bluuebunny/crossref_metadata_2025 huggingface dataset:
ISONIAZID‐RESISTANT TUBERCULOUS SUPERINFECTION
Authors: GREENBERG HARRY B.
Published: April 2015

Abstract: Isoniazid resistance developed after one to eleven years of clinical and bacteriologic quiescence in 13 once‐responsive tuberculous patients. A study of the case material disclosed that all but one of the patients had interrupted the initial antituberculosis chemotherapy soon after their sputum samples had become negative. Also, most of the patients had had cavitary lesions that contained large bacterial populations.

Residual pulmonary foci of previously dormant tubercle bacilli were likely sources of their isoniazid‐resistant superinfections. Disabled by severe personality disorders and unable to comprehend the gravity of their illnesses, these patients had interrupted chemotherapy, apparently before the medication and their own defense mechanisms had effectively repressed the isoniazid‐resistant mutants in the bacterial population.
A GERIATRIC DAY WARD IN AN ENGLISH HOSPITAL
Authors: ANDREWS J. , FAIRLEY A. , HYLAND M.
Published: April 2015

Abstract: The proper function and location of a Geriatric Day Ward are described. Patients attend from 9:30 a.m. to 4:30 p.m., one to five days per week. Statistics are given on the scope of the work carried on in the Day Ward of West Middlesex Hospital since the Ward opened in 1962. The patients obtain multidisciplinary services, including medical investigation and treatment. The period of these rehabilitation and assessment services rarely extends beyond three months. The cost is considerably less than for standard in‐patient care.

The Day Ward should bridge the gap between out‐patient care and 24‐hour in‐patient care. It should be directly linked to the Geriatric Department in the hospital. However, it should also be associated with Day Centres established in the community, if post‐discharge deterioration of the patients is to be prevented. The Day Ward not only enables early discharge of the patient, but is useful in treating out‐patients who have severe locomotor handicaps, when in‐patient admission is not feasible.
PSYCHOSOCIAL FACTORS AND RECOVERY IN GERIATRIC PATIENTS WITH SEVERE APHASIA*
Authors: SARNO MARTHA TAYLOR , SILVERMAN MARLA , LEVITA ERIC
Published: April 2015

Abstract: An attempt was made to determine the effects of age, sex, education, occupational status, deficit in auditory comprehension, duration of symptoms, pre‐illness language proficiency, and current living environment on recovery from severe aphasia. Tests involving pre‐reading, writing, understanding, and speaking were administered to 31 subjects with severe expressive‐receptive aphasia secondary to a cerebrovascular accident and of at least three months' duration. The tests were made initially and after a time interval ranging between 4 and 36 weeks, with a mean of 17.1 weeks. Comparisons were based on change scores. No significant differences at the .01 level were observed as a function of any of these variables.

It was concluded that the environmental variables under study were of little consequence to the learning process and to the improvement of patients who still had severe residual receptive‐expressive aphasia three months after a stroke. Such a finding is important to speech clinics dealing with aphasic patients.
ALVEOLAR BONE LOSS AS A PROGNOSTIC SIGN OF DIABETES IN PATIENTS OF THE 60‐PLUS AGE GROUP
Authors: CHERASKIN E. , RINGSDORF W. M.
Published: April 2015

Abstract: This study was undertaken in 19 presumably healthy elderly persons, to see if there was any relationship between alveolar bone loss and carbohydrate metabolism. In 9 of the subjects, alveolar bone loss, as determined by periapical radiography of the anterior teeth and graded on a 7‐point scale, was correlated with carbohydrate metabolism as judged from the results of the conventional glucose tolerance test. In the other 10 subjects, alveolar bone loss, estimated on a percentage basis, was correlated with carbohydrate metabolism judged according to the results of the cortisone glucose tolerance test. Within the limits of this study, there appeared to be a relationship between bone loss and blood glucose concentration. The subjects with the greatest bone loss had the highest blood glucose levels.
A NEW EMOLLIENT CLEANSER FOR DRY SKIN CONDITIONS
Authors: DICK LIONEL A.
Published: April 2015

Abstract: A recently developed soapless cleansing bar (Emulave) has proved to be very helpful in the treatment of many dry, pruritic dermatoses. It was tested in 100 cases. Almost half of the patients were more than 60 years of age. The cleansing bar was readily accepted and well tolerated.
NECROTIZING ADENOCARCINOMA OF THE ADRENAL AS A CAUSE OF PROLONGED PYREXIA: CASE REPORT
Authors: WEISS MORRIS , MARGOLIS JACK , ZINN HOUSTON J. , WALTON T. PEYTON
Published: April 2015

Abstract: This unusual case of prolonged fever (peaks of 102°‐105° F daily followed by drenching sweats) was caused by a necrotizing carcinoma of the adrenal. The patient was a 47‐year‐old man. Intensive investigation did not demonstrate anything that would account for the prolonged fever. Finally an exploratory laparotomy revealed a primary carcinoma of the adrenal cortex. Within seventy‐two hours after removal of the tumor, the fever disappeared. The patient was afebrile at the time of discharge from the hospital and has remained so despite declining strength.
A PROGERIA‐LIKE SYNDROME PRODUCED BY DIHYDROTACHYSTEROL: ITS PREVENTION BY CONJUGATED ESTROGENS (PREMARIN)
Authors: ORIMO HAJIME , FUJITA TAKUO , YOSHIKAWA MASAKI , HAYANO KAZUO
Published: April 2015

Abstract: Sixty female Wistar‐Imamichi rats, each weighing 85 gm, were divided into 10‐rat groups and fed respectively (by mouth) daily for four weeks: corn oil; dihydrotachysterol (DHT), 50 μg; DHT + conjugated estrogens (Premarin), 25 μg; DHT + Premarin, 100 μg; Premarin, 25 μg; or Premarin, 100 μg. Data were collected on body and organ weights; the calcium content of serum, aorta, heart, kidney and femur; x‐ray examination of the tail bone; and histological changes in the tissues involved.

