Читать книгу Old Age Deferred - Arnold Lorand - Страница 14

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As a general rule the first symptoms of old age do not appear before the fortieth or forty-fifth year. There are, however, many persons who, much earlier, occasionally even before thirty, show some of the typical symptoms of senility: corpulence, gray hair, wrinkles in the face, falling out of the hair and loss of teeth, etc., for example. The gums also are retracted from the teeth, which consequently appear greatly lengthened; later on the teeth become loosened and fall out. This then causes the jaw bones to atrophy, when the face becomes sunken, and the individual appears many years older. The hair loses its original color and becomes dry and gray, especially on the temples. The appearance of bald spots surrounded by gray hair increases the aged appearance of the face. On examination, the pulse of such persons may exhibit a high tension, the temporal arteries may be tortuous, and the skin found to be dry. A sensation of cold in the extremities is especially frequent. There is, as a rule, a tendency to constipation. The mental faculties are also altered; the memory weakens, and the mind is often depressed. Neurasthenia or hysteria become frequent in such persons, while impotence in men and menstrual disorders in women develop. The urine may be found to contain traces of albumin and occasionally a few hyaline casts. The presence of these, according to Professor Senator,^[1] indicates a degeneration of the convoluted tubules of the kidneys, and thus the loss of important elements of the chief excretory organ of the human body.

On examination of the state of nutrition in these persons, it may often be found to be below the normal. It is certain that such a condition in young people is abnormal, and, therefore, a pathological condition.

The question now arises: In which category of diseases is this condition to be classified?

In typical cases of this class there is a diminution of metabolism, i.e., of the assimilation and conversion of food into energy. We shall have to think of the possibility of alterations in those organs which govern the process of metabolism.

These organs are the glands with internal secretion (especially the thyroid gland, testicles, ovaries, the adrenals and pituitary body), according to recent researches, among which those of the author of this book may be mentioned. He was among the first to show the fact that glands with internal secretion control all the processes of oxidation,^[2] and that the diseases of metabolism: diabetes, obesity, gout, etc., are the direct consequence of alterations in these important glands. This is further sustained by the labors of Sajous^[3] who was the first to describe the mechanism through which these organs govern oxidation and metabolism, and to explain how they produce the disorders just enumerated.

The most important part herein is taken by the thyroid gland, whose increased activity is followed by an augmentation of the processes of oxidation in the body, whereas its degeneration is followed by a diminution of these processes. When the thyroid gland is degenerated entirely, as in myxœdema, there is also a great diminution of all oxidation processes. There are also cases where the thyroid is only partially altered by the increase of connective tissue, cases called partial myxœdema, and in these cases, accordingly, the diminution of the processes of oxidation does not take place to the same extent as in complete myxœdema.

When we thus find symptoms of old age in young persons, together with, in the most typical cases, a state of decreased oxidation, we have to determine whether or not we are dealing with a degeneration of the thyroid gland. And, indeed, such a condition is before us, for the symptoms we have just mentioned are characteristic of myxœdema.

If complete myxœdema, the highest degree of this condition, is rare, on the other hand the incomplete forms, where the thyroid is only partially replaced by connective tissue, are fairly common.

This is shown by the fact that, after the fortieth or forty-fifth year, the thyroid shows an increased amount of connective tissue, and thus cannot be so active as a thyroid with more secreting elements and less connective tissue.

We have thus reasons to suppose that the persons above mentioned, who only exhibit some but not all of the symptoms of old age, symptoms which are also found as typical in myxœdema, are suffering from a partial myxœdema or hypothyroidia. And it does not necessarily follow that in all such cases the processes of nutrition will be diminished, as is the rule in typical cases of myxœdema.

The resemblance between senility and myxœdema was first pointed out in 1890 by Sir Victor Horsley, one of the foremost authors on myxœdema, and afterward by Vermehren,^[4] Ewald,^[5] of Berlin, and the author. Horsley ascribed old age to degeneration of the thyroid gland, and we have shown (in a communication to the Paris Biological Society, presented by Dr. Gley, Professor of Physiology at the University of Paris, December 4, 1904) that, besides the thyroid, there are also different other ductless glands whose degeneration produces old age. These are the sexual glands, the pituitary body, and the adrenals.

It is a well-known fact that extirpation of the testicles and of the ovaries is followed by obesity and other symptoms of old age; in the same way cessation of the menstruation with degeneration of the ovaries at the climacteric is followed by all the symptoms of old age and certain nervous disturbances, as, for instance, troublesome flushings, which occur here, as after castration. Eunuchs, as a rule, look much older than their age. The Oriental eunuchs, and also the members of a religious caste in Russia, the Skopse, who castrate themselves through fanaticism, because of their parchment-like face covered with innumerable wrinkles, appear aged beyond their years.

