Produced by Turgut Dincer, Charlie Howard, and the Online
Distributed Proofreading Team at http://www.pgdp.net (This
file was produced from images generously made available
by The Internet Archive)
Transcriber’s Note: Italics are indicated by _underscores_; superscripts
are indicated by ^carets. Other Notes are at the end of this eBook.
SOME MEDICAL ASPECTS
OF OLD AGE
MACMILLAN AND CO., LIMITED
LONDON · BOMBAY · CALCUTTA · MADRAS
MELBOURNE
THE MACMILLAN COMPANY
NEW YORK · BOSTON · CHICAGO
DALLAS · SAN FRANCISCO
THE MACMILLAN CO. OF CANADA, LTD.
TORONTO
SOME MEDICAL ASPECTS
OF OLD AGE
BEING THE LINACRE LECTURE, 1922,
ST. JOHN’S COLLEGE, CAMBRIDGE
BY
SIR HUMPHRY ROLLESTON, K.C.B.
M.D., D.C.L., LL.D.
PRESIDENT OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON
EMERITUS PHYSICIAN, ST. GEORGE’S HOSPITAL
SOMETIME FELLOW OF ST. JOHN’S COLLEGE, CAMBRIDGE
MACMILLAN AND CO., LIMITED
ST. MARTIN’S STREET, LONDON
1922
COPYRIGHT
PRINTED IN GREAT BRITAIN.
PREFACE
The material in this small volume was collected in connexion with
the Linacre Lecture at St. John’s College, Cambridge, and has been
somewhat expanded since its delivery on 6th May 1922. The introduction
is chiefly of local interest in connexion with the history of the
Linacre Lecture. Without attempting a complete account of old age and
its diseases I have passed in review some ancient and modern medical
aspects of this subject, but, except for incidental references, medical
treatment has not been considered.
For ready help, especially as regards the illustrations, my cordial
thanks are due to C. J. S. Thompson, Esq., M.B.E., of the Wellcome
Historical Museum, and for the index I am much indebted to H. M.
Barlow, Esq., Assistant Librarian of the Royal College of Physicians of
London.
H. R.
CONTENTS
PAGE
I. INTRODUCTION 1
II. DURATION OF LIFE 9
III. ONSET OF OLD AGE 26
IV. FACTORS INFLUENCING LONGEVITY 32
V. CAUSES OF SENESCENCE, WITH A NOTE ON SENESCENCE AND
CARCINOMA 62
VI. NORMAL STRUCTURAL CHANGES IN OLD AGE 90
VII. THE PHYSIOLOGY OF OLD AGE 115
VIII. THE DESCRIPTION OF OLD AGE IN THE TWELFTH CHAPTER OF
ECCLESIASTES 129
IX. DISTINCTION BETWEEN HEALTHY AND MORBID OLD AGE 135
X. DISEASES IN AND OF OLD AGE 139
INDEX 157
ILLUSTRATIONS
FIG. FACE PAGE
1. William Heberden, M.D., F.R.S. 2
2. Sir Thomas Watson, Bt., M.D., F.R.S. 4
3. Professor John Haviland, M.D., F.R.C.P. 6
4. Henry Jenkins, reputed to have lived 169 years 20
5. Thomas Parr, reputed to have lived 152 years 22
6. Katherine, Countess of Desmond, reputed to have lived 140
years 24
7. Petratsch Zortan, in his reputed 185th year 26
8. Hungarian husband and wife, reputed to be 172 and 164 years old
respectively 36
9. Sir Henry Pitman, M.D., F.R.C.P., a medical centenarian 52
I
INTRODUCTION
The Linacre Foundation dating from 1524 is the oldest medical
Lectureship in the University, for it was sixteen years later that the
Regius Professorship of Physic was established by Henry VIII. Formerly
this College Lectureship was held more or less indefinitely by Fellows
of the College, with two eminent exceptions, namely, Sir George Paget
and Dr. J. B. Bradbury; but in 1908 the Lectureship was made an annual
and open appointment, and until this year no member of the College has
held this office: I am therefore most deeply conscious of the high
honour that has been conferred upon me.
Though the statute that the Lecturer should explain Galen’s treatises
_De Sanitate Tuenda_ and _De Methodo Medendi_ as translated by Linacre,
or _De Elementis et Simplicibus_, has long lapsed, his first words
should be directed to the pious memory of the founder; but as in 1908
the late Sir William Osler[1] devoted the first of the new series
of Linacre Lectures to a sympathetic consideration of his brother
scholar-physician, it would be worse than unwise to attempt more than
the briefest reference.
[Illustration: FIG. 1.--William Heberden, M.D., F.R.S., in his 86th
year. Linacre Lecturer, 1734–38.
From an engraving by James Ward of a portrait painted by Sir William
Beechey, R.A.]
Thomas Linacre (1460–1524) was born at Canterbury of parents who have
eluded research, and his connexion with the old family that took
its name (Linacre = flax farmer) from a hamlet near Chesterfield
in Derbyshire was regarded by J. F. Payne as merely an assumption.
