Popular Science Monthly/Volume 64/April 1904/The Conservation of Energy in Those of Advancing Years III




How to Postpone the Degenerative Effects of Old Age.

A REVIEW of the foregoing phenomena of advancing years points clearly to the line upon which these may be in part controlled or delayed. It is not to be expected that we can secure the cooperation of most, or indeed many, people in pursuing preventive measures. If that were possible, and when it is possible, great things could be accomplished. However, certain principles obtain here which should be outlined so that whosoever may see fit to do so can follow these suggestions to their advantage. It will be found that the evidence of those who have studied this subject most carefully shows that normal bodily exercises are not to be forbidden, but rather encouraged. Per contra, if bodily activities are not pursued there must inevitably follow much more rapid retrograde changes in all the tissues. In respect to the diet it is universally admitted that after middle life the amount of food taken should be less than before that time and the changes in diet should be rather to use less of the structure-forming materials, though not always to exclude them. Again there should be used relatively little, indeed as little as possible, of stimulating articles of food, which make more for acceptability than necessity. In short, the simple rule should be observed of eating no more than, a perfectly normal appetite craves, and as little as possible of those things taken because they are agreeable. As the period of old age is reached, by which is meant about seventy years, the regimen should be markedly simplified and always taken with the greatest deliberation. A general rule is recognized to obtain in most cases, that the more nearly the diet is reduced to bread and milk and fruits the longer will the person live and enjoy good health. It must be borne in mind, however, that exceptions will occur, and where the strength is being rapidly lost from any cause it is wise to increase the variety and encourage food taking until the strength is restored to the normal for the age reached. The digestive processes, as well as all the processes, are slower in advancing years.

Some persons can get along best with long intervals between feeding; others, the majority, do better by taking small amounts of food at short intervals. The evacuations appear lacking in activity and must be encouraged by rational measures, but not forced by purgative or strongly diuretic drugs. This is best met by suitable articles of diet, bulky and yet not calculated to produce fermentative changes. Such qualities are found in fruits, nuts, cereal compounds and salads. Probably the best drink is buttermilk, which seems to have a salutary effect on the action of both the bowels and the kidneys. Next comes koumyss or zoolak, upon which some elderly folk have been known to subsist almost entirely for years. It is easily made at home and can be thus supplied fresh and sound and is within the reach of all, poor as well as rich. Of the cereals, Indian meal is in some respects the best, in the form of either bread or porridge. Overmuch yeast bread is objectionable, disturbing digestion and encouraging rigidities. The question of the red meats must be studied with regard to the peculiarities of the individual, but is needed very little, usually not at all. Of fluids, these are best taken in abundance, but where the heart is weak it is not wise to take them freely before exercise, as at this time they throw a perilous strain on the cardiac structures. Medicated waters are oftentimes useful, but the less inorganic drugs enter the system the better. The habit of constantly using lithia salts, exerting as they do a certain form of irritation, is to be condemned. If arteriosclerosis is present the vaso-dilator drugs are useful, especially in the forms of natural mineral waters; aconite suits many better than nitrites.

The care of the skin is of paramount importance, and the first desideratum is to employ systematic and thorough rubbing and brushing of the surface from head to heel. The flesh brush or mitten made of coarse toweling, used by the patient for half an hour at a time night and morning, serves many admirable ends and is better than too much bathing. A good plan is for the patient before rising to employ this skin stimulus and mild exercise thoroughly while in the recumbent position; if preferred and he is strong enough it is better done while sitting. The skin of old age tends to become harsh, rigid and dry, and after this effleurage it is well to rub into the body a certain amount of some oil, and it will be found that the skin will take up thus sometimes an enormous quantity. Olive oil or cocoa butter is perhaps best, but preparations containing lanolin are excellent, especially if it is desired to increase the weight and aid accumulations of fat. Sometimes crude petroleum is found useful where stimulation of the surface is required. If the skin be hypersensitive, thought must be given and changes advised in these procedures until the skin becomes inured to a suitable amount of mechanical stimulus. Old people are sensitive to cold because their surface resistance is lowered and their heat-producing powers are waning. The tendency shown by many to stay indoors and keep themselves overprotected and over-clothed is a grave error. This habit should be overcome gradually but firmly, and the patient should be in the open air as much as possible, the clothing used being sufficient, but never too much. This is particularly true of underwear, which should be light and porous, preferably linen next to the skin, which can be supplemented by extra woolen underwear placed over this to vary with the conditions of the temperature. Outings are essential to encourage free oxygenation through the lungs and the skin. Chill of surface is much more likely to follow exertion where too much or too heavy underwear is used, and the results are far more serious than if there is too little. If the skin be leaky, becoming readily moist on exertion, excessive precaution must be used lest secondary chill follow. If the underwear is made damp by exercise, it is important to change this as soon as possible and whenever it is produced. Above all the foot gear should be frequently changed to secure airing of these over-clothed members.

