Popular Science Monthly/Volume 64/February 1904/The Conservation of Energy in Those of Advancing Years I

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THE CONSERVATION OF ENERGY IN THOSE OF ADVANCING YEARS.
By J. MADISON TAYLOR, A.M., M.D.,

PHILADELPHIA.

THE study of the conditions and changes in the tissues of human beings as they pass beyond middle age would seem at first sight to be of wide-spread interest. Upon the very simplest presentation of the matter it will be universally admitted to be of the greatest importance. The first principle of economics is not so much what we win in any line of industry as what we save; this is the essence of the conservation of values. What matters it how well the child is provided with opportunities for growth and how excellently the young adult is developed in the fullness of such strength as is compatible with individual opportunity; how high a degree of efficiency, mental or physical, can be attained, if all this is to last but for a few brief years of practical utility? Again, allowing ourselves to indulge in a more selfish view, what does it profit us if we shall acquire place and power and the means by which we may be able to enjoy life, as we have learned to live it through years of experience and the exercise of careful choice, if we are to become speedily cut off from the continuance of the enjoyment of those privileges the product of matured judgment and the full energizing of our powers? It is to me a remarkable, indeed an astonishing, fact in searching for data on the subject of senility which one would naturally assume to have grown up in the enormous field of medical literature, that so little is to be found bearing on this subject. There are here and there references to old age and the phenomena of senility in a few of the standard works on physiology, far fewer than the subject would seem to warrant. The subject does not seem to have aroused much interest in the great authorities on medicine, although there are some crisp and vigorous articles which are valuable and interesting.

My own studies have been most largely in the line of growth and development of children and yet interest by no means ends there, and my attention has been drawn to this matter through a constant study based upon part medical research and part individual interest in the whole question of bodily development and the possibilities which lie in this direction for the advance of individual efficiency in all periods of life. It has seemed that the phenomena of degeneration are present in most disturbances referable to those of the nerves and their centers where the analogue of senile changes constantly appears.

Old age has been tritely described as a purely relative term; senility is to be recognized in many persons young in years and is often absent in those of late middle, or even of advanced age. There is no time in the life of a human being when this can be said definitely to begin. It is possible that if the undivided attention and energy of able thinkers were directed toward the means of combating these changes great gains could be made. Indeed notable progress has already been initiated and is being demonstrated with increasing rapidity in prolonging the age of the race through the one avenue of research which is really a development of the last decade. In laying the foundations of constitutional vigor by giving the chief attention to the disorders of children, their proper feeding and hygiene during the first few months of life, the foundation of longevity is capable of being firmly laid. Already there are abundant statistics to prove that the possibilities of retaining vigor to late age in civilized countries is being hopefully revolutionized. Too great praise can not be given to the researches of those men who, with insistent and prophetic voice, have demanded that the infant life shall have better opportunity afforded for prolongation by the regulation of diet and hygiene. If the foundations be well laid the problem of the superstructure can be made a matter of exact procedures. Not only are we of the medical profession becoming keenly alive to this great truth, but the gospel has filtered down and is being rapidly accepted by the great mass of thinkers. It matters little what is done, or what opportunities for growth and development are offered for the nation, if the infant child is neglected, even relatively, in the first three to six months of its life. No skill consistent with modern medicine is able to repair, except in the smallest degree, the irretrievable damage upon that human constitution which has not acquired a fair start in life. Two items of knowledge have been added to the subject of child growth by the clear teachings of such men as Jacobi and Rotch in insisting upon thorough attention to the details of food and nursery life during the period of babyhood. It is possible to find among the histories of those who have attained great age and retained their vigor beyond the ordinary span of life few instances of bottle-fed babies. In the future this will not be so, although at no time can we assume that the same degree of physical integrity can be acquired by artificial feeding as could have been by the natural methods of infant nourishment. Another fact comes up in the histories of very old people that they nearly all spent the earlier months and years of their lives outside of large centers of population.

