Postgrad Med J: first published as 10.1136/pgmj.22.249.185 on 1 July 1946. Downloaded from : A MODERN SCIENCE WITH A LONG HISTORY By SONA ROSA BURSTEIN, M.A. (Wellcome Historical Medical Museum)j Two words, gerontology and , have with There is, however, a conspicuous lack of apparent remarkable suddenness made their home in the interest on the part of psychologists in the diffi- English language. The word geriatrics was coined culties of the passage from to . in I9I4 by the American, I. L. Nascher (from the Yet there is surely matter enough for expert con- Greek geron, an old man, and iatrikos, medical sideration, experiment and guidance in the conflict treatment) to distinguish the special branch of peculiar to the period of entry into old age, the medicine dealing with senile diseases, on the analogy conflict between the fear of and desire for of pediatrics, the study of children's diseases. The its postponement, on the one hand, and on the medical profession in England sometimes ignores other fear of the ills and losses and disappointments the whole subject as a special branch and sometimes of the remaining stretch of life, should the desired uses the word without comment as suitable English length of years be vouchsafed. Jung3 stands out as nomenclature; the lay public has in many cases a rare modem psychologist to speak with sympathy taken up the word, but tends to use it with the and understanding on this subject, and goes so far wider connotation of gerontology. Gerontology is as to advocate special schools for to prepare the study of all the problems of : medical, them for the new responsibilities which await them psychological, social, economic, cultural. As a in the last stage of life. word it has hardly arrived in this country yet, but While there is a dearth of objective commentary, with the growing interest in old-age problems, it there is no lack of literary evidence of the ambi- seems hardly likely that it will remain long valent attitude to old age from the earliest times unadopted. to our own day. Down through the ages comes the The present age-conscious generation-with its accepted paradox: the whole of life is too short, its

national registration, its different identity cards for last part is too long! In Biblical times, old age copyright. the young, middle and old age-groups, its post-war was the repository of knowledge and wisdom planning of social security measures and the ("ask thy father and he will show thee, thine elders warnings of its statisticians on the changing age- and they will tell thee") and the reward of composition of its population,-is perhaps more righteous living ("that thy days maybe prolonged"). aware of its higher age-group than any previous But David's dirge of the final years ("yet is their generation. In less than half a decade, problems strength labour and sorrow") and the vivid pic- of the condition of the ageing members of our ture in Ecclesiastes, of the years "when you shall society have become a paramount topic of the day say, I have no pleasure in them," are undoubt- and their solution a target for to-morrow.2 edly expressive of the spirit of the times. Of http://pmj.bmj.com/ Awareness of the earlier age-categories, childhood Cicero's De Senectute, the classic of consolation- and , has become increasingly acute literature on the subject, Montaigne said, "Cicero's within the last hundred years or so. The earliest book gives one an appetite for old age." Yet it pediatricians experienced much difficulty and many was Cicero who was responsible for the famous discouragements before convincing the medical dictum, Senectus ipsa morbus est-''old age is itself profession that the ailments of children required a disease"-on which so much later philosophy and special treatment and establishing pediatrics as a scientific effort were based. special branch of medicine. With the increase of In modem times, the two notes still strike. on October 2, 2021 by guest. Protected interest in conservation, medical interest in When the psychologist, G. Stanley Hall, retired pediatrics increased and to-day this is one of the from academic life, he produced his book, Senes- most important branches of medical science. cence: the Last Half of Life (I922), a masterly Child and the problems and malad- ethnographic survey of old age from the vague eras justments of youth have produced endless literature of the past up to the time of defined history. and'it is now quite outmoded to take the storms Yet, for all his