Functional Activity
As is well known, disuse leads to atrophy, and biologically conditions rendering an animal’s supply of food extremely easy and safe are followed by atrophy of the parts no longer necessary in a state which may thus come to border on parasitism; in an extreme degree this result is shown in barnacles (degenerated crustaceans) and ascidians (degenerated vertebrates). In man the cessation of an active life on retirement to the country, described by Samuel Johnson as “a kind of mental imprisonment,” or the sudden acquisition of wealth, often exerts a most evil influence; for if the whole body is no longer kept in a condition of functional activity, those parts allowed to remain relatively idle begin to degenerate and atrophy; loss of function means a diminished blood supply and nutrition, and so degenerative atrophy. According to Laurentius “nothing hastens old age more than idleness.” James Easton,[64] who collected 1712 records of centenarians, many of them open to criticism, endorses Hufeland’s dictum that no idler has ever attained to a remarkably great age; and Sir Thomas Browne’s[65] quaint injunction “Dull not away thy days in sloathful supinity and the tediousness of doing nothing” is old but true wisdom.
The axiom that disuse leads to atrophy applies perhaps even more to mental activity, for resting and rusting of the brain slow the pace of the whole body, whereas an alert mind can exist in an infirm body. There is no doubt that occupation with a strong desire to live for the accomplishment of a definite purpose exerts a most beneficial influence, and there have not been wanting some, such as Karl Marx, who have preached that old age is in great part a matter of will. Speaking of the circle in which Madame du Deffand moved Lytton Strachey[66] says “They refused to grow old; they almost refused to die. Time himself seems to have joined their circle, to have been infected with their politeness, and to have absolved them, to the furthest possible point from the operation of his laws. Voltaire, d’Argental, Moncrif, Hénault, Madame d’Egmont, Madame du Deffand herself all lived to be well over eighty, with the full zest of their activities unimpaired.” Want of this joy in life necessarily engenders carelessness and neglect of personal hygiene, and loss of the power to react to the environment. As the years advance and the younger generation come up, the suggestion that “his day is done,” that he has had his innings, and that it is time for him to step aside, is made to the senior not only by his family and his juniors—hetero-suggestion—but by himself, and he may then, after the modern fashion, get into the habit of repeating mentally “I am getting older and older every day.” A slight illness or incapacity may be magnified into a conviction that the end is near, and as a result of the loss of self-reliance a state of increasing invalidism is established and becomes progressive without any other cause. Just as a fall, an exacerbation of rheumatic pain, a slight operation or indisposition, necessitating rest in bed for a short time, may be followed by a functional loss of power in the lower extremities, so a more general suggestion of failing powers may lead to mental deterioration. Thus too often a man’s last occupation is to shorten his existence and make it miserable. Finot,[67] who rather optimistically believes that man should be able to live 150 years, regards this poisonous auto-suggestion as one of the factors that prevent such an achievement. Observation of contemporaries suffering from premature senile changes, due to pathological factors, may no doubt stimulate this destructive form of auto-suggestion. There is therefore a basis for the idea[68] attributed to the late Lord Rhondda that old age was a transferable disease, and for his avoidance, as far as possible, of the society of the aged on account of the risk of contagion. Association with the young keeps one more or less of the same age, very probably by suggestion to the unconscious, or in Oliver Wendell Holmes’s words “While we’ve youth in our hearts we can never grow old.” From experience at the Royal Hospital, Chelsea, where there are 500 pensioners, Thompson and Todd[69] are convinced of the powerful factor of lowered mentality due to loss of self-reliance, self-respect, and the instinct of self-preservation in inducing premature senility, and have been most successful in counteracting this by antidotal suggestion conveyed by cheerful chaff and by the avoidance of sympathetic condolence.
In addition to the joie de vivre a happy disposition that thinketh no evil, has no jealous suspicions, and is free from the tendency to worry has an important influence in keeping the mind and body young. The power of detachment from work and anxieties, as if the mind were fitted with thought-tight compartments, is a valuable asset in maintaining vitality unimpaired; this was a trait in Gladstone and Kitchener.