Under the experimental conditions, administration of DHT caused marked hypercalcemia and a significant increase in the calcium content of the kidney and heart. On the other hand, the calcium content of the femur in the rats treated with DHT was markedly decreased as compared with that in the controls. Histological and radiological evidence indicated that the administration of DHT was associated with increased bone resorption, subsequently developing into osteoporosis.

All these DHT‐induced changes were prevented by the simultaneous administration of Premarin. Thus conjugated estrogens apparently prevent the development of the “progeria‐like syndrome” in rats—a syndrome which is quite similar to premature aging. The possibility of a relationship to slowing of the aging process is suggested.
THE PHLEBECTASIAS OF OLD AGE—INCIDENCE AND DIAGNOSTIC IMPORTANCE
Authors: KOCSARD E. , OFNER F. , D'ABRERA V. ST.E.
Published: April 2015

Abstract: The angiokeratoma of Fordyce, “caviar” tongue, venous lake, and senile angioma are common in people over 70 years old. A study of these phlebectasias was made in 390 male subjects in a geriatric home and hospital. A statistical analysis regarding the incidence of various combinations of these lesions indicated that, in the elderly, their coexistence in the same person is only accidental. It seems that local factors predominate as the cause, and it is not possible to demonstrate the presence of a systemic disposition such as generalized ageing of the supportive tissues in order to explain the coexistence of various local types in one person. In old age, the two most important elements to be considered are: 1) local degenerative changes due to damaging factors acting locally on the connective tissue, and 2) increased venous pressure.
INTENSIVE RESPIRATORY CARE: ADVANCES IN MANAGEMENT OF PATIENTS WITH OBSTRUCTIVE PULMONARY DISEASE
Authors: BECK GUSTAV J. , GRENARD STEVE
Published: April 2015

Abstract: Significant advances in the physiological concepts, diagnosis and therapy of respiratory failure are reviewed. The etiology of the respiratory failure in a given patient can be deduced by studying the ventilation, perfusion, diffusion and distribution of the inspired air. This assessment and a knowledge of the mechanics of ventilation are essential for the determination of specific therapy. Curves for bicarbonate and arterial carbon dioxide tension in animals, in normal persons and in patients with chronic pulmonary disease are discussed with regard to their clinical applications.

Cardiovascular complications and neuromuscular and cerebrovascular changes due to acute relative hypocapnia and hyperbasemia induced by inadvertent mechanical hyperventilation are the most common hazards of artificial or assisted ventilation. Clinical and chemical recognition of these states by means of blood gas analyses enables prompt correction, accomplished by increasing deadspace ventilation, reducing the respiratory rate, and giving acetazolamide. In respiratory failure, the administration of oxygen is essential for the correction of hypoxia. When the respiratory failure is caused by an acute exacerbation of chronic pulmonary disease, the corrective oxygen concentrations should be kept strictly within the range of 21 to 35 per cent.
SURGICAL MANAGEMENT OF THE COMPLICATIONS OF DIVERTICULITIS
Authors: BEFELER DAVID , MITTY WILLIAM F.
Published: April 2015

Abstract: This paper concerns the indications for the surgical management of diverticulitis and its complications, including the choice between one‐stage and three‐stage procedures, and between elective and emergency operations. Primary resection of the colon should be reserved for the treatment of localized or quiescent diverticulitis. Staged resection is the preferred operation for treating the complications of divertculitis, particularly in the elderly.
THE SEASONAL SUSCEPTIBILITY TO MYOCARDIAL INFARCTION
Authors: Protos A. A. , Caracta A. , Gross Ludwig
Published: April 2015

Abstract

The data on 539 patients (358 men and 181 women) with proved myocardial infarction, admitted to the hospital during a four‐year period, were reviewed and tabulated according to yearly and monthly intervals for both sexes. The admission rates were studied in relation to hypertension, hypercholesterolemia, diabetes, and mortality, and also in relation to the seasonal changes in temperature. The analysis showed that, for men, the curves representing admission and mortality rates were not characteristic. In contrast, for women, there were two distinct peaks of admission, in April and in December; a chi‐square value of 16.10 (df = 11) tended toward a significant difference. A similar tendency toward a significant difference was noted in the increased mortality for women in the spring months of March, April and May; chi‐square value, 4.76 (df = 3). Perhaps in women an additional factor of macrothrombus formation is somehow influenced by the season of the year.
DRUGS AND THE GERIATRIC PATIENT*
Authors: Lamy Peter P. , Kitler Mary Ellen
Published: April 2015

Abstract

Reasons for caution in administering drugs to old people are discussed. A survey was made of the records of 33 elderly cardiac patients in a teaching hospital, 30 elderly ambulatory patients in the community, and 30 elderly patients in a geriatric hospital. The findings indicated that prescription practices were somewhat different for the hospital patients than for the community patients, but there did not seem to be any reduction in drug dosage on account of the patient's advanced age.

