General Discussion 191 



Tunbridge said about normal people. I agree with them that after 

 a certain age (let us say 60 years) it is impossible to consider normal 

 people. We arrived at this conclusion after having made a study of 

 old people in the Department of Medicine at the University of 

 Florence. We considered three groups of patients, who were from 60 

 to 90 years old: a group of "pseudonormal" individuals, a group of 

 arteriosclerotic patients, and a group of atherosclerotic patients 

 (i.e. patients who had suffered from a previous myocardial infarction). 

 We measured certain blood components : electrophoretic fractions of 

 serum proteins and lipoproteins, total serum mucopolysaccharides, 

 C-reactive protein, cholesterolemia, plasmatic heparinoid substances. 

 If we consider the data as a whole, we can say that there is no differ- 

 ence in the blood picture of the three groups. We observed an increase 

 of alpha and gamma globulins ; we found a normal beta : alpha lipo- 

 protein relationship. We observed that there was an almost con- 

 stant increase in the mucopolysaccharides in the blood as well as 

 a decrease in heparinoid substances. Another fact that we consider 

 to be strictly connected to mucopolysaccharide metabolism is that in 

 more than two-thirds of all patients C-reactive protein was present. 

 Therefore, when we consider groups of persons who are more than 60 

 years old, we have only persons who are not normal, and that seems 

 to be due to the fact that with ageing we have an altered metabolism 

 at the level of connective tissues, which is reflected by the variation 

 of those blood components that we have examined. 



Olbrich: Prof. Tunbridge has made one thing very clear and he 

 has therefore made this discussion simpler: there is no correlation 

 between morphological and functional changes. We know that the 

 rate of ageing varies from individual to individual, i.e. biological and 

 chronological age are not parallel or corresponding. We estimated 

 the total body water, and found that the extracellular water in 

 different age groups remains constant, whereas clinically we could 

 detect no pathology; and we found that, according to the age group, 

 there is a decrease of intracellular water and a variation in the fat 

 mass. I would like to suggest as a definition of age a decrease of 

 intracellular water, with maintenance of extracellular water and a 

 varying fat mass. As the intracellular water decreases the cell mass 

 diminishes correspondingly, if the assumption is true that the ratio 

 of cell solid to water remains constant. It follows that the demand 

 of this diminishing cell mass for blood decreases, resulting in reduc- 

 tion of both cardiac output and renal blood flow. 



The ratios of cardiac output to renal blood flow or of intracellular 

 water to cardiac output remain constant. If the cardiac output is 

 measured without knowing the blood volume, circulation time and 

 intracellular water, then these single measurements are not valid. 



