THE HISTORY OF GERIATRICS By JOSEPH T. FREEMAN, M.D. PHILADELPHIA

HE history of the study of the avoided reflection for fact, aging remi­ diseases of the aged has been niscence for scientific understanding. made venerable by the fact These parallel views will be seen to that almost every noteworthy meet, as do train tracks, by eyes looking Tclinician at some time in his careerinto the distance. found occasion to note his reflections Outlining learnedly and logically, and observations on the subject. Al­ G. S. Hall, in 1922, wrote an ethno­ though it was the rare individual essay graphic survey of old age from the that was novel, a sturdy literature grew vague eras of the past up to the time in the warmth of genius applied to it. of defined history.3 This study begins Yet many of these same contributors with many paraphrases from his book. felt that the history of geriatrics was In the hazy periods of human cul­ a barren one indeed. In 1863 Daniel ture, some of which persist today in Maclachlan1 wrote that there was little those peoples whose level is but little in the English literature except some above that of stone-age man, there were minor efforts which contained valuable definite attitudes toward the aged information on the hygiene and dis­ which were almost ritualistic for the eases of old age. A half century later, tribe. In such levels of civilization life C. S. Minot2 stated that “from the time is more obviously somatic, more clearly of Cicero to the time of Holmes, nu­ a matter of fears, food, and protection. merous authors have written on old The older half of society received ac­ age, yet among them all we shall cord in proportion to which of these scarcely find any one who had title to basic tenets was predominant. When be considered a scientific writer upon famine threatened, the aged were sac­ the subject.’’ Despite lengthening bib-) rificed for food, these meals usually liographies, there is almost a humorous being invested with solemn dignity. repetition of such plaints in the preface Where adequate burial was a problem, of each new work^ As a matter of rec­ cannibalism served as a form of sanita­ ord, such statements are more blunt tion. In Fiji, self-immolation was not than correct, for old age has a notable uncommon, sparing worthy persons lineage of students, as shall be observed. from the degradation of a useless old A brief inquiry seems necessary to re­ age. Those who rose to high position fute these honest convictions. One gen­ were particularly aware of the privilege eralization that emerges is that there of self-destruction and were aided to a have been two types of writers: first, serene end by kin and friend. Darwin those of past and recent date who phi­ noted in Tierra del Fuego that the losophized and concluded from a per­ more noble organs of the body of such sonal viewpoint with little intent to be men were eaten in order that the sur­ statistically exact, and second, those of vivors might tangibly participate in the a small but increasing number who good qualities of the deceased. Among the American Indians, the aged were day; and while you attend to the body, revered on a par with the gods and the never neglect the mind.’’ His treatise chief. on health and long life contains the es­ Very probably even in these stages of sence of the best writers preceding him. life, men who felt their physical powers Hippocrates made many observations beginning to abate—at least the more saga­ on old age.4 He noted that the aged as cious of them—had already hit upon a rule complain less than do the young. some of the many devices by which the His keen insight into disease postu­ aging have very commonly contrived to lated the severe conclusion that such maintain their position and even increase chronic diseases as do occur in the their importance in the community by aging body, rarely leave it. He tabu­ developing wisdom in counsel, becoming lated the ailments of old age thus: repertories of tribal tradition and cus­ old people, dyspnea, catarrhs ac­ tom and representatives of feared super­ companied by coughs, dysuria, pains in natural forces of persons. . . .3 the joints, nephritis, vertigo, apoplexy, By utilizing the fruits of experience, cachexia, pains in the whole body, in­ the aged often became too valuable to somnolency, defluxions of the bowels, destroy; religion gave them an aura, of the eyes, and of the nose, dimness of wisdom gave them a shield, and respect sight, and dullness of hearing.” He for accumulated surpluses extended himself lived a long life, later much their influence over possible heirs. exaggerated in legend. In ancient Greece, youth was the It is a commonplace that respect for prize; age, in contrast, a matter of the physical reached a high plane in hatred. The feeble gray head found the Egyptian civilization. The Egyp­ little respect from Homer’s people de­ tians practiced the art of lengthening spite notable exceptions cited in the life and insuring longevity by the classical literature. Strangely enough it routine use of emetics and sudorifics at was the Spartans, early seekers of the definite intervals. As a rule, two emetics physical ideal for the masses, who alone were taken each month. The stress realized the value of their older sub­ placed on sudorifics was reflected in jects. A council of twenty-eight men the customary form of greeting, “How past sixty years of age and elected to do you perspire?” office, the gerousia, held control over As a key to antiquity probably more that city-state. As for the remainder of has been learned from the Bible than the peoples of that strange peninsula, from Grecian columns or Egyptian “Greek writers take a very gloomy view masses. It yields some understanding of of [old age], never calling it beautiful, disease, sanitation, and attitudes of peaceful, or mellow, but rather dismal those distant times. In Genesis 5, there and oppressive’’ (Hall). Some of the is the lineage of the generations of individual personalities that come to Adam naming ten men whose lives mind are Nestor, Socrates poisoned by averaged eight hundred years, as reck­ his own hand at the age of seventy, Plato oned then. The terrible disaster be­ living to fourscore years, Plutarch who falling the children who mocked the advised his aging contemporaries to bald and senile Elisha is described in “keep your head cool and your feet the second book of Kings. In Psalms warm; instead of employing medicines 90:10 there is David’s sonorous dirge for every indisposition rather fast a which every generation has sung: The days of our years are threescore and ten, from Radcliffe, physician at court, ad­ Or even by strength fourscore years; mired by Dr. Johnson, labored long Yet is their pride but labor and sorrow; for a satisfactory interpretation of For it is soon gone, and we fly away. meanings hidden in the lines inscribed in the chaste Hebrew language. He explained that the reference to the grasshopper belly full of eggs delicately indicated scrotal rupture, “a disease common to persons far advanced in years.” His work was translated from the Latin by Thomas Stack, and the copy in the library of the College of Physicians of Philadelphia was at one time the possession of James Craik, physician to George Washington. Less than a century before, Dr. John Smith had written his “Pourtract of Old Age” in a far less dispassionate manner than that evident in Mead’s “Medica Sacra.” Smith, a young man, must have been a fierce fundamentalist crusader in the Restoration Period for he spins out pages of tirade, medical evangelism, and a complete acceptance of the truth of the Word regardless of all other con­ siderations. The endless defenses of each poetic sigh of the ancient King are punctuated with keen perceptions: “Let none give over their patients when they come overburdened with the infirmities of Age, as though they were altogether incapable of having No more succinct and impressive any good done unto them. Those that description of aging has been preserved are negligent toward their Ancient than that of Solomon in about two Friends, are very near of kin to those hundred words in the twelfth verse of inhuman Barbarians and Americans, Ecclesiastes8 ending in that verbal sara­ who both kill and devour them.” Sir band, “ ‘Vanity of vanities,’ saith the Humphrey Rolleston10 said that of the Preacher, ‘all is vanity.’ ” The follow­ early writers, Smith alone lacked the ing scholars through their interpreta­ qualification of mature age, which is tions of the allegorical passages were in the light of praise rather than con­ led to other observations along the demnation. same lines: Andreas Laurentius 1599, Ancient thoughts, Egyptian, Biblical, Master Peter Lowe 1612, Bishop Hall Grecian, and others flowed through 1633, John Smith 1665, Richard Mead Rome. Strong familial life was the basis 1755, and M. Jastrow 1919.®9 of the world that grew around a great Mead,8 bearing the gold-headed cane city, and this powerful unit created ef­ fectual protection for the aged. Unlike an old burgomaster of Amsterdam, to most of the Greeks but like the Spar­ obtain the revivifying effects of sleep­ tans, the Romans were eager to benefit ing between two young persons. by the counsel of older leaders in all walks of life. The influence of their ruling body of older men, a Senate, has come unchanged unto this day. The most influential writing on the subject is in Cicero’s “De Senectute” expressed through the medium of the central character, Cato Major. Benjamin Franklin commented on the wisdom of the observations. G. M. Humphry11 felt that “from schoolboy-days, now fully fifty years ago, when the ‘De Senectute’ of the great Roman orator made a lasting impression upon me, the subject of old age has had some fascination for me.’’ Minot refused to put the seal of biology on this work despite the fact that its value has been much greater than many lackadaisical texts in that field. In 1744 J. H. Cohausen published his “Hermippus Redivivus or The Sage’s Triumph Over Old Age and The Grave.”12 The whole imaginative work was built up on a single inscrip­ tion (taken from Hufeland): To zEsculapius and Health Dedicated By L. Clodius Hermippus who lived CXV years V days By the breath of young maids Cohausen hypothesized that this old While Rome was fading, medical citizen of Rome must have been a knowledge progressed in the hands of teacher in a school for young virgins in the Arabian physicians. The works of order to be blessed with the privilege Isaac Beimiram, Hali Abbas, Avicenna, of being constantly exposed to their Averroes, Rhazes, Johannus Damas- supposed healthful and life-lengthen­ cenus, and others, flower in the recog­ ing exhalations. This belief in the nition extended by Bacon. Roger therapeutic value of the respirations of Bacon,13 Franciscan friar, mathemati­ young people continues more figura­ cian, physician, wrote on “The Cure of tively today. However King David had Old Age and the Preservation of tried it in his time, and the learned Youth” in the thirteenth century. This Boerhaave had ordered a patient of his, work was translated into English by Richard Brown in 1683. In that strange In the swashbuckling sixteenth cen­ awakening age, this book emerges won­ tury, the words of a gentle Venetian derfully prophetic with humanitarian nobleman, Luigi Cornaro,14 called the “Apostle of Senescence,” spread like a soothing oil over the turbulent waves of humanity. The most quoted of the subjective works, his properly entitled book, “Sure and Certain Methods of Attaining a Long and Healthy Life with Means of Correcting a Bad Con­ stitution,” consists of four essays, the first of which was written at the age of eighty-three. The preface to the first American edition written by Joseph Addison in 1793 contained this writer’s belief in the efficacy of proper exercis­ ing by the aging. Cornaro’s work is a grandfatherly admonishment to tem­ perance, modern in ideology and ver­ biage, remarkable for its sane evalua­ tion of the methods he utilized to enjoy old age when so many others, desiring the same end, were being confounded by astrology and necromancy. Practi­ cally broken in health at forty, he forced himself to a summary of his mode of living, adopted certain prin­ ciples, and reaped a reward of happi­ ness in continuing age. He warned that those who would not partake of his “divine medicine, Temperance” would suffer from degenerative ailments. understanding. Galen and Hippocrates What Hippocrates wrote in the Thir­ are quoted with understanding, and teenth Aphorism, “old persons endure not with obsequiousness. But it is a fasting most easily,” Cornaro proved wistful tract, for in it one hears the with great benefit. The unaffected and cry of a man in a strange world sad be­ observant writings of this patriarch cause he could not be understood, fear­ blessed with an unusual amount of ful of recrimination lest he be under­ common sense demand the pause of stood. Science is neatly interwoven with deserved admiration. fable and philosophy, and here are r Inasmuch as Bacon’s thoughts did symptoms, signs, and treatment, much not blossom in his own day, the writ­ of which was liquidated from the frozen ings of Sir John Floyer of Lichfield15 asset of old literature by Floyer in a in 1724 have generally been accredited more receptive time. Bacon’s magnifi­ as the beginning of modern geriatrics. cent work presaged the modern atti­ Floyer is known also as the first to at­ tude in geriatrics. tempt accurate pulse readings by the watch which he described in the “Phy­ titious generalities the author’s candor, sician’s Pulse Watch,” and which iron­ “I know not what may be the fate and ically was passed over by his colleagues. success of the performance; nor am I Having knowledge of many of the solicitous about it, being conscious the masters of medicine (“I therefore re­ design was honest, the subject weighty, viewed my old Galen”) and a native and the execution the best my time, my astuteness, Floyer elaborated the med­ abilities, and my health would per­ ical knowledge of the aged. With scant mit,” is laudable. recognition of Bacon from whom he It is apparent thus far that this sub­ took much, he nevertheless expanded ject has maintained a fixed, if minor, and clarified many views which is in it­ place in the medical mind. In each self an apology for possibly uncon­ notable period there was at least one scious adaptation. His theme was mod­ well-informed individual who did not eration in all things with a liberal permit a lapse, either by repeating application of his favorite idea of cold much that was