Chapter VIII: On the Causation of Old Age

WE have seen in the first chapter of this book that the symptoms of old age may appear in quite young persons after changes in the ductless glands, especially the thyroid, ovaries, testicles, etc. We have also shown how these glands influence the condition of the tissues, and our external appearance, our immunity from infections and intoxications, and the condition of our nervous system and mind. We have also seen how these wonderful glands influence the length of our life and our prospects of a green old age, and thus it is evident that these glands are in close relation with the origin of old age. It is justifiable, therefore, to enter fully into a discussion as to whether old age is really due to degeneration of the ductless glands, which supposition must have occurred to anyone who has read the previous chapters of this book.

Sir Victor Horsley, of University College Hospital, London, was the first to bring old age into causal relation with degeneration of the thyroid, and after him Vermehren and Ewald of Berlin.

In a communication we made to the Biological Society at Paris, December 4, 1907, we showed that old age is not alone due to degeneration of the thyroid, but to changes in several ductless glands, of which the chief are the thyroid, ovaries, testicles, adrenals, and pancreas. In a communication to the International Medical Congress in Lisbon, in 1902, we added to these glands the liver and kidneys, which also possess an internal secretion.

Let us now see if there is any evidence in support of such a statement.

As we shall show, such proofs do exist and they are of a pathological, anatomical, experimental, and clinical nature. To begin with, it is a well-established fact that at a certain age the different ductless glands show important changes, notably an increase of connective tissue, with subsequent degeneration of the secreting tissue.

Sir Victor Horsley[141] found that the thyroid gland, after a certain age, shows an increase of connective tissue, with fatty degeneration of the epithelium and shrinking (concentration) of the contents of the follicles. Hale White[142] also, examining at autopsy seventy thyroid glands, found an atrophic condition in old subjects, an atrophy which is more marked the older the subject, and that these changes are already present in the thyroids of persons fifty years old.

Footnote 141:

“On the Thyroid and Pituitary Bodies,” British Medical Journal, 1890,
and Proceedings of the Royal Society, 1886.

Footnote 142:

Hale White: Med.-Chirurg. Transactions, vol. lxxi, 182.

The thyroid, together with the parathyroids, have been found degenerated in old age by Erdheim.[143] Bauman found only very little iodine in the thyroid of aged persons.

Footnote 143:

Beiträge zur path. Anatomie, xxxiii, p. 158, 1903.

Let us add that, luckily, not every thyroid shows important changes after the age of forty or fifty, although there is usually a slight increase of connective tissue at that age. On the other hand there are thyroids in subjects of advanced age which show no important degenerative change. This, however, is, according to our experience at autopsies, a very rare occurrence. The point of main importance is the amount of colloid substance present. A thyroid with much colloid, if it is of normal quality (which can be recognized by the way it stains with eosin), is a thyroid of good activity. As we know, the thyroid contains more iodine than any other part of the body. The main bulk of the iodine in our body comes from the thyroid. It follows from the investigations of Docent Oswald,[144] in Zurich, that the quantity of iodine in the thyroid depends upon the amount of colloid substance. Hence a thyroid with much colloid substance contains much iodine, and a large goiter composed of connective tissue alone and containing no colloid, cannot contain any iodine.

Footnote 144:

Oswald: Zeitschrift für physiolog. Chemie, 1899, and Virchow’s Archiv,
169, p. 444, 1902.

Differing with a famous French physician who said that the age of a man depended upon his arteries, we would state that it depends upon the quality of his thyroid. For the condition of the arteries, as we have shown in different parts of this book (Chapters II and VI), depends very much upon the condition of the thyroid gland, which governs the whole circulatory system.

The parathyroid glands, which are in relation with the thyroid, and changes in which may produce cramps, as shown by Jeandelize,[145] Pineles,[146] etc., also present an increase of connective tissue, with fatty degeneration of the epithelium, in old age, as was shown by Erdheim,[147] of the Vienna Pathological Institute.

Footnote 145:

L’insuffisance thyroidienne et parathyroidienne, Paris, 1904.

Footnote 146:

Grenzgebiete f. Med. Chirurg., 1905.

Footnote 147:

Erdheim: Loc. cit.

