degeneration and fibrosis due to past infections or to coronary
arteriosclerosis are extremely common. The myocardial change is of
great importance in reducing the reserve power of the heart, so that
cardiac failure is prone to supervene in acute infections, such as
influenzal pneumonia. Chronic valvulitis akin to and associated
with arteriosclerosis is common; the mitral valve is often affected
and incompetent, with a loud systolic murmur at the apex which is
displaced outwards; but the most characteristic lesion of advanced
years is pure aortic stenosis; this is commonly regarded as part of the
arteriosclerotic process in the aorta, but, as I have often noticed,
the aorta may be remarkably healthy and even thinner than usual in old
people with extensive calcification of the valves reducing the aortic
orifice to a chink; it has indeed been thought that such stenosis
of the aortic valves may protect the aorta from strain and so from
arteriosclerosis. Although involvement of the bundle of His giving rise
to the symptom complex of Stokes-Adams disease, and angina pectoris
may complicate aortic stenosis, the presence of this valvular defect
is compatible with remarkable prolongation of life. This may be due
to the more placid life of these old patients, as is suggested by Sir
Clifford Allbutt,[215] who regards aortic stenosis as more unfavourable
in persons under 55 years of age than in their elders.
_Aneurysm of the large arteries_ is rare in the aged, although
arteriosclerosis is common. Diffuse dilatation especially of the
arch of the aorta and of the common iliacs is not infrequent, and
occasionally latent saccular aneurysms are present. In rare instances
large abdominal aneurysms causing pain or remaining latent until
rupture occurs are reported. Among 112 abdominal aneurysms collected by
Nunneley[216] 15 were over 50 years of age; these figures included 32
from St. George’s Hospital, three of them being over 65 years of age.
Miliary aneurysms are of course extremely common in the subjects of
cerebral haemorrhage.
_Spasm_, especially of arteriosclerotic vessels, may be responsible for
attacks of giddiness or faintness, particularly on exertion, and there
may be some doubt whether such symptoms are the outcome of cerebral
anaemia or of cardiac insufficiency. Frequent transient attacks of
aphasia or paralysis, due to spasm of arteriosclerotic middle cerebral
arteries, may occur in patients with high blood pressure (Peabody,[217]
Osler[218]).
_Varicosity_ either localized, like aneurysms, or throughout the length
of veins, are common, especially in the lower limbs of women who have
borne children and done much standing; this condition disposes to
varicose ulcers in the lower third of the leg, and to acute phlebitis.
As pointed out by Trousseau, who was an illustration of his own dictum,
venous thrombosis may occur in the course of intra-abdominal malignant
disease.
Though _dyspepsia_ of adult life often diminishes or passes away in
the more tranquil conditions of old age, it is common; Fenwick[219]
estimated that it occurred in 21 per cent of the population over the
age of 65. Oral sepsis may be responsible for chronic gastritis and
much debility in the old. _Constipation_ often comes on after 60
and is mainly due to atonic dilatation and failure of peristalsis
in the colon, though diminished secretion of mucus may play a part.
Prostatic enlargement has been thought to interfere with peristalsis
(Hollis[220]), and in women large fibromyomas of the uterus may have
this effect. Gerontal constipation is usually more troublesome in women
than in men. Faecal accumulation in the rectum is a frequent cause,
especially in bed-ridden subjects, of what they describe as diarrhoea,
the real significance of which may be easily overlooked unless digital
examination of the rectum is undertaken. The pecten band of fibrous
tissue arising in the submucosa of the pecten, inside the external
sphincter, narrows the anal orifice and so prevents complete evacuation
of the rectum and diminishes the size of the faeces which are generally
voided in short pieces. It is usually, but not always, associated with
internal piles and due to the attendant congestion. W. E. Miles,[221]
who described the pecten band, tells me that it may be regarded as a
pathological development of advancing years, and that he has found
that it may so reduce the anal orifice in the elderly that it is with
difficulty the little finger can be introduced. Pruritus ani, due to
piles and local congestion, is not uncommon in the aged.