Those who prescribe drugs for geriatric patients have a great responsibility to see that the dosage is correct and that, when the drug has to be self‐administered, the patient is given complete instructions which he can understand.
OCCUPATIONAL VARIATIONS IN MORTALITY FROM ISCHEMIC HEART DISEASE
Authors: Sigurjonsson Julius
Published: April 2015

Abstract

A comparison was made of the proportional frequencies of deaths from ischemic heart disease (IHD) in Icelandic males of different occupational classes—farmers, seamen, laborers, craftsmen, and white‐collar workers. The study was based on the examination of death certificates for adult males for the period 1951–60. There was no evidence of significant differences in method of death certification or in diagnostic transfer.

At ages 35–64 the ratio of IHD deaths to all deaths ranged from 10.4 per cent for farmers to 30.4 per cent for white‐collar workers. In between were seamen and laborers on the lower side and craftsmen on the upper side of the over‐all value, which was 20.1 per cent. At ages 75 and older there were practically no differences. Further analysis indicated an essentially similar occupational pattern with respect to mortality rates, except for a somewhat contracted range. The rates for white‐collar workers, nevertheless, were about twice as high as for the farmers.

The difference in IHD mortality between farmers and white‐collar workers at least, could not be related to the amounts or composition of dietary fats, but there was evidence of an association with physical activity and overnutrition. So far this is compatible with the view that habitual positive energy balance may be more important as a risk factor for ischemic heart disease than is richness of the diet in fats.
ESTROGEN INHIBITION OF A PROGERIA‐LIKE SYNDROME IN THE RAT
Authors: ORIMO HAJIME , FUJITA TAKUO , YOSHIKAWA MASAKI , HAYANO KAZUO , SAKURADA TOYOJO
Published: April 2015

Abstract:

Forty female Wistar‐Imamichi rats, each weighing 98 gm, were divided into 5 equal groups and the effects of dihydrotachysterol (DHT) on the calcium content and weight of the kidney, heart, aorta and femur were compared in ovariectomized and in intact rats. The effect of DHT was much more pronounced in the ovariectomized than in the intact rats. These findings strongly suggest the protective effect of endogenous estrogens on the DHT‐induced progeria‐like syndrome in rats.
CIRCULATORY REFLEX RESPONSE IN DIABETIC PATIENTS WITH OR WITHOUT PERIPHERAL NEUROPATHY
Authors: BISHNU SUNIL K. , BERENYI MAGDALENA R.
Published: April 2015

Abstract:

Two groups of diabetic patients of comparable age were studied. In Group I were 14 patients who had a history, physical findings and electromyographic readings consistent with diabetic peripheral neuropathy. In Group II were 17 patients with a comparable history of diabetes but without any physical or EMG signs of diabetic peripheral neuropathy. Valsalva's maneuver was used to detect abnormal circulatory reflexes, and thus to determine whether or not autonomic neuropathy regularly accompanies peripheral neuropathy in diabetes.

In Group I, 2 of the 14 patients showed a normal response, and 4 a partial response (42.7 per cent). In Group II, 5 of the 17 patients showed a normal response, and 7 a partial response (70.6 per cent). The significantly lower number of responses to Valsalva's maneuver in Group I suggests a close correlation between peripheral neuropathy and autonomic neuropathy in diabetes mellitus.
FIBEROPTIC ESOPHAGOSCOPY IN GERIATRIC PATIENTS*
Authors: ANSELM KLAUS , SCHUMAN BERNARD M. , PRIEST ROBERT J.
Published: April 2015

Abstract:

Sixty‐four patients aged 65 or older were examined with the Olympus fiber esophagoscope. Fifteen had inflammatory changes, 10 had carcinoma or lymphoma, 5 had stomal ulcers after partial gastrectomy and 3 had esophageal varices. The procedure was tolerated well by all patients. Fiberoptic esophagoscopy offers a thorough and reasonably safe method of examination for the geriatric patient.
MIS‐ASSIGNMENT OF GERIATRIC PATIENTS TO A STATE MENTAL HOSPITAL*
Authors: FRIEDMAN JACOB H.
Published: April 2015

Abstract:

New admission criteria at the Bronx State Hospital exclude patients with non‐psychotic organic brain syndrome, mild psychoses or mild psychoneuroses. Thus an intensive psychiatric geriatric program was started consisting of chemotherapy; individual and group psychotherapy; family, recreational, and occupational therapy; and necessary medical attention. The comunity gradually is being educated successfully to accept the new policy.

Nevertheless, because of outside influences, 66 patients who did not meet the new criteria had to be admitted during the period October 1, 1967 through September 30, 1969. In this study, these 66 are compared with a control group of 82 patients who met our admission criteria during the same period. Included are data on sex, marital status, age, method of referral, diagnoses, and results of therapy. The findings indicate that patients in the 65–69 age group, rather than the 70+ group, are the ones whom the community tries to “dump.” The patients who were admitted but did not meet the criteria had much more insight into their condition than those who met the criteria. Those who were admitted without meeting the criteria fared much more poorly in regard to duration of hospital stay, convalescent status, discharge status, and mortality rate.