It is a fact abundantly well known, and yet not of popular knowledge, that constitutional vigor is practically impossible except in the first generation in those who live in large centers without change. Statistics go to show, for London at least, that the fourth generation of the town dweller is unknown. But enough is currently reported to make the conclusion inevitable that the sine qua non of longevity is a certain amount of time spent in the country. The city child is subject to a number of disturbing conditions other than mere absence of creature comforts, which undermine the constitution by throwing too heavy a burden upon the sense organs, through which exhaustion of the central neurons follow; these conditions are such as noises, a perpetual round of hurry, unending sequences of incident exhausting the attention, to which are superadded the physical discomforts of vitiated air and effluvia from human beings and waste organic products, besides offensive gases and infection-laded dust, etc. All these and others more than offset the civic improvements which have their value, of well paved streets and shelter from winds, better housing and many conditions furnished in cities and not in country places. What has been said does not obtain in respect to well conditioned villages and suburbs; at least to the same degree. All this makes for an alteration in the character and quality of symmetrical development. When adult age is reached, these conditions are merely exaggerated. The rush and hurry of competition still interferes with the acquirement of full organic vigor, which demands for its fruition, adequate time and leisure, so that cellular stability may be safely secured. To those of comfortable means, who can from time to time withdraw from the agitating circumstances of city life and enjoy periods of rest and quietude elsewhere, there is less left to be desired. For those who can choose their manner of living, the natural instinct may be trusted to secure selection of those opportunities in the life of most persons which will make for better conditions for continuance of life. To those who have reached middle age, and to whom the desire comes of conserving their powers to the utmost, it is distinctly possible to gain excellent success. So far as the general circumstances of life are concerned, there should be no difficulty in intelligent persons determining for themselves what had best be done. This of course will consist in relieving themselves from worry, strains and anxieties, and in the periodic withdrawal from the hurly-burly of effortful existence; in modifying their diet, in omitting the use of stimulants and narcotics and in spending long periods of time under pleasant conditions, in practical retirement. Above all, amusements should be simplified and accepted rather than sought after. There is enough. Heaven knows, of happiness to be had in keeping the eye, mind and heart open to the enjoyment of those opportunities which lie in the pathways of every one. It has been my experience to know a number of men and some women who, when the occasion came to them out of the fullness of opportunities for choice, instead of contenting themselves with enjoying life, rushed after such sports as were popular or fashionable, thought to be amusement, and the following of these exhausting pleasures cut short their career. There will be no difficulty in any one of us searching about in our experience and calling to mind instances of people who had acquired wealth and position, in the enjoyment of good health and relative youth, who yet strove so fiercely to keep themselves (or it may be their thought was for their friends chiefly), supplied with amusements that they fell into the fatal error of doing more than their health would warrant or their constitution sustain.

Perhaps the most important quality, mental or physical, which conditions the attainment and enjoyment of advanced years, is a serene mental view; a capacity for deliberate enjoyment of whatsoever betide. In short a cheerful temperament is as good as an insurance policy; indeed far better. Much might be said along this line of prevention of death by the prolongation of life, but it has been presented to every one of us many times in endless guises and from divers sources. The difficulties are that we fail to realize the practical applicability of oft-reiterated truths which become trite and wearisome and yet are of golden quality and unspeakable value. It is my purpose to offer a few useful hints how one may definitely set about to earn a postponement of the evil days which come upon all, it may be not of ill health, but of a lessening capacity for enjoyment. Heaven has been most cleverly described as being the condition of one who knows what he wants and is able to enjoy it when he gets it, and the reverse of this. Hell, is clearly the atmosphere of that individual who does not know what he wants and could not enjoy it even if he did get it.

Touching the question of self-education in serenity which is admittedly one of the most important accomplishments which any one can acquire, it will be found by each that ever so little attention in this direction will be followed by prompt reward. For instance take the ever present subject of diet. As the effects of age become obstrusive, it is the part of wisdom to omit the use of those stimulating articles of diet to which we accustom ourselves throughout our youth and adult life. It may not be so plain to all, as it is to a man even of my age, how easy and pleasant a thing it is to put aside this or that item of food or drink and substitute for it either less or something different and more suited to our present needs. It is almost a working axiom in the achievement of long life that the less we eat and the less variety of objects eaten, the better. Exceptions will arise; sometimes follies may be committed by carrying these thoughts too far. But in the main it can not be gainsaid, and a great array of conspicuous illustrative instances can be pointed out, that as a working equation, the least should be eaten compatible with existence, to secure the greatest amount of continued health. As will be shown more specifically later, the paramount condition of buoyant youthfulness, whose loss is known to characterize the beginning of old age, is elasticity of the tissues. To preserve flexibility, it may readily be possible, as has been claimed by some, that this can be done by choice of foods. The use of some articles of diet tends to encourage the deposit of lime salts or to discourage elimination. It may be that by a careful review of the experiences of certain aged folk, we might find a guide to the line of diet by which these good effects can be secured. Old age may not be altogether due to accident in the choice, nor selection of conditions, in the avoidance of accidental damage or trauma. Time will not permit enlargement on this subject now, but there is interesting and instructive reading to be found here and there for those who desire to know. The most notable book devoted to this subject is the 'Autobiography of Louis Cornaro,' whose life was prolonged far beyond that age which is ordinarily thought to be possible, by extreme care chiefly as to choice of diet, and he has set it forth in a most entertaining volume. It is only a partial guide, because temperamental differences must be considered, in the light of the experience of each person, race and community. Families and individuals and nations have different habits of diet. That which might suit one group of cases would not be an exact guide for another, but in the main the principles are the same.

