Arnold Lorand.

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of Sir Lauder Brunton. We have had a great many smokers
among our arteriosclerotic patients; but, on the other hand, we
quote further on the cases of some great smokers who lived to a
very old age as we have seen. But this latter class is not

Similarly, the hygiene of the intestines is of the utmost
importance, especially as poisons generated in the intestines
play a leading part in causing arteriosclerosis, according to
Huchard, Senator, and others. We must take great care to have
a daily evacuation of the bowels, and especially to prevent flat-
ulence, for this distention of the colon or the stomach, by carrying
the diaphragm upward, may interfere with the expansion of the
lungs and thus produce a mechanical hindrance to the movements
of the heart and a free circulation of the blood. Those with a
tendency to angina pectoris must specially avoid such dangerous
courses. Hill climbing, during which not infrequently such peo-
ple suffer sudden death, should also be avoided. More than from
1 to iy 2 liters of liquids per day should not be allowed.


The Elimination of Toxic Products Through the Intes-
tines and the Improvement of This Function.

The intestines contain billions and billions of microbes, their
number increasing downward throughout the length of the intes-
tine. The duodenum contains the least, and in some parts of it
there are none at all.

The presence of these bacteria is a great necessity to us,
as without their assistance we could not exist, for they take an
active part in intestinal digestion and help to form the inter-
mediate substances, especially from albuminous food and fat,
for our nutrition. They also assist fermentation and thus induce
a better peristalsis of the intestines, by which the contents are

That animals cannot exist without cultures of bacteria in the
intestines is shown by the experiment of Schottelius, who dem-
onstrated that young chickens could not thrive on a sterilized
nutrition, and Nuttall and Thierfelder had great trouble in keep-
ing their guinea-pigs alive when feeding them for a time on
sterilized milk.

All those bacteria which are found in the intestines are, we
may say, innocuous ; they assist digestion and do no harm. But
among such are often virulent bacilli against which, under nor-
mal circumstances, we are well guarded, as the epithelium of the
intestines is so wonderfully arranged that so long as it is in
a healthy condition it does not admit the passage of these
microbes; but in the aged, or in those exhausted by debauchery
or previous disease, or when there is an inflamed condition of
the intestines, stagnation of hard masses of faeces for a very long
time cause mechanical lesions of the epithelium when, conditions

Elimination of Toxic Products Through Intestines. 171

now having changed, nothing will prevent these microbes from
entering the walls of the intestines and either cause disease, like
typhoid or tuberculosis, or from passing through and entering
into the blood.

Besides these dangerous bacteria many other harmful sub-
stances pass from the stomach down into the intestines, whence
they are taken up by the portal vein and brought to the liver.
When the latter is in good condition so much the better for us,
but when they arrive in too large quantities, or when the liver is
more or less degenerated, as in old people, drunkards, gourmands,
etc., then trouble arises.

When the number of bacteria in the intestines is much
greater than usual, certain dangers arise from such a condition,
as thereby the immigration of bacilli into the bile-duct is facili-
tated causing inflammation of the gall-ducts and gall-bladder,
and subsequently gall-stone disease. Further consequences of
such a condition may be the closure of the bile-duct, and then
no bile can reach the intestines. The presence of bile, however,
is very important, for, according to current opinion, this exerts
an influence on the checking of putrefaction in the intes-
tines. Bile is a natural antiseptic of great efficacy, and has also
a stimulating effect on the nerves of the intestines, promoting
their peristaltic movements.

It would, therefore, greatly interfere with the useful work
of those organisms normally present if we permitted the forma-
tion of enormous quantities of bacteria, especially of such as are
harmful to us; so we must endeavor to eliminate them and not
give them the opportunity to turn against us, and we must do all
in our power to keep the peristalsis of the bowels in good working
order so as to prevent any stagnation of their contents, as such a
stagnation, in addition to favoring the growth of bacteria, also
facilitates the development of auto-intoxication. Even if it is
true that most of the end-products of proteid food in our intes-
tines, like indol and skatol, are not able to produce severe poison-
ing if injected into other animals ; still there is no doubt that in

172 Old Age Deferred.

medical practice not infrequently cases are observed where the
retention of all these products together results in very grave
conditions. Thus Ewald 1 has published the case of a woman
who, for about a month, retained the contents of the bowels and
in consequence presented a serious condition of intoxication;
after eliminating a large quantity of faeces — pitch dark — she
recovered and the symptoms of intoxication disappeared. Sena-
tor also published a very interesting case of auto-intoxication
with hydrothionuria.