The improper placement of geriatric patients in a state mental hospital with a modern therapeutic geriatric psychiatric program is detrimental to these patients, and is a grievous error for all concerned.
CLINICAL EVALUATION AND MANAGEMENT OF THE IMPOTENT*
Authors: TUCKER ERIC C.
Published: April 2015

Abstract:

A plan is outlined for the evaluation and management of the impotent male. The physiology of erection and the causes of impotence are discussed. Each case must be thoroughly studied to eliminate organic causes (which usually indicate specific endocrine therapy) before psychiatric treatment is started. A last resort is implantation of a penile prosthesis.
MEDICARE AND COMMUNICATIVE THERAPY FOR THE AGED
Authors: Weiss Curtis E.
Published: April 2015

Abstract

The academic and clinical training of speech pathologists and audiologists must include working with the geriatric population, especially if these clinicians anticipate private practice with Medicare patients. The course of study should include a review of the literature, and training in observation, diagnosis, direct therapy, supportive therapy, and research projects. Such a comprehensive experience will demonstrate to the students that the communicative problems of the aged are unique and require treatment by specially trained personnel using special procedures, and that it is detrimental to the clinician and to his profession if he attempts to treat geriatric patients without previous training or experience in this area.
RADIOLOGICAL FINDINGS IN PROGERIA
Authors: Reichel William , Bailey Joseph A. , Zigel Saul , Garcia‐Bunuel Rafael , Knox Gaylord
Published: April 2015

Abstract

Roentgen evidence of 15 skeletal features was studied in 4 patients with progeria. Fourteen of the 15 features were noted in either 3 or all 4 patients. Four of these skeletal characteristics have not been noted previously—valgus deformity of the humeral head and neck, temporal variability in the appearance of epiphyseal ossification centers, laminations beneath the periosteum of bone, and transverse lines of increased density at the metaphyseal ends of the long bones. The 15 skeletal features could be accounted for on the basis of vascular and muscular alterations, and primary bone disturbances. Such diverse involvement of mesodermal derivatives suggests that the disorder in progeria originates during the early development of these structures. Pathological findings (sclerotic skin changes, subintimal fibrosis of vessels, multifocal interstitial myocardial fibrosis) and other evidence supports an abnormality of collagen metabolism which could be related to this mesodermal disorder.
HALOPERIDOL VERSUS THIORIDAZINE FOR HOSPITALIZED PSYCHOGERIATRIC PATIENTS: DOUBLE‐BLIND STUDY*
Authors: Tsuang Min‐Min , LU Leigh Min , Stotsky Bernard A. , Cole Jonathan O.
Published: April 2015

Abstract

A 12‐week double‐blind study was started with 60 actively psychotic geriatric patients residing in Boston State Hospital, to compare the psychopharmacological efficacy of haloperidol with that of thioridazine. The dosage was flexible—an initial low dosage followed by gradual increments until a satisfactory therapeutic response was obtained. Average maintenance dosages were about 2 mg a day for haloperidol and 100–125 mg a day for thioridazine. The rating instruments used were the Brief Psychiatric Rating Scale (BPRS), Stotsky Mental Status, Clinical Global Impression, NOSIE‐30 (Nurse's Observation Scale), and Activities of Daily Living. At the end of the study, 50 patients were available for analysis. Our results indicated significant decreases in many areas of psychotic psychopathology for both drug groups, without significant differences between the actions of the two drugs. For both haloperidol and thioridazine, significant (P .05) improvement occurred in the following variables on the BPRS and the NOSIE‐30: anxiety, excitement, irritability, hostility, suspiciousness, hallucinatory behavior, mannerisms, tension, unusual thoughts, blunted affect, neatness, and manifest psychosis.

Side effects, with the low dosages used, were not common, and were surprisingly similar for the two drugs. Haloperidol appeared essentially equivalent to thioridazine in both efficacy and in the frequency and type of side effects observed.
GERIATRICS: AN EMERGING CHALLENGE TO THE HEALTH PROFESSIONS*
Authors: Sherman E. David
Published: April 2015

“Not yet can I speak with the authority of the ”retired“ from labour, a shadowy company who spend their time in regretting their retirement and criticising their successors. I am still at work with my hand to the plough, and my face to the future. The shadows of evening, it is true, lengthen about me, but morning is in my heart!”

Sir William Mulock, 1930
CLINIC FOR PATIENTS WITH LONG‐TERM DISEASES (LT‐PATIENTS)
Authors: Dahl Sven
Published: April 2015

Abstract

This is an outline, based on Swedish conditions, of an organisation created to help long‐term (LT) patients. As geriatric LT‐patients form a steadily growing problem for the Western world, it is essential to find a way in which the community can help them and, at the same time, help itself.

The LT‐speciality requires a change in the work of the hospital physician. First of all its requires that he become acquainted with the social organisation of the community and the possibilities for obtaining help. This is an important part of the whole work if he is to start and carry through the necessary co‐operation with the central and local authorities.

If a community does not find a satisfactory solution to the problem of the necessary help for LT‐patients, all the health services and the whole of the welfare program will suffer severely.
SCLERODERMA IN THE ELDERLY, WITH SPECIAL REFERENCE TO THE CRST SYNDROME
Authors: Hodkinson H. M.
Published: April 2015

Abstract

Scleroderma, hitherto rarely reported in patients beyond the age of 70, is not uncommon among female patients of the geriatric age group. The author observed 15 cases during eleven years of geriatric practice.

