Senescence, the Last Half of Life

by G. Stanley Hall

The original and indefatigable American-Frenchman, C. E. Brown-Séquard (1817–1894) who in 1878 succeeded Claude Bernard in the chair of experimental medicine in the Collège de France, was one of the first experimental physiologists to study the functions of glands and to realize the importance of their secretions. After investigating the suprarenals in animals as early as 1869 and finding that their removal always caused death, he returned to this subject twenty years later to investigate the testicular fluids which, discharged into the blood, “exalted the power of the nervous system and kept up the vital energies.” He even injected the fluids extracted from the testes of animals into his own system hypodermically, with results that he thought distinctly beneficial to himself and says that he “at the age of seventy recovered the force and energy of youth, with manifestations unknown for a number of years.” He thus believed that he had discovered a new therapeutic agent of great rejuvenating power. Berthelot says, “The subject required delicate manipulation, not only because of the extraordinary precautions required for this kind of investigation but of charlatanism, always ready to possess itself of new curative procedures. He did not protest against the abuses by which his name was used to cover industrial enterprises.” He persisted in his idea, and he, more than anyone else, should be called the founder of opotherapy or treatment by extracts from organs. His name will always have a prominent place in the history of endocrinology or the science that deals with the glands that secrete inwardly, a subject that already has a vast and rapidly growing literature, with an essentially new body of facts and insights and, at its present stage of development, yet far more precious hopes and expectations of great discoveries just ahead.

Some of the many commercial products of testicular juices, so very difficult to prepare in a form that can be preserved, were for many years widely used and the best known of these, Pohl’s spermine preparations, are still more or less in demand. But despite Brown-Séquard’s enthusiastic belief in his age-deferring cure, it lapsed from general attention, partly because the initial expectations were too high, until a very few years ago when the problems it had suggested were approached in a new way by a few investigators whose results have not only a high value in themselves but give promise of yet more important and definite subsequent discoveries—and that despite the conservatism and criticism that all efforts to deal scientifically and fundamentally with human sex problems always encounter.

Professor Eugene Steinach, who founded a laboratory of comparative physiology at Prague and was later made director of the biological institute at Vienna, continued to work there until his institute, for which Roux and others have solicited contributions from men of science, to have it opened again, was closed by the war. He began to publish his epoch-making results in 1910. In spring frogs brought to his laboratory he found 8 per cent impotent and also that testicular injection from normal frogs seemed to restore or intensify the embracement impulse and the strength of the forelegs.[180] The effect lasted, however, only a few days. Nevertheless he suggests that in borderline cases it might permanently restore fertility. The same process in castrated frogs showed the same effect, only in much less degree, and the injection of substance from the cerebro-spinal centers of these activities seemed to have a certain but very slight effect upon the sex nature.

When ovaries and testes were transferred in guinea pigs a few days old, he found, in general, that through the influences of the hormones from these glands the character of each sex underwent “slow but radical transformation over toward the other.”[181] In the one case the male organ atrophied and the breasts were developed, with a disposition to nurse, the hair became finer, the method of growth was transformed into that of the other sex; and the converse occurred when the transplantation was in the reverse direction. The change was thus both morphological and functional and Steinach believes that there is a distinct antagonism of the sex hormones due to transplantation of a heterological gland and that this is not due to biochemical differences of blood but to a distinct antagonism between male and female hormones, which have a sex specificity that is the main factor in directing growth. He distinguishes between the specific sex influence and the antagonism that brings about heterological sex signs, which favor the development of other pubertal glands and control growth, even to the dimensions of the skeleton, both stimulating and inhibiting it. The transplantation can be so effected that the glands of both sexes, in a sense, inhibit each other, so that something like experimental hermaphroditism can be caused. These changes last sometimes through life and occasionally there may be periodic milk secretions in males. Each element checks and may throw the other out of function.