trained, academic detachment, and stresses of adolescence for granted as being he was so little able to avoid an atmosphere of the inevitable accompaniments of physical changes. melancholy that he warned his wife and son not It is accepted that the transition of life from to read the book lest it depress them too much.4 childhood to adulthood may be full of causes for Sir William Osler's half-pessimistic, half-jesting conflict, fear and defensive behaviour, and many remarks in his Farewell Address, on "the relative psychologists have described cases of children who, uselessness of persons over sixty" roused enough on the threshold of the new phase of life, have uneasiness to produce a considerable correspond- shrunk back into the refuge of infantile fantasies. ence of protest.S Aldous Huxley, from the stand-

** Postgrad Med J: first published as 10.1136/pgmj.22.249.185 on 1 July 1946. Downloaded from 186 POST-GRADUATE MEDICAL JOURNAL July, I946 point of a younger man, contemplates old age with treatments, showing a fine understanding of Galen horror as "more appalling than death."6 Havelock and Hippocrates, was rescued by FloyerIn in a Ellis raises a rare voice in praise of old age as the more receptive age and presages much of the time when "the burden falls away. All the attitude of modem geriatrics. The doctrine that anxieties and responsibilities have become light; the process of ageing is wholly pathological, while even if work. remains, practice has made it easy," it shirks the acceptance of inevitability in any and again, "Call no man happy until he is old."7 diminution of powers, is a direct stimulus towards John Cowper Powys, the most recent writer on hygiene in all its forms. Metchnikoff's theory of The Art of Growing Old (i944), contemplating out auto-intoxication induced by external factors as of his seventy years' experience a wide range of the the preventible cause of old age and death gained relationships of old people-social, domestic and immense popularity of a valuable and constructive economic-offers some philosophic answers to the kind, since, along with his advocacy of sour milk age-old question of. how to be happy though old. for the destruction of putrefactive bacteria, he Religion, philosophy, reverie, reminiscence all proposed a life-extension code of orthobiosis-right play their part in the problem of coming to terms living, physically, mentally and socially.13 The with old age. Magic and alchemy have been eagerness with which a regimen for prolongation of resorted to for the swifter escapist solutions of life can be seized by the public is shown by the fountains of youth and elixirs of life. wave of enthusiasm aroused by Hufeland's book; of the body and restoration of the forces of ageing the word Makrobiotik, and the "Hufelandist move- man have been sought with endless ingenuity and ment" dominated a generation's thought. As refusal to accept defeat. The device of contact much that is best in the national measures with a young , recommended to David when of to-day grew out of public fears of the miasma he "was old and stricken in years; and they covered of disease and the instinct of avoidance, so the him with clothes, but he gat no heat,"8 was individual fears of burdensome old age and ever- employed by the Greeks and the Romans and has premature death contributed their quota to had followers in the medical profession in modem hygiene and preventive medicine. times. Cohausen, a doctor of the eighteenth That old age is a condition that needs care has century, published a treatise on one Hermippus, been recognized since the days of Hippocrates,copyright. a Roman schoolmaster, whose life, passed amidst the father of medicine, who differentiated and young , was prolonged to one hundred and enumerated a catalogue of ailments peculiar to old fifteen years.9 Hufeland, the well-known author people. Just as the goth Psalm caused the wide- of Makrobiotik,io a series of sound enough principles spread, fatalistic fixation of the span of life at for the prolongation of life, quotes this and other seventy years, so the i2th chapter of Ecclesiastes examples with approval and observes, "adepts has had enormous influence on later descriptions know well that the breath of young girls contains of the recognizable ills of approaching senility. the vital principle in all its purity." From the sixteenth century onwards, books'4 have http://pmj.bmj.com/ Serious scientists have contributed their share appeared, interpreting the