Believing that those devoted to learning should be free from the
obligations of the married state Linacre remained single, so that he
had no direct descendants; his will[2] contains references to his
brother, who had the same Christian name--Thomas--as himself, two
sisters Alice and Joan, two nieces Agnes and Margaret, and two cousins
Robert Wright of Chester and Richard Wright; but according to Payne[3]
the family history cannot be traced any further. I recently had a
faint hope that I had got on the track of collateral descendants,
but on enquiry it was courteously made clear that though the family
in question was descended from a Mrs. Linnecar, her connexion with T.
Linacre rested on tradition only and that no documentary evidence or
genealogical tree existed to justify any claim. It may be remembered
that Linacre was one of the earliest English students (_circa_ 1488),
more than a century before William Harvey, to study medicine and take
the doctorate at the ancient University of Padua, which celebrated its
seven-hundredth anniversary in May 1922. It is, next, natural to look
back to the first holder of this Lectureship, and to wonder what manner
of man he was and what he taught. To the Master of St. John’s College I
am indebted for the few details that are known of Christopher Jackson
(B.A. 1524–25, M.A. 1527), who was buried in the old Chapel on July
2, 1528, his death according to a brass erected to his memory in the
new antechapel being “e sudore britanico.”[4] Some of the Lecturers
were without a medical qualification, and of these Matthew Prior
(1664–1721), the poet and diplomatist, who was a “Medical Fellow”
for life and Linacre Lecturer from July 5, 1706, to July 7, 1710, was
the most famous. That he ever lectured is more than doubtful, but he
appears to have thought out reasons for not doing so: at any rate his
_Alma or the Progress of the Mind_ (written about 1715) contains in its
third canto the lines:
how could I explain
The various labyrinths of the brain!
Surprise my readers whilst I tell them
Of cerebrum and cerebellum!
How could I play the commentator
On dura and on pia mater!
Three of the Linacre Lecturers under the old dispensation stand out for
special remembrance on account of their influence on Medicine:
William Heberden the Elder (1710–1801), the author of the _Commentarii
de Morborum Historia et Curatione_, published posthumously (1802), held
office from 1734–38, and was described by Sir William Osler as the
“English Celsus.”[5]
[Illustration:
FIG. 2.--Sir Thomas Watson, Bt., M.D., F.R.S. President of the
Royal College of Physicians of London, 1862–67. Linacre
Lecturer, 1822–26.
From an engraving by George Cousins, R.A., of a portrait painted
in 1867 by George Richmond. R.A., now in the Royal College of
Physicians of London.
]
Sir Thomas Watson (1792–1882), whose _Lectures on Physic_ held its
place longer than any medical text-book of modern times and set an
example of style that still commands our admiration and imitation, was
Lecturer 1822–26, and in the first year of office was also a Proctor.
Subsequently (1862–67), he was President of the Royal College of
Physicians of London, the most magnificent of Linacre’s Foundations;
this appropriate association was shared by William Baronsdale (P.R.C.P.
1589–1600), by Thomas Gisborne, who was President on three separate
occasions (1791, 1794, 1796–1804) alternately with his senior Sir
George Baker, and by Sir Norman Moore of St. Catherine’s College
(P.R.C.P. 1918–22), who gave the Linacre Lecture under the new
regulations in 1913 on _The Physician in English History_.[6]
John Haviland (1785–1851), the only one of these three who remained
in Cambridge, and the only one who did not become a nonagenarian,
was Linacre Lecturer for two periods (1817–22, 1826–47), Sir Thomas
Watson intervening. As Professor of Anatomy (not human anatomy) from
1814–17 he delivered the first regular course of lectures on human
anatomy; and when he succeeded Sir Isaac Pennington (also Linacre
Lecturer, 1767–1816) as Regius Professor of Physic (1817–51) he was
the first to give courses in pathology and the practice of medicine,
thus rousing the post from the sleep of a sinecure, and to make the
medical examinations a real and rigid test instead of little more than
a farcical form consisting of a few _viva voce_ questions. Further,
had it not been for his influence and insistence the medical faculty
might have been abolished, and it was said[7] after his death that the
subsequent success of the medical school was due to his exertions. He
wrote little and perhaps for that reason his name is seldom mentioned
now, but if the work that has since been done by this medical school be
his monument he could hardly have a greater.
[Illustration:
FIG. 3.--John Haviland, M.D., F.R.C.P. Professor of Anatomy
1814–17, Regius Professor of Physic in the University of
Cambridge, 1817–51; Linacre Lecturer, 1817–22 and 1826–47.
From a drawing done in 1851 by Wageman. For this I am indebted to H. A.
Haviland, M.B.]