As is well known, the ovaries also, between the ages of forty-six and fifty, undergo important changes and involution, with consequent cessation of the menses. There is an increase of connective tissue with degeneration of the epithelial structure. There is also a retrograde metamorphosis of the Graafian follicles into fibrous tissue. The testicles have been found atrophied in old age by Professor Langhans,[148] but there are many exceptions, as shown by S. Spangaro.[149]

Footnote 148:

Langhans: “Hoden Atrophie,” Handbuch der Deutschen Chirurgie,
Stuttgart, 1887.

Footnote 149:

Spangaro: Anatomische Hefte, lx, 1902.

As Sajous[150] and we[151] also have shown in our already cited researches, that the various ductless glands are closely related, and thus changes in the thyroid are always accompanied by changes in the other ductless glands. This rule applies to the present case and after senile changes in the thyroid, with increase of connective tissue, the other ductless glands also show similar changes. These are found in the pituitary body, the adrenals, the liver, and kidneys. We have several times insisted upon this fact in various chapters of this book.

Footnote 150:

Sajous: Loc. cit.

Footnote 151:

Loc. cit.

The adrenals of old people have been examined by Minervini,[152] and he found a true cirrhosis of these glands which had included nearly the whole gland. He also found drops of fat in the cells of the medulla. Dellamare[153] found a hypertrophic condition of this gland in old age.

Footnote 152:

Minervini: Journal d’anat. et de physiol., p. 449 and p. 639, 1904.

Footnote 153:

Dellamare: Soc. de biologie, 17 Octobre, 1903.

In nature every cause has a sequel. Therefore, when we see such important changes in glands with internal secretions, there logically must be sequels to the alterations in these important organs. And these exist. When the thyroid is degenerated, to a greater or less extent all those symptoms appear which are characteristic of changes in the functions governed by the thyroid, and of which we have spoken in previous chapters.

Therefore, when the thyroid is degenerated, symptoms appear which are characteristic of myxœdema. And, indeed, Sir Victor Horsley was the first to draw attention to the fact that in old age we find all the symptoms of myxœdema; and after him, Vermehren[154] and Ewald.[155] They have compared the symptoms of myxœdema with those of old age, and found the two conditions very similar. According to our own observations the most prominent of these corresponding symptoms are:—

Footnote 154:

Studier over Myxœdemet, Kjöbenhavn, 1895.

Footnote 155:

Ewald: “Die Erkrankungen der Schilddrüse,” Nothnagel’s Handbuch,
Vienna, 1896.

The wrinkles on the face and the drooping of the lower eyelids, in extreme cases amounting to ectropion. Then the great number of wrinkles on the hands of myxœdematous people, even at an early age, and the feeling of cold in the hands and feet and their bluish color.

With advancing age, obesity is often the first symptom, just as in myxœdema, and, as we have said above, obesity can be caused by degeneration of the thyroid and sexual glands.

The hair in both conditions is very often gray, and there is atrophy of the papillæ of the hair and of the sebaceous and sudorific glands, with dryness and falling out of the hair.

Constipation or irregularity of the bowels is also common. There is often great fatigue, slow speech, and an apathetic condition in both these states. The memory shows the same typical deficiency, events of long ago being more easily remembered than those of quite recent date. The character of the patient becomes egotistical and avaricious. There is great sensibility to cold and difficulty in keeping warm. The urine is generally below the normal quantity; often it is scanty and of low specific gravity, with retention of solid constituents. The processes of oxidation are diminished both in typical myxœdema and in advanced old age. There is a diminution of the blood-corpuscles and of hæmoglobin in both conditions.

After the initial obesity in early myxœdema and old age, there comes as a second stage a loss of fat, characteristic of the advanced stage of myxœdema (the cachectic stage) and advanced old age.

There is an increase of fatty tissue after extirpation of the thyroid gland, and later of connective tissue, just as in myxœdema and old age. This increase of connective tissue is typical of old age. It first appears in the arteries, leading to atheroma, and the typical symptoms of arteriosclerosis. In myxœdematous persons, although they may still be young, we find atheromatous arteries and arteriosclerosis. Impotence is common in myxœdema, especially in advanced cases, and is also found in senility, being more marked the greater the patient’s age.

