Popular Science Monthly/Volume 27/July 1885/Hygiene of the Aged
DIFFERENT epochs in life are marked by the frequency or infrequency of certain morbid phenomena constituting that departure from the normal standard of health which we denominate disease.
What is life? is the unanswerable question the human race has ever sought to solve. Bichat called it "the sum of the functions by which death is resisted." Physiologists of the present day offer little more that is satisfactory in their definitions, calling it "the aggregate of the phenomena peculiar to living organisms." The inscrutable mystery which surrounds the principle of vitality renders any attempt at definition illogical and unsatisfactory. We have to deal with the phenomena of life, and the functions through which these phenomena are manifested. In the child we have an exuberance of life. Manhood is the period of repose; waste and repair seem to neutralize each other; and calmness, deliberation, and quietude prevail.
With old age come disturbance, waste without repair, destruction without building up, action without reaction, decay and death. These phases of animal life are constantly repeating themselves. In discussing the diseases of old age, we have to deal with the phenomena of life, the perversion of functions which have hitherto counterbalanced each other. The prime of manhood and stability is passed; internal resistance now fails to maintain itself against external force. Nutritive action does not respond to the demand to renew effete material. The equilibrium being destroyed, decay and the products of decomposition become the most important factors in the study of the diseases which now threaten to disintegrate this hitherto self-sustaining system.
It will easily be seen that the diseases which disturb the formerly evenly balanced organism tend toward what pathologists call destructive metamorphosis. Blood-changes, tissue-changes, and secretory changes, are subjecting us to constantly varying standards of health. How to maintain the equipoise as long as possible, and prevent the too rapid decline of the vital forces, as well as to suggest measures—when care and forethought can ward off the blow—is the province of the thoughtful medical man.
Threescore years and ten should certainly be reached by most of those who attain adult age, provided no inherited taint weakens the vital forces. It is difficult to determine the exact period of life at which the decline commences. In fact, there can be no absolute standard from which we can predict with unvarying certainty the gradual failure of the physical powers. Some seem to inherit a vitality which almost defies the ravages of time; but, although they are apparently in the full vigor of life, close scrutiny rarely fails to detect the fact that the scale is tipping downward. We do not grow old in a night, although we often make the remark that So-and-so has grown ten years older since the occurrence of some great grief, or some disastrous reverse in business. The eye-sight gets poorer, the hair and beard grayer and thinner; the form is more bent, the walk more uncertain, the arcus senilis appears in the cornea. After all, this is not old age; these are all warnings, but the heart is still warm, the eye still bright, the muscles still firm. The world looks as fair and inviting as it did in early manhood or womanhood—a little larger print to read, a smoother road to walk on, a few more flannels at night, and a little less labor during the day, with perhaps a greater disposition toward quiet, a greater fondness for home-life, and a disinclination to encourage the enthusiasms which time and experience have so often proved to them to be illusive.
We are to consider the physiological and pathological conditions arising during this epoch of life. Many of these are characteristic, and do not earlier manifest themselves. We have many works upon the diseases of children and adult life, but almost none pertaining to the diseases incident to age. And yet they are peculiar. The pneumonia of a child is not the pneumonia of an aged person. Slight ailments, unobserved or disregarded in the adult, become positive disease in advanced life. Our acute fevers, inflammations, fluxes, etc., are not met with among the aged.
Congestions, chronic inflammations, tumors of the brain, paralysis, rupture of blood-vessels, enlargement of the heart, chronic bronchial affections, dropsical effusions, indigestion, diseases of kidneys and bladder, especially the latter, cancers, etc., are what the physician is most often called upon to prescribe for in old people. Aside from actual disease, the conduct of the life of elderly persons is to be studied and observed. Ordinarily old age brings with it, or should, a certain degree of leisure and immunity from the distressing anxieties which vex and worry the lives of men actively engaged in business. The danger of sickness from exposure, as far as the liability to exposure is concerned, and the danger arising from accidents are lessened; old people are careful, and warily thrust themselves into danger. Calmness, quietness, and a regular habit of life, succeed to confusion, activity, and an indulgent and irregular method of living. Life wanes, the descent is easy and gradual, a peg is lost here and a prop there, the sympathies become blunted, the intellect chilled, the senses lose their acuteness, and "the play is played out." What more delightful spectacle than an aged person in full possession of all his faculties, enjoying life with the zest of manhood's prime, appreciative of the pleasures of the table, the society of friends, the charm of music, and the intellectual feast that a good book presents to him!
Hufeland, in his "Art of prolonging Life," advises old people to eat sparingly. There is a great difference between a "gourmet" or "gourmand" and a glutton. The pleasures of eating dependent upon the sense of taste, when eye-sight and hearing are daily becoming more and more impaired, the possession of leisure in which to cultivate their gastronomic talents, as well as the quiet necessary for the performance of the digestive act, combined with the necessity for careful nourishment, prohibit old people from yielding to any mistaken notion that, because they are old, food is of little consequence to them, and that the ordinary rules governing assimilation and nutrition do not hold in their case.