These principles in brief consist in a choice of vegetable and semi-animal foods in preference to red meats. I took a course in physical training long ago under a man who possessed phenomenal vigor, much older than he looked, and he declared that bread, by this is meant leavened bread chiefly, was the most pernicious agent in producing the stiffness of the tissues. This is merely instanced to show how strong convictions are at times, and how they differ from customary beliefs. I do not know how much truth is in this thought, but am of the opinion it is worth attention. Again, the question of the use or non-use of alcohol must be settled for each one. For myself I believe alcohol to be almost altogether bad, although prepared to admit that there may be instances where its use is to be recommended. Some years since there was a popular agitation on the subject of the use of opium. The outgrowth of the opium traffic sanctioned by the British government gave rise to much discussion, which if I have been rightly informed was carried on both by the government in India and by exportation to China. The contention waxed hot and almost all the testimony was against the traffic and encouragement of the use of this baneful drug. In the midst of this, however. Sir Joseph Fayrar, at that time the one chief in authority in medical politics in the government of India, wrote a most powerful and able defence of the use of opium, particularly its habitual use, in which he showed that among certain races, especially those of the Orient, opium was not followed by the destruction of mind and body which it is our custom to consider inevitable. He gave instances, numerous and convincing, that by the use of this drug or food, as it might possibly be called, a large number of intelligent, indeed most wise and capable Hindoos, had acquired great length of days without impairment to their best powers.

All such matters must be discussed with due deliberation and full knowledge of all attainable facts. The topic at the time interested me exceedingly, and in the course of a research which I made upon the causation of mental impairment, imbecility and idiocy, I became convinced that the use of opium by the individual was of relatively little harm in some exceptional instances. It certainly does not seem to be as hurtful as the habitual use of alcohol. So far as the effect of these poisons, for poisons they are, upon the second generation, it was shown that alcohol produced infinitely worse results upon the second and third generation of those that used it than followed the use of opium.

Close to the realm of deliberate thought and rational conclusions comes the debatable ground of varying opinion. The study of the life history of aged people would furnish much of value if it could be undertaken judiciously and thoroughly studied. The opinion of these or those old persons as to what article of diet, the use or omission of which aided them to acquire their age, comes close up to the realm of conjecture. As an instance of my study may be cited that of a certain lady, famous in my city for wit and wisdom, and who attained a ripe old age with apparently no diminution of her powers. She was on one occasion presiding in a distant city over a meeting of Colonial Dames, and was regarded as almost a prophetess by many, both friends and strangers. She told me that a certain lady approached her with much deference one morning and asked with bated breath if she would be so good as to tell her to what she attributed her great age and elasticity of mind and body. In the way of a joke she told her that it had always been her custom to eat great quantities of salt; and in relating the story to me, this lady said that she had no doubt that by this time that stranger was thoroughly well pickled in endeavoring to follow her lead.

It must always be borne in mind that old age is an inexact term. During the middle ages, statistics would seem to show that the recognized span of life was much shorter than it is now. As an instance of this. Old John of Gaunt, who was a byword, throughout many troublesome years, of age and wisdom, yet died before he was sixty. Warwick, the King Maker, whose history lapsed over that of many sovereigns, is said to have died at the age of fifty-four. In our own time great improvements have been wrought, more particularly within the last quarter of a century, in the matter of increasing the tenure of life, and the average of age has been brought up in a most satisfactory fashion to that which we could not have expected, although optimists have hoped for.

