150 years ago: Stimulant-narcotics in elderly persons. Practitioner Mar 2019;263(1824):29

150 years ago: Stimulant-narcotics in elderly persons

02 Apr 2019

AUTHORS

Written 150 years ago by Francis E Anstie,  then Editor of The Practitioner

Article

THE LONG LEGAL CAREER of Sir Frederick Pollock was combined especially with a large amount of  scientific reading.  

Favoured with an almost unbroken health, Sir F Pollock FRS has reached the great age of 86, yet still retains his mental energy and activity; while as regards physical status, with the exception of the inevitable decline of muscular energy, he at present scarcely betrays his age in any noticeable manner. About six years ago, however, he was led to adopt ether-inhalation by the occurrence of symptoms which were annoying, and had a chronic depressing tendency. Besides a certain  indefinable nervous malaise, he suffered specifically from gastric flatulence and painful spasm, occurring almost constantly during meals.

 

Ether inhalation

His attention was drawn to the possibility of getting relief from these inconveniences by taking some stimulant-narcotic. He noted that many elderly persons, who have lived intellectually laborious lives, have taken to the use of tobacco, or of opium, with a view to assuaging sleeplessness, and other nervous troubles of old age.

He made experiments with the best rectified ether, which he inhaled from an ordinary bottle applied to one nostril. It soon became apparent that a few whiffs were sufficient at once to quiet spasm and pain, and to induce a general tranquillity of the nervous system. At most, when several strong whiffs have been taken continuously, a dizziness has been produced – a  slight vertigo when the standing posture has been attempted; but it does not appear that this degree of etherisation is necessary for the relief of the uncomfortable sensations he was treating.


“It soon became apparent that a few whiffs of ether were sufficient at once to quiet spasm and pain, and to induce a general tranquillity of the nervous system”


So far from consciousness being disturbed or clouded by the use of  small doses of the vapour, it would seem that the intellect is both tranquillized and fortified by them. They fail to produce the least numbness of peripheral sensory nerves. Nor do they at all compel sleep; although, they evidently favour its occurrence.  

The practice of ether inhalation has been steadily continued by Sir F. Pollock. Both his physical and mental health may be called magnificent, considering his years. The pulse is regular and firm, of medium tension, and keeps very nearly to the standard of eighty; it does not appear to vary materially either during or after an inhalation. Not merely can gastric spasm and flatulence be relieved with the same instantaneous certainty as at first, but the tendency to such affections has evidently and notably diminished. Sleep is obtained, at intervals, to the amount of, perhaps, eleven hours out of the twenty-four, including a regular mid-day siesta. As is common in advanced age, not much solid food is taken; but a moderate amount of alcoholic liquids (brandy and sherry) are consumed, in small doses. The appetite for solids is visibly diminished when any considerable amount of ether has been  inhaled shortly before a meal.

There is not the smallest impairment of muscular co-ordination proper; his handwriting is singularly vigorous and perfect. Until lately Sir Frederick could balance a full wine glass on the backs of his closed fingers and lift it to his lips without spilling; and even now the hand can be held out for a long time without a visible shake. At present the inhalations are very frequently taken, and a variable quantity of ether, amounting sometimes to several ounces in a day, is used: but of course it is impossible to calculate how much of this enters the blood.



“Sir Frederick could balance a full wine glass on the backs of his closed fingers and lift it to his lips without spilling; and even now the hand can be held out for a long time without a visible shake”


Upon the facts of the above interesting case we shall base a few remarks on the use of stimulants in the nervous malaise from which aged persons so frequently suffer: sleep continuity;spasmodic affections of the stomach and intestines which also render nutrition more difficult. The aged have a right to ask relief and attempt to get it. 

Tobacco has the  defect that the elderly, if they have not smoked before, often fail to take it comfortably at an advanced age.

Opium is probably suitable to a considerable number of elderly persons, within stimulant limits and if digestion and nutrition is not impacted. We are at a loss to imagine upon what principle it can possibly be wrong to soothe the declining days of those who have already fought the battle of life. Why should it be wrong for a nervous and irritable old person, still less for one liable to stomach-cramps, to take a daily allowance of laudanum?


“Why should it be wrong for a nervous and irritable old person, still less for one liable to stomach-cramps, to take a daily allowance of laudanum?”


Ether, inhaled in the manner described by Sir F Pollock, is free from all danger to life, and can easily be kept down to the production of its purely stimulant effects. Without expressing any positive opinion on the matter, it appears decidedly worth inquiring whether ether-inhalation might not be advantageously recommended to a large class of aged persons who would scarcely call themselves patients at all.