_Piles_ are common in the aged and are related to the frequency of
constipation. Like other diseases, they do not give rise to discomfort
so soon or so forcibly as in younger persons. From muscular atrophy
hernia, umbilical in both sexes, in men inguinal and in women femoral,
is prone to occur.
_Gallstones_ are more frequent in advanced life, especially in women,
than at other times of life, gallstones being found after death in
about a third of persons over 70 years of age, though, as mentioned
elsewhere, biliary colic is comparatively rare in old age.
The _urinary bladder_ in cases of prostatic enlargement shows
hypertrophy succeeded by dilatation, fasciculation, and sacculation in
response to the obstruction to micturition and degeneration of the
muscular fibres. The ureters in similar circumstances become dilated,
and the incidence of cystitis and pyelonephritis is thus favoured.
_Arthritic Affections._--Although gout is due to a defect in protein
metabolism analogous to diabetes mellitus as regards carbohydrate
metabolism and to obesity as a manifestation of disordered metabolism
of fat, reference to this disease may be made here. Heredity has a
potent influence on the incidence of the disease particularly in early
life, but acquired gout is essentially a disease of the latter part
of life or the early stage of old age when degeneration is beginning.
The first attack may not occur until old age, and is then usually
mild in character, and, in Sir William Roberts’s[222] words, appears
almost as if it were an incidence of senescence. How far the various
conditions spoken of as irregular gout, goutiness, or paragouty
diseases, which are so numerous as to recall Murchison’s lithaemia,
should be regarded as gouty is uncertain, but that they depend on
disordered protein metabolism is highly probable. The connexion of
gout with infection, as urged by Llewellyn,[223] has a bearing on
the fibrositis and Dupuytren’s contraction often regarded as gouty
phenomena. Dupuytren’s contraction of the palmar fascia, which has been
thought in some instances to be secondary to arteriosclerosis of the
medulla oblongata (Jardini[224]), often accompanies the fibrous pads
on the interphalangeal joints of the fingers described by Garrod[225]
and Hale-White.[226] The tendency of focal infections, especially
oral sepsis, to become more frequent with advancing years also has a
distinct bearing on the occurrence of chronic infective arthritis of
various forms. The most characteristic is morbus coxae senilis which is
not uncommonly associated with Heberden’s nodi digitorum, and sometimes
with Morrant Baker’s cysts due to distension of synovial bursae
with fluid; it may be confused with sciatica. Heberden’s nodes are
unimportant and commonly free from attendant symptoms.
Spondylitis deformans with ankylosis of the articulations and
ossification of the ligaments of the spine, in some cases further
complicated by an extension of the process to the proximal joints of
the limbs (rhizomelic spondylitis), may occur in the aged though also
earlier in life.
_Osteitis deformans_ or Paget’s disease of bone begins as a rule in the
later half of life, the average age being 50 years. Lannelonge[227] and
Fournier[228] argued that it is a lesion due to congenital syphilis;
but although luetic periostitis and osteitis may imitate it, there is
no convincing evidence in favour of their contention.
FOOTNOTES
[1] _Thomas Linacre_, Linacre Lecture, 1908, St. John’s College,
Cambridge, by William Osler, M.D., F.R.S., Cambridge University Press,
1908.
[2] _Life of Thomas Linacre_, by John Noble Johnson, M.D., p. 344, 1835.
[3] _De Temperamentis_, _Galeni Pergamensis_, etc. (translated by
Thomas Linacre), by J. F. Payne, p. 5, Cambridge, 1881.
[4] The fourth of the five epidemics of the remarkable disease the
English Sweating Sickness between 1486 and 1551 occurred in 1528–1529,
and is regarded by Dr. F. G. Crookshank as influenza [_Proc. Roy. Soc.
Med._, 1922, xv. (Sect. Hist. Med.) 27].