Degeneration of the pituitary body is also followed by premature senility. This is shown by the fact that acromegalic persons, as a rule, look much older than their age. This also holds good in the case of myxœdematous patients. We have had opportunity to see, quite recently, the skeleton of a female acromegalic patient of Dr. G. A. Gibson in Edinburgh, and found typical indications of old age, an enormous augmentation of connective tissue and vascularization of the bones, with great porosity.

It must be remembered that all the glands with internal secretions, according to Pineles,^[6] Sajous,^[7] and the researches of the author, stand in very close relation to one another. Thus, degeneration of the thyroid is followed by that of the pituitary body. This was shown by the experiments of Hofmeister,^[8] Stieda,^[9] Rogowitsch,^[10] Benda, and many others. Degeneration of the pituitary is followed by a similar lesion in the thyroid.

Arteriosclerosis is a condition very frequently met with in elderly persons, and, according to recent researches, this disease is caused by a toxic agent with subsequent degeneration of the walls of the blood-vessels. Such a change can be produced artificially, as shown by Josué,^[11] by injecting adrenal extract into rabbits.

That the ductless glands are closely related holds good also for the thyroid and adrenals. This relation, however, is an antagonistic one. The adrenals increase the blood-pressure (Oliver and Schäfer^[12]), and the thyroid diminishes it. It is an interesting fact, demonstrated by Professor Eiselsberg^[13] in Vienna, that extirpation of the thyroid gland of dogs results in atheroma of the aorta. In connection with this we also mention the clinical fact, that all those agencies which are harmful to the thyroid gland, as syphilis, abundant meat food (Breisacher,^[14], Blum,^[15] Lorand^[16]), alcohol (Hertoghe and de Quervain^[17]), and tobacco (Hertoghe), are also those which are commonly considered to be the causes of high tension and arteriosclerosis. Infectious diseases are also brought in etiological relationship with arteriosclerosis, and it has been shown by a series of authors, that in infectious diseases the thyroid undergoes important alterations which may involve its degeneration (Roger and Garnier, Crispino, Torri, Bayon, de Quervain).

Infectious diseases also induce changes in the adrenals, as shown by many authors (see Chapter III).

Various toxic products, such as lead, alcohol, and tobacco, which are considered causes of arteriosclerosis, are also able to produce hypertrophy of the adrenals.

And, if we consider those agencies which are commonly considered the causes of premature senility, we notice the singular fact that they are also considered to be especially harmful to the various glands with internal secretion, particularly the thyroid and sexual glands.

Among these agencies may be mentioned infectious diseases, sexual excesses, frequent pregnancies, strong emotions continued for a long time, such as grief and sorrow, chronic intoxications (by poisonous products produced in the body, or introduced from without). We will show later, in an exhaustive way, the action of these agencies upon the glands with internal secretion.

Between the thyroid gland and the ovaries, a close relationship also exists. Thus, invariably, when we find the thyroid altered, we can also see changes in the ovaries. Consequently in myxœdema and Graves’s disease we find, with great frequency, disturbances in the functions of the ovaries, e.g., cessation of the menses, or disorders of menstruation. In such conditions the ovaries have often been found to be atrophied. We also frequently find such disturbances in acromegaly, where they may either be due to changes in the pituitary, associated with an altered condition of the ovaries, or they may be ascribed directly to changes in the thyroid which, as we have shown in a communication to the International Congress in Madrid, 1903, is very often altered in acromegaly. If microscopically examined it is probably found changed in every case. Indeed, we have attributed acromegaly to the primary changes in the thyroid which lead only secondarily to those in the pituitary body.

In diabetes, which disease, according to our investigations, is often caused by changes in the thyroid,^[18] and subsequently in the pancreas, or vice versâ, amenorrhea or impotency is frequently met with.

On the other hand, changes in the ovaries are also, as a rule, followed by changes in the thyroid gland, as may be seen in puberty, menstruation, pregnancy, lactation, and the climacteric. We will enlarge upon this later, in greater detail, but we will only briefly mention here that we may frequently see a swelling of the thyroid gland as an expression of increased activity during these conditions. We can also see this in diseases of the ovaries, and, as certain authors show, even sexual excesses can produce an altered state of the thyroid. This was known to the ancient Hebrews, for they used to examine the neck of the newly-married bride the morning following the wedding night to see if the neck had become larger by the swelling of the thyroid gland.

Thus we can readily understand that, frequently, swelling of the thyroid is the consequence of overwork of this organ, and, as in the case of great sexual excesses or frequent pregnancies, may lead to exhaustion of the gland with its grave clinical consequences.

