By an instinct that is very deep and strong most old people shrink from realizing just what their stage of life is and means, although most are ready enough to discuss such symptoms as are forced upon their consciousness. Disguise it as we will, old age is now only too commonly a hateful and even ghastly thing. Even those most garrulous and pessimistic about their infirmities are often prone to an almost fetishistic focalization upon certain symptom-groups of their own to the neglect of others by the same mechanism by which general anxiety may come to a head on a single phobia, which is thus exaggerated, because all the affectivity of their more general state finds an outcrop in some special fear. This mechanism is the same, too, as that by which love may find a vent for itself in some amatory fetish. Few, indeed, are the old men, and perhaps fewer still the old women, who do not seek to seem to others younger than their real physiological age, and all even to their innermost selves are prone to dwell more on what the great deprivator leaves behind than on what he has taken away. Childhood and youth long forward, old age longs backward.
Wishing to really know myself as old, I subjected myself upon my retirement to the examination and tests of some half dozen medical experts for eyes, ears, heart, lungs, digestive tract, kidneys, and even sex, but was surprised to find how hard it was to do so. A strong minority of my impulses preferred the ignorance that is often bliss. There are no mental tests of generally recognized validity above the teens, so that we have no criteria for determining psychological age for even the elderly, while psychoanalysts refuse on the express authority of Freud to take on patients over forty. When it was well over I was glad, for most organs and functions were found to be in fair condition, although one was in need of some special care. I realized anew, however, that there are no gerontologists, as there are experts for women, children, etc., and that barring acute attacks I must henceforth, for the most part, be my own physician and that I must give far more attention than ever before to keeping well and in condition. Body-keeping for the old is a very personal and pressing problem requiring much time and attention, and the methods that are successful differ so widely that the diet and regimen good for one might be dangerous, if not fatal, for another. But my chief interest for months centered in rather voracious medical and psychiatric literature upon senility and its disorders till my friends thought me in danger of growing morbid and predicted and feared hypochondria. Gruesome and depressing as it all was, it had nevertheless a certain grim fascination to know what a cohort of disorders encamp about and prey upon the aged, any group of which is liable to assail and perhaps take the citadel of life by storm. Evasion of these enemies gives a new sense of heroism.
Rheumatism, lumbago, varicose veins, calcified arteries, compensated for by enlargement of the heart, its valvular leaks and weakness, high abnormal blood pressure, adiposity or progressive emaciation, shaking palsy, cramps, bronchitis, asthma, shortness of breath, gout, stone, Bright’s disease, diabetes, constipation, piles, hernia, prostate troubles, tuberculosis, cancer, dyspepsias, flatulence, nausea, vertigo, flaccid and atrophied pudenda, feeble voice, defective sleep, failing eyesight and hearing, weakness of muscles, gaps in dentition, rather more hygienic than the complete edentate state; and beyond all these and many more the certain prospect of death just ahead or around the corner, liable to come from many of these causes or from any one of them already so well advanced that to know is no longer to prevent it—these are the things the old face if they have the courage not to flee from real facts. One or more of these maladies is sure to strangle, starve, bleed, poison, or paralyze us suddenly or slowly, and that ere long. Some of us will die from the top down with dementia more or less developed, while for others some vegetative organ will collapse and drag down with it all the rest of our powers, which might otherwise go on for a decade or two. These are the things that often make the old pessimistic. They are the secrets of age that must be kept from the young lest they interfere with their joy of life and which religion and philosophy have done their best from the beginning of history to mitigate. Thus the soul of the old, when it confronts the sternest of all facts at close quarters, grows more and more prone to seek diversion than consolation, for the former in fact is the chief resource of senescence although, as I shall indicate later, modern science is slowly evolving a third and better one.
Meanwhile, since medicine is far from having yet developed any systematic or coherent gerontology, although it has marshaled many facts and given us many hints toward such a science, it has seemed to me that in the present state of knowledge I can serve the reader better by epitomizing, without any attempt at systematization that would be certainly premature, the aperçus and the standpoints of those who seem to me in recent years to have written more wisely than others upon this theme, as follows.
The only attempt at a history of what medicine has done for old age that I can find is in an old book by Charcot[143] in which he attempts to list and characterize the far too few studies of any importance made upon the subject up to that date. He urges that medical science should give far more attention to it.
Dr. G. M. Humphry[144] gives us a memorable study of five hundred old people of over eighty years of age, including an equal number of males and females. He stresses the fact that the descending changes of development are just as orderly as its earlier ascending phases and that civilization enables us to see far more of the natural processes of senescence than was possible when the conditions of life were ruder, for we can now promote the powers of self-maintenance to a degree impossible before. “The chief requisite for longevity must clearly be the inherent or inborn quality of endurance, of steady, persistent, nutritive force, which includes recuperative power and resistance to disturbing agencies and a good degree of balance between the several organs.” That is, each must be sound in itself and have due relation to the strength of other organs. “If the heart and digestive system are disproportionately strong, they will overload and oppress the other organs, one of which will give way.”
His findings indicate that both men and women of average size and stature live longer than those much larger or smaller. He thinks, too, that there must be some trait associated with the development of the tubercle bacillus, “which is not only not incompatible with longevity but is not infrequently associated with it”; and this condition he found in eighty-two of the cases he studied. Most of them belonged to long-lived families, had enjoyed good health, appetite, and digestion, had taken little medicine, eaten little meat, been only very slightly addicted to alcohol, had been good sleepers, and rarely suffered from long or exhausting diseases. Most had been much out-of-doors. The average number of teeth in all these subjects was six for men and three for women, and only fifty-seven were entirely without them. The upper or alveolar part of the jaw tended to be absorbed and only the later, firmer growth of the lower part of it to be retained. In primitive man probably loss of teeth would materially shorten life. The skull, which generally becomes lighter, may also sometimes become heavier and increase inwardly as the brain shrinks. The rate of the heart varies very little as age advances. From eighty to ninety years he found it averaged 73–74 beats per minute in men and 78–79 in women. Respiration was 19–20 times per minute and, like the heart, was very slightly accelerated, although the respiratory change might be due to the prevalence of bronchitis in old people.
He found little tendency to senile dementia and many of even the very aged had their mental faculties intact and took a keen interest in passing events, possessed clear judgment, and were full of thought for the present and future welfare of others. “It is no less satisfactory to find that the active, even severe and long-continued intellectual activity of the matured brain seems in no way to impair its enduring qualities, and that good, earnest, useful employment of the body and mind are not only compatible with but even conducive to longevity.”
Of 157 of the males who replied, only six had ever had diseases of the prostate or bladder, so that in general he thinks that “the aged body does not seem to be, on the whole, prone to disease.” Few of his returns indicate the presence of any special malady. “We know that even cancers, when they attack old people, often make slow progress in them and sometimes fail to make way at all, remaining stationary or even withering, and the susceptibility to contagious disease appears to decrease from infancy to old age. Quite as remarkable is the fact that recovery from wounds, fractures, or operations, seems to be quite as rapid, and sometimes more so than in middle age. Indeed, wounds in the old heal very quickly provided they do not slough, indicating two opposite tendencies.” He also finds evidence of greater vital energy in parts nearest to those diseased provided they are able to live at all, as if nature had recuperative processes of stimulating parts adjacent to lesions. He chronicled few more surprising results than the infrequency of sclerosis.
* * * * *