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but those who do not must find other means. For them the most natural form of exercise is walking. By walking the action of the heart and the breathing are accelerated; more blood is passed into the blood-vessels, which are obliged to contract more vigorously, and carry it with great energy to the different organs and tissues, nourish the latter, and become themselves nourished by the work. At the same time the number and depth of inspirations are increased, more oxygen is taken up, and more carbonic acid is given out, and the metabolism of the whole body is promoted. Another effect of walking, and of all muscular exercise, is the improvement in nutrition of the muscles, by which the loss of strength and the tendency to the decrease of body heat are kept in check. Numerous other kinds of muscular exercise, such as riding, rowing, gymnastics, angling, and the various sports may often be substituted for walking.

The benefit of walking is greatly enhanced by daily breathing exercise during eight to fifteen minutes. A simple way of doing them is by taking in the erect position a deep inspiration, with the mouth closed, and after holding the breath during fifteen to sixty seconds in inspiration to expire as much as possible, and hold the breath in expiration as long as can be done without inconvenience. During the expiration the abdominal muscles ought to be vigorously contracted, in order to keep them in an effective condition and to exercise pressure on the organs contained in the abdominal cavity. The inspiration ought to be done with raised arms, the expiration with bending down of the whole body. Gymnastic movements of the arms and the trunk may be combined with the respiratory movements. If properly carried out the nutrition, not only of the heart and bloodvessels, but also that of the lungs, is materially benefited and premature decay avoided.

Preservation of Health in Old Age.

The suggestions with regard to the prevention of premature old age apply also to the preservation of health in natural old age when this has supervened. The rules as to exercise must be kept up; but with the inevitable progress of old age the power to take it gradually declines, and many persons give it up. This, however, is a great mistake, and mostly leads to mental depression and deterioration of general health. It is essential for old people to continue open-air exercise and to regulate it according to their powers. It is often laid down that persons above 70 or 80 ought not to walk more than one or two miles a day, and only at the rate of a mile or a mile and a half in the hour, that they wear out their vital powers more rapidly if they do more. This wearing-out theory is entirely wrong, provided overexertion be avoided, as I have said at another place; the muscles are not to be compared with a dead substance like stone which is ground down by wear, but they are a living tissue, the wear and tear of which is constantly renewed by fresh material. Old persons must continue their walks, and must graduate the extent and the rate, not according to the number of their years, but according to their strength.

I have often seen persons between 70 and 80, depressed and weak from acting on the mistaken idea that they must take no exercise, become well and cheerful when I was able to induce them gradually to resume exercise of body and mind. A little rain and cold ought not to stop the walks of old persons when in health ; with proper clothing and other provisions they can take their walks in almost any weather. Those who are unable to walk ought to be out in the open air several hours, driving in bath chairs or open carriages, or sitting in open shelters on balconies or open verandahs. The popular prejudice of many old people against open air is quite unfounded; they ought also to procure as much of it as possible indoors, by open windows day and night, without exposing themselves to draughts.

The Digestive Organs and Dietary in Advanced Life. The digestive organs share in the tendency to senile atrophy of the whole organism. The digestive power is lowered; the food, therefore, ought to be easily digestible, the quantity small, and the mastication thorough. As the expenditure of force and the power of the cells are diminished, as well as the whole metabolism, the body is unable to dispose of the amount of food it had been accustomed to in the period of full vigour. All good authorities are unanimous in this respect. Dr. George Cheyne, for instance, says : “ The aged should lessen the quantity and lower the quality of their food gradually as they grow older, even before a manifest decay of appetite forces them to it.” Sir Henry Thompson, in his “Diet in Relation to Age and Activity,” and Dr. George Keith in a “ Plea for a Simpler Life,” give substantially the same advice. A limited amount of nourishing food is the safest course in old age. On the experience that old people continue to live very long when they are in workhouses, Sir Lauder Brunton makes the practical remark : “A workhouse diet may not be very pleasing to the palate, but it certainly seems an

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efficient means of prolonging life, and it inight certainly be worth while sometimes for others to adopt it whose circumstances would allow of them to indulge in luxury." Moderation is, indeed, one of the greatest factors of health during the whole life, but especially so in

old age.

It is important to avoid constipation. If the fæcal matters are

. very hard and remain long in the bowels, they irritate their coats and may give rise to catarrh, and even to malignant growths to which there is a greater tendency in old age. Constipation also often gives rise to absorption of noxious substances (toxins) and to retardation of the portal circulation and its consequences, such as piles. Regular habit at a fixed time of the day ought to be encouraged and assisted by diet (fruit, green vegetables, brown bread), and, if necessary, by massage, by lubricating substances and by mild aperients.

