Prolongation Of Health
( Originally Published 1912 )
"The truest courage lies,
AFTER the attainment of maturity, the human body in health remains almost at the same level, as far as physical changes are concerned, for many years. This period of comparative perfection should last for forty years or more. There are, of course, certain slight changes, such as the tendency to in-creased weight, to the increase of fat, and to the lessening elasticity of heart and arteries; but, generally speaking, the prime of life, as it is called, the life on the mountain-top, should go on for about forty years, and this rule should apply to both bodily and mental powers. But in time there commences a series of changes which are known as senile decay.
That wise physician Milner Fothergill graphically describes the oncoming of this condition thus : " Such changes are easily recognized in the very old; but they are commonly overlooked until their existence is almost forced upon the attention of the observer. This is unfortunate, as it is often a matter of great moment, in the recognition of the true state of the case, to be able to detect the early evidences of impending decay. The process is normally a slow one, and consequently the first changes must be insidious and occult. Not only this, but they will be very slowly developed. This, however, forms no reason why these changes should be overlooked, and that their significance be omitted from our estimate.
" Many people, even medical men, have irrational notions about their health and their tissues. The idea that there may be atheroma in their blood-vessels, that there is a commencing hypertrophy of the heart, or that their kidneys are no longer sound, is sufficient not only to perturb them, but to set them to work at once to prove, at least to their own satisfaction, that they are free from the slightest taint of commencing decay. If it were merely a subject of self-satisfaction to the individual, it would matter little; but, unfortunately, such attitude and conduct stand in the way of a proper comprehension of the slow and gradual progress of the chronic changes. These prejudices foster ignorance; and that ignorance often assumes an aggressive character."
Since that was written, forty years ago, our means of investigation of these early changes have become more accurate and scientific, and our means of treatment more scientific and successful also. It is only in these early stages of downward progress that we can expect to do much to arrest or to cure. If the symptoms and changes are allowed to pass on, till definite structural alteration of the tissues arrives, we can only spend our efforts in patchwork repairs and in making the inevitable descent as easy as possible. The mere prolongation of life were an object scarcely worth the seeking, if we could not at the same time hope to prolong the health and strength of both body and mind.
There can be no more pleasing sight or companionship than old age, free from suffering of body and with mind serene and mature, and there is certainly no more distressing sight than old age borne down with infirmity and with mind clouded and unhappy.
Job says in his inimitable words : Thou shalt come to thy grave in a full age, like as a shock of corn cometh in in his season." This should be our ideal, to help our Creator towards the fulfilment of His handiwork. Most of us in our self-indulgence and ignorance spend our early and middle years in tearing up His kindly plans, and later in bewailing our misfortunes. Self-indulgence or any form of intemperance is a sin for which we shall have to pay here, and ignorance of such vital concerns as our health and well-being comes perilously near to a sin, for it is God's work that we are spoiling and His plans that we are frustrating; and can there be any knowledge more important or more worth the getting? Froude says : " The knowledge which a man can use is the only real knowledge, the only knowledge which has life and growth in it, and which converts itself into practical power. The rest hangs like dust about the brain, or dries like raindrops off the stones."
What should be the average duration of life in man is as yet an unsettled problem. That the duration of his life has much increased during the last hundred years is undoubted, as the statistics of all insurance offices show, but how much of that is due to lessened infant mortality is not quite clear. That the limit of life, in healthy people who have lived temperate, careful lives, should be a long way beyond three score years and ten must be considered certain. For generations as a race, if not as individuals, we have done nearly all in our power to shorten life, by overfeeding generally, by over-stimulation often, and by living and sleeping in close, badly ventilated, sunless, unsanitary houses. We seem to have lost the intuitive knowledge of what is good and bad for us, that most animals possess.
Some enthusiasts claim that vegetarianism is the one rule of life, but observation of the animal kingdom does not support any such theory. The raven, which is almost exclusively a flesh-eating bird, lives nearly one hundred years, and so do many of the larger parrots, which are vegetable feeders. What is the average duration of life in the large carnivora, such as lions and tigers, in a state of nature, it is almost impossible to gauge, but the domestic cat is not of long life. Elephants, which are vegetarian exclusively, live to very great age, 150 to 200 years, but horses and cattle, also vegetarians, seldom live beyond 25. The larger tortoises, which are probably the longest living animals known, living 300 to 400 years, are some of them insect eaters and some vegetable eaters. That their various organs, such as mouths, teeth, limbs, etc., are all planned in accordance with their feeding habits goes as a matter of course.