In all the cases the disease was in a mild form and appeared to have a favourable prognosis. Of the 15 patients, 2 were definitely, and an additional 8 were probably cases of the CRST syndrome—calcinosis, Raynaud's phenomenon, sclerodactyly, and telangiectasia. Thus the CRST syndrome, previously regarded as a rare benign variant form of scleroderma, seems to be common in the elderly and to represent the most frequently observed form of the disease. The remaining 5 cases, showing only Raynaud's phenomenon and skin changes (oesophageal changes occasionally), may represent incomplete forms of the CRST syndrome, as they were of shorter duration but differed in no other essential respects.

It is suggested that the CRST syndrome may represent merely a late stage of acrosclerosis and not a separate disease entity.
ETIOLOGY AND TREATMENT OF PYELONEPHRITIS: MODERN CONCEPTS
Authors: Riccitelli M. L.
Published: April 2015

Abstract

Pyelonephritis is an extremely complex disease and is not fully understood. In its development, it gives rise to a great variety of signs and symptoms and involves a series of pathogenic mechanisms. This article explores the various aspects of urinary‐tract infections in the light of our present knowledge. Topics of discussion are the common causes of pyelonephritis, the collection and bacteriologic study of the urine, the use and abuse of the catheter, pathways of infection, the special susceptibility of certain age groups (including the elderly) to infection, diagnostic procedures, and medical and surgical therapy.
A CRITICAL RATIO OF AGING: WATER LOSS—HEAT PRODUCTION*
Authors: CALLOWAY N. O.
Published: April 2015

Abstract: The ratio of water content to heat production in the rat, guinea pig, chicken, and human increases with age. The slope of the line increases at a different rate for each species. There is an interesting relationship between the onset of rapid senile death and the water‐heat ratio in each species when the ratio of water content to heat production exceeds 2.0.
THE KUNA INDIANS: THEIR ATTITUDES TOWARD THE AGED*
Authors: WOLK ROBERT L. , WOLK ROCHELLE B. , SHOLK ALVIN
Published: April 2015

Abstract: The Kuna Indians, who live on the San Blas Islands off the coast of Panama, are supposed to be a “racially pure” tribe and maintain their ancient customs. An outline is presented of their history, culture and form of government. Their attitudes towards aging and death are of particular interest; some aspects might be pertinent to the problem of aging in our own civilization.
CHANGING A HOME FOR THE AGED TO A GERIATRIC CENTER
Authors: HARSANYI SUZANNE L.
Published: April 2015

Abstract: This study concerns the process of changing old age homes to geriatric centers. An outline is given of what it takes to change a custodial institution into a comprehensively functioning part of the total community: 1) needed services are provided for the aging, combined with opportunities for them to reciprocate and offer their potentially valuable abilities; (2) the community is enabled to meet the needs of its members, young and old; (3) plans are made to involve the geriatric center in the life of the community; and (4) mass media are used to help with these plans. Aging should be regarded as a dynamic part of the development cycle. The goal of the geriatric center for its old people is a matter of interdependency rather than independence‐versus‐dependency.
THE AGED GO TO A CONVENTION
Authors: REINGOLD JACOB , WOLK ROBERT L.
Published: April 2015

Abstract: This is a description of how a “live” workshop was set up in an exhibit booth at a Rehabilitation Conference. Twenty aged (74–87 years) participants in a Home for the Aged workshop performed their usual tasks at the exhibit. The project was a great success. The aged workers experienced a new sense of well‐being, a better understanding of themselves, and much gratification from the praise they received. Rehabilitation workers gained more insight into the philosophy involved in the concept of sheltered workshops.
ON THE NOBILITY OF OLD AGE*
Authors: RESTON JAMES
Published: April 2015

It is when the human heart faces its destiny and notwithstanding sings—sings of itself, its life, its death—that poetry is possible.—Archibald Mac‐Leish.
EFFECTS OF L‐DOPA ON THE H‐REFLEX IN PARKINSONISM*
Authors: FUJITA SHIGEKIYO , COOPER IRVING S.
Published: April 2015

Abstract: The monosynaptic reflex (H‐reflex) was studied in 47 parkinsonian patients, before and after the oral administration of L‐dopa. In the group clinically benefited by L‐dopa (characterized before treatment by bradykinesia and rigidity), initially there was a markedly short onset time for the H‐reflex recovery curve. L‐dopa significantly reduced the bradykinesia and rigidity, and the onset time for the H‐reflex recovery curve increased. These findings indicate that the previously facilitated total excitation level of the anterior motoneuron pool was suppressed by L‐dopa. Patients who had moderate to moderately severe bradykinesia and rigidity, and a short onset time for the H‐reflex recovery curve, were better candidates for L‐dopa therapy.
BACTEROIDES SEPTICEMIA IN OLDER PATIENTS*
Authors: ELLNER PAUL D. , WASILAUSKAS BENEDICT L.
Published: April 2015

Abstract: Thirty‐seven cases of Bacteroides septicemia are documented. Eighteen of these patients were age 45 or older; the mean age was 65 years. Fourteen of these older patients were males, most of whom had gastrointestinal disease. Seven of the 18 patients died as a result of their infection.

The predominant species was B. funduliformis (Sphaerophorus necrophorus). Antibiotic susceptibility testing indicated that all strains were resistant to kanamycin and, with one exception, were sensitive to chloramphenicol.

