corresponding curvature. The Brain was firm and healthy. The cerebral convolutions were wide apart and somewhat wasted as you will see [this refers to an excellent model of the head and brain presented by Prof. Cunningham and placed in the Museum of the University of Cambridge], and the gaping fissures were occupied by watery subarachnoid fluid." The elasticity of the Thorax, the small size of the Spleen and Peyer's Glands, the healthy condition of the Arteries and the Costal Cartilages, and the wasted state of the convolutions of the Brain correspond, on the whole, with the accounts given (pages 93 to 109) of the nine other examinations of centenarians. But the Heart is stated to have been small and the Lymphatic Glands not atrophied. Prof. Cunningham tells me that this old man never took alcohol in any form, and did not smoke, that he was an industrious respectable man who spent a very large part of his life as a market gardener in the neighbourhood of London ; that he said he had been pressed into the Royal Marines about 1800 and served several years, that he remembered Nelson well and the story of Lady Hamilton, and that he had scars of what appeared to be sabre-cuts on his head ; Professor Cunningham adds that the information received from the Admiralty is that during the period of Nelson's command there was only one James Conway in the Royal Marines. He entered the service in 1796 at the age of 18. " Should this be the Conway in question he must have been 111 and not 106 years of age." The numerous examples of longevity among the Irish will APPENDIX. 213 probably have been remarked in the preceding pages ; and in the Lancet Sep. 2 1 of this year is a notice from the Keport of the Registrar General of Ireland (Dr Grimshaw), that the deaths registered during 1888 included no fewer than 208 persons (87 males and 121 females) who were stated to have been aged upwards of one hundred years at the time of their decease. Dr Grimshaw adds that "further inquiry having been made, it was ascertained that the ages of the centenarians as given in the records were in every case confirmed." Ac- cording to this report the centenarians in Ireland would amount to more than 43 per million of the population, whereas in England and Wales they are estimated at little more than 2 per million. "This" as the Lancet adds ''is certainly a startling announcement " and needs corroboration. Possibly among the senile, but still quickwitted, Irish the feature of reversion to childhood which loves to exaggerate age may be more strongly developed than it is among the slower inhabit ants on this side the Channel. Oct. 2, 1889^, I went to see Mrs Mlihlenkemp {nee Marianne Reed), set. 100, residing at 35, Markham Square, Chelsea, respecting whom Mr Shield of Chelsea had sent me information. She is a brisk, bright, chatty, withered little woman, "five feet nothing" as she says, with loud clear voice; sight rather failing but able to read a little with glasses which she has used many years ; much arcus senilis ; rather deaf ; joints of hand natural ; scarcely remembers having any teeth ; moderate appetite and digestion ; takes about an ounce of meat daily and a little wine or whiskey at night ; regular action of bowels, rarely taking medicine ; very energetic and intelligent and with excellent memory ; has not been out of the house for 1 This makes the seventy -fourth centenarian of whom an account has been given in this book. 214 APPENDIX. two years, but walks a little about the house; goes to bed about six and gets up after breakfast; does not sleep very well, thinking and pondering a good deal at night; has no malady but feels weak and short-breathed; her respiration is 36 and there is a little bronchial trouble, but the sounds of the heart are natural, and the pulse is 80, regular, rather firm, without any knottiness of the artery. She is troubled a little with incontinence of urine. She was the seventh of a family of ten, was born Sept. 10th, 1789, in London^ and has lived there the chief part of her life ; was married at 20 ; her husband lived 50 years but she had no children; was always spare ("They used to call her the fairy"), and had good health and digestion ; was a small eater, took very little meat and no beer or wine or spirit till lately, very active, an early riser and good sleeper. She broke her wrist sliding on the ice when young and her arm by a fall at 96 which united, Mr Shield says, very quickly. Her only illness was an attack of obstruction of the bowels ten years ago. Her father died at the age of 78, her mother at 70. "Most of her brothers and sisters lived into the seventies." Lord Byron, when about 12, lodged with his mother at a tailor's in Half Moon St. next door to where she lived, and was very fond of her. The children used to play together. He was a good playmate but bad-tempered ; and he and his mother quarrelled so much that the lodging-house people would not keep them. He went to Harrow and she saw no more of him. Several of the French refugee nobles lodged at her mother's house. Her husband was a Hanoverian, and 1 She says that she was baptised in St George's Church, Hanover Square ; and the following is the extract from the Kegister Book of Baptisms of that Parish : "Sep. 25 1789 Mary Anne Daughter of Joseph & Ann Eeed, born Sep. 10." She states that Joseph and Ann were the names of her father and mother ILLUSTRATIONS. 