Author Institution: Anatomical Laboratory, Western Reserve University, and Associated Foundation

Todd, T. Wingate

The Ohio Journal of Science

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THE OHIO JOURNAL OF SCIENCEVOL. XXXVIII JANUARY, 1938 No. 1CERTIFICATES OF GROWING UP ANDGROWING OLD*T. WINGATE TODD,Anatomical Laboratory, Western Reserve University,and Associated FoundationsGrowing is a subject for comment and congratulation. Nochild but revels in growth so vigorous that clothes have missedtheir chance of wearing out. Even if growth is measured interms of weight, it is dimension not tonnage which gives prideand satisfaction. So dear to our hearts are the thoughts of ourchildhood that this one never fades and growth remains increasein dimension in all our natural ambition. With some misgivingsand a trace of regret we force ourselves to think of growing upand hotly resent the thought of growing old. Both seem to besymbols of fading or of loss, Time's stealthy step like some farminute bell tolling us to our doom. Experience does not meandecline nor age senility. Organs are geared to last our time:their functional reserve or regenerative power preserves theirintegrity throughout life. Acute injuries followed by processesof repair, MacNider has shown, cause fixed cells to change theirconfiguration, to modify their receptivity to injurious agents (7).Thus tissue resistance is acquired. The process of growing oldenhances adaptability. Infirmity is the outcome of anotherprocess, the weakening of the resistance of these same cells, withsenility as its end result if intercurrent afflictions have notdestroyed the metabolic power. The organs are the armies, theadventurers, but the somatic tissues are the terrain whichbears the scars of battle and the evidence of progress. Somesomatic tissues, like the skin and hair and nails, can undergogreat changes apparently with little consequent effect on theorganism itself. Perhaps the central nervous system falls intothis category. The ectoderm may even be misleading. Ento-*An address presented to the Ohio Academy of Science, May 14, 1937.12 T. WINGATE TODD Vol. XXXVII Idermic integrity is far more vital. But in the mesodermiestructures bone and muscle, circulatory and respiratory systems,is betrayed the progress of the aging process which the organsthemselves conceal. Of these the skeleton is most readily inves-tigated, thanks to roentgenography. And that is why I askyour attention in a study of the bones, not as zoologists oranatomists, but as biologists intent upon the fundamentalprinciples of life and their expression.It is in an investigation such as this that one realizes mostclearly the futility of sideral time to express in any way theprogress of aging. The waxing phase of aging lasts we say sometwenty years, a short portion of our whole life span but oneduring which aging progresses with tremendous speed. Thewaning phase is said to last from thirty-five years till the closeof life, a period long in time but marked by relatively littlechange, so slowly does the aging process affect the healthy body.Twice previously have efforts been made to measure progress inaging, neither however very simple in execution. Lecomte deNoiiy measured the rate of healing in a wound at different agesand found that it follows an exponential curve (6). The tissuesof the body and the blood plasma together complete a closedsystem, changes in the one being reflected in the other. Conse-quently it has been suggested that the characters of the bloodplasma may be used to demonstrate the progress of aging,through its power of retarding the vigor of cellular subdivisionin vitro. Young plasma has very little more effect than anutritive saline solution. Aged plasma will completely inhibitthe subdivision (1).The method which I propose has the advantage of callingfor very simple technique, of affording a simple assessment, andof being equally reliable with the other two methods to whichallusion has just been made. It also is applicable to all mammalsas well as Man and readily enables comparisons of aging to bemade in very different forms of mammal. It has the furtheradvantage of registering health as well as maturity. The tech-nique required is the roentgeneography of the limbs to show thestage of development of epiphysial centers if the animal beyoung; the condition of articular ends and degree of mineraliza-tion of the bones if the animal be adult. In human beings andlarge animals we make roentgenograms of left side only, hand,foot, elbow, knee, shoulder and hip. At certain stages roentgen-ograms of the vertebral column and perhaps of the sternalNo. 