platitude, or by starting or hot bathing depending on whether a new vein of thought. The failure of the patient was a thin hectical, or a more rapid progress was not a peculiar fat florid, old person. This is recogni­ sluggishness but a part of the general tion of the response of constitutional medical trend. With a quickening of types to adapted therapy. Charcot con­ the whole there was activity in each of sidered this book as one of the early its parts including geriatrics. specific treatises because of the exten­ At a time when Dr. Guillotine’s sive therapeutics expounded. Elabo­ invention was falling on an era, Chris­ rated drug therapy combined in a toph Hufeland in Germany17 was writ­ definite routine of treatment directly ing his book on the “Art of Prolong­ applicable to the complaints of the aged ing Life.” Translated into English as justifies this recognition. The title quickly as 1794, Hufeland’s word, “Medicina Gerocomica or the Galenic Macrobiotic, or the art by which life Art of Preserving Old Men’s Healths” could be prolonged, had become gen­ emphasizes the feeling engendered by erally known. He delved conscien­ its perusal that there has been faithful tiously into the past and made avowal of adherence to the Galenic tradition. gratitude for Bacon’s “Historia vitae Evidently Floyer cherished the heritage et mortis” with its ideas “bold and of centuries more than Smith who ex­ new.” He also tells the story of gero- pressed his feelings in the phrase, comic or the method of instilling “Galenists and fools.” strength and vigor into old bodies by At the same time in England George contact with blooming youth, exam­ Cheyne was publishing his views on the ples of which have already been cited. subject.16 His book contained two un­ This gentle book from the pen of a original contributions: namely, that the philosopher-physician is so encourag­ aged should guard against the vagaries ing and compelling that it is easy to of the weather, which had been noted understand how it gave rise to that vul­ by Hippocrates, and second, that the gar wave of enthusiasm to which has diet of the old should be reduced to been applied the name of the Hufe- their actual needs, which was a com­ landist Movement. Statistics, descrip­ monplace even at that time. In this tions, general treatment, flow calmly rather unnecessary collection of repe­ and wisely in a philosophical channel recently deepened, widened, and per­ ward therapeutic nihilism with the ex­ fected by Bergson. It is not medicine, ception of his own potent list of fa­ nor pathology, nor physiology, but it vorite methods and drugs. He felt that is understanding, ingenuously debunk­ the giving of opium at the close of a ing, exposing quackery, and sweeping painful and fatal disease should be the boards clean of much that had “reprobated, both from professional been carried along by inertia. The and moral considerations.” Only ex­ rapid progress of the next several dec­ treme emergencies in the aged were ades can be traced to this impetus. considered in the surgeon’s scope; cor­ As the eighteenth century was end­ rective procedures for comfort or amel­ ing, James Easton18 collected the names ioration were condemned. However, of all those persons who had attained these conclusions were only a bit more to the age of one hundred years or stringent than was applied to better more from a.d. 66 to a.d. 1799, num­ physical subjects, in those difficult sur­ bering seventeen hundred and twelve. gical times. The book was dedicated to the name­ Late in the next decade Sir Henry less oldest man alive. Although many Halford22 shrewdly noted in a short lec­ of the names were cited without sub­ ture that the characteristics of aging stantiation, it is of interest to note that often do not appear until some ex­ he included St. Patrick, Attila the Red treme change occurs. Thus illness of Hun, Thomas Parr, the Countess of differing severity, the common cold, an Desmond, and Poor Joe All-Alone in accident, or mental anxiety, could so his list. upset the balance between the internal In the 1805 edition of his “Medical and external that the mark of time in Inquiries and Observations” Dr. Ben­ the physiognomy suddenly became as jamin Rush has a chapter entitled “An apparent as a hastily applied mask. Account of the State of the Body and The name of Carl Canstatt emerged Mind in Old Age, with Observations in 1839 with the publication of his on its Diseases, and Their Remedies.”19 work,23 setting him on the highest level He expressed his belief in the follow­ yet attained in geriatrics. Hailed as a ing as the important factors in longev­ “rich mine,” “an excellent resume of ity: heredity, temperance, mental everything that had been written on vigor, equanimity, and marriage,— the subject to its date,” it is a thorough “met with only one unmarried person aggregation of all the facts