11

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

long axis of the fold diagorial (45°) to the longitudinal axis of the hand to 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 measuredin seconds. The exact end

point was sometimesdifficult to measurein older
people; if the fold had not retracted completely in
90 sec, this time measurement wasused.

3, The exposed skin of the handsandface was observed for the presence ofsenile changes such as keratoses, nevi, pigmentation, etc. The degree of such

change was estimated on a 0 to 4+ scale: the presFigure 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

on a0 to 4+ scale as follows: 0, no greying; 1+,
1. Skin looseness.* Preliminary investigation re-

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

urementof 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 lateral to the
fingers. The caliper was then allowed to close by
its own spring tension, and the heightof the fold
of skin impinged was measured in mm onscale C.
The elongated endsof 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

closing range of the caliper. The heightofthe fold
represented the degree of skin looseness. The pres-

ence of excess fat in the skin probably caused the
readings to err on the lowside, but this was not
thoughtto result in seriouserror.
2. Skin retraction time.* The back of the hand was

found most suitable for measuring the elasticity 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

slight ‘salt and pepper;” 2+, moderate “salt and
pepper;” 3+, nearly complete greying; and 4+,
complete greying.
3. 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 recedingof 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 meas-

ured in diopters by use of the Prince refracting
rule. The average reading ofthe two eyes wasused.
2. Visual acuity* 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 f4.1 (the square root of 200), and intermediate readings were similarly recorded.
3. Arcus senilis was estimated on a 0 to 4+ scale.
Onlyslight limbic clouding was scored as 1+, and
increasing cloudingraised the score.

4. Hearing* was tested in a tent in a quiet loca-

tion with a rugged screening-type audiometer.**

*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

*Thetests were carried out under standardized conditions, but,

in view of the necessity of using an interpreter underfield con-

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 58.75+8.18. No significant
difference was found between the means of the two examiners,

ditions, it was not feasible to repeat them with a different examiner. The data are thought to be sufficiently reproducible to be of
relative value, although not so accurate perhaps as those obtained under moredesirable conditions.

the calipers were alike.

curement Agency, Fort Totten, N.Y., for loan of the audiometer.

who had previously ascertained that their techniques for using

**The authors are grateful to the Armed Services Medical Pro-

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