11
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 longi-
tudinal axis of the handto avoid naturalfolds of
skin. The caliper was allowed to remain closed 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 measure tn older
people; if the fold had not retracted completely in
90 sec, this time measurement was used.
3. The exposedskin of the hands andface 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-
Figure 8. Skin calipers used in measuring looseness
and elasticity of the skin.
ence of only an occasional abnormality was scored
as 1+, increasing abnormalities raised the score.
4. The degree of greying of the hair was expressed
ud
on a0 to 4+ scale as follows: 0, no greying; 1+,
slight “salt and pepper;” 2+, moderate “salt and
1. Skin looseness.* Preliminary investigation revealed that the skin fold at the junction of the chin
and neck was the most satisfactory for the measurement of skin looseness and also seemedto give
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 ljatera! to the
fingers. The caliper was then allowedto close by
its own spring tension, andthe height of the fold
of skin impinged was measured in mm onscale C.
pepper;” 3+, nearly complete greying; and 4+,
complete greying.
5. The degree of baldness was expressed on a 0 to
4+ scale as follows: 0, no apparent balding; 1+,
slight receding of the hair at the temples; 2+,
marked receding of the hair at the temples with
some thinning; 3+, marked thinning and baldness; and 4+, baldness complete to a “monk’s
cap” type.
Special Senses.
1. Accommodation* was measured in diopters by use of the Prince refracting
closing range of the caliper. The height of the fold
2. Visual acuzty* was measured by Snellen’stest.
It was found that use of the square root of the
average visual acuity (denominator) of the two
The elongated ends of the legs impinge on a 1-cm’
surface of skin and exert a pressure of 500 g. There
is little variation in spring tension in the last 2 cm
rule. The average reading of the two eyes wasused.
represented the degree of skin looseness. The pres-
eyes madethe scale more compressed and more
ence of excess fat in the skin probably caused the
readings to err on the low side, but this was not
thoughtto result in seriouserror.
2. Skin retraction time.* The back of the hand was
found most suitable for measuring theelasticity 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
*Thereliability 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, 58.2+8.13 and 58.75+8.18. 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.
linear. Thusthe 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 in-
termediate readings were similarly recorded.
3. Arcus sentlis was estimated on a 0 to 4+ scale.
Onlyslight limbic clouding was scored as 1+, and
increasing cloudingraised thescore.
4. Hearing* was tested in a tent in a quiet location with a rugged screening-type audiometer.**
*The tests were carried out under standardized conditions, but,
in view of the necessity of using an interpreter under field con-
ditions, it was not feasible to repeat them with a different exam-
iner. 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.