Indeed it has been shown by the earliest authors on myxœdema, that this disease is very frequently caused by too frequent pregnancies, especially if connected with prolonged lactation (Ord, Morvan, Combe). This will also explain why women more frequently show the symptoms of precocious senility than men, whose sexual glands are not put to such constant activity and change as are the female sexual glands. Similarly women, after frequent pregnancies, especially with prolonged lactation, or women with diseases of the ovaries, and also those addicted to habitual sexual excess, such as prostitutes, very soon become fat and fade before their time. Thus we may see symptoms of precocious senility in such women even before the end of the third decade, especially if they have begun to lead an immoral life at an early age. Even young girls may look much older through the abuse of their ovaries from sexual excesses. Their breasts become large and pendulous, and their faces bloated and relaxed. Menstruation may likewise be made to appear in early childhood by sexual abuses, as Pauline Tarnowska^[19] has found through the examination in St. Petersburg of 150 very young prostitutes.

We shall show in the next chapter that obesity, which has nothing to do with overfeeding, can be caused by like agencies.

That mental emotions, especially care, grief, sorrow, etc., powerfully influence the different ductless glands, and are able to produce degeneration of the thyroid, adrenals, and sexual glands, etc., is shown by conclusive proofs in the chapter on the “Hygienics of the Mind.”

Infectious diseases are especially liable to cause change in the kidneys, and in various infectious diseases, sometimes even in tonsillitis, we may find an inflamed condition of these organs.

The kidneys can also be damaged by the passage of various toxic products, which are either produced in the body (auto-intoxication) or introduced with the food (condiments), or as stimulants—e.g., alcohol, strong tea, etc. All these toxic agents are capable of doing damage to the kidneys just as to the thyroid gland. We shall treat later on, in separate chapters, of the action of these stimulants upon the ductless glands.

The condition termed auto-intoxication may be induced by many different factors, among which may be mentioned the products of intestinal putrefaction (Senator^[20]) and the waste products from the processes of oxidation, such as uric acid, for example. Animal food is more apt to produce intestinal putrefaction than any of the various other foodstuffs.

There are three important organs which protect us against such a condition of auto-intoxication; these are the kidneys, liver, and thyroid, and possibly also the parathyroids.

The kidneys act by promptly eliminating such toxic products in the urine. They are glands with internal secretion, as shown by the experiments of Brown-Séquard,^[21] E. Meyer,^[22] and clinical observations of Senator^[23] and H. Strauss.

The liver, which, according to Gilbert, H. Strauss,^[24] and others, is also a gland with an internal secretion, is strongly antagonistic to intestinal poisons. It destroys toxic products brought to it from the intestine through the portal vein, and several authors, Professor Adami, Sir Lauder Brunton and Bokenham,^[25] show that it is also able to eliminate such products with the bile after previous transformation. We will treat of these protective functions of the liver in a separate chapter, together with the hygienics of this important organ; but we will just mention here that the liver plays a great rôle in the transformation of the toxic end-products of albuminous food into harmless substances, such as urea.

The third important toxin-destroying organ is the thyroid gland, which, as shown by the experiments of Dr. Leo Breisacher,^[26] of Detroit, formerly assistant to Professor Munk, of Berlin, and of Dr. F. Blum,^[27] of Frankfort, as well as Dr. Chalmers Watson,^[28] of Edinburgh, destroys those poisonous substances produced by the decomposition of proteid food. Moreover, Sajous has shown that this is a prominent function of the pituitary body, the thyroid and the adrenals, acting jointly as the “adrenal system.”

It will be evident that these various glands can only do their work to perfection so long as their parenchymatous tissue is not replaced to any large extent by connective tissue. Of these glands the thyroid takes the foremost rank, as it governs the other glands. As we have shown in a communication to the French Congress of Medicine, in Liège, 1905, the thyroid influences the liver, and in a paper before the Paris Biological Society, February 25, 1907, we have shown that the thyroid also influences the kidneys. In fact, the liver and kidneys are closely allied to the thyroid, and when this organ is degenerated, the other two glands follow suit.

Accordingly we may expect that, when the thyroid undergoes a process of degeneration, such an event may also take place in these two protective organs, as we have shown in our above-mentioned two communications. In consequence of the diminished activity of these organs the development of a condition of auto-intoxication may be facilitated. Patients showing symptoms of old age in early years, also show to a greater or less extent symptoms of such a condition, as do myxœdematous persons.

Meat food especially, if taken in large quantity, is a certain producer of uric acid, and it is an interesting fact, shown by several authors and also by the writer,^[29] that by thyroid medication we can augment the elimination of uric acid, and also prevent its formation in large quantity, both in the case of uric acid formed in the body or introduced from without by the food.

This fact stands in relation to the powerful influence exercised by the ductless glands, and especially the thyroid, upon the process of oxidation; and, as we are anxious to prove the assertions we here advance, we shall show in the next chapter how these wonderful glands influence the processes of nutrition in the tissues, and at the same time the external appearance. We have already mentioned a form of obesity that has nothing to do with overfeeding, as one of the symptoms of precocious old age, and in the next chapter we will review in detail the agencies which govern this condition.