logically beyond eighty years.” His keen inter­ considered that could be considered as pretations lifted the banal into the contributory to the knowledge of old field of interest and speculation. With age. The debt to Canstatt began to be Benjamin Franklin, and later Charles liquidated immediately by greater Caldwell,20 Rush is one of the earliest depth and sounder approach with accredited American writers on this fewer of the blasts of personalities subject. which in the older literature were in­ Meanwhile the thought of the sur­ teresting but had ceased to be instruc­ geons was reaching a point of early tive. His theory of aging was that the crystallization expressed in Anthony death of individual cells was so much Carlisle’s little book printed in Phila­ molecular death of the organism which delphia in 1819.21 This strait-laced was not replaced. Prior to this time, gentleman had strong tendencies to­ writers, unhindered by precise infor­ mation, had outlined an excellent hy­ brought together in a systematic man­ giene based on thoughtful observation. ner.” By the middle of the nineteenth Canstatt erected a dam across that century, subjective medical works be­ stream of thought, creating a vast reser­ came the literature of the laity, and voir into which it is refreshing to dip, geriatrics assumed its proper scientific but also enforcing newer channels for niche, protected from ignorant criti­ the newer currents. The following cism by intensifying specialization. year, Prus, in France, completed a Maclachlan’s very solid work of medi­ summary similar to that of his Ger­ cine1 written in 1863 is in the modern man colleague, underlining emphat­ style of diagnosis, description, and ically that the way back was blocked. treatment, but of its time, like the early Within the next ten years, G. E. pictures in a photograph album. Day24 produced an excellent compen­ Every study is the subject of pains­ dium foreshadowing the more com­ taking, and frequently aimless, accu­ plete texts to follow. His grouping and mulation of facts which some industri­ discussion of the afflictions of the aged ous and impatient person eventually were modern for their day and com­ condenses and classifies. These texts are plete in their time, though somewhat a convenience, but in addition become a sketchy. Books such as this one were standard for comparison, perhaps envy, necessary to the evolution of the mod­ certainly criticism, the degree depend­ ern study. Van Oven25 several years ing on the ability and standing of the later made obeisance to Hufeland as original compiler. Similar books ap­ his fellow Englishman, Day, had made pear, and the pyramiding of texts is to Canstatt. His paragraphs on the de­ finally surmounted by a Colossus that cline of life in health and in disease are bestrides the field until the next crest general and pleasant and carry in bal­ of knowledge is laboriously con­ anced fashion the increased burden of structed. From the heights of Canstatt a newer trend. we have stepped up once more on the The issue is taken up in another lan­ works of Day and Maclachlan to the guage by Durand-Fardel in 1854,26 “A high perspective created by Charcot. peine existe-t-il quelques rares travaux In 1867 J. M. Charcot27 wrote down sur la pathologie de la derniere periode some of the cream of his vast experi­ de la vie,” despite the recent work of ences at La Salpetriere which, trans­ Prus and Canstatt, and while Charcot lated by Leigh Hunt and rounded out was beginning to elucidate incompara­ by the lectures of Alfred Loomis, was bly those facts. His study takes up ana­ published in 1881 as “Diseases of Old tomical units, indicating thought in Age.” The past is fully recognized in terms of physiology, with a discussion the words “Traditional ties are not of the diseases of each, and the summa­ sundered; the labor of times gone by tion in a theory that life is a vital force is not lost; and we shall treasure up the of limited duration. immense heritage which our predeces­ Those bits of knowledge that were sors accumulated in the course of cen­ of lasting value were beginning to be turies. Still it must be confessed that swept together leaving a chaff full of new horizons have opened to us. . . .” charm, but dated. Charcot said, “To The change from speculative philoso­ constitute in reality a senile pathology, phy to physiology is complete in Char­ the scattered fragments must be cot. He did not see the aging body as an obsolescent physical machine, but hundred persons over eighty years of sought to establish its type-physiology, age including seventy-four centena­ hinted at by Floyer, as distinctive as rians. His questionnaire covering al­ that of other periods of life. It was most every detail of life was received clearly observed that the morpholog­ gracefully by the many colleagues who ical changes of age sometimes progress