THE CONSERVATION OF ENERGY. 547 



estimation of the limiting conditions present, improvement results. 

 This is true, and demonstrated to be so, under circumstances which 

 would be considered prohibitive ; for instance, where there have been ob- 

 served those phenomena supposed to indicate threatened apoplexy, how- 

 ever that term be interpreted. 1 have had a number of cases under ob- 

 servation for many years where I was originally consulted for a train of 

 symptoms which pointed toward cerebral changes such as vertigo, lapse 

 of memory, sensory disturbances in hearing and in sight, formications, 

 paresthesias, periods of brief unconsciousness, etc., in people of seventy 

 years or more. Ordinarily the treatment advised for such conditions 

 would be to reduce the individual to live the life of a hothouse plant. 

 I have found in this contingency great practical advantage in attend- 

 ing to the cutaneous elimination, especially by frictions, oilings, mas- 

 sage, passive movements carried on to full stretchings as described 

 above, and gradual increments of stretching exercises, forceful exten- 

 sions and finally free movements and open-air life. Some of the in- 

 dividuals are now past eighty, strong and well. Even where there are 

 found to be alterations in the kidneys, sometimes albumen, casts and 

 sugar, the encouragement of the peripheral vascular stimulus was 

 followed by the happiest results. Above all, in the cardiac arhythmias 

 attention to the skin and regulated movements reduce these and some- 

 times cause them to disappear. 



The pulse in old people, as has been said, is quicker than in 

 middle life. The average of those cases reported by Humphrey, all 

 of them over eighty years of age, were for men seventy-three per 

 minute, and women seventy-eight, and the average respiration was 

 seventeen. The proportion of regular to irregular pulse was four 

 to one. I find irregularity in the pulse more common, indeed, it 

 is generally present more or less even in the healthiest. Humphrey 

 also found in the majority of old persons examined, little or no 

 change in the arterial system. Clifford Allbut makes the assertion 

 that in many cases of extreme age no evidence of arteriosclerosis 

 is to be found. One of the oft-recurring phenomena of old age is 

 edema due to the loss of vascular tone and defective lymph circulation. 

 This condition would be much less frequent if the tissues, especially 

 the larger muscles, were kept in a condition of elasticity, thus relieving 

 direct pressure and occlusion of the contained avenues of circulation. 



The exhaustion after fatigue is not well recovered from in the aged, 

 and hence it is not permissible to maintain protracted activities; these 

 should be supplemented by definite periods of rest, and if the heart be 

 not strong this should be taken lying down, but this is no reason to en- 

 courage complete inaction. Again, the change characteristic of the 

 bones of the aged, their loss of weight due to diminution in size, the 

 walls of the shaft becoming thinned throughout from within, especially 

 towards the ends of the bones, as at the head of the femur, forbids strong 



