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fold of skin several centimeters proximal to the
knuckles near the middle of the hand, with the

long axis of the fold diagonal (45°) to the iongitudinal axis of the handto avoid naturalfolds of
skin, The caliper was allowed to remainclosed for
exactly 60 sec and then removed, andthe timefor
the skin fold to retract back to the normal skin
contour was measured in seconds. The exact end
point was sometimesdifficult to measurein older |
people; if the fold had not retracted completely in
90 sec, this time measurement was used.

3. The exposed skin of the hands and face was observed for the presenceofsenile changes such as keratoses, nevi, pigmentation, etc. The degree of such
change was estimated on a 0 to 4+ scale: the pres-

ence of only an occasional abnormality was scored

Figure 8. Skin calipers used in measuring looseness
andelasticity of the skin.

as 1+, increasing abnormalities raised the score.
4. The degreeof greying of the hair was expressed

‘on aOQto4+ scale as follows: 0, no greying; 1+,

1. Skin looseness.* Preliminary investigation re-

slight ‘‘salt and pepper;” 2+, moderate “salt and

urementof skin looseness and also seemedto give

5. The degree of baldness was expressed on a 0 to
4+ scale as follows: 0, no apparent baiding; 1+,
slight receding of the hair at the temples; 2+.
marked receding of the hatr at the temples with

vealed that the skin fold at the junction of the chin
and neck was the mostsatisfactory for the meas-

the best correlation with age. The measurement
was carried out by grasping the skin with the
thumb andforefinger, pulling it gently outward,

and applying the,caliper opened to 4 cm so that
each leg was firmly against the skin lateral to the
fingers. The caliper was then allowed to close by

tts own spring tension, and theheight of the fold
of skin impinged was measured in mm onscale C.
The elongated ends of the legs impinge on a |-cm*
surface of skin and exert a pressure of 500 g. There
is little variation in spring tension in the last 2 cm
closing range of the caliper. The height ofthe fold
represented the degree of skin looseness. The presence of excess fat in the skin probably caused the
readings to err on thelow side, but this was not
thoughtto resuit in serious error.
2. Skin retractron trme.* The back of the hand was
found most suitable for measuringtheelasticity of
the skin. The hand and forearm were placed at
rest on a table. The caliper was opened to 2. cm
(on the crossarm scale) and allowed to close ona

pepper;” 3+, nearly complete greying; and 4+,
complete greving.

some thinning; 3+, marked thinning and bald-

ness: and ++, baldness complete to a “monk's

cap’ type.
1. Accommodation* was measSpecial Senses.
ured in diopters by use of the Prince refracting

rule. The average reading of the twoeves wasused.
2. Visual acurty* was measured by Snellen’s test.

It was found that use of the square root of the
average visual acuity (denominator) of the two
eyes made the scale more compressed and more
linear. Thus the best vision, 20/10, was repre-

sented as 3.2 (the square root of 10) and the worst,

20/200, as 14.1 (the square root of 200), and intermediate readings weresimilarly recorded.
3. Arcus sentlis was estimated on a 0 to 4+ scale.

Only slight limbic clouding was scored as 1 +, and

increasing cloudingraised thescore.
4. Hearing* was tested in a tent in a quietlocation with a rugged screening-type audiometer.**

*The reliability of the skin looseness and skin retraction time

measurements was tested by having two examiners take data on
20 hospital patients of various ages with the skin calipers. The

mean values with their standard deviations were: for skin looseness in mm, 20.85+0.71 and 20.90~0.70; for skin retraction
time in seconds, 58.28.13 and 58.7528.18. No significant
difference was found between the means of the two examiners,
who had previously ascertained that their techniques for using

the calipers were alike.

*The tests were carried out understandardized conditions, but,

in view of the necessity of using an interpreter under field conditions,it was not feasible to repeat them with a different examiner. The data are thoughtto be sufficiently reproducible to be of
relative value, although not so accurate perhaps as those obtained under more desirable conditions.
**The authors are grateful to the Armed Services Medical Procurement Agency, Fort Totten, N_Y., for loan of the audiometer.

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