There is no denying the fact that in old age we find, besides degeneration of the thyroid, symptoms of degeneration in various other tissues and functions, and the question now arises, whether these changes in the tissues are really the sequel of previous degeneration of the ductless glands, or whether both are only accidental and in no causal relation We have already answered this question four years ago in our communication to the Paris Biological Society, showing that old age is due to degeneration of the ductless glands, and stating that these glands govern the tissues and not _vice versa_. Still, we shall enter here more fully upon this question, showing by experimental and clinical evidence that the changes in the ductless glands are primary, and followed by a degeneration of the tissues as a consequence.

We can produce experimentally typical symptoms of old age in young animals by extirpation of the ductless glands, more especially the thyroid, ovaries, and testicles.

When we extirpate the thyroid gland of an animal we get an increase of fat in the subcutaneous tissue, or an increase of connective tissue. We know of the case of a young bull which, two months after extirpation of the thyroid, gained about thirty kilos in weight, due to an increase in fat. The same thing occurred in a colt. We are indebted for our knowledge of both these cases to Dr. Hertoghe, of Antwerp, the well-known authority on the thyroid gland.

After extirpation of the thyroid gland prominent writers have found a diminution in the processes of oxidation; and by thyroid gland feeding we can augment these processes, as was shown by Vermehren, Magnus-Levy, Thiele, Nehring, and many others. This property of the thyroid gland is made use of in the medicinal treatment of obesity. Since writing these lines we have observed a loss of forty pounds in a man, a patient of Professor Launois, of Paris, who, after this loss, felt better. We treated him in Carlsbad for six weeks with thyroid extracts, and the average loss was about a pound a day. True, this patient was also taking Carlsbad water, but we have never seen so considerable a loss due to this water alone. The diet of this patient had not been strict. This loss of weight, then, is mainly to be ascribed to the thyroid treatment. This treatment is dangerous, however, unless carefully regulated by a physician.

Thus extirpation of the thyroid is undoubtedly in causal relationship to obesity, which, as already mentioned, is often the first symptom of old age. But it also can produce another sign of old age, and this is the increase of connective tissue in the various organs and tissues. That connective tissue formation is an attribute of old age has been clearly shown by Demange and Oettinger, who found at every autopsy on old persons an increase of connective tissue in the walls of the capillaries. Ord and Mahomet found exactly the same thing in the capillaries of persons suffering from myxœdema. This has been proved experimentally by Professor Eiselsberg,[156] of Vienna, who found atheromatosis of the aorta and other blood-vessels in dogs whose thyroids he had removed.

Footnote 156:

“Die Krankheiten der Schilddrüse,” Stuttgart, 1901.

This increase in connective tissue has been found in various viscera after removal of the thyroid; thus it was found by Kishi[157] in the liver of one hundred and fifty dogs and monkeys. Rosenblatt and Jeandelize[158] also described an interstitial hepatitis in similar cases.

Footnote 157:

Virchow’s Archiv, p. 260, 1904.

Footnote 158:

Loc. cit.

The same change has also been noted in the kidneys after extirpation of the thyroid (e.g., Blum[159] found an interstitial nephritis), and in the brain an increase of neuroglia occurs, as observed by Blum, Walter Edmunds, and others.

Footnote 159:

Blum: Loc. cit.

Increase of connective tissue in the skin is a common occurrence after thyroid extirpation, and the name “myxœdema” is probably derived from the fact that in some cases, as the disease advances, the connective tissue is transformed into a mucinoid substance. The name “cachexie pachydermatique,” as suggested by Charcot, seems to be far more adequate.

Formation of fat and of connective tissue is not only seen after removal of the thyroid, but can also be observed after extirpation of the sexual glands, the ovaries and testicles.

As mentioned in Chapter II, Loewy and Richter,[160] of Berlin, observed that removal of the sexual glands always produced a diminution of the oxidation processes.

Footnote 160:

Archiv für Anat. u. Physiol., Supplement, 1899; and Ergebnisse der
Physiologie, ii, 1902.

The experiments of Prof. Loewy and Prof. P. F. Richter are not invalidated, in our opinion, by the experiments of Lüthje, who did not find an increase in metabolism after ovarian feeding. The reason for this may be that he was not in possession of active extracts. Anyone who works with animal extracts knows what a great difference there is between various organo-therapeutical preparations, some being more efficacious than others.