Although clinically indistinguishable from septicemia due to other Gram‐negative organisms, a useful clue to Bacteroides sepsis was the delayed appearance of growth in blood cultures. Bacteroides should be considered as a possible etiologic agent in older patients with sepsis who have failed to respond to conventional treatment and whose blood cultures show no growth within forty‐eight hours.
WHAT IT MEANS TO BE OLD TODAY*
Authors: THOMPSON PRESCOTT W.
Published: April 2015

Abstract: Sixteen specific aspects of life for the aged are listed. Since most are negative, the positive aspects (more free time and more use of inner resources) must be stessed, to maintain balance. Measures of “aging‐readiness” are discussed. The great gap between theory and practice in helping the aged is the problem we must try to solve.
NECROTIZING PRIMARY CARCINOMA OF THE RIGHT ADRENAL CAUSING FEVER “OF UNKNOWN ORIGIN” IN A 71‐YEAR‐OLD MALE: CLINICO‐PATHOLOGIC STUDY
Authors: ANSARI AZAM , SHAFER REX B.
Published: April 2015

Abstract: The case of a 71‐year‐old male veteran who had remittent fever (101–103°F) for six weeks is described in detail. The underlying cause for this perplexing symptom remained undiscovered until his death, despite exhaustive investigations. Autopsy revealed a necrotizing primary adenocarcinoma of the right adrenal gland, with metastasis to the right cerebellar hemisphere. Only one other similar case has been described before in the literature.
On Being Old and On Dying
Authors: KAST ERIC C.
Published: April 2015

An image of an old person is presented that emphasizes his limitations and capabilities. Isolation and depression are the main characteristics of the physiologic aging process. Hypochondriasis may be a defense against isolation. The impact of malignant tumors, cardiovascular catastrophes and chronic brain syndrome on old people is discussed.

As a basic therapeutic guideline in dealing with old people, cognizance should be taken of the realistic isolation of old people and the need for integration within their own society with their own spiritual and physical standards. All attempts should be made to preserve their dignity and self‐respect. This can not be done through condescension or solicitude but through open and free discussion of their infirmities and the necessary therapeutic measures.
The Aging Process
Authors: HENDERSON EDWARD
Published: April 2015

The sorry state of our knowledge of the process of aging calls for emphasis on basic research. Today our resources are chiefly expended on praiseworthy and necessary attempts to alleviate the diseases associated with old age and to provide good medical and psychological care. Meanwhile, through studies of healthy older humans and other species, we should try to discover what the process of aging is. Only thus can we make more significant contributions toward enhancing the quality of life in old age, let alone lengthening the life span.
An Appraisal of Anorexiants in the Treatment of Obesity*
Authors: FINEBERG S. K.
Published: April 2015

Descriptions of the serious effects of amphetamines refer to large overdosages, orally or parenterally. This is quite different from the dosages involved when anorexiants are used properly as an adjunct in the total treatment of obesity. They constitute an initial “crutch” to help strongly motivated stable patients to change their eating habits. Anorexiants should never be used on a long‐term basis. As the total program is difficult for both patient and physician, any temporary therapy of such value to the obese patient should not be prohibited if given under the supervision of an experienced physician who knows the indications for withdrawal. Under these circumstances, the hazards are minimal.
A Fellowship in Geriatric Medicine*
Authors: LIBOW LESLIE S.
Published: April 2015

After several years of experience in training interns and residents in Geriatrics during their two‐ or three‐month rotational period on this service, a full‐time Fellowship program has now been established in Geriatric Medicine, with the cooperation of the Department of Medicine. It is expected that the Fellows will achieve: 1) a special knowledge of and adeptness with the illnesses and health needs of the elderly, and 2) special abilities to plan for community needs regarding its elderly. The base for the program is the 80‐bed medical and surgical convalescent unit of this 1000‐bed general teaching hospital. Two‐thirds of the patients admitted return to the community within ten weeks. The Fellowship program includes participation in: 1) daily bedside rounds, 2) weekly staff conferences emphasizing an interdisciplinary approach to patients' problems, 3) weekly journal‐club sessions on “current concepts” in geriatrics, 4) community‐based health programs, 5) daily teaching conferences of the Department of Medicine, and 6) a research project related to the medication problems of the elderly. The first Fellow has been accepted and a two‐year to three‐year program is planned which will be divided between Internal Medicine and Geriatric Medicine.
Therapeutic Decision Making and Institutional Advocacy in Caring for the Ill Aged*
Authors: MILLER MICHAEL B.
Published: April 2015

The clinical management of the severely ill aged patient in an institution is a complex process. In addition to decision making by the patient, family and physician, there is another factor related to increased safety and an improved quality of living for the patient. This factor is the inclusion of the institution in decision making with respect to therapeutic goals and methods. Institutional participation may help in uniting the divergent attitudes of the patient, the family and the attending physician. Firm control of the clinical management of the patient must always rest with the attending physician, but a beneficial contribution can be expected from other professional sources within the health care facility when they possess the necessary skills to become involved in decision making.
Comparative Study of Coagulation, Fibrinolysis and Cardiorespiratory Function in Elderly and Young Subjects after Exercise*
Authors: GIBELLI A. , MORPURGO M. , GIAROLA P. , BEULCKE G. , CASACCIA M. , PETRINI C. , RAMPULLA C.
Published: April 2015