A great deal of the immunity of old people from sickness will depend upon their power of digestion and assimilation.
Food and drink should be partaken of sparingly, and at proper intervals: an overloaded stomach, or a stomach filled with badly cooked food, or food taken at an improper time, will occasion much distress to an old person. At the same time, it may lay the foundation for disease which will cut short a hitherto robust old age.
If actual pain and danger do not follow this gorging, it will probably entail loss of sleep, and consequent exhaustion, all of which we seek to shield the old from, as we do the child.
In the normal act of digestion, the consciousness of that act is wanting. Most persons engaged in active life fail to give the proper amount of time to eating and digestion; for this natural and physiological action to be performed with the ease and perfection of detail which Nature, in her arrangement of the means for such an end, intended, deliberation must accompany the eating, and rest of mind and body the digestion of food. Haste when eating, and activity, bodily or mental, during the digestive process, are fatal to the object for which food is taken. It is only in old age (I refer particularly to America), now, that that leisure which is indispensable to the proper performance of digestion is obtained, and yet, when, after years of toil, we perchance through the inheritance of a resisting power which has enabled us to arrive at sixty years of age, and upward, find the time to rest, our teeth are gone, our stomach, from constant action, is unable to act with that promptness and energy which early in life enabled us to digest food on the run, as it were. Then the physician is called upon to encourage, stimulate, and prop up by his art, Nature's waning forces.
The manifestations of dyspepsia in the aged do not vary materially from those of adults, but the causes are somewhat different; the treatment is conceived on a plan based on the age and life-long habits of the patient. An aged stomach is not an active stomach. Atony characterizes its functional action. Acid digestion, gastric catarrh, and flatulency, are the leading forms of dyspepsia of the aged. Old people have not in general what we call a healthy appetite. One well-known writer has said that they eat because no other interesting occupation is afforded their senses. This may be true of the very aged, and it undoubtedly is a fact that most people of eighty years and upward find as much pleasure in eating as in almost any other occupation left them. The appetite is often lost when no disease can be detected. There is loss of the sense of taste, and even several days without food does not provoke hunger. In another form, the breath is somewhat offensive, the tongue furred, when in the former case it was clean.
Fisher tells us that, if this continues, it leads to senile marasmus or atrophy of the aged. Some old people suffer from a difficulty in swallowing, which seems to be the result of a partial paralysis of the throat; the pharynx does not respond to the stimulus of food as it passes over it. Solids pass more easily than liquids. Deglutition is more difficult in an upright than in a horizontal position. Fisher speaks of the case of a man sixty years of age who swallowed soft and mucilaginous preparations with great difficulty, but warm food, salty or irritating substances gave little trouble. Day has noticed the same fact, and observes that irritating or highly seasoned foods were the only ones swallowed easily. Canstatt thinks that the abuse of tea and coffee leads to the development of this state, which he says is very common in Holland.
Old people are subject to accumulations of gas in the intestinal tract, which not only occasion distress from over-distention of the stomach, causing pressure upward upon the diaphragm, and consequent interference with the heart's action, especially when lying down, but also from its passage downward into the bowels.
Diarrhœa is one of the consequences of dyspepsia, and it is not unusual to find old people who have several movements of the bowels daily, without any of the exhaustion attendant upon ordinary diarrhoeas. Another remarkable fact is, that we find, even in very old people, a diarrhœa which would naturally seem to weaken and prostrate even a strong man, but the effects of which are not noticed until suddenly we learn that death has taken place. Overfeeding is a frequent cause of these senile diarrhœas. The pressure of undigested food in the intestinal canal is followed by a sudden purging, without pain, hut exceedingly rebellious and difficult to conquer. Before treating of the methods of cure for dyspepsia and its accompaniments, such as loss of appetite, difficulty in swallowing, , constipation, etc., there remains to be studied the food suitable for old people, the quantity to be eaten, and the time for eating.
It would be useless to present a dietary list to which one should be strictly confined. A long life of indulgence in eating and drinking, as well as diversity of taste, would preclude any attempt at regulating the diet of healthy elderly people. To those who have arrived at an advanced age without any form of indigestion, I would suggest a cup of coffee and a slice of dry toast before rising in the morning. The reason why this should be served while one is yet in bed is, that very old people, even when perfectly well, are often subject to a slight faintness and nervous tremor before rising, and the exertion necessary to dress often leaves them too faint to eat. It takes but a few moments to prepare it, and, as old people like to rise early, it is usually an hour or two before the family are prepared for the morning meal.
