When, some twenty-two years or more ago, the first accounts came to hand of the marvelous effects of extracts from the thyroid gland of sheep, they were at first received, as in general are all reports about wonderful cures, with incredulity or scepticism; and it is quite possible that the same might be the case regarding the success of our method of treating the symptoms of old age, and the prevention of their premature development, by thyroid and other organic extracts, were it not that we are supported by a mass of evidence, to which we will at once refer.
It has been noticed by all the leading investigators on the effects of thyroid extracts, such as G. Murray,[352] Hector Mackenzie,[353] Hertoghe,[354] and others, that the majority of old people treated for myxœdema by thyroid extracts, after a certain period of treatment, presented a much younger appearance, sometimes even to the extent of from ten to twenty years. This fact is perfectly true, as we can see from the photographs of these cases, taken before and after treatment, by Murray, Laache,[355] Oppenheim,[356] Ewald,[357] Hertoghe, and many others; the greater number of these photographs show persons looking very much younger after but a few months’, and in some instances less, treatment. Several of the above-mentioned authorities, and also Vermehren[358] and others, report that dark hair has grown on places which, before the treatment, were bare, and where previously gray hair had fallen off. This would appear incredible were it not a fact, familiar to all who are in the habit of prescribing, in many cases, treatment by thyroid extracts.
Similar facts have been observed by us personally in a number of cases, among them two, of a very interesting character, in the wards of Dr. Hector Mackenzie, at St. Thomas’s Hospital, in London. One was a woman of 65, who looked more like 42 after several years’ treatment with thyroid extracts; the other was a woman of 42 who, as it seemed to me, looked quite ten years younger after taking daily one thyroid tablet for twelve months. About 2 years ago we saw in the wards of Dr. G. A. Gibson, at the Glasgow Royal Infirmary, a woman of 72 who, after a similar treatment during the past twenty years, looked, as we agreed with Dr. Gibson, only between 50 and 60. Most of the above cases were those of persons suffering from myxœdema; so the question arises whether all other people, not affected with this complaint to the same extent, may not also derive equal benefit from a similar treatment.
We have shown in several chapters of this book that in old age the iodine content of the thyroid gland is much diminished and the tissue of the gland itself is degenerated in varying degrees, at times approximating to myxœdema; and, as found also by Sir Victor Horsley, Hale White, Vermehren, Ewald, and ourselves, old age presents clinical symptoms similar to those of myxœdema.
Naturally not every old man has the whole thyroid gland degenerated, and clinically, therefore, there will be varying degrees in the myxœdematous conditions, some presenting more and some less of the symptoms; so that some men of 80 years of age may look younger than others at 65 or 70.
If a man of 60, suffering from absolute myxœdema, that is, a complete degeneration of the thyroid gland, will present an appearance of 50 or less, after thyroid treatment, as shown in the photographs of the above-mentioned authorities, and as seen by ourselves, why should another man of 60, having only partial symptoms of this complaint, as usual at this age, not benefit to the same extent and look younger after similar treatment? It would be quite adverse to all notions of pathology for a man, in a better condition of general health and suffering only from a mitigated and partial form of a disease, not to derive equal or greater benefit from a similar treatment as the other person of the same age affected by a complete development and thus increased degree of the same disease. This, indeed, would be contrary to all sound reasoning.
But we have had personal opportunities of treating numerous persons, not actually myxœdematous, but exhibiting only slight symptoms of such a condition, such as are found in people with premature senility, and also in many cases of obesity and arteriosclerosis, and in every case we have been able to observe a more youthful appearance afterward.
The features have become notably more refined and more sharply defined, and there were many other benefits that may often follow thyroid treatment, such as loss of excessive weight, increased quantity of urine and of perspiration, and better action of the intestines. The gait especially became much easier; some were able to climb hills, whereas prior to the treatment they became fatigued from less than a ten minutes walk. The improvement in the mental condition was sometimes striking; memory especially became much better, as did also the general intelligence. It was also very interesting to note that abrasions, or any kind of sores, healed rapidly with fine granulations; for which reason such a treatment may give good results also in leg ulcers. We have obtained the best results from our thyroid treatment in those persons who were prematurely ageing; but even in the aged we have produced an improvement in the symptoms.
