Arnold Lorand, an Australian physician,[154] bases his work on the principle that man does not die but kills himself. He does not philosophize but tells us that while it is impossible to create a young man out of an old one, it is quite within the bounds of possibility to prolong our youthfulness by ten or twenty years. In other words, we need no longer grow old at forty or fifty. We may live on to the age of 90 or 100 years instead of dying at 60 or 70. Old age is just as amenable to treatment as chronic diseases. He has great faith in the present possibilities and still larger hopes for the future of serum therapy, for to him life is most of all connected with the glands. He discourses upon the hygiene of throat, lungs, heart, kidney, liver, stomach, bowels, reproductive organs, and the rest with a bewildering volume of details but good perspective, and the reader is again disheartened to find that the treatment prescribed for one organ is deleterious to another. Indeed, Lorand’s somewhat encyclopedic and undigested data, despite the common sense and practical spirit in which they are presented, bear, on the whole, less upon old age itself than upon general hygiene at all stages of life, so that his title is to that extent a misnomer.
He sums up his practical conclusions in the form of twelve commandments, which are, briefly, to keep in the open and take plenty of exercise; eat according to rule; bathe and move the bowels daily; wear porous underclothes; early to bed and rise; sleep where it is dark and quiet; rest one day each week; avoid emotional strain; get married; be temperate in the use of alcohol, tobacco, tea, and coffee; and avoid over-eating and -heating.
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T. D. Crothers, M.D.,[155] thinks we have not sufficiently considered the abilities of old age from a medico-legal standpoint. He also thinks that if we do not live to be 100 something is wrong with us or our ancestors. We all carry a large reserve that many die without drawing upon, and this reserve is especially available in old age (he develops this point psychologically). Many old people with melancholia, hallucinations, and the characteristic physical defects of old age have, nevertheless, a higher kind of sanity to which their juniors do an injustice by the tests they propose. They are quite capable of making wills and otherwise deciding the large questions that come before them and often do so from a broader point of view than younger men. It is possible, then, to rise to a higher level, to a kind of graduate school of life, to use the unused, etc. Again, the varied experiences of long life give mobility of mood up and down what Adler calls the life line, so that the old have a larger assortment of viewpoints and even moods, to say nothing of greater ups and downs in horizon and standpoint generally.
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C. G. Stockton, M.D.,[156] suggests family records and pride to avoid mixing good stock with that which decays early. He recognizes the great contributions of the dentist and oculist, deplores the neglect of old age, and insists that the aged do respond to treatment very readily. He also deplores the attitude of many physicians who discourage resolute methods of curing defects and warding off evils because the patient is old. He stresses the value of emunctory procedures both within and without.
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Dr. W. G. Thompson[157] deplores the fact that physicians have given so little attention to old age and that the medical literature upon the subject is so meager. The very old have survived all corroborative evidence as to their age, their failing memories confuse tradition and fact, and they come very often to take pride in their age and so add to it. The author’s study is based on the census statistics of 1910, which record, from 90–94 years, 6,175 deaths; from 95–99, 1,427; 100 years and over, 372. The respiratory diseases as a group took first rank as the cause of death; organic heart disease, apoplexy, and Bright’s disease occurring in frequency in the order mentioned. Among diseases of the digestive system enteritis outranked all others.
As age advances and its activities and diversions become less and less, locomotion is reduced, along with acuteness of sight and hearing, and the pleasures of the table remain the only gratification of a monotonous existence. Very many accustom themselves to the habitual use of laxatives to counteract the effects of overeating, and often we have obstructions, especially of the rectum or colon, that may become fatal. This, however, is more often seen in those who eat too little and become perhaps atrophic and marasmic. These people become careless of matters of the toilet and obstructions often cause death. Apoplexy is relatively rare among centenarians and carcinoma also declines as a cause of death after the ninetieth year. Indeed, the disease that does not develop until after the ninetieth year can scarcely be due to hereditary factors and the infrequency of cancer in the later stages of life emphasizes the constitutional resistance to extraneous influences that the majority of centenarians possess in a high degree. Acute and very quick or fatal pneumonia is not infrequent.
One very peculiar difficulty in treating old patients is their prejudice and obstinacy in matters of diet and hygiene; because they have lived so long they naturally think they know better than anyone else what is good for them and, with a certain irritability, resist interference. As a rule, they are relatively very susceptible to the action of drugs and two-thirds of the ordinary dosage for adults generally suffices. Very often the very aged suffer from the neglect of personal cleanliness. There are many diseases common from the sixth to the ninth decades of life that are very rare later, for example, tuberculosis. Suicide is very rare, the census of 1910 recording only one of a centenarian and nine among nonagenarians. The latter generally have a long-lived ancestry and many families are remarkable for this trait. But this is by no means essential. The aged often exhibit no predominant symptom of any one disease to which their death is attributable, and hence “senility” is so often given as the cause of death. Tranquillity, moderation, and regularity seem to be the chief factors in securing a long life and a peaceful death.