Professional men who retain their offices as in the Church, the Civil Government, the Bar, tend to live longer than business men who retire to leisured ease after a strenuous struggle. B. Yeo’s[70] analysis of 42 Bishops and Deans, 49 Judges, and 188 Peers, showed that in all three classes the average duration of life was practically the same, namely, 72 years. Among churchmen mention may be made of Cardinal de Salis (110), Gregory IX. (100), Abbé Maignon (100), Martin Routh (100), for 63 years President of Magdalen College, Oxford, thus surpassing the more modern instance of Edward Atkinson, aged 96 years, for 59 of which he was Master of Clare, but not that of Laurence Chaderton (1536–1640) who, after being Master of Christ’s College, Cambridge, with great success for 38 years, survived for 18 years and became a centenarian. There are some remarkable examples of artists retaining an active life to a very advanced age, such as Titian, Giovanni Bellini, Michael Angelo, Sidney Cooper. Politics often keep men busy and active to an advanced age, and the names of Palmerston, Brougham, Lyndhurst, the octogenarian premiers Gladstone and Clemenceau, Strathcona, Sir Charles Tupper naturally come to one’s mind. In the legal profession Chief Justices and Judges can retain their seats and so keep up their vigour long past what is regarded in some walks of life as the retiring age. Sir Edward Coke (82), Lord Mansfield (89), Lord Brampton (90), Lord St. Leonards (93), and Lord Halsbury (97), are examples in point. Within recent years there have been two octogenarian Lord Mayors of London, Sir Thomas Crosby (in 1911), and Sir John James Baddeley (1921); the first created a record by being the first medical man to hold this office, and Sir John Baddeley celebrated his year of Mayoralty by bringing out a beautiful historical account of Cripplegate.
Fig. 9.—Sir Henry Alfred Pitman (1808–1908), M.D., Camb., F.R.C.P., Registrar of the Royal College of Physicians of London, 1858–1889.
From portrait in the Royal College of Physicians of London, painted in 1886 by W. W. Ouless, R.A.
From the inevitable exposure to infection and worry the medical fraternity is generally considered to rank low in the professions as regards longevity, but it is easy to point to exceptions especially among those whose mental vigour made them prominent in their own and in one instance for all time. Hippocrates is variously stated to have died at the ages of 85, 90, 104, or 106 years with the words “I leave behind me two great physicians, temperance and frugality.”[71] I have references to 43 medical centenarians for 18 of which, including the record of W. G. Meade, physician at Tunbridge Wells and buried at Ware, Herts, in November 1652, aged 148¾ years, I am indebted to my friend Mr. R. R. James. The only one that I knew personally was Sir Henry Pitman, for 31 years (1858–89) and until his 82nd year Registrar of the Royal College of Physicians of London. Among the others Dr. de Bossy of Paris may be mentioned as the son of a centenarian. From analysis of 2113 eminent medical men Drinkwater[72] found that the average age was 67 years, or considerably above the average age of the male population over 21 years, which was estimated at 59 years, and that 627 or nearly a third of them all were between 71 and 80 years of age.
But the examples given of mental activity late in life, and they could easily be multiplied,[73] are exceptions to the rule that the majority of men begin to fail in their work between 60 and 70. This no doubt is because most septuagenarians suffer in greater or less degree from pathological old age. In the case of the healthy vigorous man enforced retirement at the age of 65 or 70 is not to the advantage of either the retiring victim or the community, for it restricts his opportunities for production and useful activities guided by ripe experience. To quote examples of epoch-making work done by men long past the age when the majority have lost originality, initiative, and elasticity of mind: Galileo, Newton, Charles Darwin, Sophocles, Voltaire, Molière, Goethe, Michael Angelo, and Titian, made original and lasting contributions to science, literature, and art long after fifty. Morgagni’s famous De Sedibus et Causis Morborum, brought out when he was 80, and the Commentaries of W. Heberden (aged 91), published posthumously, represent the accumulation of many years and so cannot be fairly quoted as examples of ability persisting into late life. Rules and regulations must, however, be based on what is best for the majority and hence, though the exceptions are prominent and regrettable, the age limit of 65 to 70 must at present be accepted as generally advisable for otherwise permanent appointments.
Although functional activity maintains the tissues in a state of health, it is not an infallible panacea for the prolongation of life; in the first place the danger of overwork and excessive fatigue must be borne in mind. While the attractive suggestion that excessive functional activity leading to extreme hypertrophy may exhaust the vitality of the tissues and lead to atrophy, may not be borne out by the examples quoted in its favour, such as the occupational neuroses and atrophy of the upper arm muscles in hammermen and file-cutters, there is some reason to retain a belief that this sequence of events may occur, for example in dilatation of the extremely hypertrophied hearts seen in long-continued high blood pressure, renal disease, and valvular lesions;[74] but even here the possibility of other degenerative changes, due to toxaemia, must be borne in mind. Further, functional activity while keeping the cells of the body in a healthy state depends on their structural integrity, and this in its turn is the outcome of the modifications due to environment, and possibly of the inborn lease of vitality. So that although an active life may within limits prolong life, there are many instances in which, from extrinsic pathological influences or inherent inadequacy, it fails to do so, and a man becomes unequal to the demands of his position.