The somewhat neglected subject of Old Age has a very pertinent
connexion with the most essential aim of medicine as a whole, namely,
the prevention of disease. For when the ideal of the prophylaxis
of infection and of other causes of morbid action is attained,
a healthy old age and physiological death without attendant
disabilities and horrors should be the common lot of man instead of
being somewhat exceptional in the case of the first and extremely
rare as regards the final act. The conditions favouring longevity and
_mens sana in corpore sano_ are those necessary to make the future of
the human race a happy and beneficent prospect instead of a problem
inspiring doubt if not pessimism; or in Descartes’ words, “we might be
free of an infinity of maladies both of body and mind, and even of the
infirmities of old age, if we had sufficient knowledges of their causes
and remedies.” But in addition to this broad ground of interest there
are reasons why a discussion of this subject has a special claim for
consideration in Cambridge. The objects of a University include the
preparation of its alumni for life in its fullest and best sense, and
from this point of view the permanent ornaments of the community ever
set an unobtrusive example of the way to deserve and enjoy a healthy,
happy, and useful old age, namely, activity of mind and body and
moderation in all things; such a life of 75 years (that of Professor
G. D. Liveing) in the University must be in your recollection as
described by the Public Orator as _tam honesta, tam utilis_. Further,
as in private duty bound, I cannot forget that Sir George Humphry,
to whom this great medical school owes so much, greatly interested
himself in the subject of old age and published the results of an
elaborate collective investigation. Lastly, it is desirable that the
problems of old age should be attacked by young and active minds in the
laboratories of the University and not left as a semi-personal field
of enquiry and observation to those whose “way of life is fall’n into
the sere, the yellow leaf,” and who hear old age’s stealthy footsteps
catching them up in the race; for in the past most of the writers on
geriatrics have written with at least some personal qualification
and interest, such as Cornaro, Sir John Sinclair, Sir Anthony
Carlisle, Charcot, Sir George Humphry, Sir Hermann Weber, R. Saundby,
Metchnikoff, Stanley Hall. As an exception, however, we may point to
Dr. John Smith,[8] who, in his thirty-fifth year, was the author of
_King Solomon’s Portraicture of Old Age_, which paraphrases in 266
pages the “six former” verses of the 12th Chapter of Ecclesiastes
containing 205 words.
II
DURATION OF LIFE
In the protozoa and some other lowly forms of animal life
multiplication by binary fission occurs indefinitely, so that one
organism is succeeded by two, and as there is no vestige of a corpse,
as Weissmann expressed it, the organism is immortal. Maupas’s[9]
investigations indicated that without occasional conjugation of two
individual protozoa and the resulting rejuvenation the organisms
undergo senile degeneration and die; but Woodruff[10] has shown
by observations extending over 13½ years that _Paramoecium_, and
so presumably infusoria in general, can multiply indefinitely in
favourable conditions without conjugation, though periodically an
internal reorganization (endomixis[11]) of the individual takes place.
It seems not improbable that endomixis provides the rejuvenation
otherwise resulting from conjugation. C. M. Child[12] brings forward
reasons for modification of the explanation that death is escaped
simply by division; he shows that in certain circumstances senescence
occurs in the protozoa as it does in the higher animals, but that death
is avoided by the rejuvenescence in each process of reproduction,
reconstitution occurring and new organs being formed in the place of
the old. In other words, all organisms from the protozoa to man undergo
senescence and die unless rejuvenescence intervenes; this compensation
holds good in the lower forms and death may never occur; but in the
higher forms rejuvenescence is so much restricted by the evolutionary
increase in the physiological stability of the protoplasmic substratum
and the resulting higher degree of individuation that senescence is
much more continuous and death is inevitable. It is the penalty for
high individuation, and is the result of conditions and processes that
have produced the complicated mechanism of the higher animals and man.
While holding out the faint hope that the advance of knowledge and of
experimental technique may make it possible at some future time to
bring about a greater rejuvenescence and retardation of senescence in
man and the higher animals, Child points out that the present condition
of their protoplasmic substratum is the result of millions of years of
evolutionary equilibration, and that this task must therefore be one of
extreme difficulty.
Modern biologists such as Driesch, E. Schultz, Child, Steinach, and
Julian S. Huxley, to the last of whom I am personally much in debt,
have indeed shown that experimentally the life cycle and growth,
which are so closely correlated, may be modified dramatically by
various methods. By starvation planarian flat worms become smaller
and their life cycle is reversed by the process variously called
dedifferentiation, reduction, or involution, whereby their structure
becomes simpler; similar retrogressive changes have been produced in
the social ascidians, _Clavellina and Perophora_ (J. S. Huxley[13]),
this process of dedifferentiation or reversible differentiation being
the primitive reaction of organisms to unfavourable circumstances. By
alternate feeding and starvation Child has kept planarian flat worms
at the same size while controls passed through nineteen generations,
thus showing that the life of cells is not a matter of time but of
metabolism. In the higher animals the conditions are of course more
complex on account of the self-regulating mechanisms, especially the
ductless glands. But by disturbing the endocrine balance experimental
biology has produced some remarkable results: by feeding white mice
with tethelin (a phospholipin obtained from the anterior lobe of the
pituitary) Robertson and Ray[14] found that epithelial proliferation
was accelerated, though increase in weight of the animals was retarded,