A light luncheon at noon, and dinner not later than five or six o'clock. If the dinner is taken at noon, and supper at six o'clock, it will be found to suit the habits of the aged better in one way, as old people love to retire early. In most countries, among civilized nations, the practice of crowding three meals into the twelve hours or more of daylight has grown to be such a habit that it seems a heresy to suggest eating when hungry, day or night; nevertheless, I would suggest to the healthy and not too aged person to forget the "bugbear" of "not eating before retiring," which compels many a person—otherwise disposed to pass ten or twelve hours with the stomach in a collapsed condition, while during the other twelve it is constantly distended with food. I would say to the aged, eat sparingly and eat frequently. Let your food be light, and easily digestible, but eat when hungry, whether it be twelve o'clock at noon or twelve o'clock at night. Aged people are light sleepers, and often wake up during the night with an intense craving for food, and a good plan is to have a cup of bouillon and a cracker on a stand near the bed. The broth can be readily heated by an alcohol lamp in five minutes. This simple habit will often procure hours of uninterrupted slumber, which would otherwise be passed in restless longing for daylight and breakfast.
I have said, eat sparingly and frequently; eat sparingly, because the digestive action is not so strong as in earlier life, nor is the demand for large quantities of food so urgent. Eat frequently, for several reasons. The digestive organs are not then burdened with large quantities of food, and dispose of it with greater ease. A moderate amount of food in the stomach gives a feeling of comfort and quiet to a person whose sole occupation may be a little reading or knitting, or even nothing at all, when extreme age is reached.
The kind of food to be eaten varies with the condition: if the old person needs building up, the more nutritive foods, that is, those containing the greatest amount of nourishment to a given volume, the greatest proportion of assimilative matter; if, on the contrary, it is necessary to encourage the digestive action, we select stimulating food. In this connection I shall quote from an eminent French authority: "As age advances, not only is one able to bear with impunity food which is piquant, pungent, and more exciting, but the use of these latter foods is necessary to the physiological conditions acquired by the 'organs of digestion.'
"This alimentation becomes especially necessary to individuals whom residence in great cities, sedentary life, and confining work separate in a great measure from the natural conditions of life, found in free air and bodily exercise." With regard to the use of wines or liquor by the aged, I would say, if there is a proper time in the life of a man when he should use stimulating drinks, that time is when he has arrived at a good old age.
A glass of sherry or burgundy during dinner often aids digestion wonderfully. When the tongue is pale, and the desire for food absent, a "nip" of brandy will stimulate the stomach into secreting properly. This condition of atony or sluggishness of action is not at all unusual. A glass of milk-punch at night often goes, as a very good and exceedingly temperate old lady once said to me, "to the right spot." Coffee is a natural drink for the aged. Its mildly stimulating, soothing qualities directly indicate it as a beverage for the old. Gasparin tells us that "coffee has the property of rendering the elements of the body more stable, and thus, if not affording nourishment, it diminishes the waste going on."
The origin of many dyspepsias in the old will be found in the lack of the proper means for the complete mastication of their food. The loss of their teeth, and the neglect to replace that loss with artificial ones until a dyspepsia is established, will often entail a long train of ills. A set of false teeth will sometimes remove dyspeptic troubles of long standing. The teeth with metal plates (platinum or gold), although more expensive than rubber or celluloid, are to be preferred. Mastication must be well performed even if the food is not very solid. The one golden rule is to eat slowly.
Some old people have idiosyncrasies about certain foods, which must not be overlooked. Milk is one of the most easily digested of foods, on account of its various constituents, and can be taken when nothing else is permissible. Eggs, soft-boiled or raw, are easily digested. Oysters, fish, and lamb, follow in about the order named. Beef, mutton, and fowls, and wheaten bread, occupy about the same time in digestion. I have met with two forms of dyspepsia more frequently than any others in prescribing for old people—the acid form, where there is an excess of acid found in the stomach, and the atonic form, where there is sluggish action of the mucous membrane of the stomach, and the time for digestion is greatly lengthened. In acid dyspepsia, Dr. Ringer recommends the use of glycerine, stating that an old gentleman, upon learning that glycerine prevented milk from turning sour, concluded that it would be just the thing to prevent "himself from turning sour." I have used glycerine combined with charcoal with considerable success in remedying this form of dyspepsia.
Dilute nitro-muriatic acid, a half-teaspoonful in a claret-glass of water, immediately after meals, breaking up the weaker acids and affording the natural acids of the stomach, is an exceedingly useful remedy. The atonic form of dyspepsia, combined with loss of appetite, requires quite a different treatment. The stomach is feeble, and needs stimulating; two or three grains of capsicum with one half-grain of aloes in a capsule will excite it to action; the constipation which often accompanies this form will be obviated. When there are accumulations of gas, charcoal tablets au hour or two after meals generally give great relief; but it is not a good plan to keep up their use permanently, as it tends somewhat toward constipation. Electricity is the great tonic for these debilitated, relaxed stomachs. The sympathetic nervous system is rehabilitated, and the most marvelous effects are often produced. The apathetic condition of the intestinal track is dissipated, the liver pours out its bile, and life seems to move on again. Alkalies taken before meals stimulate the flow of the gastric juices. Slight fatigue often spoils the appetite, and lowers the digestive power. Nothing so securely revives this as a glass of wine before meals. While small quantities of alcohol aid digestion, larger quantities retard it and encourage gastric catarrh. The quantity of wine or brandy must be small when taken for this purpose.