[5] The portrait of Heberden in his 86th year was painted by Sir
William Beechey, R.A., who when he got to Windsor found he had
forgotten his canvas and sent for a shirt on which he painted the
picture, now in the dining-room of the Master’s Lodge, St. John’s
College, Cambridge; there are two copies in the possession of the
Heberden family, and one in the Censors’ room of the Royal College
of Physicians. For some of this information I am indebted to Mr.
W. B. Heberden and to Mr. W. Fleming, Bedell of the Royal College of
Physicians of London.
[6] The Cambridge University Press, 1913.
[7] _Vide Gentleman’s Magazine_, 1851, N.S., xxxv. part i. 205.
[8] Γηροκομία βασιλική or _The Pourtract of Old Age wherein is
contained a Sacred Anatomy, both of Soul and Body, and a Perfect
Account of the Infirmities of Age Incident to them Both_, by John
Smith, M.D., London, 1665.
[9] Maupas, _Arch. de zool. expér._, 1899.
[10] Woodruff, L. L., _Proc. Nat. Acad. Sc._, Washington, D.C., 1921,
vii. 43.
[11] Woodruff and Erdmann, _Proc. Soc. Exper. Zool._, N.Y., 1913–14,
xi. 73.
[12] Child, C. M., _Senescence and Rejuvenescence_, p. 310, Chicago,
1915.
[13] Huxley, J. S., _Journ. Microscop. Sc._, 1921, lxv. 643.
[14] Robertson, T. B., and Ray, L. A., _Journ. Chem. Biol._, 1919,
xxxvii. 455.
[15] Drummond and Cannan, _Biochem. Journ._, Cambridge, 1922, xvi. 53.
[16] Sisson and Broyles, _Johns Hopkins Hosp. Bull._, Baltimore, 1921,
xxxii. 22.
[17] Hopkins, G., _Journ. Physiol._, Cambridge, 1912, xliv. 425.
[18] Osborne, T. B., and Mendel, L. B., _Journ. Biol. Chem._, 1915,
xxiii. 439.
[19] Metchnikoff, _The Nature of Man_, English translation, 1903, p.
272.
[20] Browne, T., _Pseudodoxia Epidemica_, p. 396, 6th edition, 1672.
[21] Eugenius Philalethes, junior, F.R.S., _Long Livers: A curious
History of such Persons of both sexes who have liv’d several Ages, and
Grown Young again_, 1722, p. 27.
[22] Hufeland, C. W., _The Art of Prolonging Life_, vol. i. p. 121,
English translation, 1797.
[23] Mahaffy, J. P., _John Stearne_, An Address at the Bicentenary of
the Medical School of Trinity College, Dublin, July 1912.
[24] Bacon, R., _The Cure of Old Age and Preservation of Youth_, p. 63,
1683. Translated by R. Browne.
[25] Hufeland, C. W., _Art of Prolonging Life_, 1797, vol. i. p. 176.
[26] Flourens, _De la longévité humaine ou de la quantité de vie sur la
globe_, 1856.
[27] Cornaro, L., _Discourses on a Sober and Temperate Life_, p. 101,
English translation, 1779, London.
[28] Metchnikoff, _The Nature of Man_, p. 278.
[29] Lankester, E. Ray, _The Advancement of Science_, p. 237, 1890,
London.
[30] Easton, J., _Human Longevity_, 1799, Salisbury.
[31] The _Observer_ of March 26, 1922, contained a note on the
discovery of a tombstone in the graveyard of Lamas Street Welsh
Congregational Chapel, Carmarthen, recording the death on Nov. 14,
1831, of Ann David, aged 181 years.
[32] Sinclair, J., _The Code of Health and Longevity_, Frontispiece to
vol. i., account in vol. ii. p. 274, 1807.
[33] King, G., _Census of England and Wales_, 1911, vol. vii. p. xlvi.
[34] Hufeland, C. W., _The Art of Prolonging Life_, 1797, vol. i. p.
168.
[35] Humphry, G. M., _Old Age_, p. 126, 1889, Cambridge.
[36] Hall, G. Stanley, _Senescence: The Last Half of Life_, 1922,
London and New York.