As a rule castrated animals take on fat, and this fact has for many years been made use of by farmers. At the same time the flesh of such animals acquires a better flavor, the pronounced flavor of the meat of non-castrated animals being objectionable to some consumers. This demonstrates the very instructive fact that the internal secretion of the testicles has its effect on all parts of the body.

Castration in man is very frequently followed by obesity and symptoms of old age. Thus the eunuchs of eastern countries are very often fat and, at the same time, look much older.

The influence of the ovaries upon fat formation can also be shown by their therapeutical action in obesity. Although not so active as thyroid extracts, we have found that by the combined use of thyroid and ovarian extracts, we could produce a considerable loss in weight, when, by thyroid treatment alone, we could not obtain it. This, however, is only in the case of women. We will treat of this subject more fully in the chapter on ovarian treatment.

Besides the above-mentioned experimental facts, which show that these attributes of old age—obesity and increase of connective tissue—can be produced by removal of the thyroid or sexual glands, we also have to deal with facts gained by clinical observation, which show that any cause inimical to the ductless glands, especially the thyroid and ovaries, may bring about old age. Take, for example, infectious diseases. They have a very damaging effect on the various ductless glands, especially so if they are of long duration. Their influence upon the thyroid has been clearly shown by various observers. (Roger and Garnier, Crispino, Torri, Bayon, de Quervain, and others. See Chapter III.)

Not only the thyroid gland, but other ductless glands, are affected by infectious diseases, and in the third chapter of this book we have shown that the adrenal glands show alterations indicating hyperactivity in infectious diseases.

The pituitary gland is also altered in infections, as shown in the same chapter.

Changes in the pituitary body may also be a factor in producing premature old age. It is a fact that all people suffering from acromegaly appear much older than their age. In fact, one of the first symptoms that arouses the anxiety of the relatives of such a patient is that he looks so much older, and it is only later that they notice the overgrowth of the nose, the hands, and feet. Since, in many people who are getting older, the head and nose may increase in size, we may suppose that this is the clinical expression of senile changes in the pituitary body. There is a condition known as “acromegalie fruste,” in which the symptoms are only slightly pronounced and which is often unrecognized. As we have already said, all diseases of the ductless glands may be only partially developed. This is due to the fact that only a proportion of the thousands of follicles, of which such a gland is composed, need be affected.

The ovaries and testicles also show changes as an evidence of their fight against infections, and we have mentioned the findings of Professor Metschnikoff with regard to these glands.

In every severe infectious disease the liver shows great change in its parenchymatous tissue, with a subsequent increase of connective tissue.

The increase of connective tissue in various organs, and especially in the blood-vessels, after infectious diseases, can be regarded as an illustration of our remarks on these same changes following degenerations of the thyroid. It is a well recognized fact that atheroma can be caused by various infectious diseases, and can also be artificially produced by several infectious agents.

The kidneys, through their rôle as eliminative organs, usually suffer, even more than the other glands, in the course of infectious diseases. Even a slight angina may produce an acute parenchymatous nephritis, and the more virulent the infection, the more will the kidneys suffer.

Not infrequently, unknown to us, important parts of the renal tissue are lost after such infections, and a chronic nephritis may creep on insidiously. After such loss there may be proliferation of connective tissue, and the kidneys thus become unable to fulfill the most important eliminative functions in the body. Owing to this incomplete elimination, toxic substances may be retained in the body.

From the above considerations we can see how important it is to guard against the risk of infection. This is often impossible, considering the billions of microbes by which we are surrounded day and night. The best precaution is to keep those organs in good working order which safeguard us against infections—i.e., the ductless glands.

Even more potent than infectious diseases in producing old age are the results of degenerative changes in the ovaries. The effects of castration have already been mentioned. Much in the same way do those causes act which exhaust the internal secretion of the ovaries, e.g., many pregnancies, or sexual excesses. We must take into consideration the fact that, as shown by many authors, the different ductless glands are altered during pregnancy (Launois,[161] Guieysse, etc.). Many mothers of large families look old before their time, as do also many of those who lead a professedly immoral life. Even in young girls we can see the consequences of such deteriorating agencies in hypertrophy of the mammæ, developing in very short time, and also a tendency to deposition of fat on the abdomen, which becomes pendulous in women who have had many children. The features of women who indulge in sexual excesses undergo a striking change even in early life. They become coarse, bloated, less sharply defined, and the cheeks and chin become fat and flabby. Indeed we have often been struck by the great resemblance of such a face to that of an early stage of myxœdema, a condition due to deficiency of thyroid secretion, which in turn, as shown by Sajous, influences other ductless glands. The effects of numerous pregnancies are far more marked if lactation is prolonged.