By the amelioration of the functions of the skin, kidneys, and intestines, which functions are, as a rule, impaired in old age, such treatment may already be indicated; and especially since the production of heat is thereby augmented, which is a great advantage to old people, who usually complain of cold. At the same time we are able to increase the processes of oxidation, which are, as already mentioned, diminished in old age. Thus, from the improvement in all these functions from the administration of thyroid extracts in old age, the treatment is, prima facie, justified. Great care must, however, be exercised in prescribing such extracts, and they should never be given unless the effects on the patient can be properly observed every three or four days, as all the drugs which are as effective as the thyroid, such as arsenic or other active drugs, can do much mischief if taken in large quantities. For such, so to say, physiological purposes as we are required to give them, thyroid extracts should be administered in a quantity just sufficient to make up the amount of thyroid secretion which the body demands; the greater the age, the larger the dose; but we must not forget that, as in advanced cases of myxœdema, so also in advanced senility, we must not expect too great results from the treatment. The thyroid extracts that we give can only act if the thyroid gland still has some of its secreting structure intact and is not yet completely degenerated, which latter is the case in complete myxœdema and advanced senility. It is best to commence at about 40, and in persons with symptoms of premature senility, even before this. Simultaneous obesity will offer the best opportunity for this treatment, and by the mere reduction of superfluous fat a more youthful appearance may be obtained. In younger people, about or prior to middle age, one tablet daily, or sometimes two for a week or so, then going back to one a day, will be the best method. It also is necessary to have free intervals of five or six days between treatments, and then to commence de novo. We must bear in mind that the effects of the thyroid gland may be cumulative.
From observations on ourselves and on patients we recommend for such as are not advanced in age, say, below 40 or 45, one tablet for a week or two, then stop for a few days, resuming with one tablet for a week; then an interval of three days before commencing again; while for those with symptoms of premature senility two or more tablets could be given, proceeding as above. In more advanced age two or three tablets may be given for two, three or four weeks before a free interval of several days takes place.
We must emphasize the fact, however, that a physician who prescribes such extracts, should have a thorough knowledge of the physiology and pathology of the thyroid gland for his safe guidance. On the other hand, we again urge that patients should never use them otherwise than under the guidance of a physician.
When thyroid is taken in an irrational way in large doses, or when continued for too long a time, we may sometimes have the very opposite symptoms for a time—even more fat, and in some cases older looks; but if we abandon the treatment for two or three weeks we may witness, as we ourselves have done, a general improvement in the condition and personal appearance; after iodide treatment we may observe the same, sometimes with increase of fat. Thyroid extracts cause a greater activity of the thyroid, and at times even an overactivity—thyroidism—which may be followed by its exhaustion. This has been proved by experiments by Christiani, who transplanted a fresh thyroid gland on an animal with healthy thyroid, and thereby produced a degeneration of the latter. Walter Edmunds, by feeding monkeys and dogs on too large a quantity of thyroid extract, produced in their central nervous systems changes similar to those following extirpation of the thyroid gland. Much iodide of potassium is apt to produce, not only a diminution in size of the thyroid, but sometimes its degeneration (see Garnier,[359] Chapter III). As we have observed, the symptoms of exhaustion of the thyroid after thyroid treatment are, as a rule, merely temporary, and may pass off after a rest of a week or so; but yet we must sound a warning against hasty and imprudent treatment.
These extracts contain more or less iodine according to their manufacture; and it has been shown by Claude Bernard that iodine is not easily eliminated from the body, but is retained for a given time; so that the effects of the treatment may be felt also in the free interval, and according to our observations, often better then than during actual treatment. Taking the extracts for too long a time without intervals may, at times, produce disagreeable symptoms, such as palpitation of the heart, nervous excitability, sleeplessness, etc.; so that during the course of the treatment the patient should be examined every three or four days as to the condition of the heart and urine; and if the pulse rises above 90, if it were lower before, the treatment should be suspended for a few days; much meat, alcohol, strong tea or coffee, should be avoided. When thyroid extract in large doses and much meat are taken together, according to our observation in a few cases, traces of sugar may appear in the urine up to, say, from 0.1 per cent. to 0.4 per cent., which quickly disappear if the meat is reduced, in spite of continuing the thyroid cure, as we have noted in two cases. It is, of course, well understood that thyroid treatment should not be tried in patients who show symptoms of a hyperactive condition of the thyroid gland—e.g., a rapid heart action, etc.; but we must rather try to improve only a deficient activity of the thyroid gland. By giving small quantities of iodides before beginning thyroid treatment we could best ascertain the condition of the thyroid gland; for if symptoms of iodism appeared we would then be in the presence of a very active thyroid, and thyroid treatment would be contraindicated. In many cases of inactivity of the thyroid gland we have obtained excellent results by administering simultaneously thyroid preparations and small quantities of iodides. The use of stimulants such as alcohol, strong tobacco, and strong tea or coffee, should be forbidden during thyroid treatment.
