Chapter 14 - Old Age and its Diseases
Changes Occurring in Advanced Life
Medical Treatment of the Old
Diseases of the Old
Bronchial Flux

14.4 Bronchial Flux

Bronchial Flux. Bronchorrhoea.

A more than usual amount of mucous expectoration, accompanied with cough, is very common with old people so common that in many cases they think very little of it, even when the expectoration becomes very profuse. This discharge, however, from the mucous surface of the bronchial tubes, is very apt to be attended by shortness of breath on making even very slight exertion; and the whole trouble is aggravated in damp weather, and by constipation, and the stoppage of leucorrhea in females, or the interruption of insensible perspiration through the skin.

Slow progress. This complaint makes very slow progress, as a general rule, often continuing many years without doing any great mischief. It is apt, however, to degenerate into a mischievous condition in the end; and should, therefore, as a general thing, receive some attention.

Treatment. Attend carefully to the skin. Keep it in as healthy a condition as possible, by regular and faithful bathing and friction. This is of prime importance.
Care must be had not to suppress the discharge too suddenly. It may be necessary, at times, to use some expectorant (see expectorants among the prescriptions) to make the raising easier. But when it is thoroughly loosened up, we should begin to suppress it by astringent inhalations. For this purpose Astringent Inhalant on page 274 is excellent. It might be well, however, to begin with the Anti Hemorrhagic Inhalant on page 274, which is slightly styptic.
Removal to a dry climate is a valuable remedy, provided the climate is not too hot, and is healthful in every other respect.

Other Diseases. The other diseases with which old persons are afflicted are so common to all ages, that I do little more than name them, adding a few general remarks.

Asthma. The asthma, or intermittent difficulty of breathing of the old, is connected with various other troubles, as chronic inflammation of the bronchial tubes, air in the lung tissue, swelling of the lungs, enlargement and dilatation of the heart, and diseases of its valves, etc. It is also dependent on impurities of the blood, and is connected with torpid action of the kidneys. It is impossible, sometimes, to say which of these conditions it is dependent upon. As far as may be, however, the cause must be searched out; and then, while the general remedies for asthma must be employed, the particular thing with which it is connected must also receive attention, especially if it be connected with derangement of the kidneys.
Asthmatic old people are almost always dyspeptics. The stomach and bowels, therefore, require particular attention. The warm purgatives, combined with alkalis, are generally useful: as rhubarb and soda, equal parts, or Mettauer's Aperients, with a little tincture of ginger or tincture of cayenne in it. A very valuable preparation is compound tincture of gentian and tincture of calumba, two ounces each, one-half ounce of tincture of ginger, and half an ounce of bicarbonate of soda. Mix, and take a teaspoonful as occasion may require.

Apoplexy and Paralysis. The nervous system being weakened in aged people, the way is opened for greater frequency of attack from apoplexy and paralysis. The exciting cause may be hyperemia, too much blood; or anemia, too little blood. It may be general debility, or gout, or a poisoned state of the blood.
The treatment is to be conducted much on the same principles as when these diseases occur in younger subjects.
I pass over numerous complaints which may be said to be somewhat more common in advanced life than at earlier periods. They are so fully treated in previous pages of this book, that it is deemed needless even to name them here. There is, however, one other class of diseases occurring so very often in old age, and in so many cases making advanced life a burden, that I cannot pass them wholly in silence. I refer to

Diseases of the Urinary Organs. These afflict the old, not only very commonly, but very severely. A man who reaches the age of seventy or eighty without experiencing some serious trouble from deranged kidneys, diseased bladder or prostate gland, or gallstones, or gravel, or unhealthy urinary deposits of some sort, may think himself greatly favored.

Treatment. It is not necessary here to go over the whole ground of treatment. That is done in other parts of the book. I will say, however, that a surgical operation for Stone in the bladder is not often to be thought of in the case of old people. Other remedies must be sought. And among these, none hold out so good a chance of relief as the free drinking of the alkaline bicarbonates dissolved in water. This will frequently dissolve stones formed of uric acid, urate of ammonia, and triple phosphates. Poland water in large quantities is good

Indican in the Urine.

The determination of the relative amount of indican present in the urine has come to be regarded, by physicians at large, of extreme importance as indicating the quantity of poisonous material which is being thrown back into the system.

Nature .Indican is formed from indol, which is a product of the putrefaction of albuminous substances, and which after being absorbed into the system is chemically changed or oxidized and eliminated by the kidneys.

Importance. As putrefaction is constantly going on in the normal intestine, save in that of the newborn, indican is present in the normal urine, the amount found in the adult varying from .0025 to .005 gm. in the twenty-four hours, when the diet is mixed. A milk diet will show a very small amount; while a diet composed generously of meats shows the largest amounts excreted in health. An excess of indican shows that there is putrefaction of proteid substances going on somewhere in the body to an abnormal degree. This may take place (1) outside of the intestines, as in such conditions as putrid cancer, tuberculosis cavities, gangrene, pus in the lungs, etc. In all these conditions the indol which is formed is absorbed directly into the blood and excreted as indican; (2) in the intestines themselves (and this constitutes by far the larger number of cases) indican is increased by any of the various conditions which increase intestinal putrefaction, or by obstruction to the free passage of food through the intestines, such as ,knots," peritonitis, appendicitis, tuberculosis and typhoid ulcers, paralysis of the stomach or small intestine, lead poisoning, cholera, etc.
But it is because an excess of indican is the surest sign we possess of autointoxication.' that great generator of every sort of human ill and the despair alike of the physician and his patient that it is of most importance.

Test for Indican.Indican is a colorless, syrupy substance, very soluble in water, alcohol or ether, and having a bitter taste. It is converted by heat and acids into indigored or indigo blue according to the amount present. Into a wine glass pour 1 drachm of pure hydrochloric acid, and add one or two drops, never more, of pure nitric acid. Now add 15 drops of urine and stir; in from 5 to 20 minutes a distinct bluish red or amethyst color appears, of a light shade if the indican is diminished, and perfectly distinct if the amount is normal. On the other hand ff a reddish blue or violet color appears the indican is increased (roughly speaking in proportion to the rapidity at which the color appears). See Plate. Opp. pp. 372.

Constipation. Recent investigations show that constipation especially if chronic, may be the sole cause of an increase in the amount of indican. Astringent drugs will quickly increase the amount formed; while in simple diarrhea, and even in typhoid accompanied by severe diarrhea, an increase of indican is rarely found. On the other hand, in false diarrhea in which there is retention of the feces a large amount may be discovered in the urine. In these cases purgatives like castor oil will cause an immediate diminution of the indican. Those who live ,high," or on a diet rich in proteids, are apt to secrete a urine showing an excess of indican.

The Liver.Whenever the flow of bile is impeded or diminished intestinal putrefaction, and consequently indican, is increased, since the bile acts not only as a stimulant to intestinal action, but as an antiseptic.

Treatment.Appropriate dieting measures will usually relieve the urine of its excessive burden of indican. If it does not, the patient should submit to a thorough examination to ascertain from which source the indican is derived.

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