allegorical passages and to the search for a specific against and illuminating them with observational recording of senile decay. At the end of the last century the outstanding characteristics of old age-the Brown-Sequard, and much more recently Steinach tremor of the hands, the tendency to stoop, the and then Voronoff, have sought to apply the loss of teeth, the inclination to early waking, the results of their researches in organo-therapy for failing eyesight, the growing apprehensiveness of revitalizing the ageing bodies of men. Though environmental dangers, the greying of the hair, the the verdict of the scientific world has been at best waning of and potency. on October 2, 2021 by guest. Protected doubtful as to any lasting results, the publicity The earlier "care" literature of old age has the attained by Steinach's and Voronoff's experiments same tendency as the "cure" literature-the and the popularity of their operations bore witness prescription of temperance for a healthy old age to the enormous number of elderly persons set on and prolonged life, with an occasional flash of regaining the physical zest of youth. insight into the effect of mind on body. Plutarch A more hopeful and productive line of attack on advised his ageing contemporaries to "keep your old age has been that arising out of the view that head cool and your feet warm; instead of employing old age is a disease. This view is reflected in such medicines for every indisposition, rather fast a day; titles as Roger Bacon's Cure of Old Age and and while you attend to the body, never neglect Preservation of Youth." Yet the work of this the mind." The sixteenth-century "apostle of thirteenth-century Franciscan friar and physician, senescence," Luigi Cornaro (I467-I566), in his with its mixture of science with fable and Su-re and Certain Methods of Attaining a Long and philosophy, is prophetic with humanitarian under- Healthy Life,'5 written at the age of eighty-three, standing. His account of symptoms, signs and gives an evaluation of the methods he has used to Postgrad Med J: first published as 10.1136/pgmj.22.249.185 on 1 July 1946. Downloaded from July, I946 GERONTOLOGY 187 reach and enjoy a ripe old age, in spite of having name of medicine, science and .21 been practically broken in health at forty. His In I939 appeared a vital book, Problems of Ageing, work, curiously sane among contemporaries resort- edited by E. V. Cowdry, in the form of a symposium ing to astrology and witchcraft, preaches the same mobilizing and integrating the work of specialists message of temperance and fasting. in different fields. It was sponsored by the Josiah Floyer's Medicina Gerocomica, which appeared in Macy, Jr. Foundation, in New York, which in I724, was the first scientific treatise on Diseases of earlier years was only interested in degenerative Old Age. Present-day knowledge of senile diseases disease.22 The development of interest from the is based upon Carl Canstatt's Krankheiten des major pathological hazards to the wider biological h6herem Alters und ihre Heilung (I839), which and psychological aspects of the ageing-process is checked the stream of thought that had outlined significant. Still more significant is the appearance systems of hygiene based on observation but not of a second edition only three years later, with on precise information. An important pioneering added contributions on the psycho-social and effort of J. M. Charcot, who in the late sixties economic aspects of the problems of ageing, notable inaugurated a course of study in senile diseases at among them being one by George Lawton on La Salpetriere, the home for the aged in Paris, "Psychological Guidance for the Aged," and resulted in the publication of his lectures in i867.i6 another by Edward J. Stieglitz on the "Social His work is a milestone in old-age study, marking Urgency for the Research." The pioneer in its complete emergence from speculative philosophy psychological guidance to retard and even reverse to the domain of science, with recognition of the mental decline was Dr. Lillien J. Martin. Dr. ageing body, not as an obsolescent machine, but Martin provided her own best case-historv by as having its own type-physiology. Aware of the starting, at the age of sixty-five, the San Francisco responsibility of the trail-blazer, Charcot expresses Old Age Counselling Centre, where, until the time both humility and hope as he acknowledges his of her death in I943, at the age of ninety-two, she debt to