215 escaped to England when Napoleon entered liis native town; was in the service of the Duke of Kent and much patronised by him. He acted as courier to various young noblemen ; and she travelled over great part of the Continent with him. Subsequently he was made principal door-keeper at the House of Lords ; and she there became acquainted with many of the members of that house. The Duke of Wellington told her "she was the cleverest little body in the House." At the time of the fire at the Houses of Parliament she knew where the mace was to be found and was the means of saving it. She does not "much care whether her life is further prolonged or not." It is to be hoped that she may have that tranquil easy departure which is commonly accorded to those who have lived so long. ILLUSTRATIONS. Frontispiece : Photograph of Benjamin Atkins and his wife, each of whom was 101 (see page 208). Of the following Photographs the first shows the section of the Upper End of the Thigh-bone of an adult man, the form of the part, the angle of the neck with the shaft, and the structure of the interior. The wall of the bone, enclosing the medullary cavity, is seen to be thick below, to diminish in thickness as it ascends into the neck in consequence of plates separating from it which form the cancelli of the neck, head and great trochanter. A vertical series of these cancelli ascend to the ujjpermost part of the head ; they are the chief recipients of weight from the x^elvis, and serve to transmit the weight from that part to the inner side of the wall of the shaft. Others form an arch subtending the upper wall of the neck and transmitting weight from it to both sides of the wall of the shaft. The second shows a similar section from a woman reported to have died at the age of 103. There is no reduction in the size or alteration in the form of the bone. Indeed, for a woman, it is large, and the neck forms an open angle with its shaft. But it contrasts with No. 1 remarkably in the thinness of the wall of the 216 ILLUSTRATIONS. bone, which has resulted from absorption at the interior, and in the diminution of the cancelli with the consequent enlargement of the spaces between them. The bony plates which form the arch sub- tending the ujDper wall of the neck can scarcely be recognised, and the vertical series ascending to the summit of the head are much reduced in number and size. The contrast thus presented is sufficient to account for the fact that fracture in this region is common in old persons — especially in women, the angle of the neck with the shaft being at all periods of life more open in women than in men — though it is comparatively rare in adults and young persons. The Lithograph-Plate represents the Lower Jaw-bone at different periods of life : Fig. 1, at birth, when the angle is wide, the neck being nearly in a line with the body of the bone, which chiefly consists of the alveolary, or tooth-socket, part. The dental canal and the mental hole, which transmit the nerve to the teeth and the lower lip, are near the lower edge of the bone. Fig. 2 represents the jaw at about the third year. The neck is still nearly in a line with the body of the bone, and the sockets for the teeth (of the first and second dentition) still occupy a con- siderable part of its thickness. Fig. 3 is the massive jaw of an adult, in which the neck, or rather the ascending portion that carries the neck, is nearly at a right angle with the body of the bone. The latter is chiefly formed by, and derives its strength chiefly from, the s^*6-alveolary part. The mental hole is at a considerable distance from the lower edge. Fig. 4 is the jaw of an old person, apparently an old woman. It resembles the infantile jaw in the obliquity of its ascending part, but quite differs from it in that the alveolary or dental portion has disappeared and the sw6-dental part only of the body of the bone re- mains. The mental hole, indicated by a bristle, is on the upper edge. Fig. 5 rex:)resents the facial bones of an old person. The alveo- lary parts of both upper and lower jaws are quite gone. The obliquity of the neck and ascending portion of the lower jaw throws the mental part far in front of the upper jaw, and brings the chin and nose, supposing the projecting soft part of the latter to be pre- sent, into very near proximity. Permanent Photo. Colin Lunn, Cambridge. 