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 observed those phenomena supposed to indicate threatened apoplexy, however that term be interpreted. 1 have had a number of cases under observation 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 attending to the cutaneous elimination, especially by frictions, oilings, massage, passive movements carried on to full stretchings as described above, and gradual increments of stretching exercises, forceful extensions and finally free movements and open-air life. Some of the individuals 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 sometimes 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 encourage 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
