The Gerontological Aspects of Atheroma

We may, as a matter of convenience, distinguish two categories of gerontological research, the study of old age or old people on the one hand, and the study of ageing on the other. Almost the whole of pathology is our field in the study of old age; for whilst there are very few diseases which spare the aged, many present special features when occurring in them, either attacking them more readily or being more dangerous and less tractable. The study of these phenomena presents a vast and important task, in which, however, orthodox pathology can be of great help. In the study of ageing the field is much narrower and the guidance to be derived from existing disciplines much less. Each one of the diseases of old age is characterized by the fact that it attacks individuals or groups of individuals, leaving a significant proportion of mankind untouched. These diseases are, however, only the superimposed complications of an under lying process of functional deterioration in which all human beings share, and it is with this universal process that we are concerned in the study of ageing. It must be admitted that strict proof for the existence of such a separate process of ageing is lacking. The concept that we are all subject to an identical processor complex of processes of deterior ation is based on purely circumstantial evidence and on an impression which has been prevailing in the human race throughout the centuries. But if, as a working hypothesis, we accept the existence of ageing as a separate physiological or pathological entity and begin to look round for its manifestations, we are struck by the extraordinary difficulty of finding them. In order to be acceptable as a part of the complex of senescence a phenomenon must fulfil at least two conditions: it must be exhibited by all the members of the species, and it must be demonstrable at a time at which the complications of old age are still rare. Atheroma of the aorta is one of the very few * Whaitt Research Scholar. co ditions which not only passes the test of both t se criteria but also furnishes us with easily accessible and comparatively easily measurable lesions. An analysis of aortic atheroma might, therefore, apart from its intrinsic interest, contribute to our understanding of the process of senescence.