and that the duration of life was prolonged. Drummond and Cannan,[15]
however, failed to confirm these results, and feeding with the anterior
lobe of the pituitary has given rise to very contradictory reports;
acceleration (Clark, Robertson, Goetsch), retardation (Pearl, Wulzen),
and no effect (Gudernatsch, Lewis and Miller, Hoskins, Sisson and
Broyles[16]) have been described. Steinach’s rejuvenation of senile
rats by ligature of the vas deferens, which is followed by increase
in the interstitial cells of the testis and definite prolongation of
life, will be referred to later (_vide_ p. 76). The retardation of
growth due to a diet deficient in vitamins, first proved by Gowland
Hopkins[17] in 1912, may be maintained for long periods, but when the
diet is appropriately altered growth is resumed and proceeds to the
full standard (Osborne and Mendel[18]); it remains to be proved that
the total duration of life can thus be prolonged. Though every living
species of animal may in normal circumstances have its allotted span
of life, this is so subject to accidents and modifications by external
influences that the average duration of existence, especially in the
long-lived species, does not represent the natural term of years. Thus
the expectation of life at birth in England and Wales is 51·5 years
for males and 55·35 years for females, as contrasted with the ideal
physiological duration of life for 100 years. Violent death in one
form or another--traumatic or infective--is so much the rule that the
occurrence of natural death in the animal kingdom has been questioned,
just as de Candolle denied the natural death of trees and ascribed it
to injury or disease. Metchnikoff,[19] who paid special attention to
this question, described natural death in the Ephemerids, day-flies,
the imagines of which are incapable of feeding and after an hour or
two of “aerial life devoted to love” die, their ova falling into the
water; Sir Ray Lankester accepts the view that they are “wound up” for
a few hours only of life, but according to Child death is probably
due to starvation. In man natural death from old age--a physiological
ending--is very rare, much less frequent indeed than death certificates
and ordinary parlance would suggest; for in such cases there is very
commonly some latent disease, such as pneumonia, which just turns
the scale in the trembling balance. Montaigne warns us “what an idle
conceit it is to expect to die of a decay of strength, which is the
last of the effects of the extremest age, and to propose to ourselves
no shorter lease of life than that, considering that it is a kind of
death of all others the most rare and hardly ever seen.” While it must
be admitted that this still holds good, it is a stimulus to our efforts
to render it no longer true.
The length of days ascribed to Methuselah (969), Adam (930 or, if the
“conceit urged by learned men,” as Sir Thomas Browne[20] says, that
he was 50 or 60 years old when called into being be accepted, 980
years), Seth (912), has aroused attempts at explanation on the basis
of a difference in chronology. The suggestion that the “years” were
lunar and not solar, in other words containing 30 instead of 365 days,
was controverted at length by Eugenius Philalethes[21] (not Thomas,
twin of Henry Vaughan “the Silurist”) as too radical, for on this
interpretation some of the patriarchs would have become fathers of
children before they were ten years old. Long ago, Hensler, following
Justin, put forward the view that the year consisted of but three
months up to the time of Abraham, when it was extended to eight months
until the era of Joseph, after which it contained our full complement
of twelve months. This explanation was supported by Hufeland[22] on the
ground that some eastern nations still reckoned three months to the
year. Adopting this explanation Methuselah’s age would be cut down to
243 years.
The Psalmist’s threescore years and ten and its sorrowful extension to
fourscore are so often exceeded by human beings who appear normal that
the possibility of a far longer existence has often been raised. John
Sterne or Stearne (1624–69) who, though founder of the Irish College of
Physicians, was, according to Mahaffy,[23] more of a theologian than a
physician, believed that there was no reason why men should not live
as long as the patriarchs before the Flood; but he also argued that
these patriarchal ages must have been exceptional, for had all the
human beings between the Creation and the Flood, a period of more than
1400 years, lived to an average breeding age of 400 years and begun,
as did the patriarchs, to beget children at the rate of one male every
three years, the population of the earth could not have found standing
room on its surface; his colleague in Trinity College, Dublin, Miles
Symner, Professor of Mathematics, provided him with a calculation
showing that there would have been less than one cubic foot available
for each individual. This seems to be echoed in a slightly different
connexion by Weissmann’s conception of natural death as due to natural
selection and as an adaptation for the good of the species, the
degenerated organisms being no longer fertile or useful, an hypothesis
hardly necessary, as Metchnikoff points out, when degeneration which
is the prelude to dissolution has appeared. Roger Bacon[24] stating
that man, originally immortal and after the Fall able to live for a
thousand years, had his life gradually abbreviated by corruption of
his own making, believed that it should be possible by taking care as
to regimen to prolong life for a hundred or more years than the common
duration. Since the time of Aristotle the vital cycle has been thought
to be a multiple of the period of growth. Francis Lord Bacon considered
that animals in general should live eight times as long as they take
to come to maturity, and Hufeland,[25] adopting this principle, and
regarding 25 years as the termination of adolescence, concluded that
man’s natural span should be 200 years. Buffon took 14 years as the
age of puberty, and multiplying it by 7 decided that human life
should naturally be 100 years. Assuming that union of the epiphyses
of the long bones marked the time when growth was finally completed,
Flourens[26] calculated that throughout the animal kingdom life was
five times as long, and that as in man the epiphyses united at 20 or 21
years of age the span of human life should be 100 years.
