Clinicopathological Tests of Ageing 93 



mental vigour who died suddenly, yet both the pathologists 

 and clinicians have found it difficult to name the cause of 

 death. Conversely, apparently severe degrees of tissue or 

 organ damage may be found on routine pathological examina- 

 tion without any history of an equivalent degree of dysfunc- 

 tion during life. Perhaps I can best illustrate this by quoting 

 the paper of Vischer and Roulet (1952) who reported the 

 autopsy findings of two centenarians who had lived active, 

 healthy lives free from disability until the onset of a brief 

 terminal illness. The male, aged 102, died with gangrene of the 

 left foot, but autopsy revealed severe generalized athero- 

 sclerosis, thrombosis of the left femoral, popliteal and tibial 

 arteries and of the accompanying veins, terminal broncho- 

 pneumonia, carcinoid tumour of the ileum, enlargement of the 

 prostate gland, nodular hyperplasia of the thyroid and 

 chronic emphysema. The second case, a female aged 102, died 

 as a result of bronchopneumonia, but autopsy also revealed 

 the presence of severe atherosclerosis with obstruction of the 

 coronary arteries, cholelithiasis, nodular goitre, and severe 

 degenerative changes in the liver and in the heart. 



Surveys of autopsy findings in elderly persons by Howell 

 and Piggott (1949, 1950, 1951, 1952, 1953) and Cameron 

 (1955) revealed the multiplicity of the pathological findings 

 observed at autopsy in the elderly. One disorder was the 

 terminal cause of death but many other morbid changes had 

 undoubtedly contributed. 



There is general agreement amongst clinicians and patho- 

 logists that widespread and extensive arterial changes, 

 particularly atheromatous degeneration, are a common finding 

 in the elderly and the pathological studies I have referred to 

 stress the apparent correlation, but Cameron (1955) is 

 cautious in his conclusions and states: "I doubt very much 

 whether there are specific structural changes due to old age 

 and that alone. I hold the view that ageing is merely the 

 vector sum of a number of morbid processes, most of which 

 take time to develop, and often a long time to reach a serious 

 climax." 