1 GROWING UP 3ends of the clavicles are essential. But the vertebral columnroentgenogram is no longer helpful after the twentieth birth-day for then epiphyses of centra are united (21). And theroentgenogram of the clavicle is useless for a similar reasonafter the age of twenty-eight (12). Symphysis pubis can,however, be helpful up to thirty-five years (13). If the animalis small it is simplest to make one roentgenographic film ofthe entire body.The method merely accomplishes by a quickly and easilyapplied technique wrhat otherwise can be readily carried out byactual examination of the skeleton (11, 19, 20). It is applicableequally to the living and the dead. It gives us a picture of lifein the fourth dimension, namely duration.One need scarcely remind a biological audience that thereare, in the skeleton, primary and secondary centers of ossifica-tion, that these appear at certain stages of early life, enlarge,take on the adult contour of the bone and finally merge them-selves as integral parts of the skeleton. I purposely speak ofprimary as well as secondary centers for I do not want toconfine our attention to epiphyses but include such skeletalelements as carpals and tarsals, union of primary innominateelements and even sutures.The initial appearance of these centers and the ultimateincorporation of the bony element into which they develop inthe skeleton, or fusion with the shaft if they appear in epiphyses,has been very crudely and unsatisfactorily investigated, usuallywithout any collateral inquiry into the health or living condi-tions of the children studied. Consequently statistical reduc-tions of age relationships have labelled both ossification andunion unreliable as age indicators because of the considerableage range covered by each of these stages. That there is aconsiderable range in age is perfectly true. The important pointis that if unions are systematically studied, it is found that thesequence of union is invariable. This fact I pointed out toStevenson in 1923 on the basis of researches already carried outwhile making the collections of human and mammalian skel-etons for the Hamann Museum. It was utilized by Stevensonas the theme for his thesis (11). The invariable sequence,despite the range in age relationship of union in each item,throws a very different light on the problem. It means thatthe entire union pattern is speeded up or retarded in relation tosidereal time. The question naturally arises: Why the individual4 T. WINGATE TODD Vol. XXXVII Ivariation? Plotting our results on a very large series of observa-tions (18), we find the curve skewed. It has an abrupt forwardboundary and a straggling tail. Hence, there is a very definitelimit to acceleration but no practical limit at all to retardation.Clearly this is not a feature inherent in the organism butsomething induced by the environment. Further investigationshows that retardation may be experimentally induced (17) orresult from adverse conditions of health, diet or housing (16).As the result of infliction on successive generations the retarda-tion may develop the aspect at least of a hereditary character (2).Another closely related question occurs to one at this stage,namely, how, if the entire union sequence can swing forward orbackward in sidereal time, one can tell without the evidence ofthe years whether the sequence is retarded or not. Whenretardation has reached a clinically significant degree, there aredefinite evidences, pathological or quasi-pathological in nature,which testify to its irregularity (3, 17, 20).Still another question arises, born this time of the conven-tional linkage of ossification with union of epiphyses in thoughtand discussion. The epiphyses which ossify first unite last, it issaid. In a sense this is true, but it is one of the half-truthswhich prove most misleading. Both primary and secondarycenters appear in sheaves from which one or more centers maybe missing owing to defects in available mineral, Vitamin D orboth (4, 23). If a center fails to ossify on time, it may bedelayed for a long while and other centers ossify ahead of it.But that has no influence on the age of final union. These twomorphological processes, being influenced quite separately byenvironmental conditions occurring at great intervals of time,could not, except by accident, present a unified relationship toa third phenomenon.It is extraordinary also that investigators of epiphysialossification or union rarely thought of studying the bony nodulein the interior (9) until I brought this forcibly to scientificnotice (14, 15, 18). At first mineral is laid down as a finelygranular dot in the nubbin of cartilage. The granular dot isapproximately spherical. Then it begins to grow lopsided andnext fashions for itself a contour, extending irregularly until itbegins to resemble the periphery of the adult bone or bone-end.The later stages, if it be a separate bone such as a carpal or atarsal, progress slowly but individuality and vigor of outline isthe result with all the characteristic modelling of the finishedNo. 