were requested to supply information. to such a degree that there is almost a Humphry, attracted to old age because merging of physiological and patho­ of its “calm interest in the present, and logical states. Although he lectured unshadowed by apprehension respect­ only on gout and other arthritic con­ ing the future” noted that “the aged ditions, the lectures of Loomis ampli­ body does not seem to be, on the whole, fied the subject matter in its complete prone to disease,” and also that healing and most learned form. The conclusion frequently takes place as promptly as that “the importance of a special study in the young. To express his dislike of the diseases of old age cannot be con­ for human vegetation that simply grew tested at this day (1867)” waits fulfil­ old, he quoted Cowper: ment. Despite the signposts to the way For fourscore years this life Cleora led; of knowledge, geriatrics stands out as At morn she rose, at night she went to bed. a field in which a certain type of med­ ical work most persists, the school of In 1886, J. M. Fothergill32 pub­ furred tongue, cloudy urine, diet fads, lished his work “to fill a gap in med­ and all those other common procedures ical literature.” It is simply the work of which pass over new methods too Machlachlan moved forward two dec­ lightly. To condemn an aging person ades. In 1890, A. Seidel’s compact es­ to that traditional pat on the back is says33 appeared in Wood’s Medical and to return to that time when intelligent Surgical Monographs. It is a model of physicians struggled in the dark only concentration of facts, based on the now beginning to be illuminated by pathology of the aged body, arriving fitful light. at the conclusion that senile involu­ It is natural that insurance com­ tion is an incurable disease. The newer panies should take interest in longev­ attitude based on known observed ity and the various factors entering into changes in the organism and leading its attainment. In post-Civil War days up to sensible therapy is splendidly in the United States, Smith and Gris- exhibited. com28 wrote two essays on old age valu­ After the turn of the century, C. S. able to medicine because of the excel­ Minot34 outlined his theory of aging lent preface by Clifford Allbutt. based on cytomorphosis and the rate Statistics on old age have been collected of growth. The principles are sup­ by several notable physicians. Those of ported by statistics and graphs, and his Easton have been quoted. In 1908 efforts were crowned with the en­ W. A. N. Dorland29 wrote “Age of comium of “brilliant labors.” The Mental Virility,” which is a defense of question as to why a man should grow old age supported by many figures. In old has been asked by every individual. 1888 J. Bailey30 wrote his “Modern Nascher35 recorded ten, and Warthin, Methusalehs” and in the following year eleven, theories that had been advanced was published G. M. Humphry’s “Old as an answer. Metchnikoff’s concep­ Age”11 in which are the records of nine tion36 based on autointoxication domi­ nated a generation of thought. Sir Vic­ geron, old man, and iatrikos, medical tor Horsley37 looked upon the thyroid treatment. The etymological construc­ gland as the keystone in the arch. tion is faulty but euphony and mnemonic A. Lorand,38 following his lead, ex­ expediency were considered of more im­ tended this conception to include the portance than correct grammatical con­ whole endocrine system. As a com­ struction. prehensive book on the endocrines, his Jacobi, fathering pediatrics, foster­ ideas contain much prophetic insight fathered this work, calling it the first which bears up relatively well in the modern comprehensive text on abnor­ swift current of endocrine progress, but mal and normal old age. The defects there is too much swerving of its tenets. evident today are apparent not because That which was an important gain in of its content then, but because knowl­ endocrinology failed as a concept of edge has moved beyond it. The same geriatrics. The ductless glands are often is true of Robert Saundby’s work40 pub­ surprisingly efficient in the aged, and lished about the same time in England, nothing was adduced to explain why which recognized certain shortcomings they should change except as the body in the English literature and proceeded changed, a coincidental rather than to expound a “very competent clinical cause and effect occurrence. guide.” Sanford Bennett’s system for defer­ While the World War raged, Schles­ ring age39 depended on the routine ex­ inger published in Vienna a work in ercising of the various muscle-groups two volumes crowning, and worthy of, of the body according to schemes which the best Germanic traditions. His con­ he laboriously tried and used. He pro­ clusions were derived from experience fessed to follow Cornaro who “proved directly applied to the aged, living, the truth