the past and looks forward to the future: was still actively engaged in consulting work with "Traditional ties are not sundered; the labour of aged clients. Her work is carried on and developed times gone by is not lost; and we shall treasure up by Dr. George Lawton, founder and director of thecopyright. the immense heritage which our predecessors Old Age Counselling Centre in New York.23 The accumulated in the course of centuries. Still it Unit on Gerontology of the Public must be confessed that new horizons have opened Health Service published in I942 a survey of three to us. . . ."I7 hundred and five active studies in gerontology The new horizons were defined and widened by begun or projected by American scientists. Dr. Nascher who, in I9I4, gave to the study a discipline Stieglitz, who is consultant in Gerontology to this and a name by publishing a textbook entitled Unit, in his introduction to a symposium on Geriatrics. The extended scope of his subject is geriatric medicine,24 emphasizes the importance of indicated in his sub-title: "The Diseases of Old orientation of the biological, clinical and socio- http://pmj.bmj.com/ Age and their Treatment; including physiological economic aspects of the study of ageing man. old age, home and institutional care, and medico- The American branch of the International Club legal relations." for Research on Ageing, founded in I939, has The medical study of old age was continued in annual conferences for the discussion and integra- England by Robert Saundby,i8 Leonard Williams'9 tion of research of leading investigators in this and others. Williams anticipates something of field and has established a museum of senile

the principles of modern geriatrics by devoting his tissues, clinical research on the effect of vitamins on on October 2, 2021 by guest. Protected book to "the consideration of the best means of old persons and, finally, a Journal of Gerontology.25 arriving at old age, together with an inquiry into In this country there has been no such steadily the present position of some of the maladies of progressive development in the study of ageing as which militate against the attainment in America. Nevertheless an increasing social of a reasonable span of life."'o But it was in awareness of the presence, importance and magni- America that the subject took living roots. tude of that section of the population which is in Nascher was followed by his pupil, Malford W. the higher age levels became evident in about the Thewlis, with Geriatrics: a Treatise on Senile middle of the war years, and the last two years Conditions, published in I919. This was followed ha-ve poured forth a spate of newspaper corre- by a greatly enlarged second edition five years later, spondence,26 housing schemes,27 literature and' and in the war years third and fourth editions, activities centred round the needs of ageing "entirely rewritten" and "thoroughly revised" fol- persons.28 In the period of heavy air raids, the lowed each other in close succession (194I and I942). Friends' Relief Service rose to the occasion with In the same few years, symposium after sym- prompt action for the removal of the aged from posium on the subject of ageing was held in the the target areas and the provision of homes and Postgrad Med J: first published as 10.1136/pgmj.22.249.185 on 1 July 1946. Downloaded from 188 POST-GRADUATE MEDICAL JOURNAL July, 1946 hostels. Other more official arrangements fol- courage the co-ordination of geriatrics with institu- lowed, all intended as temporary expedients.29 tional and home after-care, has been awarded a But the emergency situation had brought to grant by the Nuffield Foundation, augmented by light disconcertingly extensive evidence of uncared- the London County Council, for research into for old age and the emergency expedients became chronic pathological changes in the aged.34 In absorbed with other age-conscious activities into medical practice, the profession begins to recognize the beginnings of a long-term . Organi- that, by extending life and the proportion of the zations, both voluntary and statutory, having long-lived, it has helped to create a situation with direct contact with old people, began to draw wide social and economic implications, and to take together to discuss the common problem. The its share of the responsibility. The changing age- National Old People's Committee, estab- composition of the population has focused greater lished in I94I as a committee of the National