Taken in the above manner with the necessary precautions and only under medical supervision, thyroid as a preventive for premature senility, and as a treatment for the symptoms of senility, is entirely harmless. We have never observed the least inconvenience in any of the numerous cases we have treated when our instructions as to doses and diet were carried out, nor in ourselves. We have personally, for experimental purposes, taken these extracts for the past five years—once for ten months with short intervals—and stood it very well. Sometimes a few occasional pimples were seen, and sometimes sore throat developed, and in some patients headache. It is essential that only fresh preparations from a reliable source should be used.
The effects of these extracts on the nervous system and mentality are very remarkable. As already mentioned, we noted greater immunity from fatigue, bodily and mental, in many patients, and also in ourselves. Memory seems to have been much improved.
The same has also been noted by Hertoghe, who told us that he used to take three tablets immediately before beginning his lectures. We do not think it advisable to exceed two or three tablets a day; and even then it is best not to take this quantity, as a general rule, for longer than one week, when we must then reduce this quantity to one tablet.
In combination with thyroid extracts or alone, ovarian extracts have given us favorable results in the treatment of aged women, and also in younger ones before the menopause, especially after oöphorectomy. Obesity that follows the menopause, or the degeneration or extirpation of the ovaries, and which may also be regarded as one of the primary symptoms of old age, has been in nearly every case very favorably influenced by ovarian extracts, particularly in such cases as thyroid extracts were used at the same time.
A very interesting case is mentioned by Burghart[360] of obesity in a young woman of 20, consequent to an undeveloped condition of the ovaries and uterus. By giving ovarian extracts he was able to reduce the weight by 8 kilos, and when the treatment was discontinued, obesity returned.
As we have already shown, the ovaries also influence the processes of oxidation. Loewy and Richter were able to considerably increase oxidation in animals by ovarian extracts. Very important also is the fact that Spillman and Etienne[361] observed an increase in the number of red blood-corpuscles after ovarian treatment. For the above reasons alone, ovarian extracts should be tried in old age, where we find, as already stated, a diminution of oxidation, and very frequently also, in old women, an anæmic condition. Chroback and Landau were the first to employ with good results ovarian preparations for the relief of the symptoms following castration in women. According to our observations on many women under our care, the greatest benefit can be afforded by ovarian treatment to cases having the disagreeable nervous disorders which follow the menopause, such as hot flushes, nervous depression, headaches, nervous insomnia, etc., these symptoms having disappeared in nearly every case after several weeks’ treatment.
We consider ovarian extracts to be a specific against the painful feelings of heat in women in the years succeeding the menopause, or after oöphorectomy in younger years. In order that these extracts should be active, it is necessary that they should be prepared from the corpus luteum part of the ovaries, which contains their internal secretions. The pig would be the best animal for the purpose, for its ovaries have been found superior to those of other animals; and they also contain more iodine, much more than the ovaries of cattle.
When prescribing ovarian extracts we may give larger doses than of thyroid extracts, as they are less dangerous when taken in large quantities than the latter. We usually begin with two tablets, increasing to four, a day.
Less active than the ovarian preparations are the extracts of the testicles, at least in the form in which they are at present used. It is very probable that this may be due to the testicles of bulls being mainly used up to now, for just as their ovaries are, so also may the testicles of cattle be less efficacious. In addition it is also probable that these extracts do not contain certain effective parts of the testicles. It has been demonstrated by several authorities, as Shattock and Seeligmann,[362] Ansele, and Bouin, that the internal secretion of the testicles is derived, to a certain extent, from the interstitial cells, a group of cells imbedded in the spaces between the individual tubules. In some animals, as in the pig, as found by Shattock, these cells are contained in such amount that they form a special part of the testicles called by Shattock “paratubular glands;”[363] and for this reason alone pigs’ testicles should be preferred. It seems that the interstitial cells can only play a rôle in combination with certain other parts of the male sexual organs, for certainly when alone they cannot represent the part of the testicles which gives the real internal secretion. This is shown by the fact that they are found in the largest number in degenerated conditions of the testicles—for example: in cretins (Lanz), in undescended testicles (Bellingham Smith), and in atrophied testicles of old men (Haviero Spangaro[364]).
