Diseases of Old Age

The mass may take any shape, depending upon the part of the organ involved. Smooth and round in general hypertrophy, it becomes more or less irregular in unsymmetrical overgrowth, or from circumscribed tumors.

The portion most frequently involved, either alone or (usually) associated with more or less general hypertrophy, is the posterior median part, known since Sir Everard Home as the third lobe. This nomenclature, however, is inexact. The prostate has no third lobe, and what Home, from his dissection of diseased prostates, named the third lobe,” is, in reality, pathological formation, and is now more correctly styled median centric hypertrophy. It consists of that triangular part of the prostate lying between the ejaculatory ducts, and overgrowth in this situation is believed to be due to the absence of capsule here. It may be found with little or no enlargement elsewhere. In form it is usually an oval, rounded tumor (there may be two or more), which grows up from the floor of the back part of the prostatic urethra and juts out posteriorly into the cavity of the bladder. It may reach the size of small pear, and indeed resemble pear in shape, showing tendency to pedunculation.

the lateral lobes, only one may be affected, but usually both, more or less general enlargement corresponding with the local overgrowth (Fig. 57). Under these circumstances the pyriform central tumor tends to fill up the internal orifice of the urethra, leaving passage on either side along its floor, for the urine. The mucous membrane on either side of the central mass is often drawn up, between it and the hypertrophied lateral lobes, forming crescentic bar at the neck of the bladder.

Embedded in the hypertrophied mass, it is usual to find several small circumscribed tumors, dense, hard, seemingly fibrous in character, easily enucleated and elastic, so that, when cut through in clean section of the organ, the cut surface of the tumor overrides the general smooth plane of the incision, as if the little mass had previously been compressed. They are formed of unstriped muscle with some new glandular tissue, and are considered analogous to mammary glandular tumors, or to the glandular bodies which develop (pathologically) in and around the thyroid. These tumors, usually small, may become as large as marble; many are found of the size of pea. Other localized hypertrophies of the prostate are more rarely encountered in the shape of distinctly pedunculated tumors, which grow from any portion of the posterior margin of the prostate and hang into the cavity of the bladder. They may surround the neck of the bladder like fringe. Median centric hypertrophy may take this form, constituting sort of ball-and-socket valve at the neck of the bladder. Finally, there may develop in the thickness of the bladder-walls small supernumerary outlying prostatic glandular tumors, varying in number and in size, but only existing coincidently with one of the ordinary forms of overgrowth.

H., V. B., & Keyes, E. L. (1884). A practical treatise on the surgical diseases of the genito-urinary organs, including syphilis: Designed as a manual for students and practitioners. New York, NY: D. Appleton and Company.

Entered by: Kate Holder, 7/17/2020

Edited by: Rachel Johnson, 6/24/2021

Senile pneumonia commences very insidiously, and usually runs a latent course. [...] It may begin with a protracted attack of shivering - rarely a distinct chill; when a person has a distinct chill, pneumonia almost invariably follows [...] when there is no shivering or pain - which occur in only about half the cases - the onset may be marked by a very light increase in, or irregularity of, the movements of respiration, a slight elevation of temperature, a feeling of great exhaustion, and a short, hacking cough. In some cases even all but the feeling of weakness are absent. It may be ushered in by nausea, vomiting, diarrhea, and collapse. [...] There is pain in the head, usually in the frontal region. There is great prostration, and the appetite is impaired, while thirst is increased. [...]

In old age expectoration does not appear early, and even when it does, is liable to sudden suppression. First scanty, gray, and frothy, then yellow or “catarrhal,” it finally may become reddish, glutinous, or viscid. [...] In the majority of cases the sputa resemble those of bronchitis, the color being opaque, yellowish green. Purely puriform sputa never occur in the pneumonia of old age. [...] A watery, blood-stained, or prune-juice expectoration indicates either a severe and dangerous form of pneumonia, or pulmonary congestion and edema. [...] The sputa contain an exceptionally large amount of sodium chloride. [...] The temperature may rise progressively, with slight intermittent remissions; or it may suddenly fall. [...] Both these occurrences are common in senile pneumonia. [...] When the onset can be approximately estimated, the temperature will be found to be highest on the third day, unless fatal defervescence occurs. The pulse in the aged is normally more frequent than in adult life. Hence, in senile pneumonia the pulse does not afford reliable indications. [...]

When dyspnea is very intense, and the pneumonia is at the base of the lung, it tells of nervous exhaustion, and is very serious. [...] pain is never very intense; it is rather an uneasy, dull feeling, occupying no particular spot, and very frequently is diffused over the whole chest. Tenderness on palpation or percussion is not so marked as in the adult. Pain, if present in senile pneumonia, is referred to various localities [...] but it is always anterior. In pneumonia at the apex it is transitory or completely absent.

In “typhoid” pneumonia there is no pain; but, as the disease progresses, a sense of “oppression” occurs, which increases with the increasing weaknesses. One side of the face, more than the other, has a “mahogany” colored flush upon it, not diffused as in typhus fever, but as a circumscribed spot. This flush is often the first objective sign of senile pneumonia. The heat of the skin is greatest in the morning. Three or four days from the onset of the pneumonia, herpetic eruptions appear upon the cheeks, lips, and nose. If the lips become blue, it denotes vaso-motor disturbance, and is a very grave sign. As the disease advances, the face loses this dusky hue and becomes sallow - a very dangerous symptom - and the surface-heat gives place to a cold, clammy perspiration.

Charcot, J.M. & Loomis, A.L. (1881). Clinical Lectures on the Diseases of Old Age. W. Wood & Company. Pg. 197.

Entered by: Ayushi Chintakayala, 6/22/2020