More modern estimates of the duration of human life under ideal
conditions of protection against infection have been to the same
effect, thus conforming to the estimate of Cornaro,[27] who died
at that age, that a hundred years was “the time allowed to man by
God and nature.” Metchnikoff,[28] while admitting that there must
be variations, considered that man should live more than 100 years,
and Luciani fixed the physiological duration of life at 100 years.
Ebstein’s (1891) estimate of 70 years as the usual duration of life,
which is the age at which the maximum number of deaths occur when the
first few years of life are excluded, is different from the ideal
duration under the best physiological conditions and corresponds more
or less with B. W. Richardson’s rough rule that the individual’s
probable age at death can be arrived at by taking the average of the
ages of his parents and grandparents; in this procedure the important
factor of heredity is taken into account, and the disturbing part
played by accidents and infections in modifying the ideal expectation
of life is to some extent neutralized by taking the average of the six
lives.
Although 100 years may be regarded as the physiological life of man it
is rarely reached, and one of several reasons is that the physiological
requirements for this apparently exaggerated term of years are very
seldom provided. Sir Ray Lankester[29] suggested that just as giants in
stature are exceptional variations so centenarians should be regarded
in the same light, as giants in years instead of in inches. He meets
the obvious objection that whereas the parents of giants are of normal
height, longevity and centenarianism appear to run in families, by
doubting if the actual quality of potential long life is transmitted
and by ascribing family longevity to the inheritance of traditions
and habits favourable to long life. In this connexion it should be
remembered that many giants are pathological and due to acromegaly,
whereas unusual height, over six feet, certainly runs in families;
analogy therefore makes it reasonable to believe that length of
days, like length in inches, may run in families, although these two
approaches to giantism very seldom occur in the same individual.
[Illustration: FIG. 4.--Henry Jenkins, reputed to have lived 169 years
(1501–1670). Present at Battle of Flodden Field on September 9, 1513.]
The authenticity of persons alleged to be of great age rightly excites
critical examination, and some of the most famous examples, such as
Henry Jenkins (169), Thomas Parr (152¾), Katherine, Countess of Desmond
(145), as Sir George Cornewall Lewis and Mr. W. Thom showed, as well as
many of the 1712 centenarians in James Easton’s[30] list covering the
years A.D. 66 to 1799, cannot be regarded as established.[31] In the
same category we must place Petrasch Zorten (1537–1724), whose portrait
at the reputed age of 185 was reproduced by Sir John Sinclair.[32]
Old people take a natural pride in their age and tend to exaggerate
it; according to Mr. G. King[33] the excess in the census returns of
persons over 91 and the deficit in those between 85 and 90 years of
age could only be explained by the conclusion that the temptation to
overstate the age so as to appear among the nonagenarians had not been
resisted. The vast majority of centenarians are naturally among the
bulk of the population, namely, the poor, among whom natural selection
is provided with a correspondingly greater opportunity of finding those
“vigorous frames which promise a long life,” and in these circumstances
the means of checking the exact age may be less easy than in the case
of the well-to-do.
_Sex._--Females are more long-lived than males; the 1911 census
for England and Wales shows that after 10 years of age there are
more females than males living in all the quinquennial periods, the
proportion of females progressively increasing until at the age of
85 and upwards there are 645 females to 355 males in 1000 living at
that age group. Among centenarians also the ratio of the sexes is much
in favour of that popularly said to be the weaker. Out of the 691
reputed centenarian deaths registered in England and Wales during the
10 years 1910–19 inclusive, 504, or 73 per cent, were females, and
187, or 27 per cent, males. But during the same period in Ireland the
disproportion was much less: among the 945 reputed centenarian deaths
545, or 58 per cent, were females, and 400, or 42 per cent, males. It
has been said, though without sufficient statistical evidence, that
although the female sex is favourable to longevity extreme length of
days is attained only by males. The superior longevity of the female
sex, in spite of the risks attaching to child-birth, depends on several
factors, such as an existence less exposed to accident and infection,
a more temperate life, and in addition, so Sir George Humphry argued,
on a stronger inherent vitality, for during the first year of life when
there is no difference as regards the first two circumstances more
boys than girls succumb. The higher male death rate in the first year
of life, however, may be partly due to a mechanical cause, namely,
the large size of the male infant’s head, as a result of which the
numerical superiority of male infants born is reduced by the effects of
trauma. Another factor is, perhaps, that old women do not feel so old
as old men do, and that therefore auto-suggestion plays a less powerful
part with them.
[Illustration: FIG. 5.--Thomas Parr. Reputed to have lived 152 years
(1483–1635).
From a Print by Payne.]