The most important specific recommendations I wish to offer for the postponement of the degenerative effects of age and for the recovery of so much of the normal vigor as is possible in each have to do with the forms and qualities of the exercises. As has been shown, the tendency of the tissues in advancing age is toward a steady and irretrievable hardening or stiffening or loss of elasticity, due to normal or abnormal increase in the connective tissue. The results of these changes are seen not only in the rigidity of the spinal column and ligaments, the skin, the muscle sheaths, the structures of the blood vessels, the connective tissue framework of the great organs, etc., which are obvious enough, but the really disastrous effects are those brought about by this xerosis upon the organs concerned in the processes of nutrition and of the special senses. This point I do not see brought out in any literature which has met my eye. Let me illustrate this. We have, as age creeps on, a loss in cellular activity in the functions of the special senses, well shown for example in dimness of vision, loss of hearing and slowness of cerebration. Much of this is inevitable and must continue. Some of this, however, can be delayed almost indefinitely. It will be observed that the tissues about the neck of an old person exhibit conspicuous loss of elasticity, so much that oftentimes dense rigidities are present, especially marked in the nuchal region.

I have been surprised and gratified to find that regulated movements of the neck and upper truncal muscles, employed for the purpose of accomplishing something else, resulted in a conspicuous improvement in hearing, in vision, in cerebration and, as a consequence of a betterment in cerebral circulation, also in sleep. Following this thought I have repeatedly been able to promise, and fulfil the promise, that an individual who had suffered impairment in these particulars should enjoy distinct improvement in the function of sense organs by employing regulated movements.

What is true of these structures is equally true of the abdominal viscera. A large proportion of the digestive disturbances, even of those in earlier middle life, are due to a relaxation in the supporting tissues of the great organs in the abdomen. It is estimated that dilatation, and letting down of the stomach, will be found in sixty per cent, of all adult persons. Oftentimes there are no symptoms indicating this, but when present they point toward a series of disturbances resulting from loss of muscular quality in the stomach itself. In those whose abdominal walls are feeble the organs have a tendency to sag and droop. This produces a series of alterations in the relationships of the organs and particularly of the blood vessels and structures concerned in their function. In the case of the kidneys, whose support is largely through the vessels which enter and leave them, and whose shape is so nearly spherical that they move readily, the suspensory tissues are not seldom twisted, thus shutting off the passage of waste material and interfering with the action of the nerves to the extent sometimes of causing pain and suppression of the function. In females this tendency to ptosis falls seriously upon the genito-urinary cycle, hence the uterus and ovaries are thrown out of their normal adjustments. In women who have borne children the abdominal parietes have all suffered more or less overstretching, and the slackening of these supporting tissues works mischief and discomfort. In some men, too, this is experienced. It becomes especially conspicuous where faulty attitudes are added to the structural defect. I have elsewhere expressed my opinions more fully on this and offered suggestions for relief (Phila. Medical Journal, January 10, 1903). These visceral ptoses are recognized as of large significance and their remedy is a matter of increasing importance. It can be seen at a glance that misadjustments of the abdominal organs require attention, sometimes to a very pronounced degree. The first means of relief sought by women is by the use of various forms of the corset. This garment is so universally used that we are compelled to accept it as a necessity, although I am of the opinion that we could get along very well without it if it were possible to bring women to believe so. However, the main thing is to induce women to use those corsets which will do the least harm. A certain amount of harm inevitably must follow the use of a needless artificial support. The walls of the abdomen should be competent to support the contained viscera. Where these walls are notably defective they should be supported artificially only until they can be trained to do the work adequately for which they were constructed. It is an axiom that all artificial support is merely for the purpose of conserving function until the tissues can be brought back to the normal. The first thing to be acquired in getting rid of these defects is to teach the person to stand correctly and continue to maintain proper attitudes under all circumstances. Wherever there is a stooping position maintained without effort at holding the abdominal organs in place voluntarily, there is a tendency for the abdominal viscera to pour out over the brim of the pelvis, which is thus necessarily in a slanting position.

