302 PHYSIOLOGY CHAP. 



of the aged and of the vacillatio senilis which resembles that 

 caused by cerebellar disorder. 



The heart of the aged does not often become smaller and the 

 sounds want clearness but are sometimes sharp. Damage speaks 

 of a senile cardiac hypertrophy, caused by arteriosclerosis of the 

 aorta and of the other arteries. Ribbert also noted hypertrophy 

 of the myocardium in individuals dying in extreme old age, and 

 in one case of an old man suffering from recent interstitial 

 nephritis. 



The whole arterial system loses its elasticity in old age, 

 consequently the circulation is less active and the pulse slower 

 and less frequent. This diminished elasticity and contractility 

 (Eibbert) is a regular feature of senility and comprises the whole 

 circulatory system (arteries, capillaries, veins, and heart). 



In this connection there arises the important question whether 

 arteriosclerosis is an essential characteristic of old age or merely 

 one which occurs very frequently and must be regarded as a 

 complication of the strictly physiological senile state. Huchard 

 and Schobert have asserted that arteriosclerosis is a constant 

 occurrence in old age. The prevalent tendency of the present 

 day, which is the outcome of the most recent and thorough 

 anatomical and clinical research, such as that of Ribbert, Thomas, 

 Hampeln, and others, is to distinguish between arteriosclerosis of 

 a pathological type and that of physiological senility. As we have 

 already seen, however, the process of atheroma in both arteries 

 and veins (phlebosclerosis) which may lead to real calcification is 

 extremely common in old people. The atheromatous process 

 attacks the most important blood-vessels (aorta) and the secondary 

 ones alike. In advanced old age we always find tortuosity and 

 hardening of the temporal vessels, and the same symptoms 

 frequently occur in the arteries of the lower limbs. The crural 

 arteries and veins frequently turn into stiff calcified cords 

 (Birch-Hirschfeld, Sach, Ghelfi), thus accounting for many 

 disturbances in the gait of old people and attacks of intermittent 

 lameness. It is of course impossible here to draw a strict line of 

 demarcation between physiology and pathology, since the retro- 

 gressive physiological alterations induce inflammatory reactions, 

 which complicate the syndrome. We can, however, adopt 

 Kaufmann's view that in chronic senile arteriosclerosis the 

 processes of degeneration predominate. 



When we come to the general involution of the organism of 

 the aged, the liver presents the most points of interest; the 

 brown atrophy, which reduces its volume by about one half, depends 

 upon the shrinking of the hepatic cells, especially of those in the 

 centre of the acinus. These cells also contain a larger number of 

 yellowish-brown pigmented granules than those of the periphery 

 of the acinus. 