Again, mere existence beyond the ordinary bounds set by nature is of little value unless accompanied by many characteristics and qualities which make life worth living. It certainly should not be a desirable fate to remain alive and yet lose the capacity of enjoyment or, what is even more important, the capacity of being enjoyed. If it be not an integral part of the personality of an old man or woman to present qualities of attractiveness to others, the fullness of life has not been attained. The factors which go to make up the quality of desirable and admirable old age are above all, first and foremost, self respect, an interest in the affairs of others, a dignity and kindliness, a patient and uncomplaining endurance and a capacity constantly exercised to be of use in the world. A woman, for instance, can if she give her undivided attention to it, grow old so charmingly that she may at great age attain more grace and fascination than she had in her youth or middle life. We all know instances of this truth though some are thus more blessed than others. A man again may become a greater power for good even when well past the age of so-called usefulness than at any previous time. Nor do these qualifications depend necessarily so much upon the original structure of mind or body as the maintenance of a faithful vigilance and conscious desire to be, and do, that which shall furnish forth these good attributes.

The principles of action upon which the effects of advancing years may be postponed are simple, clear and practicable. The difficulties are chiefly the indifference or indolence which age begets. Wherever a person has acquired an active desire to retain the freshness of youth and is moderately diligent in pursuing whatever means should be adopted, the results are successful often beyond expectation. The conditions of success are an original soundness of constitution and fairly healthy organs. It might be added reasonably comfortable circumstances, but I know several cases where the environment was far from satisfactory, and daily labor onerous, yet these people were not discouraged. One other condition might be mentioned as needed often, but not constantly, viz., the counsel of a wise physician. Medical advice ought to be more frankly and constantly sought for the lesser infirmities of age than during middle life for reasons obvious. As the internal resistances lessen small disorders more readily throw the actions of the organism out of balance, and fatal results follow seemingly small causes. Another prerequisite is consistency and persistence in the measures employed. The balance of power in the old is not easily retained, and regained with far greater difficulty. It is an axiom among horsemen that an old horse can be kept fit if used carefully and constantly, but once allowed to get into poor condition through disuse it can never be reinstated.

The potentiality of cellular cleanliness, and lymph activity, on the mechanism of life is paramount, and is not yet duly appreciated by men in or out of the profession of medicine.

Diet has been alluded to already and all that it is needful to say here is to repeat that temperance in food and drink is an essential condition of the best results. Regularity of conduct is important both in bodily habits and the daily routine of labor or pleasure.

Certain organic defects bear heavily upon the integrity of the ageing organism unless corrected. What miseries have followed unrelieved disturbances of the ears, nose, throat, digestion and eyes in many important lives, can never be fully known. George M. Gould has furnished an amazing lesson in the need for exactitude in correcting refractive errors in the eyes in his analysis of the causes of ill health in later life of epoch making men, among whom are Wagner, Beethoven, Spencer, Huxley, Darwin, Carlyle, Browning, Parkman, DeQuincey (who was thus driven to use opium) and Whittier. The continued usefulness of these men was thus cut short in mid career, let alone the agonies they were compelled to suffer unrelieved.

Open air life is a sine qua non. Many old people become hypersensitive te the cold and exposure to the extremes of temperature can become easily fatal. To spend much time in the open air is a guarantee of health, over and above that which was aforetime enjoyed if one has been in the habit of remaining much indoors. It is wise for old people to follow the sun by early rising and going early to bed. To utilize the young morning hours is best for all, but for the aged it is essential. Much sleep is not needed for them, unless they especially crave it as some do and most do toward the end. Dozing during the day is pleasant and salutary, but long night sleep is not necessary as a rule.

The suitability of clothing is deserving of careful study for each. As a rule old people crave much heavy underwear and they are disinclined to expose the skin to the air, and especially to drafts. This is due partly to the lessened activity of the cutaneous capillary circulation, to lowered cellular resistance and blood making power, but also habits and prejudices exert a most potent influence. The readiness with which old people catch cold has more to do with their habits than their age. It is a matter of common knowledge that the products of waste must be more carefully removed in the old than the middle aged. In this the skin must be reckoned as perhaps the greatest eliminating organ and the one most neglected. It is easy to drink lithia water or use other medicines. It is no effort to swallow a pill at night; but unless equipped by a valet or body servant the care of the skin involves personal effort, but one which will amply well repay. Finally, an enormous field of possibilities is opened by studiously striving to retain the fullest elasticity of all the tissues; and to this I desire to call particular attention with some detail and emphasis in the later sections of this article.

The constantly forming poisons invading the nobler tissues require to be removed. If the organic activities can not be relied on, a judicious use of laxatives, diuretics and special baths must be resorted to.