The question must arise as to what is the object of the prolongation
of life after the reproductive function has waned as it does in
women--the more long-lived of the sexes--about half-way through the
physiological term of years. In some lower animals life terminates
very shortly after propagation of the species has been effected; but
this is not the rule, and the biological meaning of the continuation
of the life of individuals that but cumber the ground and may lead
a parasitic existence requires explanation, though educational
advantages and moral lessons may undeniably be provided by healthy
old age with its store of what a Cambridge man, now justly famous,
described in his rather rebellious youth as “that greatly over-rated
property experience.” It has been suggested by Sir Ray Lankester that
the inherent property resulting in longevity may be bound up as a
“correlated variation” with some other characteristic useful in the
struggle for existence and the perpetuation of the species. An obvious
possibility is that the long-lived have a higher fertility rate than
average mortals. Hufeland[34] argued that as very old people are nearly
always married more than once and generally at a very late period of
life “a certain abundance in the power of generation is favourable to
longevity.” There are few satisfactory data to determine the converse
proposition with which we are now concerned, namely, is longevity
accompanied by unusual fertility? As already mentioned, the great
majority of centenarians are found among the bulk of the population,
namely the poor, who are far more prolific than the well-to-do; but
this does not prove much, for the inverse correlation of fertility and
good social status is largely artificial and due to voluntary birth
control. Among the 824 persons between 80 and 100 years of age analysed
by Sir George Humphry[35] in 1889 there were 335 married men and 292
married women, and in each group the average number of children was
six, which is somewhat in excess of what is popularly supposed to be
the average size of a family; but the question of average fertility
is one on which Dr. Major Greenwood warns me that it is difficult to
give an unambiguous answer, for it all depends on whether completed
or incompleted fertilities are meant; thus in the 1911 census the
completed fertilities average 5·8 and the uncompleted 4·2. No value
could, he considers, be attached to the general figure obtained by
dividing the total number of children by the total number of couples
enumerated. Hence Sir George Humphry’s and other statistics are not
really comparable. While finding that longevity was equally shared by
the single and married women and by those who had children and by those
who were barren, Sir George Humphry stated that among those who had
children fertility was associated with longevity.
[Illustration: FIG. 6.--Katherine, Countess of Desmond. Died 1604 at
reputed age of 140.]
III
ONSET OF OLD AGE
The onset of old age varies in different countries, and, like the
development of puberty, is accelerated by the high temperature of
tropical countries. There is also considerable variation in families
and individuals of the same race and country; thus while one man may be
senile at 60 years of age another is vigorous both in mind and body at
80. The inconstancy of onset depends on the various factors that may
play a causal part; old age may be a physiological involution, but too
often is a pathological product. When the period of reproductive power
(maturity) wanes that of old age begins; in women this is marked by the
menopause, the age of 45 years being taken as the limit of fertility,
but before this even in the late thirties the spectre of fading
attractiveness may upset the matron and lead to the irregularities of
the “dangerous age.” For man there is no such index, and the change
is so insidious that most of us would expostulate at Stanley
Hall’s[36] statement that old age in men begins in the early forties
and sooner in women, or less than half-way through the physiological
lifetime of a hundred years. According to Dante 45 marks the
termination of youth, and it seems generally agreed that as a rule--and
every one is entitled to consider himself as the exception--
The gay bloom of fifty passes quickly away
And people get fat and infirm and all that.
[Illustration: FIG. 7.--Petratsch Zortan, a Hungarian. Reputed to have
lived from 1537 to 1724.]
It has from analogy of the female sex been rather fancifully suggested
that in man there occurs about the age of fifty a critical period
(_climacterium virile_) due to changes in the sex glands (Mendel[37])
or prostate (Rankin[38]); but of this there is no proof. It recalls
as a kind of echo the ancient conceptions of the grand climacterics
at 49 (a multiple of the number 7), 63 (7 × the magical number 9 of
the Arabians), and 81, and the description in 1807 by Professor B.
Waterhouse[39] of Cambridge, Mass., who in 1800 introduced Jennerian
vaccination into America, of a kind of male moulting between 43 and 50
and a worse one at 63, an idea expanded into the climacteric disease
imagined in 1813 by Sir Henry Holland.[40] There is indeed no doubt
that after an illness, and the so-called climacteric disease admittedly
seldom occurred without some previous factor such as an attack of gout,
a common cold, a bout of intemperance, recent marriage, or particularly
grief or bereavement, old age may come on apace. In some instances the
so-called climacteric disease was perhaps really chronic renal disease,
in others merely the prolonged or imperfect convalescence due to some
lingering infection after an acute illness, such as influenza; and,
as in the latter case recovery may occur, Holland’s contention that
recovery was an argument in favour of the existence of this climacteric
disease holds good only in distinguishing it from permanent senility,
which indeed was the objection that he was concerned to meet. The
conception of the climacteric disease is interesting historically only;
and it may be agreed that apart from accidents of environment the
progress of senescence in healthy men is gradual and uneventful.
So stealthy is the onset of senescence that commonly it is not
recognized by its victim and, though he may seldom mention it, every
man is firmly convinced that he not only looks but is at least ten
years less than the register would tell him. Though unconscious of the
change in himself he notes it with perhaps some self-congratulation
in his contemporaries. It is only if he tests himself, for example by
timing himself for a mile’s walk, that a healthy man of say 70 years
has it borne in on him that he is not what he was. The information that
he is old may be suddenly conveyed by overhearing the chance remarks
of others, by catching a reflection of his bent back in a mirror,
by tardy recovery from illness, or the advent of some disability,
such as hypertrophy of the prostate or dyspnoea on holiday exertion.