[37] Mendel, K., _Neurol. Centralbl._, 1910, xxix. 1124.
[38] Rankin, G., _Brit. Med. Journ._, 1919, i. 63.
[39] Waterhouse, B., Letter to Sir John Sinclair in the latter’s _Code
of Health and Longevity_, 1807, i. 33.
[40] Holland, H., _Med. Trans. Coll. Phys._, London, 1813, iv. 316.
[41] Lacassagne, A., _L’Homme vers la fin de sa vie_, p. 7, 1919, Lyon.
[42] Nascher, I. L., _Geriatrics: The Diseases of Old Age and their
Treatment_, p. 18, London, 1919.
[43] Gilford, Hastings, _Med.-Chir. Trans._, London, 1897, lxxx. 17.
_Disorders of Post-natal Growth and Development_, 1911.
[44] Variot et Pironneau, _Bull. Soc. pédiat. de Paris_, 1910, xii. 307.
[45] Roy, D., _Thèse de Paris_, No. 110, 1910.
[46] _Lancet_, 1889, ii. 349.
[47] Weber, Hermann, _On Longevity and Means for the Prolongation of
Life_, 1919, 5th edition, by F. P. Weber, London.
[48] Brownlee, J., _The Use of Death Rates as a Measure of Hygienic
Conditions_, p. 51. Special Report Series No. 60. Medical Research
Council, 1922.
[49] Savage, G., _Memorial to Sir William Osler_, vol. i. p. 247, 1919,
New York.
[50] Butler, S., _Evolution, Old and New_, p. 380, 1911.
[51] Weber, F. P., _Med. Press_, London, 1920, N.S., cix. 271.
[52] Compare Fischer, Martin H., _The Unpopular Review_, 1919, ix. 323.
[53] Paget, J., “Errors in the Chronometry of Life,” in _Studies of Old
Case Books_, p. 92, 1891, London.
[54] Osler and McCrae, _The Principles and Practice of Medicine_, p.
834, 1920, New York and London.
[55] Clifford Allbutt, _Diseases of the Arteries including Angina
Pectoris_, vol. i. pp. 164–7, 1915, London.
[56] _Lancet_, 1922, i. 874.
[57] _On the Handicapping of the First-Born_, Eugenics Lecture Series,
x., 1914.
[58] Noirot, L., _L’Art de vivre longtemps_, p. 195, 1868, Dijon.
[59] Laurent, O., _Bull. Acad. de méd._, Paris, 1919, lxxxi. 835.
[60] _Annuaire internationale de statistique_, Part II., Europe,
Movement of the Population, Table 12, pp. 180–81.
[61] _Statistiska Meddelanden_, Ser. A., Band I. 1 _Dödlighets-
och Lifslangdstabeller for Åren 1816–1910 af Kungl. Statistiska
Centralbyrån_, Stockholm, 1912, p. 28. (For this reference I am
indebted to Dr. Major Greenwood.)
[62] _Public Health Reports_, Treasury Department, Washington, 1922,
xxxvii. 487.
[63] Saundby, R., _Old Age, Its Care and Treatment_, p. 21, 1913,
London.
[64] Easton, J., _Human Longevity_, p. xxvi, Salisbury, 1799.
[65] Browne, T., _Christian Morals_, Part I. Section XXXIII.
[66] Strachey, L., _Books and Characters_, p. 83, London, 1922.
[67] Finot, J., _Rev. mondiale_, Paris, 1922, xxxiii. 387.
[68] _The Mirrors of Downing Street_, by a Gentleman with a Duster, p.
165, 1920.
[69] Thompson, R. J. C., and Todd, R. E., _Lancet_, 1922, i. 874.
[70] Yeo, B., _XIX. Century_, 1883, xxiii. 390.
[71] _Vide_ F. Adams, _Genuine Works of Hippocrates_, Sydenham Society,
vol. i. p. 10, 1849.
[72] Drinkwater, H., _Practitioner_, London, 1914, xciii. 844.