In a later article[182] Steinach published results of experiments upon the exchange of sex glands in other animals between the different sexes and found that the female masculated by being given the testes of her brother followed more or less his development rather than her own, almost equaling him in growth, weight, and robustness. This Steinach calls hyper-masculinization and a degree of this follows the development of the glands after transplantation, which the microscope showed was attended by real intussusception. He also showed hyper-feminization, so that we have a change of the ovaries into hypertrophic but analogous pubertal glands, with corresponding change of traits, dependent upon the degree of success or completeness of the operation. Thus he thinks, too, we can explain somatic and psychic precocity by the hypertrophy of these glands. In another article[183] the author emphasizes the great variability in the development of sex, both as to size of organs and their functions in different individuals and believes that besides environment, heredity, race, etc., climate has a great deal to do with it. He finds that in warm countries the advent of sex maturity is somewhat earlier in all its aspects, although there is some suggestion that these accelerations may be connected with the development of other secondary traits. Experiments made with animals in artificial climates point to the same result and changes in this direction are observed in animals accustomed to cold that are transported to warm climates.

Interesting as these experiments on the interchange of primary and secondary sexual qualities are, they were, for Steinach, only preliminary to what chiefly concerns us here, namely, his studies of rejuvenation[184] and his problem was to see whether by his operations he could shed light upon the problem of whether age is a condition we are defenseless against, like an incurable disease, or senescence can, at least within certain modest limits, be influenced. He says his experiments have decided in favor of the latter alternative. He had first to determine whether orthoplastic, homoplastic, or a combination of both methods was the best. The former was chosen because it was quickest and easiest and independent of earlier implantation material, especially with men. And so, with his colleague, Lichtenstern, various operations were performed, of which three type cases are as follows:

Case 1. Man of 44, lean, weak, wrinkled, incapable of physical work by reason of easy fatigue. Libido failing for years and almost extinct, testicular pains, and double-sided hydrocele. With local anesthesia the typical Winkelmann operation was performed. On both sides there was ligature of the vas deferens between the testicle and the epididymis. The cure took a week and the patient was soon discharged. A few weeks witnessed a striking change. He increased in weight, the wrinkles almost vanished, and in five months he had won back muscular power and become a hard worker, carrying heavy burdens. “Libido and potence returned with great intensity.” The upper part of the thigh grew hairy and both hair and beard increased so that he had to shave more often. Improvement continued during the year and a half in which he was under observation and he seemed in every way a vigorous and young man.

Case 2. Man of 71, of large business, who came to the hospital with an abscess in the left testicle with septic signs—chills, high temperature, etc.—so that it was necessary to remove the source of maturation in toto. At the same time the right, sound testicle was subjected to ligature of the passage from the epididymis to the vas deferens. In twenty-four hours the patient lost his fever and in three weeks left the hospital. Quite apart from the acute symptoms, this patient had for years suffered marked signs of age, especially calcification phenomena—dizziness, shortness of breath, weakness of heart, great fatigue, tremors, etc., with libido extinct for eight years. Within a few months a marked change occurred. A feeling of masculinity returned and in nine months the patient described his own condition in a letter in which he says in substance that, to his great surprise, certain nocturnal phenomena had recurred, his appetite was so great that for a long time it was difficult for him to satisfy it, instead of previous depression he found himself again full of the joy of life and considered himself very elastic for his age, while his friends often remarked the great change that had taken place and could not believe he was seventy-one. He suffers little from fatigue, calcification and dizziness have ceased, he can think clearly, had to go to the barber more often, and all his functions have greatly improved.

Case 3. This was a wholesale merchant of 66 who for some five years had shown senile symptoms, such as difficulty of respiration and in thinking, weak memory and also muscles, and libido almost gone. In this case there was rapid prostatism and catheterization, also emaciation, and occasionally more pronounced psychic disturbances. The first operation on this case was prostatomy but this did not arrest loss of weight or increasing weakness. Then there was ligature of the vas near its entrance into the epididymis on both sides, which was followed by a very rapid recovery, with improvement of nearly all symptoms.

Thus the author thinks that in fighting old age orthoplasty is by far the best method, and to the objection that these cases are not true psychic senescence but only symptoms of intercurrent disease he replies that this only gave occasion for the operation and that the disease itself was the result of age. Thus, in general, he concludes that for advanced senescence the ligature of the vas, as above, gives the most remarkable results, and that for those before the senium also it may often work very favorably. The same is true of premature old age, the advent of which has immense individual variations.