We often have occasion to note cases of persons having no
bowel action for two to three days, who then complain of head-
ache, loss of appetite, and various nervous symptoms, neuras-
thenia, etc., all of which may, perhaps, be regarded as of reflex
origin ; but when we see in such people a yellow or yellowish-gray
complexion which, after a good purge, resumes its clear condition,
clinically, we regard it as auto-intoxication.

Even if, as already mentioned, most of the elements of
albuminous catabolism are not toxic if injected into animals, still,
occasionally, toxic products can be formed, such as cholin and
neurin, which come from the former. These elements arise
from decomposition of the lecithin, which, of our various food-
stuffs, is contained in the greatest quantity in eggs; and these
substances can provoke serious nervous symptoms. In such
cases there is, of course, a stagnation of long duration of the
bowels, but such a condition as the latter can arise without a
stricture or obstruction, although these are the most frequent
causes. Another toxic product is the pepto-toxin of Brieger.

Stagnation takes place in sluggish bowels. As a general
rule, faecal movement is caused by peristalsis of the intestines,
which consists of circular contractions of the bowel by which the
contents are propelled toward the end of the same ; besides these
movements there are also pendular or vermicular contractions of
certain parts of the intestines ; all these movements also assist the

1 Ewald : "Die Autointoxication," Berl. klin. Wochenschr., No. 7-8, 1900.

Elimination of Toxic Products Through Intestines. 173

admixture of the chyme with the juices of the intestines. All these
contractions are caused by impulses from the nerves which lie in
the walls of the intestines, the plexus myentericus ; they can also
be provoked by impulses coming from the central nervous system.

The nerve ganglia that lie in the walls of the intestines can
be influenced mechanically by the contents of the intestines, when
such are bulky, and also when they are fermenting ; therefore, the
bacteria, by promoting fermentation, also aid in peristalsis. The
bulky condition of the bowel contents can be best induced by food
of the vegetable kingdom through its cellulose contents, of which
tissue the cells of plants or fruits are largely formed. When
these irritating agents act on the nerve filaments in the intestines,
the bowel will contract and expel its contents.

But when food contains no irritating substances and is easily
assimilated without forming residues, or when the innervation
by the vagus is sluggish and the peristaltic movements are slow,
the contents of the intestines can remain longer, especially in the
haustra of the intestines. It may be that the bowels move every
day, but that does not prove that everything in the intestines has
been expelled therefrom, for some amount of faeces can yet re-
main in the haustra of the intestine even for many days ; so that
in such cases there is still a constipation of one part of the bowels.
We have observed, personally, and on patients, that, after
a good opening of the bowels, when a purge is given — for in-
stance, directly after a meal — a short time afterward there has
been another copious discharge that had evidently remained
behind. Thus, no doubt a retention of faeces, and sometimes a
condition analagous to auto-intoxication, can be caused in people
who have the bowels opened every day, although not to the
extent of those having obstruction or habitual constipation.

To avoid such a condition a good purge should be taken
at regular intervals, say once a week, even by persons who have
a movement daily, in order to eliminate matter which may have
remained. It will not be necessary, naturally, to use a too
powerful purgative, but one adapted to the necessity of the case ;

174 Old Age Deferred.

taking, as a rule, such a purge as will act a little better than the
ordinary bowel movement, and graduated according to the
strength of the person so using it.

Before closing this chapter we must also briefly insist upon
the importance of the fact, that the secretions of the intestine
and of its glandular annexes have also an anti-bacterial and
anti-toxic action. Very important is the role of the bile for the
disinfection of the intestine, as it contains two acids, the glyco-
cholic and taurocholic, which possess highly anti-fermentative
properties. As already mentioned, the bile also assists in the
assimilation of fat, and also exercises a stimulating action on the
peristalsis of the intestines.


