vii THE STAGES OF LIFE AND DEATH 301 



In addition to the commencing general atrophy, we find 

 fatty degeneration, pigmentary infiltration, calcareous incrustation 

 and infiltration (calcification) and ossification. These processes 

 are the main general features of old age ; they may spare certain 

 organs, and yet be extremely advanced in others. 



The atrophy of the skeleton is above all remarkable. The 

 bones are markedly affected by senile atrophy ; they become 

 smaller in all dimensions ; the compact bones become thinner, 

 the spongy ones more rarefied, whilst they all become very 

 brittle (fragilitas mtrea}, especially those of the lower limbs, owing 

 to the changes in the nutritive vessels and the removal of 

 calcareous salts (Nelaton and Sappey). The red marrow dis- 

 appears and the fatty marrow diminishes and tends to become 

 gelatinous. 



Owing to this change in his bones, man becomes bent under 

 the burden of years, he stoops and grows thinner; his head 

 becomes smaller owing to a retrogressive process in the skull 

 which has been thoroughly studied by Sauvage (1869). The face 

 undergoes changes which are still more marked, the decay or loss 

 of the teeth diminishes the height of the jaw and makes it 

 project more, thus shortening the distance between the nose and 

 the chin. These and other changes in the bones show that the 

 characteristics of senile physiognomy are due to the skeleton, and 

 not merely to alterations in the softer parts. 



The connective tissue in the aged diminishes less than do the 

 more active tissues. The heart, the blood-vessels, the liver, the 

 kidneys, and the spleen of old people are relatively richer in 

 connective tissue than in the normal conditions of youth. The 

 connective tissue of the aged is however more tenacious, some- 

 times thicker ; it is more homogeneous in the skin, and of less 

 functional utility (Kibbert). 



The muscles become smaller and paler with the disappearance 

 of the transverse striation and the sarcolemma ; the perimysium, on 

 the other hand, is increased, and we sometimes find fatty infiltra- 

 tion. Faradic excitability in the lower limbs is always less than 

 in the upper ones (Ghelfi). Senile tremor (Sauvage) results from 

 neuro-muscular weakness and from the diminished frequency of 

 the contractions in the performance of voluntary acts (tremitus a 

 debilitate}. It is compatible with perfect health. It usually 

 begins with the head, more rarely with the hands, and^ seldom 

 extends to the lower limbs. It is continuous, slow (four to five times 

 per second), oscillatory, rhythmic, and involuntary (Pieraccini). 



The joints of the aged are often weak, and even when they do 

 not look red or swollen, crepitation is often noticeable, especially 

 in the knee-joints. The condition of the muscles and joints, 

 together with the retrogressive cerebral and spinal changes, is 

 the cause of the awkward, slow, and frequently limited movements 