That testicular extracts are able to improve the symptoms of senility has been shown by the celebrated physiologist, Brown-Séquard,[365] from experiments on himself. He used an extract prepared from the crushed testicles of guinea-pigs or dogs. After injecting these extracts into his arms and legs, this old savant of 72 noted a considerable increase in his muscular and mental powers. As he mentioned in his communication to the Paris Biological Society, he observed in himself an augmentation of the energies of the nervous centers; he found that he could do more work than formerly, and that without getting tired he could more easily ascend the staircase, nearly running, just as he used to do until he was 60; and by the dynamometer he noticed a decided increase in the muscular power of his extremities. All his excretory functions were improved; he had laxative action of the bowels without resorting to purges to the same degree as formerly; his stream of urine became much longer, thus indicating a better muscular power in the urethra; he could work standing for a few hours, whereas before he was always obliged to be seated; and he found that his intellectual powers increased considerably.
It is almost unnecessary to add that this startling communication was received, in spite of his great fame, with scepticism, and by many even with derision. And yet it is these discoveries by Brown-Séquard that have laid the foundation of our present knowledge of the internal secretions. That the effects were not due to auto-suggestion has been shown by the experiments of Zoth and Pregl,[366] who found, by means of Mosso’s ergograph, an increase of muscular power through the injection of testicular extracts. It is also very interesting to note that in a few diseases which usually occur only in advanced age, testicular extracts have given good results, such as in Parkinson’s disease and in tabes dorsalis, as shown in the communications of Brown-Séquard and D’Arsonval to the Paris Biological Society in 1892.
We have also, for experimental purposes, tried on ourselves testicular extracts from the pig, and indeed we found a decided increase in muscular and mental powers. Thus we were able to climb the highest hills much more quickly and with much less fatigue than before; and we made the same observation in regard to increased mental activity; and we must strictly defend ourselves from any suspicion of having been influenced by auto-suggestion, which is not to be inferred after similar observations of other authorities. Similar results we have personally observed after injection of spermin (Poehl). This substance, obtained from the testicles of animals, was introduced by Prof. v. Poehl,[367] of St. Petersburg, and has been commented upon by many authorities, among them Professor Senator and P. F. Richter. According to Poehl it advances all the processes of oxidation in the tissues, as is shown also by the experiments of other authorities—for instance, Prof. Tarchanoff, Prof. Loewy, Richter,[368] etc.—who found that it is able also to powerfully alkalinize the blood. It has been proved by a mass of experimental evidence that spermin is a catalytic ferment, and that it regulates tissue oxidation. Poehl insists that the diminution of alkalinity of the blood may also reduce the resistance of the body to infection, a fact fully sustained by the theory of Dr. Sajous,[369] that immunity is influenced by alkalinity; and it is probably due to this that many authorities have obtained good results from spermin treatment in various infectious diseases and in conditions of auto-intoxication. Loewy and P. F. Richter found that spermin increases hyperleucocytosis and the alkalinity of the blood. The same effects have been claimed by Brown-Séquard and D’Arsonval for testicular extracts. They reported cases of successful cures in tuberculosis, and Ouspenski[370] has successfully treated Asiatic cholera with them.
In the experiments made by Loewy and Richter, at the suggestion of Professor Senator, on animals, it was found that experimental diseases, such as pneumonia, terminated much better after an injection of spermin (see, also, Chapter III).
As found by Bukojemsky,[371] Hirsch, etc., spermin treatment has given good results in senile marasmus; and senile pruritus can be improved by it, as stated in two cases by Bosse.[372] Very interesting, also, are this latter savant’s observations in a case of optic atrophy due to syphilis, when spermin was used. The patient was nearly blind, and after sixteen injections of spermin he could again see the hands of a watch.
Spermin is contained in different organs, especially in the ductless glands; and among these the testicles are naturally the richest in such a secretion. In order to obtain the best testicular preparation, the whole substance of the testicles must be taken, together with the interstitial cells, and not the latter only. Brown-Séquard prepared his extracts from guinea-pigs and dogs, which do not have a large number of these cells. We should like to take into consideration the discovery of Professor Lanz, who found in the testicles of impotent cretins a large quantity of interstitial cells; yet neither the physical nor mental condition of cretins permit the inference of very active sexual glands.
In our opinion, the most active testicular extracts would be those derived from the testes of the pig; but not from the testicles only, for the preparation should also contain extracts from the prostate as well, for in the human body the action of the testicles is inseparable from that of the prostate. This has been shown by the experiments of Camus and Gley, who found that seminal fluid exhibits more lively movement of the spermatozoa when a little prostatic liquid is added to it. It is thus very probable that by adding prostatic extracts to those of the testicles, the vitality of such extracts may be enhanced.
It is important to note that in his article on old age in Dr. Stedman’s well-known work, Boy-Teissier[373] relates that he obtained very good results from Brown-Séquard’s testicular extracts in the treatment of old age.