attention on chronic and degenerative diseases and Council of Social Service, gradually became more on and of the aged and infirm; and more representative of these organizations and medical officers are drawn into group surveys of in I944 became an autonomous body working in the living conditions of their ageing patients.35 association with the Council. To-day there are 9 In gerontology, as in other departments, medicine regional and I20 local Old People's Welfare Com- can no longer remain an independent, self-contained mittees in different parts of Great Britain, engaged institution but must be linked with other social in setting up hostels, visiting the lonely, organizing processes in the pattern. Home Helps Schemes, meals services, social clubs, While the present preponderance of old and holidays, convalescent treatment, making repre- elderly in the population is historically unique, the sentations to the local authority regarding housing effect of a rapidly changing civilization in preci- of old people and drawing public attention to the pitating a social problem in the form of a section needs of old people by means of conferences, of the community has had its parallel in English publications and exhibitions. An exhibition illus- history. In the sixteenth century, the rise of the trating work being done and still needing to be new economy, the expropriation of the peasantry

done for "Old Age in the New World" was held at and the dissolution of the monasteries flooded thecopyright. County Hall in March of this year. The report of country with unemployed and unemployable the Assistance Board for I944 (published in thousands. While methods of driving and harrying December I945) is specially devoted to the condi- could be used with the so-called "sturdy beggars," tions and circumstances of old-age pensioners. it was perceived that the so-called "impotent While the forces of social welfare are thus poor," of whom the aged formed a great part, mobilizing to provide palliatives for present ills, the must somehow be provided for or disposed of. spreading disease of old-age distress receives some The Poor Law Relief Act of Elizabeth in i6oi was check and relief but not cure. There is urgent need the first act acknowledging State responsibility in of finding roots and causes by deeper investigation the matter. There had been ("God's http://pmj.bmj.com/ and of integrating and co-ordinating all results, and Houses") in mediaeval times, maintained by the so coming to a true cure of a condition of social Church, for the care of the aged and sick, rather pathology. The first real impetus to the scientific than for their treatment, and many almshouses examination of old-age problems has been given by were founded for the same purpose during the Lord Nuffield, and later the Nuffield Foundation, sixteenth century, when charity as a divine injunc- who supported a scheme of clinical research work tion made good works a means of grace. carried out in co-operation with the London County It is rare in the earlier philosophical and medical Council at Tooting Bec Hospital;30 inaugurated, in literature to come upon any reference to the aged on October 2, 2021 by guest. Protected co-operation with the Ministry of Health and as a group of people on the high age level. The Assistance Board, a country-wide survey of the writers are as a rule individuals themselves old, condition of old people;3, at the end of I944 made specially gifted, writing subjectively of their own a donation of £3,000 which led to the establishment experiences and for their own leisured kind. Only of the Gerontological Research Unit at Oxford, the remarkable Dr. John Smith of the seventeenth with Dr. Korenchevsky as its head;3 z and early this century, who only lived to be forty-nine and wrote year gave £20,000 to the University of Cambridge, his Portrait of Old Age36 in his thirty-sixth year, on the strength of which the Psychological LaboFa- shows any sympathetic consciousness of the de- tory is undertaking, under the direction of Dr. F. C. pendence and helplessness of the greater group of Bartlett, investigations into the causes and results old people. "Let none," he says, "give over their of ageing, and measurement of work efficiency and Patients when they come to be burdened with adaptability in relation to age.33 Now Dr. Trevor the infirmities of Age, as though they were Howell who, on the basis of his work with Chelsea altogether uncapable of having any good done unto pensioners, has