Stimulants and Old Age. The aged ought to be moderate with tea and coffee, and ought to reduce tobacco to a very small quantity. Still more important is the question of the employment of alcohol. So much has been written, and well written, by judicious and great men that we need not enter on a discussion of its use and abuse in general, but we must say a few words on its relation to old age. I may refer to a short article on “ Alcohol and Old Age” which I contributed to the British Journal of Inebriety. The conclusion presented in that paper is that indulgence in alcohol in old age is very injurious, and ought to be entirely avoided, barring rare cases of heart failure, and then only temporarily; that it “is one of the most frequent and potent causes of arterial sclerosis and the degeneration of the small vessels on which the nutrition of the organs and tissues depends." It also promotes the atrophy of the cells of the brain and the decay of the mental faculties; it is, further, a frequent cause of the diseases to which old age is specially liable : gout, dyspepsia, bronchitis and pneumonia. Dr. E. A. Parkes, in his “ Practical Hygiene,” already said : “ It seems to me that there must be danger in the use of alcohol when the arteries become rigid in advancing age." I must allude here to the old creed that the habits of old people ought not to be changed, even if they are injurious—that, for instance, an old man accustomed to take every day one or two bottles of port wine, or 10 to 15 oz. of cognac or

1 See


Alcohol and Old Age" in the British Journal of Inebriety, vol. iv, No. 2, pp. 87-92. 1906. London : Baillière, Tindall and Cox,

whisky, ought not to be deprived of this large amount of alcohol. We cannot accept this as a rule, or, at all events, must regard the exception with greater favour than the rule. We have seen in many hundred persons the diminution of the amount of stimulants, when gradually made, attended with the best results. The same is the case with other injurious habits, such as excess of smoking, excess of meat, excess of sleep.

An important point to which the late Sir Lauder Brunton directed special attention is that aged persons should not be exposed to infection. A common cold, which is a trifling indisposition to young people, may in old ones lead to bronchitis, pneumonia, and death. Persons affected with colds ought, therefore, not to come in close contact with the aged. Sir Lauder also points out that all influences depressing the vital energy often form predisposing causes to infections and other diseases; and amongst them exposure to low temperatures, as well out of doors as in the house, where cold passages and water-closets often prove injurious.

The Day's Routine of a Healthy Old Man. I have often met with aged persons who had nothing to do and who stayed in bed till lunch, which was an abundant meal, read and slept in the afternoon, took a big dinner in the evening, went to bed rather early, “tired to death,” as they said, although they often had not stirred out of the house, nor exerted their mental faculties in any way. In contrast to this, I will sketch something like what the average day of many old, but active men, and also women, is who are occupied from morning till night and find the day too short when bedtime comes. They usually rise between six and half-past seven, take a glass of hot water or a cup of weak tea, and do breathing exercises during six to twelve minutes, and afterwards take a bath, mostly hot (989 to 103° F.), followed by a cold or tepid shower bath, or by sponging the head thoroughly with cold water. After drying and rubbing the body briskly with a bath-towel, they take again some breathing or other gymnastic exercises during a few minutes before dressing. Between eight and nine o'clock they take a light breakfast, consisting of weak tea or coffee, with much milk, or cocoa, or porridge, with bread and butter and some marmalade; also frequently an apple, an orange, or a few figs. An hour's walk follows some time after breakfast, and then a couple of hours' work. Lunch is generally composed of some fish or poultry with green vegetables, potatoes, pudding, or cooked fruit, with as much variety as agreeable and possible. After an hour's rest another walk or drive in an open carriage or bath-chair, afternoon tea, and again some reading or other work till dinner, which is similar to lunch, and always moderate in quantity. Dinner is followed by some hours of entertaining occupation, such as playing cards, or chess, or draughts, or other games, varied with conversation or listening to family music.

I have not mentioned any drink at the principal meals; the fact is, that most of my old friends rarely take any fluid, excepting now and then a small quantity of soup at these meals; but some take half a tumblerful of water, and occasionally a single glass of wine; they take, however, a tumblerful of hot water at bedtime, and on rising, in order to assist by this fluid the removal of waste products. The whole of this routine ought not to be regarded as a fixed unalterable arrangement, but ought to be varied, as far as possible, to the taste of the individual, for in many old people sameness causes dislike and dulness, while variety stimulates the appetite, and everything ought to be devised to create cheerfulness.

As to the walking exercise, the amount varies according to age, or rather, strength, from one mile to five or seven miles, and occasionally

If it is impossible to have an entire bath, an energetic rub down of the whole body with a wet towel, combined with a good sponging of the head, forms a tolerably fair substitute.

Most of my old friends, when in health, go to bed between ten and eleven, and remain there about seven to eight hours; very few of them sleep more than six or seven hours, none above eight, and wisely so, for too much sleep in the aged leads to weakening of the small bloodvessels and imperfect nutrition of the brain, to apoplexy, softening, or other allied affections of the brain.

An old man need not always keep to the same strict routine, but may make judicious alterations. It is also advantageous to the majority to have a change of locality during several weeks or months of the year, or to travel in a comfortable way, which forms an agreeable occupation to mind and body.


Management of the Mental Faculties in Old Age.. The brain and the nervous system are apt to decay in old age with the rest of the body; the cells and fibres of the brain become atrophied and their various functions deteriorate. The memory mostly gives way first, and in some persons already at an early period the asso

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