[73] For a consideration of this subject see Sir Hermann Weber’s _Means
for the Prolongation of Life_, and Dr. Lapthorn Smith’s book _How to be
Useful and Happy from 60 to 90_, London, 1922.
[74] Compare Allbutt, C., _St. George’s Hosp. Rep._, 1870, v. 43, and
C. Hilton Fagge, _Principles and Practice of Medicine_, 1886, vol. ii.
p. 22, London.
[75] Lacassagne, A., _L’Homme vers la fin de sa vie_, p. 44, Lyon, 1919.
[76] Owen, I., _Brit. Med. Journ._, 1888, i. 1312.
[77] Allbutt, C., _Diseases of Arteries, including Angina Pectoris_,
vol. i. p. 250, 1915, London.
[78] Robertson, T. B., and Ray, L. A., _Journ. Biol. Chem._, 1920,
xlii. 71.
[79] Williams, L., _Minor Ailments_, p. 319, 1920, London.
[80] Sharpey-Schafer, E. A., Presidential Address, Brit. Assoc., 1912,
_Brit. Med. Journ._, 1912, ii. 589.
[81] Salimbeni et Gery, _Ann. Inst. Pasteur_, Paris, 1912, xxvi. 577.
[82] Fischer, M. H., _Oedema and Nephritis_, 1921, New York.
[83] Lumière, A., _Rôle des colloïdes chez les êtres vivants_, 1921,
Paris.
[84] Bechhold, H., _Die Kolloide in Biologie und Medizin_, Dresden,
1912.
[85] Marinesco, G., _Études histologiques sur le mécanisme de la
sénilité_, 1904; also _Presse méd._, Paris, 1922, xxx. 309.
[86] Campbell, H., _Treatment_, London, p. 153, 1909.
[87] Carrel, A., _Journ. Exper. Med._, Baltimore, 1913, xviii. 287.
[88] Loeb and Northrop, _Journ. Biol. Chem._, 1917, xxxii. 103.
[89] Carrel, A., and Ebeling, A. H., _Journ. Exper. Med._, Baltimore,
1921, xxxiv. 599.
[90] Robertson, T. B., and Ray, L. A., _Journ. Biol. Chem._, 1920,
xlii. 71.
[91] Nathan, _Ann. de méd._, Paris, 1922, xi. 59.
[92] Drew, _Brit. Journ. Exper. Path._, London, 1922, iii. 20.
[93] Hufeland, C. W., _The Art of Prolonging Life_, 1797, vol. i. p.
227.
[94] Lorand, A., _Old Age Deferred_, pp. 51, 114, Philadelphia, 1921.
[95] Biedl, A., _Endocrinology_, Los Angeles, 1921, v. 523.
[96] Berman, L., _The Glands Regulating Personality_, p. 260, The
Macmillan Co., 1921, New York.
[97] Lydston, G. F., _Journ. Amer. Med. Assoc._, Chicago, 1919, lxxii.
396.
[98] Stanley and Kelker, _Journ. Amer. Med. Assoc._, Chicago, 1920,
lxxiv. 1501.
[99] Stanley, _Endocrinology_, Los Angeles, 1921, v. 708.
[100] Gilford, H., _The Disorders of Post-natal Growth and
Development_, p. 643, 1911, London.
[101] Bouin et Ancel, _Compt. rend. Acad. Sc._, Paris, 1903, cxxxvii.
1289, 1904, cxxxviii. 110.
[102] Lipschülz, Ottow, Wagner, and Bormann, _Proc. Roy. Soc._ Lond.,
1922, ser. B, xciii. 132.
[103] Kuntz, A., _Endocrinology_, Los Angeles, 1921, v. 190.
[104] Nathan, _Presse méd._, Paris, 1922, xxx. 237.
[105] Sand, K., _Journ. de physiol. et de path. gén._, Paris, 1921,
xix. 525.
[106] Blair Bell, _The Sex Complex_, p. 28, 1920.
[107] Sternberg, _Berl. klin. Wehnschr._, 1921, lviii. 556.