If the neck-bones are held vertically, the ribs well lifted, and a moderate degree of tension exerted upon the abdominal walls, the viscera will rest upon, and within, the confines of the pelvis, and this position should be learned and practised; nor is it at all difficult if the attention is directed that way and some little familiarity acquired in maintaining the correct position. The body can not be held in normal attitudes unless the skeletal muscles are in fairly good tone. Most of these effects can be secured by a skillful use of breathing exercises.

It will be obvious to any one that those persons who habitually maintain an erect position in standing or sitting are stronger than those who stoop or slouch. It may be said that many of the last are perfectly well and strong, and it must be replied that they are not as well as and as strong as they should be, and further that their abdominal tissues are in perpetual danger, because an organ, or part of the body, which stands outside of its normal lines of adjustment comes closely to being in the position of a foreign body, and can not be so well protected by the central nervous control mechanism. Again, the position of the organs in the thorax are in less danger than those of the abdomen, because they have a well-constructed box to dwell in, but nevertheless they too are subjected to a good many perils if out of alignment. A person who stoops and allows the shoulders to sag down and forward and the ribs to fall back toward the spine, shortens the anteroposterior diameter of the thorax anywhere from two to five inches. It needs little demonstration to show that the lungs, heart, great vessels and other important structures in the thorax can not live, and move and have their proper being under such circumstances. Not only so, but prompt and adequate attention to these conditions results in not only improving the general health, but goes far toward maintaining symmetric functional action and the postponement of senile changes in the connective tissue.

In short, all these facts are rehearsed to give prominence to the conclusion, which seems to me inevitable, and abundantly demonstrated by data in my experience, that attention to proper attitudes, involving economies in interorganic relationships, is the one fundamental factor in postponing senile changes. The physiologic reason for urging care and persistence in retaining elasticity of tissues is to be found in the fact that sclerotic changes and faulty attitudes combine to interfere with peripheral vascular competence as well as peripheral innervation. To recur for a moment to the illustration used above, of the marked improvements following increased flexibility in the tissues of the upper thorax and neck, it is my opinion that this is to be brought about by thus promoting and encouraging fuller circulatory interchanges, especially of the lymphatic channels. I am also of the opinion, that arteriosclerosis is thus postponed, and sometimes prevented, hence the same principles hold good throughout the entire economy. It may not be necessary to develop this thought further, but to assume the truth of what I regard as an original observation, that systematized effort at elasticizing of the tissues is the basis upon which sclerotic changes generally can be delayed and made less. The means by which this result is to be attained consist chiefly in employing movements taught by a skillful person, and this should be the physician himself, assisted, it may be, by an expert trained by him to pursue the work in detail. Free exercises in the open air, proportional to the capacities of the individual, are of the greatest importance and should be regulated with the same care and supervised with the same conscientiousness as any other medical measures. Among those of the utmost importance are prescribed movements which differ in degree at least from the ordinarily employed remedial movements whose main object is to improve muscular tone, and which are largely flexor for the arms, with only a moderate degree of extensor activities. For older people there should be a steadily increasing attention to the extensors and less action demanded of the flexors. First these should be passive in the form of stretchings, rotations and torsions carefully and deliberately applied to the limbs and trunk and the neck. These should be moderately supplemented at first by voluntary movements in the same direction. Later, as vigor improves, and the heart action is strengthened, and the blood vessels recognized to be better able to stand the increased vascular tension induced by exercise,[1] these may be employed more forcefully until, by and by, the patient, even when well advanced in years, can endure a degree of muscular work which is surprising. Not only so, but this results in a feeling of well-marked enjoyment, not only of the restoration of sensations due to the improved circulation and in increased resistance to temperature changes, but in the procedures themselves which come to be distinctly relished.