contributed a good deal to en- them; . . . those that are negligent towards their Postgrad Med J: first published as 10.1136/pgmj.22.249.185 on 1 July 1946. Downloaded from July, I946 GERONTOLOGY 189 Ancient Friends are very near to those inhumane years of life need not be made heavy and hopeless Barbarians and Americans who, with great pomp with handicaps and impairments as of old. The and alacrity, both kill and devour them, thinking concern of those who work to-day for old age in thereby they perform a most charitable office in the new world is to "add more life to the years delivering them from those incurable maladies rather than years to the life."41 which will forever render them miserable." At the end of the same century, the reformer John BIBLIOGRAPHY AND REFERENCES Bellers raises a voice for the welfare of the older For the most recent, authoritative review of the position, see: i. CREW, F. A. E. (2946), Lancet, 1, 597. worker in his proposed College of Industry.: "that See also: NOTESTEIN, W., etc. (I944), "The Future Population of Europe as they grow in years in the Colledge, they shall and the Soviet Union." (Especially chaps. iv and viii.) Princeton abate an hour in a Day of their Work, and when University. POLITICAL AND ECONOMIC PLANNING (April 1940), Broadsheet come to sixty years old (if Merit prefer them not No. I65. 2. Cf. SAMSON, E. D. (1944), "Old Age in the New World" (Target sooner) they shall be made Overseers, which for for To-morrow Series), London. ease and pleasant Life, will equal what the Hoards 3. JUNG, C. G. (1933), "Modem Man in Search of a Soul," 225 ff. 4. MARTIN, L. J., and GRUCHY, C. de (1930), "Salvaging Old Age," of a private Purse can give; and excel, in so much I5. 5. OSLER, SIR W. (I906), "The Fixed Period," reprinted in Aequani- as it hath less care and danger of losing."37 mitas, 389. The history of the care and treatment of the 6. HUXLEY, ALDOUS (2932), "Texts and Pretexts," I49. 7. ELLIS, HAVELOCK (1936), "Questions of Our Day," 230 ff. aged groups of society is a history of opinion as 8. Kings I, chap. i. 9. COHAUSEN, J. H. (Eng. tr. 744), "Hermippus Redivivus or the to who is responsible-the family, the individual Sage's Triumph over Old Age and the Grave." nearest of kin or of neighbourhood, the State, the xo. HUFELAND, C. W. (Eng. tr. 2797), "Makrobiotie or the Art of Prolonging Life." employer, private charity, the people-and in the xI. BACON, ROGER (tr. by BROWNE, R., 2683), "The Cure of Old of that opinion is reflected the economy, Age and Preservation of Youth." I2. FLOYER, SIR JOHN (I724), "Medicina Gerocomica or the Galenic the sanctions, the experience, in short the whole Art of Preserving Old Men's Health." 13. METCHNIKOFF, ELIE (Eng. tr. 2903), "The Nature of Man." culture pattern of a given society. The answer Idem (Eng. tr. 2907), "The Prolongation of Life." which seems to be arising to-day to the questionings 24. Notably: LAURENTIUS, A. (I599), "A Discourse of the Preservation of the of generations is that the aged, with proper co- Sight; of Melancholike Diseases; of Rheumes and of Old Age" (translated by Richard Surphlet, London). operation from society, need no longer be the LOWE, P. (I6I2), "Discourse of the Whole Art of Chyrurgerie," copyright. group they have been made in the past London. dependent SMITH, JOHN (I666), "King Solomon's Portrait of Old Age," and can take over a great deal of their own London. MEAD, RICHARD (I775), "Medica Sacra" (translated from the responsibility and a share of the group-load with it. Latin by Thomas Stark). The centuries-old lament over impaired efficiency JASTROW, MORRIS (I929), "The Gentle Cynic." 25. CORNARO, LUIGI (I550), "Sure and Certain Methods of attaining and diminishing powers with agemg has at last a Long and Healthy Life." i6. CHARCOT, J. M. (i88I), "Clinical Lectures on the Diseases of Old become outmoded. With the mobilization of a Age" (translated by Leigh H. Hunt, with additional lectures by large percentage of older workers in the war effort, A. L. Loomis, London). 27. Idem. there has been no time to listen to this complaint, i8. SAUNDBY, ROBERT (I9I3), "Old Age, its Care and Treatment in