Footnote 161:

Launois et Mulon: “Hypophyse et femme enceinte,” Société de biologie,
p. 448, 21 mars, 1903; and Thèse à la Faculté des Sciences, 30 juin,
1904.

Not all women after many pregnancies, or after unduly frequent sexual intercourse, will show symptoms of premature senility, as much depends on heredity and also on the surroundings in which they live. Certainly if they live in precarious circumstances, as do the poorer women of the working classes in many European countries, especially Germany and Austria, where these women perform hard bodily work and are badly fed, and have much sorrow and care, they will soon appear old; and women looking like matrons at thirty are of common occurence in the lower classes of these countries. But this is seen also in the women of southern Europe, although they do not work so hard. This is due to the fact that in southern countries girls reach puberty early and are married very young, in the East often at the age of twelve. Thus, sexual activity begins earlier and ends much sooner. Its end, of course, means the beginning of old age. As soon as retrograde changes commence in the ovaries, the summer of a woman’s life is over; and, just as summer is sometimes prolonged into autumn, so at this period of her life may she still retain strong sexual desire. Happy the woman whose heart, as well as her ovaries, undergoes a senile involution, for there is nothing more terrible for a formerly beautiful woman than to see her charms wane while her heart remains young.

Yvette Guilbert, in her novel the “Demi-vieilles,”[162] describes in a picturesque manner the pangs of a woman at the climacteric age. Let us quote a few lines: “They try to remain young, hide the gradual onset of their ugliness, and look for a chance to taste of love again. They cry out for the past, for even while they fight against time they cannot detain it in its course.” This description, however, does not apply only to the majority of middle-aged women, but more especially to professional beauties.

Footnote 162:

Quoted after Professor Kisch.

It can be seen from these considerations how necessary it is for a woman who has frequent pregnancies to observe the rules of hygiene. That these produce excellent results we have proved. We know of a score of ladies of the aristocratic and wealthy classes who, though having six or even seven children, look none the worse. A certain Austrian archduchess still remains a beautiful woman, in spite of her eight children and the fact that she is a grandmother. Such examples may be frequent in old families with this hereditary tendency. Though the bearing of many children can hasten old age, yet, on the other hand some women, after the birth of their first child, become better and fresher looking. We can see this especially in girls of twenty or more who, having appeared somewhat withered before marriage, begin to bloom afresh after the birth of the first child. Increased activity of the ovaries and thyroid is the explanation of this phenomenon. As already mentioned, the thyroid takes an active part in ovarian changes. In a young girl of fourteen, just previous to menstruation and puberty, we may find a swelling of the thyroid gland. During menstruation we can often see a distinct enlargement of the thyroid, and at the same time certain nervous symptoms such as are usually connected with thyroid change.

Increased activity of the thyroid during pregnancy is shown by a swelling of the gland, often causing a regular goiter, and, at the same time, not infrequently by the typical symptoms of exophthalmic goiter. Lactation is also dependent upon thyroid activity. After prolonged lactation there is an exhaustion of thyroid activity; and, on the other hand, by giving thyroid extract we can increase the flow of milk.

The swelling of the thyroid in the above conditions can be explained by the greater demand for thyroid secretion, and that this hyperactivity occurs is also shown by the observations of the early writers on myxœdema. Morvan, Ord, and Combe found that myxœdema was frequently caused by numerous pregnancies, especially if associated with prolonged lactation.

This also explains why women become prematurely old so much more frequently than men, for their ovaries are much sooner exhausted, in consequence of their activity being much greater than that of the male sexual glands. There is a much greater demand not only on the female sexual glands, but also on the female thyroid, which enlarges every month in many women, and is greatly exhausted by each pregnancy. As Hertoghe[163] says, with reference to this exhaustion of the thyroid by pregnancies, “each child demands one tooth.”