On the Prevention and Treatment of Habitual

We all know from physiology that the expulsion of foecal
matter from the intestines takes place in such a manner that the
contents therein act as a kind of extraneous body with stimu-
lating action upon the walls of the intestines and the plexus
myentericus contained in the same. Consequently there follows
a contraction of the walls of the intestines, and their contents
are expelled. All nerves, the plexus myentericus included, are
under the control of the central nervous system, which creates
motor impulses through the medium of the pneumogastric
(vagus), or may cause a check to the peristaltic movements
through the intervention of the splanchnic nerves.

Thus, as we see, different agencies influencing the central
nervous system, like strong emotions, shock, etc., may cause an
irritation of the pneumogastric, the motor nerve of the intes-
tines, and thus occasion a movement of the bowels. Different
toxic products may act also upon the pneumogastric; strong
motor action of the intestine with diarrhoea may also be caused
by the abundant secretion of the thyroid gland, as in Graves's
disease, where an excess of toxic matters of the thyroid gland
are secreted.

In the same way we can also produce diarrhoea if we give
thyroid extracts in too abundant quantity; but giving the same
in more moderate doses will effect an improvement in the
peristaltic movements.

That the thyroid gland has a controlling influence on the
innervation of the intestine is evident from the fact that, when
the thyroid is degenerated, the bowels are very sluggish. Under


176 Old Age Deferred.

such conditions we often find very stubborn constipation; but
when we administer to such persons thyroid extracts for a given
time, we note a considerable improvement of the bowels, which
can even go to the extent, if too excessive doses be given, of
causing diarrhoea as already mentioned.

In addition to the thyroid gland, there are other ductless
glands which seem to influence the peristaltic movements by
acting on the splanchnic nerves, and these are the sexual glands.
In women they are frequently altered. Dysmenorrhcea, amen-
orrhcea, and other troubles are frequent, and constipation is a
typical symptom of such conditions. This may also serve to
explain why women are more often constipated than men.

But the alteration of the sexual glands can also cause con-
stipation in men, if we may draw the inference from the great
frequency of constipation in diseases of the prostate gland, which
to some extent may be in relation with the subject with which
we are now dealing.

In order to avoid constipation we must therefore observe a
careful hygiene of the thyroid, and also of the sexual glands, fol-
lowing the advice we offer in special Chapters XVIII and

Besides constipation, as above, from the central nervous
system, the same may be caused through the lack of a stimulation
which may come from the intestinal contents. As we have
already seen, the peristaltic movements of the intestine and the
expulsion of faecal matter take place through the stimulation of
the nerves in the intestinal walls by the intestinal contents, which
act either mechanically or by the irritation which their fermenta-
tion causes.

To prevent constipation we must take such nourishment as
will act in a stimulating way, either mechanically, owing to its
bulk, or by the fermentation it causes. In order to have good
bowel movements we must create them, and this is best done, not
by a diet of meat and finely ground cereals, which are absorbed
with scarcely any residue to effect the purpose, but by one of

Habitual Constipation. 177

vegetables and fruit, which contain cellulose in the largest quan-
tity, this substance forming the framework of the structure in
which the cells are imbedded ; it constitutes the wall of the cells.
This cellulose provides us with the best residue from food, which,
if present in large quantities, will exercise a mechanically stim-
ulating action on the intestinal walls.

Vegetables are thus a valuable aid in the prevention of con-
stipation, and of these the following are the best: spinach,
carrots, green beans, and boiled lettuce, taking into consideration
their action as laxative food. Cabbage also acts well as a bulky

Graham bread and brown bread in general, and in particular
a special kind, called "cellulose" bread, are also very good agents
with which to prevent and to treat habitual constipation. Some
breads, as various kinds made from bran, are so coarse that, to a
certain extent, they may be considered as setting up a kind of
internal massage of the intestines.