We have seen in Chapter V what a marvelous influence the sexual glands exercise on vitality and long life; if, therefore, by testicular extracts we can enhance the activity of the sexual glands, it would really be worth while to do so.
In addition to thyroid, ovarian, and testicular preparations, the extracts also of the kidneys should give good results in the treatment of old age and in the prevention of a prematurely aged condition, by improving the eliminative functions of the kidneys.
It has been found by many authorities, of whom we especially mention Gilbert and Carnot,[374] Obolenski,[375] Dubois,[376] Renaut,[377] and Teissier,[378] that by giving extracts of the kidneys they were able to improve the condition of patients suffering from various forms of renal diseases, especially when suffering from uræmic conditions and parenchymatous inflammations. We have also tried such extracts and found, indeed, beneficial results in many cases, as reported in an address we gave to the Medical Association of Greater New York on October 15, 1906. Since then we have had opportunities of noting similar results in a still greater number of patients, especially in aged people, among them being several with arteriosclerosis. In each case we have observed a decrease in the number of casts. In some cases of chronic parenchymatous nephritis we were surprised to find that there were no casts at all, after several weeks’ treatment by renal extracts—four tablets a day—whereas, before treatment, there were found in one case twenty hyaline and granular casts in one specimen of urine only. We have also noticed, in many cases, a notable diminution of albumin, although it seems to us that the decrease in the number of casts has been more prominent; and in many cases there has been an increased flow of urine.
From the above results of treatment by renal extracts, such a treatment with extracts prepared by maceration of the kidneys of pigs, appears indicated, as a means to prevent premature old age, and also in old people generally, especially since we never observed any deleterious symptoms after administering two to four tablets a day. It would, possibly, be useful to recommend in such cases pigs’ kidneys daily; and as they are not palatable raw, unless tolerated in that condition, they can be grilled.
Good effects, and probably to a greater degree, may be observed also after the use of pancreatic extracts. Their use in old age is indicated by the fact that there is in the pancreas, just as there is in the kidneys or thyroid, an increase of connective tissue in old age, and thus the pancreas is not able to produce the necessary amount of ferments for the digestion and assimilation of the proteid, carbohydrate, and fat food. We also often see, therefore, aged people lose weight, especially in advanced senility.
According to the observations of many authorities, among them Abelmann,[379] H. Salomon,[380] and E. Meyer,[381] it would seem that, by the use of certain pancreatic extracts, there is a very decidedly better assimilation of proteid, of amylaceous, and especially of fatty matters. As in old age there is often a decrease of stomach and pancreatic juice, pancreatic extracts seem to be especially indicated.
We have obtained good results in each case that we have treated by pancreatic extracts, and also in experiments on ourselves, having used a preparation introduced by H. Salomon. Even in aged persons we have noted easier digestion and the disappearance of digestive trouble after two or three tablets of the extract of pancreas taken immediately after dinner and supper. In cases of liver and gall-stone troubles, where previously there was a considerable loss of bodily weight, in nearly every case after pancreatic treatment there was no more falling off in the weight, and in some instances we have even found a considerable increase in weight. It is our custom to apply these extracts to every case where we want to increase bodily weight by a better assimilation of the food. Especially in cases where we have given much milk do we find that it is much better tolerated by the addition of these extracts to the food. We have also found, by experiments on ourselves, that the feeling of oppression and heaviness in the stomach after hearty meals, especially of indigestible food, has been much improved by the use of two to three of these pancreatic tablets. Especially have they proved useful after late dinners in preventing a disturbance of the sleep.
We have given above an account of the different organic preparations by which we can treat the symptoms of old age with good results. According to our experience it is not advisable to use all these extracts at one and the same time, but only a few. At any rate, thyroid tablets can be used for a long time, but in every case with intervals between the treatment. With these ovarian or testicular extracts can be used, as can also pancreatic extracts. The last mentioned ones should be used only as long as necessary—until digestion is improved and bodily weight is increased, if so desired. They may then be discarded until again needed. Thyroid extract should also be discarded, after two weeks’ or one month’s use, for a week or so, and then slowly begun again. It is difficult to give general instructions that will suit every case; it is therefore best to treat cases in an individual manner, the prime maxim being that by such extracts the function of certain glands should be improved until what was defective or deficient has been made up. The thyroid extracts require that the effects should be carefully watched; but all the other extracts are free from harmful consequences, especially if not taken in abusive doses, and provided also, of course, that they are fresh and not decomposed by long keeping.