Nine aged subjects (67 to 87 years old) and 9 young and adult persons were submitted to an exercise load (cycloergometer) varying between 1.0 to 1.5 W/kg. Tests of cardiorespiratory function, blood coagulation and fibrinolysis were carried out before and after exercise, and then after 5, 15 and 60 minutes. The increase of respiratory rate was more marked in the elderly subjects than in the young and adult persons. No differences were observed with respect to the increase of heart rate and blood pressure. The increase of oxygen “pulse” was considerably less pronounced in the elderly. The pulmonary ventilation and the ventilatory oxygen equivalent were significantly different after six minutes of exercise. No significant differences were observed for blood lactic and pyruvic acid, or for the blood coagulation indexes, including factor VIII. The increase in fibrinolytic activity was marked and constant, irrespective of age.
Geriatrics and the Humane Environment
Authors: ROSS C. HOWARD
Published: April 2015

A report is presented to the American Geriatrics Society on the 24th Annual Conference on Aging, sponsored by the University of Michigan and Wayne State University, and held in Ann Arbor, Michigan, June 7–9, 1971. Plenary sessions, workshops, panel presentations and discussion groups filled half a week of endeavor concerning “The Care of Old People—Creating the Humane Environment.”

A description of old people in need of care was combined with issues and achievements, nudging the economics of health goals along the way. The mobilization of organized groups of retired persons, with a political potential, was an outstanding feature.
Predictive Medicine. XII. The Oral Cavity
Authors: CHERASKIN E. , RINGSDORF W. M.
Published: April 2015

The state of the oral cavity affects general health, and vice versa. Nevertheless, rarely, if ever, are the oral tissues considered in multiple testing programs. Predictive medicine programs differ, in that they include signs and symptoms referable to the oral cavity. Representative data indicate, for example, that alveolar bone loss proceeds at a much slower rate in persons with good oral hygiene and efficient carbohydrate metabolism.
A Novel Rehabilitation Program for the Non‐Institutional Disadvantaged Elderly Residing in an Urban Community
Authors: WENDKOS MARTIN H. , SOUDACK MOLLIE , FISCHER GRETA
Published: April 2015

Since late 1969, a unique rehabilitation program has been operational to meet the needs of disadvantaged elderly residents of the urban Katamon district of Jerusalem. This pilot project has involved 45 male and female Jewish immigrants who had arrived in Israel between 1948 and 1950. The novel aspect of the undertaking was the utilization of mildly handicapped residents (termed “visitors”) to assist in the care of regressed fellow residents (termed “visitees”). In the latter group, the regression was considered to be largely the result of impoverishment of the environment in combination with the difficulties inherent in achieving a satisfactory adjustment in a new land. Another important element of the program was the establishment of a close dyad relationship between “visitors” and “visitees.” The end‐result was a reciprocity of benefits for the two groups. Factors that might account for this mutuality of improvement are discussed.
Predictive Medicine. XIII. Tolerance Testing
Authors: CHERASKIN E. , RINGSDORF W. M.
Published: April 2015

The prime purpose of tolerance testing is to elicit an exaggerated response to a particular stimulus, as when glucose loading is used to determine the glucose tolerance pattern. Examples are presented to show the relationship of age to alveolar bone loss in terms of glucose tolerance tests (glucose stress), and of age to blood glucose concentration (no glucose stress). The amplitudes of fluctuation in clinical and biochemical signs are compared in healthy versus sick subjects. In a predictive medicine system, the aim is to ascertain a predisposition to, or early evidence of pathosis. Therefore, data obtained under ordinary circumstances (no stress) serve adequately if it is recognized that physiologic values and normal values are not synonymous and that subtle changes may be predictive.
Senile and Presenile Dementia: Further Observations on the Benefits of a Dicumarol‐Psychotherapy Regimen
Authors: WALSH ARTHUR C. , WALSH BERNICE HESSOM
Published: April 2015

This study began seven years ago in an attempt to assess the effect of anticoagulant (Dicumarol) therapy in senile or presenile dementia or organic brain syndrome due to arteriosclerosis. The present regimen consists of an initial two‐month trial of Dicumarol. The patient's prothrombin time is used as a guideline for stabilizing the dosage. Concomitant intensive psychotherapy recently has been added during the initial two‐month period. The improved patient is then referred to his local physician for maintenance anticoagulant therapy. All 22 patients in the present series improved, 8 markedly.
Predictive Medicine. XIV. Results
Authors: CHERASKIN E. , RINGSDORF W. M.
Published: April 2015

Much has been written about the nature and causes of the aging process. For purposes of a predictive medicine program the following points serve as a reasonable base: 1) old people report more symptoms and signs, 2) the old die more readily than the young, and 3) old people with many symptoms and signs die more readily than old people with few such manifestations. Thus it is highly desirable to use all the techniques possible to reduce the number of clinical findings to a minimum.

A predictive medicine program can anticipate classical disease. One example is given to show that the supposed inevitable increase of cardiovascular symptoms and signs with age can be thwarted by dietary means (vitamin E). Another example is given to indicate that, partly by exercise or diet, people may be made younger at heart.
Notes on the Second White House Conference on Aging*
Authors: McGAVACK THOMAS HODGE
Published: April 2015

