You’re Looking Very Well

Dr George Cheyne, an eighteenth-century doctor, believed the English were dying due to an excess of comfort, wealth, and luxury—the ‘English Malady’—and that the way to prevent ageing was by eating only enough food to allow the body to maintain its heat. A little later the German physician Hufeland argued that fast living led to short living, that you should drink no alcohol, chew your food deliberately, and be positive. He stated: ‘We frequently find a very advanced old age amongst men who from youth upwards have lived, for the most part, upon the vegetable diet, and, perhaps, have never tasted flesh.’ He accepted the view that at birth an individual was endowed with a finite amount of vitality and that this decreased with age.

The scientific study of ageing only began to make progress with the work of Benjamin Gompertz, whose paper in 1825 described human vital statistics from several countries, and showed that the prevalence of many diseases increased in the same way as mortality. He concluded that death may be the consequence of two generally coexisting causes; the one, chance, without previous disposition to death or deterioration; the other, a deterioration, or an increased inability to withstand destruction, namely ageing. Gompertz was interested in the latter situation: how can we model the probability of a person living to a certain age, if nothing unexpected happens to him? His important results showed that mortality increases exponentially as age increases between sexual maturity and old age.

The Belgian scientist Adolphe Quetelet recognised that both social and biological factors determined how long humans live, and made important contributions to life histories. Quetelet began his research by the physical study of the ‘average man’. He laboriously recorded population statistics surrounding the birth, height and physical proportions of men at various ages. Among his findings were strong relationships between age and crime. Charles Darwin’s theory of evolution came out at this period, and Quetelet wanted to know whether selection for those who are better adapted continued after the individual’s reproductive phase. Darwin’s cousin, Francis Galton, was interested in ageing, and collaborated with Quetelet to measure the correlation between age and strength. In 1884 he collected the physical reaction times of some 9,000 people aged from 5 to 80, which were not analysed until much later.

In 1881 August Weismann delivered an important lecture on ageing at the University of Freiburg. It was the first attempt to explain ageing in terms of Darwinian evolution and the behaviour of cells. He was convinced that immortality would be a useless luxury and of no value to an organism, and that the cause of ageing would be a limitation of cells’ ability to reproduce. He regarded ageing as adaptive, as it helped get rid of decrepit old individuals who competed for resources with others in their group. This was wrong, as we shall see. He nevertheless recognised the important principle that once an individual had successfully reproduced and cared for their offspring, it ceased to be of any value to the species. He also made clear that the germ-line cells which give rise to eggs and sperm must not be subject to ageing, for if they were, the species would die out. It was another 60 or so years before there were further attempts to understand the evolution of ageing.

Jean-Martin Charcot, a famous neurologist at the Pasteur Institute, also promoted the study of old age, which he recognised as being neglected. His lectures on the medicine of old age, Clinical Lectures On Senile And Chronic Diseases, aroused scientific interest in the field, and became available in English translation in 1881. They had a big influence, as Charcot saw old age as the simultaneous enfeebling of function and a special set of degenerative diseases, and these needed to be distinguished. Elie Metchnikoff, a Russian who went to the Pasteur in Paris in 1888, continued Charcot’s work and coined the term gerontology in 1903. Geronte is French for ‘man’ and has nothing to do with ageing but it remains with us as a name for the science of ageing.

Metchnikoff won a Nobel prize for showing how certain cells in our bodies defend us against invaders like bacteria, by eating them and dead material, a process known as phagocytosis, and he saw old age as cellular involution in which cell decay outbalances cell growth. He believed ageing was due to bacterial toxins released from the intestine, and that Bulgarians lived especially long lives because they ate yogurt. He thus touted yogurt as an anti-ageing medicine. Based on his theory, he drank sour milk every day. George Edward Day (1815–72) wrote a common-sense book from the physician’s perspective on ageing in 1848. He complained that other physicians had little interest in caring for the ills of the aged. That refrain still rang true during the first few years of the twentieth century.

Modern geriatrics was born with the invention of the word ‘geriatrics’ by Ignatz Leo Nascher from the Greek word geras for age. Nascher was born in Vienna in 1863, graduated as a pharmacist and then obtained his medical degree from New York University. He wrote a number of articles on geriatrics and a 400- page book, published in 1914, Geriatrics: The Diseases of Old Age and Their Treatment. He described ageing as a process of cell and tissue degeneration. He thought, mistakenly, that all our cells except for the brain were replaced as we aged. A major problem for him was how to distinguish between diseases in old age and diseases of old age. His interests in geriatrics and his development of treatments for older people almost certainly came from visits to Austria, where the care of elderly people was blossoming at the time. He retired at the age of 66.

Nascher’s interest in geriatrics is a bit strange as it contrasted wildly with his contemporary William Osler, the famous Canadian physician who was chairman of medicine at Johns Hopkins in Baltimore. Osler appeared to be remarkably ageist, as shown in his final address, called ‘The Fixed Period’, in which he stated that men over 40 years, beyond the golden age of 25 to 40, were relatively useless. Men over 60 years were considered absolutely useless, and chloroform was not a bad idea for this age group. This address is said to have been responsible for a number of suicides.

While there were scientific studies on child development, ageing was still largely ignored in the early twentieth century. The psychologist G. Stanley Hall was a founding father of psychology as a science. His major work was on child development, but, concerned about his own ageing, he wrote a book about ageing, Senescence, in 1922. He interviewed some elderly adults and found that their attitudes towards death changed as they aged. This was the first analysis of the changing attitudes and thinking linked to ageing:

How different we find old age from what we had expected or observed it to be; how little there is in common between what we feel toward it and the way we find it regarded by our juniors; and how hard it is to conform to their expectations of us! They think we have glided into a peaceful harbor and have only to cast anchor and be at rest.

It was Peter Medawar in 1952 who pointed out that environmental factors progressively reduce an individual’s lifespan, and natural selection would ensure that the good genes that support reproduction act early, and the bad ones that prevent reproduction much later. This was a major advance and it later became the basis for Tom Kirkwood’s disposable soma theory, which recognised that just a small amount of energy was devoted to repair of ageing processes as compared to reproduction, growth and defence. The theory also claims that ageing is due to the accumulation of damage to the body, and that long-living organisms devote more to repair.

Perhaps the greatest impetus for the modern ‘merchants of immortality’ came from Leonard Hayflick’s finding that there were just a finite number of times a fibroblast cell could divide when placed in culture. This eventually became known as the ‘Hayflick Limit’. The original article by Hayflick was rejected by the Journal of Experimental Medicine with a scathing letter from the editor that stated, in part, ‘The largest fact to have come from tissue culture research in the last fifty years is that cells inherently capable of multiplying, will do so indefinitely if supplied with the right milieu in vitro.’ It was eventually published in Experimental Cell Research in 1961.

If Nascher was the father of geriatrics, Marjory Warren was its mother—particularly in relation to care of the aged. She worked at the Isleworth Infirmary, which in 1935 took over responsibility for an adjacent workhouse to form the West Middlesex County Hospital. During 1936 Dr Warren systematically reviewed the several hundred inmates of the old workhouse wards. Many of the patients were old and infirm, and she matched care to their needs. She initiated an upgrading of the wards, thereby improving the morale of both patients and staff. She advocated creating a medical speciality of geriatrics, providing special geriatric units in general hospitals, and teaching medical students about the care of elderly people. Among her innovations was to enhance the environment and emphasise increased motivation on the part of the patient.

Before the Second World War there had been little interest in old peoples’ mental or physical health. Joseph Sheldon, while working at the Royal Hospital in Wolverhampton, undertook a survey of 583 old people sponsored by