The great factor is the senile’s sense of dependence on others. The old man does not realize that one more mouth means less food for the children or that his carelessness makes work or his peculiarities alienate sympathy and affection. Perhaps he feels he is a burden and his death would be a relief to those for whom he provided in earlier years. So delusions of persecution may arise.
What can we do? Symptoms are often bettered at an asylum. Phobias vanish and so do fears for the immediate future. All energies may be guided to one channel and the person may be made useful and his fear of being useless thus cured. The old are thus often anxious to do little services to show they are not worthless and little tasks can occupy them without strain. A patient pensioned after sixty-five years of work could get no other employment, felt useless, instead of being cheery became depressed, and was cured by being re-employed. The influence of young people keeps up interest in life—especially marriage with a young person, the development of a hobby, collecting anything, such as stamps, coins, books; witnessing new sights, but not fairs, where numbers confuse.
Drugs give temporary relief. Small doses of morphine give exhilaration and arouse the imagination, but its effects soon wear off. “Phosphorus in solution is the most effective drug for prolonged use.” It is a mental and nervous stimulant and aphrodisiac, increasing mental power and producing a sense of well-being. One-fiftieth-grain doses several times a day, stopping just as soon as the intellect begins to brighten, are often beneficent. This can be kept up for years. Perhaps amorphous phosphorus may be used.
* * * * *
Sir Dyce Duckworth[152] asks: Why are some remarkably young for their age and others old? It cannot all be explained by anything in the individual life or habits. Perhaps it is in part because the ancestors lived a hard life. We want the degree of inherent vitality proper to each individual patient. This would be as important for prognosis in pneumonia as are the hæmic leucocytes. Arterial hardening may be local only, for example, radial. There are two kinds of arterial degeneration, namely, the brittle and the tough, the former more liable to cause hemorrhages and fatty degeneration.
Very important is the discovery that the rigidity of calcified arteries is greatly increased immediately after death. The lime is present before, as disclosed by the X-rays, but it is like wet or unset mortar and only sets after death under the influence of carbon dioxide and the rapidly diminishing alkalinity of the blood. The so-called air in the arteries after death is chiefly carbon dioxide and this explains why such arteries do not rupture so frequently as we might expect. Premature death of parts of the body is constantly occurring, for example, baldness, teeth. One may be vulnerable to one and another to another type of injury or bacilli. Syphilis is mainly a conjoined trait or infection and greatly predisposes to tubercle. Indeed, a syphilitic patient may be regarded as a prematurely aged one in spite of a good constitution, because there is always the possibility of sequels or parasyphilis, general paralysis, etc.
Among the early mental signs of interstitial nephritis is an explosive temper. Fits of hilarity and weeping may alternate (first pointed out by Clifford Allbutt). The costal cartilages ossify generally before the sixth decade and this is often premature. A hobby may no longer avail to preserve mental activity, and “the golf ball to-day is not seldom one of the beneficent agencies for this purpose.” Cirrhosis of the liver is longer averted in the patrician than in the plebeian because the laborer becomes senile sooner than others owing to his life of strain in all weathers. In arthritis, the nodosity of joints, especially in the fingers, in the form of Heberden’s nodes, is thought by some an indication of longevity. They are often found in those who have few classical symptoms of gout and few reach eighty or ninety without these trophic changes. Dupuytren’s contractures and the camptodactylia of Landouzy, or incurved little finger, are among indications of a gouty habit and are not truly rheumatic lesions. Indolence of the bladder does not imply prostatic symptoms. Very common are widespread catarrhal disturbances, as for example, tussis senilis, with much flux of mucus, often rich in sodium chloride. Fits of sneezing, also of hiccough and even gaping, are frequent.
The main treatment for early senility is physiological righteousness (Sir A. Clark). We must especially know the degree of vigor, of vitality, and specific habit of body. We must pay attention to the degree of blood pressure and early indications of renal inadequacy, orthostatic albuminuria, the tendency to epistaxis, and maintain as our keynote moderation in all things. The best idea is that of universal service which would bring all the world together on a high plane. The author refers with a good deal of skepticism to Metchnikoff’s Bulgarian bacillus but mentions Saundby’s book with great praise.
Robert Saundby, M.D.,[153] has given us what is, to date, the best handbook, both for practitioners and for old people who are intelligently interested in conserving their life and strength, on the common infirmities and care of the aged, exclusive, for the most part, of nervous and psychic symptoms. He first describes normal old age, then its diseases in successive chapters—diathetic infections, and those of the circulatory, respiratory, digestive, and genito-urinal systems. Perhaps most practical are the dietaries he gives for different stages of old age and different diatheses. He commands a wide knowledge of Continental literature on the subjects he treats. He has a just sense of the dangers of stressing specifics from, for example, Pythagoras, who thought there was a special virtue for longevity in honey; Bacon, in sweating; Harvey, in avoiding acids; down to Blanchard, in sal volatile; blood drinking cures, olive oil, licorice, etc. He believes that Metchnikoff’s panacea and the undue stress laid by Lorand on thyroid therapy have not escaped the dangers of undue focalization. He allows a very wide latitude not only in regimen and exercise but food, condiments, and even stimulants, for the aged.
No one can read his account of the changes that take place in each part and organ of the body as they are successively described and the very different treatments that each needs as it goes wrong, without a sense of the fatality with which these vast cohorts of life-quelling symptoms advance and, in view of the many strategies the lethal processes make use of to undermine the fortress of life, without experiencing a profound sense of the hopelessness of watching out in so many directions and realizing that, as differentiation proceeds in the different organs, any regimen helpful to one would almost certainly be harmful to others.