Health and Disease," London. http://pmj.bmj.com/ unless to seek to improve matters.38 J. H. S. I9. WILLIAMS, LEONARD (I925), "Middle Age and Old Age" (Oxford Bossard emphasizes the importance of remembering Medical Publications). 20. Cf. STIEGLITZ, E. J. (I940), Science, 92, 50o: "In man, probably that the aged are not a separate entity in the the most significant period of life for gerontologic study is late maturity, approximately the two decades between 4o and 60." community but ourselves at a later date.39 Perhaps 2I. E.g.: Medical Clinics of North America (I940), 24, I-I64. Amer. J. it is a significant symptom of the new attitude that Orthopsychiatry (I940), 10, 2786. Univ. of Pennsylvania Centennial Celebration (Sept. 2940). the most active workers on old age problems in Nat. Inst. of Health (May I94I), Washington. Amer. Chem. Soc. (Sept. 294I), Atlantic City. America are shown, by a consultation of the Chicago Med. Soc. (Dec. I942). American Who's Who (I943) and curricula vitae in 22. Cf. COWDRY, E. V., ed. (I933), "Arteriosclerosis: A Survey of the Problem." on October 2, 2021 by guest. Protected various journals, to be almost all in the fifth decade 23. MARTIN, L. J., and GRUCHY, C. de (I930), "Salvaging Old Age," New York. of their age. Dr. Martin Gumpert, the author of a Idem (I933), "Sweeping the Cobwebs," New York. vivid and challenging book,40 warm with under- LAWTON, GEORGE (1943), "New Goals for Old Age," New York. Idem (April I944), "Mental Decline and its Retardation," in Scientific standing of the ambivalent nature and difficulties Monthly (Washington), 323. 24. STIEGLITZ, E. J., ed. (2943), "Geriatric Medicine," Philadelphia of both the individual's ageing-experience and the and London. reciprocal relations between the generations, an- 25. Brit. Med. J. (2945) II, 659. 26. Cf. The Times (2945), July 7th, gth, zith, 12th, x4th, i6th, 27th. nounces himself as forty-six at the time of writing. 27. FITZGERALD, MARION (2944), "Housing with Amenities for The recent exhibition of the Old People's Elderly Women," in Friends' Quarterly Examiner, July 2944, Welfare 177-283. Committee at County Hall brought the lesson right Public Assistance J. (June 25, I945), 377, "Hostels for the Aged." SCOTTISH HOUSING COMMITTEE (I944), "Planning our New home by showing to the visitor as first exhibit, Homes," p. 26 et passim. under the label: "Old Age in the New World"-a 28. BUCKINGHAMSHIRE OLD PEOPLE'S WELFARE (I945), "Putting them on the Map," Aylesbury. mirror! Provision for old age is not all in NATIONAL OLD PEOPLE'S WELFARE COMMITTEE (I946), "Old People's Welfare," N.C.S.S., London. and financial savings. It is in the years of maturity PECK, F. E. (2945), "The Recruitment, Training and Organizing that the best are made to conserve of Voluntary Visitors to Old People," Manchester (Selnec House). preparations PLYMOUTH COUNCIL OF SOCIAL SERVICE (2944), "Old health and functional efficiency so that the later People's Welfare in Plymouth," Plymouth. Postgrad Med J: first published as 10.1136/pgmj.22.249.185 on 1 July 1946. Downloaded from 190 POST-GRADUATE MEDICAL JOURNAL July, I946 THOMASON, PETER (I945), "Old Age: A Burden or a Joy?" HOWELL, TREVOR H. (I944), "Old Age: Some Practical Points in Manchester. Geriatrics," London. 29. FRIENDS' RELIEF SERVICE (I945), "Hostels for Old People," LEWIS, A. J., and GOLDSCHMIDT, H. (July-Oct. I943), "Social London. Causes of Admission to a Mental Hospital for the Aged," in Socio- RACKSTRAW, MARJORIE (I944), "An Old People's Hostel," logical Review, 86-98. reprint from Socia Work, N.C.S.S., London. , J. V. (I944), "Annual Report of the Medical Officer of 30. See note 25. Health," Ramsgate, 8. 3I. Lancet (March 4, 1944). See also: The Times (Feb. 9, 1946); Brit. Med. J. (Mar. 2, I946); Lancet (Mar. 9, I946), etc. 32. See note 25. 36. SMITH, JOHN (I666), "King Solomon's Portraiture of Old Age," I66. 33. The Times (Feb. 3, I946), etc. 37. BELLERS, JOHN (I695), "Proposals for Raising a Colledge of 34. Lancet (I946), I, 595. Industry of all useful Trades and Husbandry," 6, London. 35. BANKS, A. LESLIE (I945), "The Care of the Infirm and the Long- 38. See STIEGLITZ, E. J. (June-July I944), "Senescence and Industry," Stay Patient," in Monthly Bulletin of the Ministry of Health and in Scientific Monthly. Emergency Public Health Service, 4, II2-II8. 39. BOSSARD, J. H. S. (I934), "Social Change and Social Problems," Idem (Oct. 6, 1945), "Geriatrics: A New Branch of Medicine," in chap. xv. Pharm. J., 158. 40. GUMPERT, MARTIN (I944), "You are Younger than You Think," CAHILL, JOHN (Feb. 27, 1946), "The Last Stage of All: Hospital New York. Care of the Aged," in Med. Press and Circular. 41. PIERSOL, G. M., and BORTZ, E. L. (I939), "The ageing process: CREW, F. A. E. (I946), V. supra, note I. a medical-social problem," Ann. Inst.-Med., 12, 964.