Perhaps the commonest warning is a feeling of fatigue. Sir Andrew
Clark regarded the onset of old age as the period when a man ceased
to adjust himself to his environment; but some persons never are
able to do this, and misfits are not necessarily old. Laurentius
divided old age beginning at 50 into the three stages of “the green
because it is accompanied with prudence, full of experience, and fit
to gouerne common weales,” the second at 70 years is “very cold and
drie,” and the last, without a specified age incidence, is that of
decrepitude corresponding to the famous description in the 12th chapter
of Ecclesiastes. A more modern and comforting division is that of
Lacassagne[41] of pre-senility, old age beginning at 60 or sometimes
70 in men, and in women 10 to 15 years earlier, advanced old age, and
lastly decrepitude. Nascher[42] speaks of a senile climacteric about
the latter part of the 7th or 8th decade--the transitional period
between old age and decrepitude--corresponding to the changes at
puberty and at the menopause.
_Precocious old age_ due to the effects of disease, especially syphilis
and acute infections, and to metabolic defects, which permanently
damage the cells of the body, has a special interest as it supports
Metchnikoff’s pathological view that old age as ordinarily seen is
a result of toxic injury (_vide_ p. 82). Hastings Gilford[43] has
specially investigated premature senility, and under the title progeria
has described a remarkable condition of premature senility combined
with, or secondary to, infantilism. This condition was independently
described in 1910 by Variot and Pironneau[44] as the senile type of
nanism. In such cases it would appear reasonable to ascribe these two
opposite conditions to the same toxic or other factor, the infantilism
depending more on damage to the ductless glands before development was
complete, and the senile changes to direct injury of the cells in the
body in general.
IV
FACTORS INFLUENCING LONGEVITY
The determining factors of long life may be broadly divided into
those included under heredity, environment, due functional activity,
and personal habits. It is impossible to separate these factors into
watertight compartments, for a certain amount of overlapping between
them is unavoidable.
HEREDITY
The influence of heredity has often been insisted upon and is perhaps
the most important factor in longevity. Out of 824 persons between 80
and 100 years of age analysed by Humphry, 406, or 49·4 per cent, came
of long-lived families. Numerous striking examples of such families
are on record, but a few only need be given. Roy[45] quotes the case
of Dr. Iverex, who died in 1700 at the age of 104, his father at 112,
his mother 107, and his grandfather 130 years, and gives four other
examples of three centenarians in the same family. Another remarkable
family group was that of Joseph Retas who died at Tarbes at the age
of 118 in 1888, and was the son of a man aged 111 years and had a
brother aged 114 years. Two centenarian twin sisters were recorded in a
village near Athlone[46]; centenarian sisters and brothers are not so
very exceptional. Sir Hermann Weber[47] recorded two families, in one
of which the average age of ten children was over 90 years and in the
other of eight children nearly 90 years.
A good stock may ensure long life in the face of adverse environment,
such as town life and alcoholism; thus Dr. John Brownlee[48] showed
statistically that while persons dying at the age of 51 in the average
environment would have, had they lived in the country, a mean life
of seven years longer, this difference was less at higher ages, and
remarks that a person who has the potentiality of living to the age
of 80 years has a force of life which is more or less independent of
environment. Sir George Savage[49] often noted that of two aged members
of the same family one was sober the other intemperate; and a good many
centenarians have taken alcohol in quantities that would be too much
for ordinary people.
Heredity is not an all-powerful factor, for an individual whose family
history is not remarkable for longevity may greatly prolong his life
by carefully correcting unfavourable hereditary tendencies. Thus the
late Sir Hermann Weber, who lived to the age of 95 as the result of
practising the maxims of his _Prolongation of Life_, mentions that his
mother died of cardiac failure before she was 60 and his father at 60
from cerebral haemorrhage, and he gives other instances of the same
happy result of wise management. Not unfrequently husband and wife both
live to an advanced age, no doubt often as the result of favourable
environment. A photograph of a married couple both 101 years old
appears as the frontispiece of Sir George Humphry’s book on _Old Age_,
and must of course be accepted; but the same cannot be said of the
frontispiece to volume ii. of Sir John Sinclair’s _Code of Health and
Longevity_ (1807), representing the Hungarian husband and wife, aged
respectively 172 and 164 years, who had been married 147 years.
It has been suggested that “cell-memory” by providing experience as to
the proper way to behave at the different periods of life has a bearing
on the coming of old age; Samuel Butler[50] argued that cells without
hereditary memory of past existence at, say, 75 years, would become
puzzled and so disordered as to die. Parkes Weber[51] has modified
this view by assuming a failure of the wish to live on the part of the
nerve cells of the brain, a want which might also be hereditary. The
possession by the cells of “the will to live” would be an important
factor in longevity and should be obtained by individual effort or in
other words be an acquired character, though the reverse conditions
such as physical mutilations,[52] often spoken of as acquired
characters, are known not to be inherited.
In different countries and in different individuals the cells of the
body may differ in the rate at which they live; they have, as Sir James
Paget[53] said, a different “time-rate”; in some the time-rate is
rapid, for example in the natives of hot climates where maturity comes
early and old age at a time that seems very premature by our standard;
in others the body, sometimes the mind, works slowly, is set at a more
leisurely rate and therefore takes longer to run its course. In some
persons this appears to be shown by a slow pulse, a characteristic that
may also be hereditary.