Not only vegetables, but fruits, by reason of the fruit sugar
and acids they contain, may also prove laxative if taken in given
quantities. Fruits may be taken stewed, as a compote, or baked,
as for instance, apples; they may also be taken an naturel if
the condition of the stomach permits. Of compotes the most laxa-
tive are plums, prunelles (sour figs), and apples; also pineapples,
cherries, and various berries, all of which may also be partaken
of in the form of a mush or puree, to great advantage; also
fruit juices and fruit wines, if free from alcohol.

Of fresh fruits, grapes and, according to our observation,

pineapples also undoubtedly have the best laxative quality, as

also have green figs, which can be taken regularly as a preventive

against constipation. Figs when dried, especially the so-called

Olympia figs from Smyrna, or the California variety, are also

most beneficial, their laxative properties to a certain extent being

probably due to the seeds which they contain, which serve as a

means for intestinal massage.

Orange and grape-fruit, taken on an empty stomach in the


178 Old Age Deferred.

morning, may also have a laxative effect, due probably to the
quantity of fruit acids they contain.

We sometimes hear patients complain of constipation after
partaking of milk. According to our experience, this is more
often the case when boiled milk, heated above 6o° C, is taken.
On the other hand, we believe that when uncooked milk is taken
it may act as a laxative in many persons, due to the action of
milk-sugar and acid. Acidulated milk may have this property
in a greater degree, as also may buttermilk, and especially whey ;
all of these are, on the whole, good laxatives.

The diet of those suffering from habitual constipation
should be as follows: In the morning, on rising, take a glass
of cold water and an orange. For breakfast, one or two oranges
or several slices of fresh pineapple, or, in countries where one is
so fortunate as to obtain such delicious and wholesome fruit, a
grape-fruit; after that one or two soft boiled eggs, cereals,
Graham or brown bread, or one of the kinds of coarse breads rich
in cellulose, and fresh butter thickly spread on the bread (if the
stomach is good). Then follow with orange marmalade or
puree of prunes, ending with some grapes. Honey (another
excellent laxative) may also be added. Two glasses of milk or
more, for those who can stand it ; in fact, as much as they desire.
For dinner, the following is recommended : Roast or boiled
meat, two sorts of green vegetables (by preference spinach),
French beans, carrots, boiled lettuce, one course of stewed
compote of fruit, and finish with dessert of grapes, figs (dried or
green), or preserved plums (California or Bordeaux). For
drink, mineral waters, such as the various light American kind,
either mixed with wine or alone. Alkaline waters, such as
Biliner, Vichy, etc., if taken very cold, may also contribute to the
laxative action. For supper, something akin to breakfast. As
we shall point out in the chapter on the hygiene of food, we
recommend meat only once a day.

We are confident, from experience gained with our own
patients, that people who follow such a regimen will have an easy

Habitual Constipation. 179

bowel movement daily, and will thus avoid those dangers which
are connected with the habitual use of laxative drugs.

For those who, in spite of such a course of diet, have slug-
gish bowels, we recommend massage and electricity, and also cer-
tain hydrotherapeutic procedures. The method of carrying out
such must be obtained from the special hand-books written for
that purpose; but we would merely mention here that massage
should preferably be performed by one belonging to the medical
profession, or, at any rate, by one trained in the Swedish system.

Electricity may be applied by either galvanic or faradic
current, both of which give excellent results.

Hydrotherapeutics must not be overdone or harm may result.
We find that a compress of lukewarm water (Pressnitz compress)
worn round the abdomen and back through the night, produces
good results in many cases, if the diet is, at the same time,

For those who only suffer occasionally from constipation,
as, for instance, after a railway journey, it is an easy and always
efficacious method (if there is no inveterate constipation) to
take a suppository of glycerine and introduce it into the rectum.
After only ten to fifteen minutes interval there may be a copious

In persons where the dietetic and above-mentioned mechan-
ical remedies have not proved effective, irrigation of the rectum
and intestines should be employed. We would not, however,
advise the constant use of this method, as torpidity of the in-
testine might result if practiced daily (see chapter on the hygiene
of the intestines).

In cases where there is a more serious degree of constipation
a little soap, or olive or castor oil, should be added to the water,
together with a little soda to assist the formation of an emulsion.