1 GROWING UP 5bone. If the ossification is that of an epiphysis, there are stagesin the face abutting on the shaft, just as characteristic as thoseof the subarticular contour, but they are not so suited forassessment into a chronological sequence.The orderly sequence of development in the epiphysial,carpal or tarsal contour can readily be recorded as we havedone for the human skeleton (15) and are now describing inmore complete detail (18). Thus initial ossification, sequencein fashioning of contour and ultimate union can all be used asindicators of progressive maturation in the skeleton.But there are pitfalls. The sick child or unhealthy animalwill not be easy to assess. Retardation of progress may resultin delayed union, though the sequence of union in the approx-imately fifty skeletal areas of epiphyses to be studied willusually be retarded as a program, not in some haphazardfashion. Under certain conditions, it is true, one or two epi-physes are picked out and retarded while the progress of unionin the skeleton as a whole passes them by. Retardation whichis often erratic, irregular and asymmetrical in the epiphysis,though not bilaterally asymmetrical, may occur in the phaseof expanding bony contour. Deficiency in necessary mineral orcatalyst may cause delay in the initial ossification of one ormore in a sheaf of centers. All these are special problems for theinvestigator who is making a tool of the phenomenon of ossifica-tion. They have been discussed in considerable detail elsewhereand need not delay us now. It is these features, however,which have given rise to the assumption of natural variationthrough lack of understanding of the cause of individualdifference.The first use to which we put this special knowledge of thesequence in skeletal maturation was archeological. It was theidentification of the age of Akhenaten, the heretic pharaoh ofthe Eighteenth Dynasty. Our assignment of twenty-two yearsto this active and restless personality has never been acceptedbut no one cavilled at the eighteen years assigned to one of hissuccessors, Tutankhamen. We are now at work on the age ofthe famous Princes in the Tower, Edward V of England and hisbrother, the Duke of York. There is no doubt that the bonesare the bones of these princes but they show evidence of suchpoor health in the children that both are retarded in progressbetween one and two years. The story of our disentangling the6 T. WINGATE TODD Vol. XXXVII Imystery of a skeleton in a famous oil litigation has been alreadydescribed in full (8).Not only the anthropologist or the medico-legal expert findsan effective tool in skeletal maturation. The zoologist is enabledthereby to judge the comparative age of young skeletons and toassess in terms of maturation the evidence in any skeleton setbefore him. It is true in other mammals as in children thatvagaries may be induced by dietetic deficiencies or healthdefects. But barring these, the assessment of maturation inany mammalian skeleton is not a difficult task. The assessmentprovides a ready means of investigating the duration of theseveral phases of growing up.The physiologist's problem is this one of differential matura-tion. Our investigation of living primates, for the sequence canbe studied by roentgenography in the living just as well as bydissection of the dead, shows that the phase of infancy and thatof the grade school period in the anthropoid are very shortwhereas the preschool and adolescent phases cover about asmuch time as those phases of a child's life. It is in the slowingdown of progress in different phases of maturation that theprimate differs from the non-primate, the anthropoid from theOld World ape and Man from the anthropoid.There is definite usefulness for this tool in the nutritionist'swork. Not only is the sequence of maturation significant inkeeping a check upon experimental animals but fluctuations inits progress may be assessed against a standard table or againstcontrols in the investigation of optimum conditions of life andhealth or the influence upon the animal of specific experimentalprocedures.Then there is a clinician's problem which has already beenlightly sketched. Disturbances in the maturation program,retardations that is in progress, are signs of handicap far morepronounced than those which result merely in failure of growth.The recovery of a child from one of these more severe handicapsis announced in the restoration of normal progress in thematuration schedule.There is a farmer's problem to be touched upon here. Andthis is not by any means the least significant for it is bound upin the larger issue of early and late maturing of stock and theraising of animals for meat. It has been touched upon butnot systematically studied by Sanson (10), von TscherwinskyNo. 