[Illustration:
FIG. 8.--John Rovin and Sarah his wife, Hungarians, at their
reputed ages of 172 and 164 years respectively; their married
life lasted 147 years.
]
Of the hereditary factors most concerned in longevity the inherent
vitality of the central nervous system is the most essential;
physiological death in man and the higher animals is probably due to
failure of the cells of the brain, which do not multiply after birth
and are less capable of rejuvenescence than those of the other organs.
The integrity of the cardio-vascular system is also most important; in
Sir William Osler’s[54] words much depends “on the quality of arterial
tissue (vital rubber) which the individual has inherited.” According
to Sir Clifford Allbutt[55] there are two modes of hereditary
transmission of arteriosclerosis, the direct and the indirect; the
direct which he calls decrescent or primary, consisting in an original
frailty or toxic susceptibility which like other peculiarities may
run in families; and the indirect or hyperpietic, a secondary event
due not to inherent taint in the arterial walls but to metabolic
changes causing high arterial pressure; it is in such families with
hereditary high blood pressure that cerebral haemorrhage occurs in
one generation after another about the same age (65–70). In examining
people the discovery of a blood pressure low for their age often
justifies, in the absence of any pathological condition, the suggestion
that the family is long-lived. The frequency of cardiac hypertrophy
(43 per cent of Councilman’s cases), even though it be a pathological
condition, shows that its reserve power is good. Death among the aged
very commonly depends on some morbid change in the cardio-vascular
system; thus at the Royal Hospital, Chelsea, Majors R. J. C. Thompson
and R. E. Todd[56] found that among 169 deaths of pensioners with
an average age of 77·2 years the largest number 64, or 38 per cent,
were due to this cause; lesions of the respiratory system, pneumonia,
and bronchopneumonia, coming next with 41 deaths, or 24 per cent,
malignant disease being responsible for 22, or 13 per cent. The nervous
and circulatory systems are intimately correlated with each other,
disorder or disease of one, particularly of the cardio-vascular system,
exerting an evil influence on the other. In a negative manner weakness
of the digestive system may favour longevity by preventing the excesses
which vigorous individuals may for a time at any rate indulge in with
impunity; but as a rule the digestion of the long-lived is good.
The first-born is significantly handicapped, as Karl Pearson[57] has
shown, and more subject to tuberculosis, insanity, and criminality. But
out of 71 centenarians analysed by Sir George Humphry 17, or 24 per
cent, were firstlings, and 24 per cent of 824 persons between 80 and
100 were first-born. It must be remembered that first-born are more
numerous than any others, and some of the above were only children.
The most frequent position in the family among these 895 old people
analysed by Sir George Humphry was the third.
ENVIRONMENT
The influences included under the head of environment are numerous,
and this factor cannot be entirely separated from that of heredity,
for environment may favour and shape hereditary characteristics. The
subject of the harmony and the want of harmony existing between man and
his surroundings is so vast that it is possible to touch on a few only
of these aspects.
The average length of life varies in different countries; a temperate
or moderately cold climate is conducive to a slower development of
maturity and so to a longer life than tropical regions. The Balkans,
Greece, Scandinavia, the Pyrenees, California, and small islands are
considered favourable to longevity. A high elevation has been regarded
as an important factor, and the great age of the monks of Mount Athos
has been thus explained, though other influences, such as simplicity of
life, may well play a part. Switzerland, however, does not conform to
the view that a high elevation confers long life on its inhabitants.
From observations around Dijon Noirot[58] drew up a scale showing that
the elevation above the sea and length of life rose together. National
habits have a bearing, and this may help to explain the longevity of
the Jews, who follow the Mosaic laws of health, and why the French
appear to be more long-lived than the Germans. The long-continued
persecution and hard life that the Jews have undergone has led to the
survival of the fittest and a hereditary factor. The former simplicity
of the Russian peasants would also provide a reason for their reputed
longevity (one centenarian in every thousand). In Ireland, though
much depleted by migration of young adults, the absolute number of
centenarians is very high; in 1888 there were 208 such deaths, or 43
per million living; in the ten years 1911–20 inclusive there were
1030 centenarian deaths, or about 23 per million living; and the
Registrar-General, Sir William J. Thompson, kindly informs me that in
1921 there were 314 centenarians living in a population of 4,496,000,
or about 70 per million of the population. It seems probable that this
is the outcome of a simple life. In England and Wales the number of
centenarians is both relatively and absolutely less; in 1887 there
were said to be about 2 and the 1911 census returns showed 3·6 living
centenarians per million of the population; the return of the 1921
census is not yet available. In the ten completed years 1910–19 there
were 691 centenarian deaths, or an average of 69 annually among a
population averaging about 35 millions--about two per million living.
In California there are, according to Laurent,[59] 300 centenarians
in a population of three millions, or 100 per million, the extremely
favourable climatic conditions accounting for this high ratio. In the
same country there is a difference, much to the advantage of the rural
inhabitants, between the prospect of longevity in the towns and in the
sparsely populated districts. From their open-air life agricultural
labourers provide the largest percentage of long lives.