Enemata possess the advantage of having nothing to do
with the stomach, and thus this important organ can be spared
much irritation which, unfortunately, cannot be avoided when
other purging remedies, such as drugs, are given, all of which

180 Old Age Deferred.

must pass through the stomach when taken by the mouth. If we
find it necessary to resort to laxative drugs by the mouth we
must first try such drugs as are least irritating to the stomach
and intestines, and foremost among these is rhubarb, which can
be taken in the form of a compote as well as a drug. To this it is
well to add magnesia and bicarbonate of soda. We should, if
possible, administer only the mildest purgatives, and, therefore,
if rhubarb is not effective, we may give cascara sagrada, or the
pulp of tamarind, which is, moreover, pleasant to take; but the
action is not so pronounced as in the case of cascara sagrada
(rhamnus purshiana).

Before resorting to drugs, however, we think it would be
better to try the natural mineral waters, and only when these fail
should we fall back on drugs.

There are two kinds of mineral waters, each varying in its
action : I . The milder acting water, of a laxative nature. 2.
Stronger water, with drastic action. Of the former we will men-
tion those which are employed for several weeks continuously
for a regular cure: Germany: Kissingen; Austria: Carlsbad;
Marienbad. As the author of this book is himself a practicing
physician at one of these springs, he thinks it more becoming to
pass over in silence which of these waters is preferable. Each
of them, as also many others not mentioned for want of space,
have their undoubted merits. A teaspoonful of Sprudel salt,
taken in a glass of lukewarm water in the morning on an empty
stomach, will give excellent results; but it should not be taken
every day for any length of time, as otherwise, as with all other
drugs if taken continuously, it may deaden the excitability of the
nerves of the intestines, and success depends upon keeping these
nerves in such a condition that they may respond, upon a light
stimulation, with a contraction of the intestinal walls and expul-
sion of the fsecal matter.

Of the strong mineral waters with drastic action, there are
several excellent springs in America, some of them surpassing
many of the European mineral waters. In Europe there are in

Habitual Constipation. 181

Hungary : Hunyadi-Janos, Ferencz-Jozsefforras, etc. ; Spain :
Rubinat, Villacabra-Loeches, etc. ; and elsewhere a number of
such springs. As all are natural remedies they should be used
in preference to drugs when the intestine does not respond to
mild laxatives and a strong whip is needed. In my opinion they
are less fitted for every day treatment, though well adapted for
a thorough cleaning out of the intestine to get rid of stagnant
matter (see Chapter XIX).

These strong, drastic, natural waters act by causing a transu-
dation into the intestine, creating a condition somewhat similar
to a catarrh, but in a more benign way.

Briefly, the best and most rational treatment of sluggish
bowels is by stimulating the intestine by means of an appropriate
diet which, at the same time, tends to ward off old age.

Hygiene of the Intestines.

As the means by which we are able to keep the intestines
in good working order are of the same efficacy also for the
stomach, all that is necessary to mention in this chapter about
the intestines will apply equally to the hygiene of the stomach.
The same applies also to the pancreas, so that it is unnecessary
to treat of its hygiene separately. It is also our intention in this
book to mention only the hygiene of those organs which are
able to rid the body of toxic products, as it is mainly by their
degeneration that premature old age is brought about.

There is scarcely a serious disorder of the stomach without
an attendant alteration of the intestinal functions. All the differ-
ent agencies that are dangerous to the stomach will also prove
dangerous to the intestines. We have mentioned several of these
in the chapter on food and the hygiene of eating, where we have
pointed out that defective mastication is very deleterious. Food
introduced into the stomach passes into the intestines, and if it
reaches these insufficiently masticated it will present great diffi-
culties for the penetration of the intestinal ferments. Not only
will it not be well digested, but as the different ferments cannot
well penetrate these compact masses they will putrefy, thus con-
siderably increasing the natural fermentation, in consequence of
which a great amount of toxic products and a considerable irri-
tation of the intestinal mucous membrane will result, which may

Online LibraryArnold LorandOld age deferred; the causes of old age and its postponement by hygienic and therapeutic measures → online text (page 17 of 42)