[108] Mott, F. W., _Brit. Med. Journ._, 1919, ii. 658; _Proc. Roy. Soc.
Med._, 1922, xv. (Sect. Psychiat.), 1–30.
[109] Aron, _Compt. rend. Soc. biol._, Paris, 1921, lxxxv. 107.
[110] Retterer, E., _Compt. rend. Soc. biol._, Paris, 1919, lxxxii. 423.
[111] Walker, K., _Brit. Med. Journ._, 1922, i. 297.
[112] Steinach, E., _Verjüngung durch experimentelle Neubelebung der
alternden Puberstätsdrüsen_, J. Springer, Berlin, 1920.
[113] Benjamin, H., _New York Med. Journ._, 1921, cxiv. 687.
[114] Simmonds (quoted by Marinesco), _Deutsche path. Ges._, Jena, 1921.
[115] Tiedje, H., _Deutsche med. Wehnschr._, 1921, xlvii. 35.
[116] Romeis, B., _München. med. Wehnschr._, 1920, lxvii. 600, 1821.
[117] Marinesco, _Presse méd._, Paris, 1922, xxx. 309.
[118] Lenz, L., und Schmidt, P., _Deutsche med. Wehnschr._, 1921,
xlvii. 327.
[119] Moullin, C. W. M., _Enlargement of the Prostate_, p. 194, 3rd
edition, 1904.
[120] Harrower, _Practical Hormone Therapy_, p. 344, 1914.
[121] Frank, _Journ. Amer. Med. Assoc._, Chicago, 1922, lxxviii. 181.
[122] Marinesco, _Études histologiques sur le mécanisme de la
sénilité_, 1904.
[123] Léri, _Le cerveau sénile_, 1906.
[124] Ribbert, H., _Der Tod aus Alterswäche_, Bonn, 1908.
[125] Salimbeni et Gery, _Ann. Inst. Pasteur_, Paris, 1912, xxvi. 577.
[126] Lane, W. A., _The Operative Treatment of Intestinal Stasis_,
1918, London.
[127] Abernethy, J., _The Constitutional Origin and Treatment of Local
Diseases_, 1811.
[128] Clarke, E., in _The Operative Treatment of Intestinal Stasis_, p.
246, London.
[129] Vide Saundby, _Old Age, its Care and Treatment_, pp. 5, 28,
London, 1913.
[130] Pearson, K., _Arch. Middlesex Hosp._, 1902, ii. 127.
[131] Lazarus-Barlow, W. S., _Ibid._, 1905, v. 43.
[132] On analysis of the Registrar-General’s returns for England and
Wales (1901–1909) C. Singer (_Quart. Journ. Med._, Oxford, 1911–12, v.
33), found that the incidence curves of carcinoma of the lip, face, and
breast were exceptional in rising up to the highest age recorded (90).
[133] Laurent, O., _Bull. Acad. de méd._, Paris, 1919, lxxxi. 835.
[134] Gilford, H., _The Disorders of Post-natal Growth and
Development_, 1911, London; and _Brit. Med. Journ._, 1913, ii. 1617.
[135] Goodpasture, E. W., _Journ. Med. Research_, Boston, 1918,
xxxviii. 127.
[136] Oertel, H., _Ibid._, 485.
[137] Councilman, W. T., _Contributions to Medical and Biological
Research_, dedicated to Sir William Osler, 1919, vol. ii. p. 918, New
York.
[138] Kissmeyer and With, _Brit. Journ. Dermat. and Syph._, London,
1922, xxxiv. 175.
[139] Pringle, J. J., _System of Medicine_ (Allbutt and Rolleston),
1911, ix. 549, London.
[140] Cheatle, G. L., _West London Med.-Chir. Journ._, 1921, xxvi. 154.
[141] _Letter to a Friend_, in Greenhill’s edition of _Religio Medici_,
p. 135, Macmillan, 1898.
[142] Bacon, F., _The History of Life and Death_.
[143] _Autobiography of Sir Charles Cameron_, p. 137, 1920.