Footnote 163:

Hertoghe: “Die Erkrankungen der Schilddrüse und der chronische
gutartige Hypothyreoidismu,” München, Lehmann, 1900.

According to Hertoghe, pregnancies are especially apt to produce degenerated conditions of the thyroid gland.

Sexual excesses, on account of the concomitant nervous excitement, are also very prejudicial to the adrenals, for just as frequent nervous excitement in general, they produce alterations in the blood-pressure and favor the development of arteriosclerosis.

Sexual excesses are also very harmful to men, although their action on the thyroid, in men, has not yet been ascertained. It is a fact, however, that they diminish the resistance to infections, and favor the onset of neurasthenia and arteriosclerosis.

Changes in the thyroid also become manifest during the climacteric, and the troublesome nervous manifestations at this period are largely due to this fact. Later, on account of the degeneration of the thyroid and ovaries in many of these women, there is an accumulation of fat, of a bacon-like character, in the same situations as was described above in women after many pregnancies and sexual excesses—_viz._, the breasts, the hips, and the abdomen. The facial appearance of these women who become obese after the climacteric resembles that of a typical case of early myxœdema. In the later stages, as old age advances, just as in myxœdema, the fat may disappear and be replaced by great thinness and emaciation—the cachectic stage of myxœdema. This is less frequently seen now-a-days, on account of the improvement and checking of the disease by thyroid treatment.

It is a very strange fact that although sexual abuses soon bring about symptoms of old age, as do also many pregnancies, clinical observations show that total suppression of sexual activity is also, if not still more, a powerful factor in the production of premature senility. There is no denying the fact that spinsters, after the age of thirty or forty, often look older than married women with small families. See also our chapter on the “Hygiene of the Sexual Glands” on this subject, in which we show by experimental evidence the dangers of the total suppression of sexual activity.

Evidently nature will not be trifled with, and the ovaries and testicles are made by the Almighty to serve a certain purpose, just as any other organ. Their remaining in total idleness is no less harmful than in the case of any other organ. We fail to see for what reason this organ alone should be made an exception, and to deny this fact would be hypocrisy.

Persons who live in total sexual abstinence are very often of a nervous, neurasthenic, or even melancholic disposition. If we consider how intimate are the relations of the sexual organs with the thyroid, we cannot exclude the possibility of changes in this important gland under such conditions.

The relationship between the sexual glands and the thyroid is also demonstrated by experimental evidence. Thus Cecca found, after extirpation of the ovaries or testicles, that the thyroid shows an accumulation of colloid substance; again, Jayle saw the appearance of exophthalmic goiter in a case after castration; and, on the other hand, Prof. Hoffmeister, of Strassburg, found a premature ripening of the follicles in the ovaries after thyroidectomy.

Freund constantly found goiter in cases of fibromyoma of the uterus, and in two cases the goiter has disappeared after operation on the uterine tumor.

It is a well-known fact that exophthalmic goiter can be improved by ovarian extracts, as Latzko, of Vienna, and others, have shown.

Changes in the thyroid, as a rule, produce certain changes in the sexual glands. Thus, in exophthalmic goiter menstruation is usually irregular and often disappears. In myxœdema there is atrophy of the ovaries and sterility. The above conditions in man often produce sterility.

In partial cases of myxœdema metrorrhagia is frequent. By giving thyroid extracts these uterine hæmorrhages may be stopped.

After having shown that old age can be caused with more or less certainty by degenerative changes in the sexual organs, we will now try to show that it can also be caused by various kinds of intoxication. Especially is this true of large quantities of alcohol continued for many years.

Alcohol specially influences the ductless glands. Small quantities may at first stimulate their action, but large quantities, if taken for a very long time, will cause degeneration.

In the third chapter of this book we have already briefly mentioned the bad effects of alcohol upon the ductless glands. We have seen that, as de Quervain, Hertoghe, etc., have shown, alcohol produces very marked degeneration of the thyroid gland. This has been proved by autopsies on chronic drunkards. As well as on the thyroid, alcohol also acts upon the other ductless glands. It acts, for instance, upon the adrenals. Its action in small doses is similar to that of adrenalin. Alcohol in small tonic doses excites the activity of the splanchnic nerves, and so may produce an increased flow of adrenalin and a higher blood-pressure (see