The well qualified representative of the Journal of the American Geriatrics Society gives a succinct, well organized report on the Second WHCoA. It is presented under the headings: Action and Long‐Range Planning (the keynotes); Recommendations of the Sections (Education, Employment and Retirement, Physical and Mental Health, Housing Income, Nutrition, Retirement Roles and Activities, Spiritual Well‐Being, Transportation, Facilities, Programs and Services, Government and Non‐Government Organizations, Planning, Research and Demonstration, and Training); Special Concerns Sessions; and General Sessions and Luncheon Meetings. At the closing Session, the delegates unanimously approved a line of procedure designed to obtain the quickest possible action on the major recommendations of the Conference. There was a general feeling of optimism that the follow‐up work had been left in most competent hands.
Rating Scales for Psychotropic Drug Research with Geriatric Patients. II. Mood Ratings*
Authors: SALZMAN CARL , KOCHANSKY GERALD E. , SHADER RICHARD I. , CRONIN DENISE M.
Published: April 2015

A review of scales for rating mood in geriatric patients reveals the criteria that must be met: 1) the subject must be responsive and cooperative; 2) the scale should be brief, with clear response choices; and 3) the questions should be clear and relevant to the current situation of the patient. Individual mood scales do not offer much advantage over a brief, well constructed, multidimensional rating scale.
Clinical Evaluation of the Makari Tumor Skin Test in 470 Patients*
Authors: TEE D. E. H.
Published: April 2015

A double‐blind evaluation of an intradermal “tumor skin test,” carried out over a three‐year period, involved 470 subjects, the majority of whom were suspected of having malignant disease. The test gave highly positive results in early cancer and it broadly discriminated between subjects with early cancer and those with non‐neoplastic disease. Also, the response to the test was related to the stage of the carcinomatous process. These conclusions are in general agreement with previous findings. This intradermal test is potentially a valuable aid in the diagnosis of early cancer and in determining prognosis, provided certain defined limitations are observed in relation to peptic ulcer, fibrocystic disease of the breast, diverticulitis, ulcerative colitis and cirrhosis of the liver.
Abdominal‐Wall Pain of Bony Origin: Two Clinical Entities in Geriatric Patients
Authors: HOWELL TREVOR H.
Published: April 2015

Two clinical entities of pain in the anterior abdominal wall are described. One of these is due to the lower ribs “kissing” the iliac crest and bruising the soft tissues in patients with dorsal kyphosis. The other is due to referred pain from spondylosis of the lower dorsal spine. Both may be mistaken for acute or chronic intra‐abdominal disease, and the patient subjected to unnecessary laparotomy in error.
Geriatric Care in Italy
Authors: DE NICOLA PIETRO
Published: April 2015

This article is an outline of existing and proposed improvements in the care of geriatric patients in Italy. A new hospital law requires the inclusion of a geriatric unit in each regional general hospital. Besides units for the care of short‐term patients with acute diseases, it is desirable to have special units for sixty to ninety days of care in general hospitals and nursing homes. These are in addition to other units for long‐term chronically ill patients. This unitary type of organization provides more efficient care and is more economical.
Psychiatry, Racism and Aging*
Authors: CARTER JAMES H.
Published: April 2015

The basis for present inadequacies in the treatment of aged black psychiatric patients is discussed. Training programs in psychiatry should include working with people of a different race. The philosophical and social aspects of black culture should receive more attention. There is often a direct relationship between social status and type of mental illness. Many of the black patient's problems are related to race, and he is confronted with more obstacles in obtaining appropriate help. For elderly black people, there is pressing need for better integration of mental health services with other health and social services.
Coordinated Medical Care of the Aged by a Modern Home and Hospital for the Aged and General Hospitals
Authors: RODSTEIN MANUEL
Published: April 2015

A system of coordinated care for certain disorders by The Jewish Home and Hospital for Aged and adjacent general hospitals is described. Patients requiring surgery, surgical diagnostic procedures, radiotherapy, radioisotopic diagnostic and therapeutic procedures and the insertion and follow‐up of electronic cardiac pacemakers are given inpatient and outpatient care by the general hospital. Coordinated care is insured by full exchange of medical and social information, use of a private ambulance service, free availability of beds and early return to the Home for rehabilitation and after‐care. In most cases, medical care at the general hospital is supervised by specialists with independent appointments on the staff of the Home. In 1970, 199 patients from the Home were given inpatient care in general hospitals; the average length of stay was 11.3 days. Thirty‐nine patients were given outpatient care, with a total of 160 visits.
Diabetic Residents of Homes for the Aged: Observations for an Eleven‐Year Period*
Authors: CANTELON J. F. D.
Published: April 2015

ABSTRACT: Data are presented for the years 1960 through 1970 on 673 diabetic elderly residents of Homes for the Aged in Toronto. There were 218 males and 455 females. The fasting blood sugar level usually was elevated only in patients with longstanding diabetes. In the subjects tested, 75 per cent of the glucose tolerance curves were abnormal. Treatment consisted of diet alone (restricted‐sugar in many cases) for 175 patients, diet plus oral hypoglycemic agents for 320, and diet plus insulin for 178 patients. There were 392 deaths; arteriosclerotic heart disease was the chief cause. The average age at death was 81.2 years. Retinopathy was present in a moderate number of cases. Nephropathy and neuropathy were rare but occlusive arteriosclerotic lesions of the lower extremities were common.
The Exploratory Laparotomy: Case Report
Authors: CASE THOMAS C.
Published: April 2015

ABSTRACT: A case report is presented to illustrate the beneficial results of a diagnostic laparotomy in a supposedly neurotic patient who for twenty years had had repeated attacks of abdominal pain with fever. Previous clinical, x‐ray and laboratory findings had not been definite enough to justify surgery. The laparotomy findings indicated subacute cholecystitis and pancreatitis secondary to partial obstruction of the cystic duct by an aberrant blood vessel.