In this connection let me say a word about the senile heart. It is generally accepted in a fatalistic sort of way that old people are unfit for activities, that they must do as they are inclined to do, little or nothing but exist, like vegetables. My own experiences and convictions in this particular seem fortified by the best authorities consulted. In my opinion the disinclination to movement and effort is rather the result of under-oxygenation, a habit, or other conditions which make for what one may almost call senile laziness, than an instinctive economic impulse. It is obvious that the healthier and happier old people are those who are reasonably active. My experience justifies the conviction that where activities have been encouraged, always with full estimation of the limiting conditions present, improvement results. This is true, and demonstrated to be so, under circumstances which would be considered prohibitive; for instance, where there have been observed those phenomena supposed to indicate threatened apoplexy, however that term be interpreted. 1 have had a number of cases under observation for many years where I was originally consulted for a train of symptoms which pointed toward cerebral changes such as vertigo, lapse of memory, sensory disturbances in hearing and in sight, formications, paresthesias, periods of brief unconsciousness, etc., in people of seventy years or more. Ordinarily the treatment advised for such conditions would be to reduce the individual to live the life of a hothouse plant. I have found in this contingency great practical advantage in attending to the cutaneous elimination, especially by frictions, oilings, massage, passive movements carried on to full stretchings as described above, and gradual increments of stretching exercises, forceful extensions and finally free movements and open-air life. Some of the individuals are now past eighty, strong and well. Even where there are found to be alterations in the kidneys, sometimes albumen, casts and sugar, the encouragement of the peripheral vascular stimulus was followed by the happiest results. Above all, in the cardiac arhythmias attention to the skin and regulated movements reduce these and sometimes cause them to disappear.

The pulse in old people, as has been said, is quicker than in middle life. The average of those cases reported by Humphrey, all of them over eighty years of age, were for men seventy-three per minute, and women seventy-eight, and the average respiration was seventeen. The proportion of regular to irregular pulse was four to one. I find irregularity in the pulse more common, indeed, it is generally present more or less even in the healthiest. Humphrey also found in the majority of old persons examined, little or no change in the arterial system. Clifford Allbut makes the assertion that in many cases of extreme age no evidence of arteriosclerosis is to be found. One of the oft-recurring phenomena of old age is edema due to the loss of vascular tone and defective lymph circulation. This condition would be much less frequent if the tissues, especially the larger muscles, were kept in a condition of elasticity, thus relieving direct pressure and occlusion of the contained avenues of circulation.

The exhaustion after fatigue is not well recovered from in the aged, and hence it is not permissible to maintain protracted activities; these should be supplemented by definite periods of rest, and if the heart be not strong this should be taken lying down, but this is no reason to encourage complete inaction. Again, the change characteristic of the bones of the aged, their loss of weight due to diminution in size, the walls of the shaft becoming thinned throughout from within, especially towards the ends of the bones, as at the head of the femur, forbids strong muscular exertion such as lifting. Nor should activities be sudden and severe, otherwise the danger of a false step and a fall may result in a shock or fracture or both. Nor is it important nor desirable that the muscles should be kept at their full strength, even if it were possible. The quality of musculature is mainly desirable for the purpose of oxygenation and to maintain full skin activity, freedom from stiffness and the consequent compression upon the blood vessels and nerves. In short, the component parts of the machine in healthy old age are slowly and equally weakened. They fail to respond to calls, the centers giving out less early than the outer parts, but these same centers should be maintained at their best for so long as it is possible. Finally the wheels of the machine stop. This slow decline is really a beautiful spectacle and requires the sheltering influences of civilization and sympathetic care. In the state of primitive society man died even as the animals and birds die, the one by the hand of the stronger. When assailed by sickness or age, death came swiftly from one or another agency of nature, either from animal or man. In civilization much vigor can be conserved indefinitely, or at least to well toward the century mark, provided the aged persons exercise judgment in the manner of life lived; and if cut off before a reasonable time the fault lies within themselves or their circumstances. In this slower decline it is more possible for disease and decay to become manifest, but even here prevention is a large possibility. If the heart, or the digestive organs, shall be kept disproportionately vigorous they will overload and press the other organs, and one of these, the weaker one, gives way.