1 GROWING UP 7(22) and Hammond (5). We have given it considerable attentionin our laboratory (17) and find it a fascinating study of verygreat practical community importance.Of all the several aspects of the maturation pattern to whichI would refer in this brief discussion, however, there is nonethat equals in its import that of the educator and the parent.Our school system is based on age and it is in terms of age thatwe evaluate the responsibilities of a child. That is our con-vention: it may lead us right or it may lead us wrong. Thechild himself chooses his companions by size without regard toage and this is a surer guide. But he realizes himself in termsof his maturity which is betrayed in his skeletal pattern for theorganism, to be in health, must function as a unit. His aspira-tions, his hopes, his cravings, his human relationships arepostulated not on age or experience or stature or weight buton the level he has reached in maturity, which we lightly call,"growing up." It is of little moment that a boy be twelveyears old or have the stature of a lad of fourteen. If the levelof his maturity be but ten years his thoughts and feelings willbe determined by that level. Experiences beyond that will passineffectively over his head. If the girl be twelve years old andher stature that of ten, these will have no bearing at all on hercapacity for social adjustment should her level in maturity befifteen. To treat her as a child will be but to outrage her wholebeing and to evoke in her a resentment and the sullen rebellionin which unremitted misunderstanding inevitably results. Whenwe shall have realized and based our domestic and social rela-tionships upon this more complete knowledge, life will havegreater fulness both for our children and for ourselves.REFERENCES(1) Carrel, Alexis. 1935. Man, the unknown. Harper, N. Y.(2) Dawson, A. B. 1935. The influence of hereditary dwarfism on the differ-entiation of the skeleton of the mouse. Anat. Rec., vol. 61, pp. 485-493.(3) . 1935. The sequence of epiphyseal union in the skeleton of the mousewith special reference to the phenomenon of "lapsed union." Anat. Rec,vol. 63, pp. 93-99.(4) Francis, C. C, and P. P. Werle. The appearance of centers of ossificationfrom birth to five years (in preparation).(5) Hammond, John. 1932. Growth and development of mutton qualities in thesheep. Oliver & Boyd, Lond.(6) Lecomte, du Noiiy, P. 1937. Biological time. Macmillan, N. Y.(7) MacNider, W. de B. 1937. (Personal communication.) Concerning thesignificance of certain morphological changes developing in selected organsof aged animals. (In press.)(8) Mayer, Milton, and John Howe. 1931. Steps in the dark. Rockwell,Chicago, pp. 197-202.3 T. WINGATE TODD Vol. X X X V I I I(9) Pryor, J. W. 1905. Development of the bones of the hand as shown by theX-ray method. Bull. State College Kentucky, ser. 2, no. 5.. 1906. Ossification of the epiphyses of the hand. Bull. State CollegeKentucky, ser. 3, no. 4.1908. The chronology and order of ossification of the bones of thehuman carpus. Bull. State Univ. Kentucky, new ser. 1, no. 2.1916. Some observations on the ossification of the bones of thehand. Bull. Univ. Kentucky, vol. 8, no. 11.(10) Sanson, A. 1872. Memoire sur la theorie du developpement precoce desanimaux domestiques. J. de l'Anat. et de la Physiol., t. 8, pp. 113-159.(11) Stevenson, P. H. 1924. Age order of epiphyseal union in Man. Am. J.Phys. Anthrop., vol. 7, pp. 53-93.(12) Todd, T. W., and J. D'Errico. 1928. The clavicular epiphyses. Am. J.Anat., vol. 41, pp. 25-50.(13) Todd, T. W. 1930. Age changes in the pubic bone. VIII. Roentgen-ographic differentiation. Am. J. Phys. Anthrop., vol. 14, pp. 255-271.(14) . 1930. The roentgenographic appraisement of skeletal differ-entiation. Child Development, vol. 1, pp. 298-310.(15) . 1932. Roentgenographic appraisement of developmental growthin the skeleton. White House Conference on Child Health and Protection,"Growth and Development of the Child. Pt. IV. Appraisement of theChild." Century, N. Y. pp. 258-279.(16) . 1933. Growth and development of the skeleton. White HouseConference on Child Health and Protection. "Growth and Developmentof the Child. Pt. II. Anatomy and Physiology." Century, N. Y.pp. 26-130.(17) Todd, T. W., Wharton, R. E., and Todd, A. W. 1938. The effect of thyroiddeficiency upon bodily growth and skeletal maturation in the sheep.Am. J. Anat. (In press.)(18) Todd, T. W. 1937. Atlas of skeletal maturation. Pt. I. The hand.Mosby, St. Louis,(19) Todd, T. W.? and A. W. Todd. 1938. The epiphyseal union pattern ofungulates with a note on Sirenia. Am. J. Anat. (In press.)(20) Todd, T. W., Todd, A. W., and Todd, D. P. Epiphyseal union in mammalswith special reference to Rodentia. (In press.)(21) Todd, T. W., and R. B. Sommerfield. The epiphyses of the vertebralcolumn. (In preparation.)(22) von Tschirwinsky, N. 1889. Zur Frage uber das Wachstum der Rohren-knochen und den muthmasslichen Zusammenhang dieses Waphstums mitdem Wechsel der Schneidzahne bei den Schafen. LandwirtschaftlicheJahrb., Bd. 18, S. 463-476.(23) Venar, Yasha, and T. W. Todd. 1936. Experiments on the maintenance ofmineral density in the skeleton. J. Lab. & Clin. Med., vol. 22, pp. 221-230.

Certificates of Growing Up and Growing Old

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Certificates of Growing Up and Growing Old

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