2.— INTERIOR OF UPPER END OF ADULT THIGH-BONE. Permanent Photo. Colin Lunn, Cambridge. 3.— INTERIOR OF UPPER END OF THIGH-BONE /ET 103. 5^ CD /^^'^ '-Ti INDEX Accidents, 172, 183, 194, 205 Alcohol, 52, 57, 62, 127, 159, 167, 181, 186, 191, 203 Analysis of returns of centenarians, 55; of men from 80 to 90, 157; 90 to 100, 175; of women from 80 to 90, 185; from 90 to 100, 197 Arcus senilis, 59, 77, 161, 187 Arteries, changes in old age, 22, 59, 105, 145, 160, 177, 187, 199 Back, bent in age, 20 Bladder, disease of, 25, 48, 169 Blood-relationship of parents, 134, 173 Bones, changes in, 15, 101, 215 Brain, changes in, 24, 106, 147, 163, 169, 170 Breathing, 59 Bronchitis, liability to, 143, 162, 170, 171 Boyd's tables, 107 Cartilages, changes in age, 21, 106, 177, 187, 199, 211 Centenarians, 12, 32, 207, 213; height, average of, 56, 65 ; pulse, do. 46; respiration, do. 46; ana- lysis of, 54 ; . post-mortem ex- aminations of, 93, 211 Chevreul, M., 36 Children, number of, 40, 65, 190, 202 Civilisation prolonging life, 10 Cousins (parents), 41, 173 Crawford, Sir Charles, physique of the people, 113 H. C. Death, in old age, 5; in nature, 7; retarded by civilisation, 9 Development, ascending and de- scending through life, 2 Diet, 126 Digestion, 56, 61, 126, 152, 159, 163 Disease, exemption from, in the aged, 26; in nature, 8 Disposition, 121, 159, 166, 176, 186, 191, 198, 203 Early rising, 53 Eaters, large or small, 46, 53, 57, 122, 167 Enjoyment of life in the aged, 140 Families, 125 Family history, 67, 133, 173, 183, 195, 206 Fever, 168 Firsthngs, 41, 61, 65, 124, 165, 180, 190, 202 Fracture, spontaneous, 183 Gangrene, senile, 151 Gibb, Sir G. Duncan, observations by, 89, 96 Glands, lymphatic, in the aged, 103 Gout, 43 Habits, 50, 121, 160, 166, 177, 181, 186, 191, 199, 203 Hair, baldness and greyness, 42, 131, 166, 203 Hastings, Miss, 34 Hearing, 56, 64, 115, 151, 158, 176, 186, 198 Heart, in the aged, 105, 144 ; action of, 23, 48, 59 ; affections of, 144 15 218 INDEX. Height, see Stature Heredity, 135 Pulse, 13, 59, 66, 119, 160, 177, 187, 199 Intellect, 37, 62, 64, 131, 159, 166, Eecovery and Bepair in the aged, 176, 198 Intemperance, Dr Owen on, 128 Jaw, changes in age, 18, 216 Kidneys, 106 Life, prolongation of, 10 Longevity, requisites for, 11, 135 ,, in women, 12 ,, in family, 173 ,, among Irish, 212 Maladies, 47, 49, 60, 131, 142, 162, 168, 179, 182, 188, 191, 200, 203; recovery from, 50 Malignant disease, 151, 164 Marriage, 39, 61, 125, 158, 165, 175, 180, 190, 197, 202 Memory, 37, 57, 159, 177, 186, 198 Micturition, 48, 61, 149, 162, 169, 178, 182, 188, 200 (Edema, senile, 25, 164 Owen, Dr Isambard, on intemper- ance, 128 Peyer's glands in the aged, 103, 211 Parr, Thomas, 93 Physique, 135 ; of the people, 113 Phthisis in families of the aged, 13, 67, 174 Prostate gland, disease of, 25, 107, 149, 163, 179, 211 26, 30, 50, 67, 140, 153 Respiration, 13, 23, 119, 161, 178, 187, 200 Eheumatic affections, 43, 150, 163, 169, 172, 198,205 Roberts, Mr, physical condition of the people, 114 Rolleston, account of post-mortem examination of a centenarian, 97 Sight, 45, 56, 64, 115, 151, 158,' 175, 185, 197 Skeleton, changes in the aged, 15, 101, 215 Skull, changes in old age, 20, 101 Sleep, 46, 130, 160, 177, 187, 203 Smith, Lady, 37 Spleen in the aged, 103, 211 Stature in the aged, 13, 38, 65, 108, 111, 159, 175, 185, 197 Teeth, decadence of, 16, 44, 59, 66, 118, 161, 178, 188, 200 Temperament, 131 Temperance, 128, 138 Thigh-bone, neck of, changes in age, 19, 215 ; fracture, 28 Thorax, elasticity of, 39, 99 Titian, death of, 24 Twins (parents), 65, 124, 164, 180, 191 Weight, 114 ; of organs, 107 Women, longevity of, 12, 38 CAMBRIDGE : PRINTED BY C. J. CLAY, M.A. AND SONS. AT THE ITNIVERSITY PRESS. HAROLD W. JACOX, M. D. BY THE SAME AUTHOR. A Treatise on the Human Skeleton (including the Joints), with Two Hundred and Sixty Illustrations drawn from Nature. Eoyal 8vo. 14s. The Human Hand and the Human Foot. Fcap. 8vo. 4.S. %d. Observations in Myology, including the Myology of Cryptobranch, Lepidosiren, Dog-Fish, Ceratodus and Pseudopus Pallasii, with the nerves of Cryptobranch and Lepidosiren and the disposition of muscles in vertebrate animals. Demy 8vo. 6s. Old Age and changes incidental to it. The Annual Oration dehvered before the Medical Society of London, May 4, 1885. Crown 8vo. 2s. w^' DATE DUE hh m JiS. jLh± JiD ^ ilsjhj La hii ii >hL 4AH^^ he rig, -■(- Demco, Inc. 38-293 COLUMBIA UNIVERSITY LIBRARIES 0043055923 Humphrey Old age QP85 H88 1889 CT' • > .' ' 5 ' ' rV.;^.-, ,•<«,- V.lcW'o i -L