The use of inorganic drugs has little place in relieving the grave disorders of the old. When these are found in the form of the natural mineral waters they have, since time immemorial, been held in high esteem for definite and indisputable good effects, the nature of which has never been satisfactorily explained. Modern studies on the physiology of the blood, especially of the serum, helps to account for this. Recently Trunecek, of Prague, has announced a method of treating the phenomena of arteriosclerosis which has been not only most successful, but suggestive, and seems to me to throw light on the value of mineral waters which will prove a rich field for research. His thesis is that certain salts can be introduced into the blood current which shall aid in dissolving the calcium phosphate found in the structure of the sclerosed vessels. Hence he adopted the plan of throwing into the circulation direct, by hypodermoclysis or intravenously, a strong solution of sodium phosphate and magnesium phosphate which are found normally in blood serum but only in minute quantities. His followers have obtained gratifying results, and many modifications are made of his original solution. Leopold Levi used this by the bowel and the mouth and it was found that the latter gave just as good effects.

Under this treatment the usual discomforts and evidences of disturbed circulation, such as dyspnea, asthma, vertigo, angina pectoris and prostration, rapidly lessened or disappeared far better than by the use of aconite, iodides and nitrites, although it occasionally transpired that when these last were also used the progress was more satisfactory.

It occurred to me to review the analysis of the various mineral waters, and I was surprised to find how many of them exhibited likewise many of these ingredients, in varying proportions, along with one or other factor to which the virtue of the water was chiefly attributed. Hitherto these factitious items have been regarded as indifferent or to them have been attributed various hypothetic or conjectural virtues. We have been long recognizing that the use of certain of the alkaline waters lessened the acidity of the urine and presumably of the blood, and the laity have been taught, partly by the profession but chiefly by the manufacturing chemists and the public press, that if ever the demon of uric acid can be laid, by the ingestion of enough of lithia salts or of some of the new and wonderful substances the special product of the great laboratories, their imperiled lives can be saved and most ills removed. The reaction against this notion has set in, but the fad remains, and will prevail long among the people, and the nonreading of the profession, that alkalies are helpful in a vast variety of vague states accompanied by the output of the uric acid in the urine common to about one fifth of the community. The real point of effort should be the restoration of the functional activity of the liver, which has to do with the conversion of ammonium cyanate, uric acid and other end products into urea. This is to be accomplished in a number of ways, the basis of which is to bring about bettered circulation in the liver and more complete functional power. For this, as well as to accomplish many other functional betterments, no single measure is comparable to regulated, deep breathing exercises. Complete expulsion is even more necessary than full inspiration. The abdominal muscles can thus be made to press upon the viscera, especially the liver and great organs, aiding largely in vascular interchanges hence secretion and excretion. By this means chiefly, if not alone, bowel action is sometimes regulated, and kidney competence enhanced.

There may be, and it seems that there is, considerable efficacy in the use of natural mineral waters, which exhibit a reasonable proportion of those salts that exert a solvent action on lime salts or other adventitious substances. Drugs, however, serve a temporary purpose and, in such conditions as the discomforts arising in beginning degenerative processes of age, would seem to need an indefinite continuance. The real curative remedy and defensive measure is in aiding oxidation of the tissues by all rational means, special movements and stimulation of the vasomotor mechanism of the great eliminating organs.

  1. This increased vascular tension as Oliver and others have shown, is quickly followed by a fall. Hence the most salutary means of lowering tension is by exercise to the point of skin relaxation—sweating.