[144] Graves, R. J., _Dublin Quart. Journ. Med. Sc._, 1847, N.S., iii.
339.
[145] Quoted by D. Roy, _Thèse de Paris_, No. 110, 1910.
[146] Sinclair, J., _Code of Health and Longevity_, 1807, i. 68.
[147] Boyd, R., _Phil. Trans. Roy. Soc._, 1861, cli. 241.
[148] Monauni, _Arch. d’opth._, 1921, xxxviii. 180.
[149] Nascher, I. L., _Geriatrics_, p. 36, 2nd edition, 1919, London.
[150] Clarke, Ernest, in _Operative Treatment of Intestinal Stasis_, by
W. A. Lane, p. 245, 1918, London.
[151] Hollis, W. A., _Brit. Med. Journ._, 1916, i. 677.
[152] Luciani, _Text-book of Physiology_, English translation, vol. v.
p. 302, London.
[153] Salimbeni et Gery, _Ann. Inst. Pasteur_, Paris, 1912, xxvi. 577.
[154] Symmers, D., _Arch. Int. Med._, Chicago, 1909, iii. 270.
[155] Roussy, G., et Leroux, R., _Ann. de méd._, Paris, 1921, ix. 161.
[156] Durante, _Manuel d’histologie pathologique_ (Cornil et Ranvier),
1902, ii.
[157] Jewesbury and Topley, _Journ. Path. and Bacteriol._, 1913, xviii.
432.
[158] Weber, F. P., _System of Medicine_ (Allbutt and Rolleston), 1905,
i. 185, London.
[159] Charcot, J. M., _Clinical Lectures on Senile and Chronic
Diseases_, p. 28, New Sydenham Soc., 1881.
[160] _Loc. cit._
[161] Ophülz, W., _Stanford Univ. Publications, Med. Sciences_, 1921,
vol. i. Part I. p. 31.
[162] Turnbull, H. M., _Quart. Journ. Med._, Oxford, 1913–14, viii. 201.
[163] Hansen, K. M., _Ugsek. f. Laeger_, Copenhagen, 1919, lxxxi. 1281.
[164] Macnaughton, F. G., _Brit. Med. Journ._, 1922, ii. 14.
[165] Rolleston, G., _Brit. and For. Med.-Chir. Rev._, 1863, xxxi. 505.
[166] Hammar, A., _Endocrinology_, Los Angeles, 1921, v. 543.
[167] Hale-White, W., _Med.-Chir. Trans._, 1888, lxxi. 181.
[168] Findlay, G. M., _Journ. Path. and Bacteriol._, Cambridge, 1920,
xxiii. 482.
[169] Councilman, W. T., _Contributions to Medical and Biological
Research_, Dedicated to Sir William Osler, 1919, vol. ii. p. 919, New
York.
[170] Walker, K., _Brit. Med. Journ._, 1922, i. 297.
[171] Launois, “Appareil urinaire des vieillards,” _Thèse de Paris_,
1885.
[172] Nemenow, M., _Ztschr. f. Urol._, Berl. und Leipz., 1921, xv. 45.
[173] Hertoghe, “L’Hypothyroidie bénigne chronique,” _Bull. Acad. roy.
de Belg._, 1899.
[174] Mott, F. W., _Brit. Med. Journ._, 1919, ii. 658.
[175] Paul, F. T., _Lancet_, 1910, ii. 294.
[176] Haneborg, _Acta Medica Scandinavica_, 1921, Supplement I. p. 117.
[177] Bell, _Lancet_, 1922, i. 715.
[178] MacNider, _Science_, 1917, xlvi. 643.
[179] Rappleye, _Boston Med. and Surg. Journ._, 1918, clxxviii. 191.
[180] _A Discourse Of The Preservation Of The Sight: Of Melancholic
Diseases: Of Rheums and Of Old Age_, composed by M. Andreas Laurentius,
Ordinarie Phisition to the King and Publike Professor of Phisicke
in the Universitie of Montpelier. Translated out of the French into
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