INFANTILE ECZEMA By I. R. MARRE, M.R.C.S., L.R.C.P. (Skin Physician to the Acton and Evelina Hospitals) This is a common disorder, which embraces characteristic. The disease is persistent and a number of different conditions, and in my chronic, and prone to relapses and recurrences, experience can most reasonably be divided up into but there is often a spontaneous improvement or four unequal groups. These are: healing towards the end of the second year. a. Atopic or allergic group. It is in this group that eczematous may b. Seborrhoeic group. exchange their skin condition for asthma or hay c. Ichthyotic or Xerodermic group. fever as they get older, and they may go on to the

d. Infected group. chronic atopic eczema of later childhood, adoles-copyright. cence and life, with thickening and lichenifi- of which the first two groups comprise by far the cation of the skin flexures. It is in this group, too, largest number of cases. that the eczematous will give positive skin I have found it useful to attempt to place each tests to proteins more frequently than in the other case in its special group, as treatment and prognosis groups or than in normal children, but in my view vary a good deal. Occasionally one does see this sensitivity is not specific, since I have found p;.tients who show characteristics of more than that the skin in infantile eczema will tend to show one group, but this is by no means usual. a positive result to a large number of protein skin

tests, and that the withdrawal of these proteinshttp://pmj.bmj.com/ a. Atopic or Allergic Group seems to make little difference to the course of the This is the largest group and consists of those disease. Occasionally one will find a child benefit children with true infantile eczema. There is markedly by the withdrawal of the protein to commonly a history of family allergy such as which it is especially sensitive. Substances which asthma, hay fever or eczema, and really severe commonly give positive skin tests in these infants cases can give a history of allergy in the families are Egg (particularly Egg-white), Milk, Wheat of both parents. and Barley. The child is well at birth but shows first signs on October 2, 2021 by guest. Protected of skin trouble when about eight to twelve weeks Treatment old. This consists of a papular, papulo-vesicular The importance of local treatment is hardly to or vesicular eruption involving the face and body, be overestimated, and all efforts must be made to with a special tendency to affect the limb flexures. protect the infant's skin from the environmental Typically a patch consists of an ill-defined ery- changes to which they seem unable to adjust them- thema, closely set with vesicles, which is intensely selves in their journey from the uterus to the pruritic and the child makes frantic efforts to outside world. scratch. Trauma leads to removal of the tops of The infant must not be exposed to direct sun- the vesicles and to the exposure of a raw weeping shine, strong winds or severe changes of tem- surface which becomes crusted with dried serum. perature, and the temperature of the room should Persistent rubbing and scratching lead to an ex- be kept evenly about 700 F. Clothing should be tension of the inflammation with infiltration and loose, light and soft, and wool should never be fissuring, and the child finally presents an ex- worn next to the skin; smooth cotton garments coriated, wizened, woebegone appearance that is should be used in preference.