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.