of his statements by his per­ dead, sick, and well. Almost one hun­ sonal experiences.” Sated with modern dred years after Canstatt, a small sup­ physical culture magazines pictorially plement of these two volumes was pro­ idolizing over-developed bodies, this duced, ranking on a par with the earlier ancestor, adorned eighty-three times book. Its importance seems to have with the author’s picture, is apt to be been overlooked somewhat.41 forgotten. Thewlis’ book42 is advanced over Stimulated by Lorand, guided by the that of his mentor, Nascher, just as the pathologists, recognized by the state, latter is pre-war, the former, post-war. knowledge moves forward in this cen­ Although much of the material is out­ tury. The name Geriatrics, although moded, the treatment is sympathetic it has been used throughout this study, and deserves attention. Floyer insisted was not invented until 1914 when I. L. on baths, Lorand, on the endocrines, Nascher applied it to his masterpiece.35 Cornaro, on temperance, and Thewlis placed undue emphasis on the kidneys. Believing that attention would be more There seemed to be no geriatric equa­ readily concentrated upon this subject if it were considered entirely apart from tion that could not be balanced by maturity, the author suggested that it be making the renal tract serve as X, for studied as a special branch of medicine, example, “a diet for nephritis will be to which he has applied the term geriat­ satisfactory even though the patient rics. This term, which has been generally may not have nephritis.” This stress adopted, is derived from the Greek, impairs the value of many discussions in addition to the fact that the therapy tion are Arnoldus de Villa Nova, Van fails to live up to its times. However, Swieten, Richter, Louis, Scudder, criticism falls away in the gratitude for Demange, Tiirck, Chaussard, Grisolle, the book, and with an unintentional Gillette, Ewald, Brossard-Ysabeau, Re- play on words, it may be said that in it, veille-Parise, Boy-Teissier, Quesnel, geriatrics comes of age. The bibliog­ Weber, Holmes, Lipscomb, to mention raphy is excellent. Thewlis continues but a few. Charcot dismissed far too to contribute new facts in this field in many as “more or less ingenious para­ which he stands out as one of the most phrases of the famous treatise ‘De prominent workers. senectute.’ ” The work of L. B. Williams43 pub­ We have come into the present lished in 1925 is a combination of en­ wherein the application of new knowl­ docrinology and autointoxication, its edge sifts down so that the aged benefit, date of publication being its most mod­ although possibly at second-hand, and ern feature. Despite a characteristic certainly more as individuals than as English charm of style, there is little of a group. Texts are less harmonious, value or novel incorporated. The static journals are fuller, and more studies tendency of the second decade of the are being made both in routine and in twentieth century was cut short by A. S. particular reference to the aged. The Warthin’s “Old Age.”44 The thesis is illogical procedure of treating a child that “senescence is a normal involu- by Jacobi, an adult by Roentgen, and tionary process” and it continues to a an old person by Galen is vanishing as logical, if depressing, end. The minor Charcot had demanded. We have come changes of the body are shown to be through the subjective school, through for the good of the individual; the empiricism, superstition, fads, undue major changes (including death), for emphasis, to the present; stepping off the good of the species. The monkey­ in a well-rounded view of the older in­ gland school is disposed of with honest dividual as a thoughtful individual scorn: “so-called rejuvenation pro­ who must be handled ever so skillfully duced by the sex-hormones of the trans­ not because of any supposed defects in planted testes, or by ligation of the vas, his aging mechanism, but because from is no rejuvenation in any sense of the a life of observation, he knows what is word, but is a re-erotisation wholly.” being done for him, and can evaluate However, the book is more valuable to his reactions almost from a distant the comprehension of the larger prob­ plane. This individual realizes that lems of biology than to the treatment “age is never chronological, except in of the ailing. a legal sense,” knowing that there is a The glitterings in a handful of sand distinctive individuality of the aging owe their occurrence to the point of body even as has been marked arbi­ view, differing in no respect from many trarily into other phases of the continu­ of the names that emerge almost by ity of life. As Floyer wrote: “Every man chance in a chronology. Among the is a fool, or becomes a physician, when many that additionally deserve men­ age is upon him.”

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