For nerve jitters, thiamine chloride is a far saner remedy than the barbiturates. How fortunate is the physician trained in homoeopathic materia medica, for he has a veritable treasure house of remedies that will bring relief and comfort to these old people suffering from functional conditions whose number is legion.
Constipation must be avoided. It should be controlled and not allowed to go on to obstipation and impaction. Milder laxatives and cathartics such as milk of magnesia, cascara, bile salts and acids, senna, aloin, Carlsbad Sprudle type of salt or sodium phosphate are the most advisable unless a normal saline or mild potassium permanganate enema can be administered by some intelligent person when required.
Functional conditions of the heart, lungs, liver, stomach and intestines should be corrected as promptly as possible and the progress of organic lesions of these organs should be held in abeyance and their distressing symptoms alleviated to the best of our ability.
Especially is this true since it is well recognized that constant or repeated pain, like constant fears, has as profound effect on the body as on the mind. Many severe infections attack the aged with only mild or even with no temperature elevation. Dont ever lose sight of the fact that aged patients are commonly afflicted with more than one disease, e.g., heart failure, hypertension, nephritis and diabetes.
Most old people like medicines. It is a known fact that as people row older their systems become more sensitive and susceptible to most drugs. Therefore in our prescribing we should ever be careful to administer appropriately reduced doses. It is well recognized that elderly people eliminate many of the opiates much more slowly than younger individual and we must constantly be on guard to see that they do not receive doses of these agents which could allow a cumulative action resulting in immediate danger to a patients life.
Having considered these general factors of their lives, a sensible working motto would seem to be -be temperate in all things.
TUBERCULOSIS.
In spite of a universal misconception even among the rank and file of medical men, tuberculosis is not only not rare, but only the contrary is quite common in the older age groups, and the mortality rate is unusually high. Among this class it is usually of the fibrotic type, so that its victims are not the subjects of the debilitating effects that are seen in younger individuals. This very fact tends to throw the family and even the physician off guard. The older the person with chronic tuberculosis the less is he affected by the disease per se.
Any physician can recall grandparents in an intimate family circle who were commonly looked upon by their children as victims of merely benign chronic bronchial affections. until one day a grandchild was suddenly stricken, out of a clear sky, with tuberculous meningitis and promptly succumbed. Intelligent investigation then uncovered that the grandparents sputum continually yielded tubercle bacilli. Thus they had continually spread tubercle bacilli in the home. Some investigators would have us believe that the tubercle bacilli from these victims are less virulent than that from younger subjects, whereas their virulence is just as great.
Certain people live upto ripe old age having had tuberculosis all their lives. Even with advanced disease they remain fairly comfortable; and are able to enjoy life, although they may be forced to stay within certain limitations. As a matter of fact, their end is usually brought about by some other condition.
PETERS, MEYERS and KRAUSE all point out that, due to the normal changes in anatomical structure and in physiological function and because of the presence of various pathological states, the establishment of a positive diagnosis by the usual means is often difficult, if not wholly impossible. Whereas, if we shall promptly and routinely resort to roentgenograms of the lungs, tuberculin skin tests, and repeated search for tubercle bacilli in the sputum, diagnosis will be established without delay. If these procedure yield negative evidence, one can dismiss tuberculosis and follow other procedure and more profitable leads.
Tuberculous ulceration of the intestine if frequent. Tuberculous peritonitis, meningitis, osteitis and arthritis are by no means infrequent. Therefore we must be on our guard against their occurrence.
ANGINAL SYNDROME.
This condition accounts for many deaths (the peak of fatalities lies between 60 and 79 years). The ration of males to females is over 2:1 Always be sure to differentiate it fro multiple intercostal neuritis especially occurring on the left side. A benign type s described as largely attributable to nervous excitability. This type reacts less to cold. the severe type seems associated with varying degrees of cardiac pathology. The duration of the attack in this latter group likely depends on whether the myocardial anoxia is transient or longer in duration. Of course, if the the anoxia should be permanent, then myocardial infarct is produced.
CEREBRAL APOPLEXY.
is a common occurrence in the aged. In the order of their frequency it is produced by haemorrhage, thrombosis, and embolus (usually subsequent to chronic myocardial or valvular disease).
According to the findings and the conclusions of ROBINSON and BRUCE, longivity is based on three physiologic levels: low weight, low pulse rate and low blood pressure.
We should endeavour to discover all of the various conditions mentioned in their preclinical stages. Thus, there would be a chance of either rectifying them or, if this is impossible, of holding them in abeyance indefinitely. A semi-annual or annual health examination should aid us in accomplishing this objective.
The following slogans may be of value in aiding us to impress these older people with the aims that we are striving for:
1. Learn to grow old gracefully.
2. “Reconcile oneself to the inevitable.”
3. Cut ones cloth of activity to the changing pattern of diminishing energy and vitality.
4. Conserve ones remaining strength by practicing “personal selfishness”.