Roughly, I think, there exists a law something like this. The time or number of years it takes for an animal to arrive at full maturity regulates the length of life. An elephant takes about forty years to get fully mature; multiply that by two, and that roughly represents his period of full strength. Another similar period represents his gradual de-cline; thus 40+80+80 makes zoo years, which seems to be his limit. A dog takes, 2 to 272 years to get fully mature; 21/2+5+5 makes 12%. A horse 5+I0+I0. A man arrives at maturity about 20. His life should therefore be 20+ 40+40, which makes 100. Whether the same rough law holds good in birds and fishes is very difficult to establish. Some fish, as carp, which grow very slowly to a great size, are very long-lived. I was at Versailles in 1872, and in one of the ponds there a big carp came up to be fed, as they have done for years; he had a silver plate let into the back of his neck, which showed that this was affixed before the great French Revolution, so he must have been eighty years old at least.
That we, as a race, have failed to make the most of our lives must be regarded as a certainty. We all of us know men and women over ninety, in good health and in possession of their mental faculties; and as sanitary, physiological, and sociological science grows, so must the duration of man's life. Ninety years should be our lowest ambition.
Old age is inevitable, and death of course is inevitable, but that miserable fiasco we call senility is not a law of nature. It is, on the contrary, evidence and proof that the law has been broken, by ourselves, by our forebears, or by both, and it emphasizes the importance of the inheritance that we hand on to our successors. But are we to remain stationary and satisfied with the laws of nature as we read them today? Is there to be no evolution of law as of life? What we call law is much the same as that crippling word " normal." I am not speaking now about a normal temperature of the body, nor about the normal constitution of inorganic matter—though as for these things we may be able to perceive in our short lives what is only a temporary normal, a point which in the infinity of time may be slowly rising but about the normal in moral thought, in philosophy, and in the science of life. An actual normal point is in reality non-existent; it merely represents an approximate present average. Yet it is one of those words, like orthodox," that obsesses us, and that the unthinking mind regards as almost sacred ; but the reasoning mind cannot fall down and worship an approximate average. This reverence for the normal is almost a gospel of despair; it produces nothing but mediocrity, and is an obstruction in the path of progress. Is the old age-limit of three score years and ten, dating back from David, to remain our normal standard still? Surely not. The average duration of life and working years is steadily in-creasing, and their limits and possibilities are not yet in sight. The normal of today should go on steadily growing into the subnormal of to-morrow ; we may have to think in years or centuries in place of days, but a healthy discontent or a natural ambition should ever be driving us on towards an ever-retreating goal. This great result is not going to be attained by any royal or easy road, by this or that man's medicine, by sour milk or by any other food fads, but by an all-round application of scientific and logical thought; by improved sanitation, and by a wise and temperate reform of all that belongs to our moral and physical lives. A democracy, the ideal form of government, is good or bad according to the character of the people who form it, and is an Unerring reflection of the average of their development; but it nearly always contains an aristocracy, not one of birth or wealth, but of wisdom and knowledge, which is working to raise the standard of the whole body politic. In like manner
we physicians and all the aristocracy of Science should ever be striving to raise the standard of physical and mental health in the demos of the world, which is in a measure entrusted to our care. That dream, the elixir of life, has not been discovered, but the researches into the action of the internal glands, which Brown-Sequard introduced to the world on June 1, 1889, have in a way revolutionized medicine. Biedl eloquently says : As the founder of the doctrine of internal secretion, Brown-Sequard has opened to Physiology a new and fruitful field for experiment; he has paved the way for the right understanding of many pathological derangements; and he has pointed out a rational and, in many cases, a remarkably successful method of treatment."
Our present knowledge of these glands is but superficial, but we already know enough to see their power and in some measure their possibilities in the treatment and postponement of senile decay. We shall preach and we shall practise, we shall fall, as did Metchnikoff, by the way, and we shall be jeered at as mad prophets who stultify their own prophecies, but in the true spirit of altruism we must march steadily on, remembering that " tulit alter honores " is the fate of all reformers, and that the welfare of the many can only come from the work and suffering of the few.
As I have hinted in my first chapter, senility, in its most distressing aspects, is not the result of wearing out or of overwork. Men and women who work till they drop rarely get gradual decay; they die suddenly or after a few days' illness. Senility, scientifically speaking, means the cessation of renewal, more than the destruction of existing tissues. Where lies the centre of vital power and what it is we cannot definitely say, but it is almost certain that the chief agents of that power are our ductless glands, and it is their failure that spells senility.
It is perhaps hardly necessary to draw a picture of morbid and premature old age, but as a warning it may be useful. Firstly, look on the bodily side : the wasting, slackening muscles, the loss of spring and activity, the slow, shuffling walk, the shortness of breath, the pallor and sallowness of the skin, and the vacuity of expression.
The more unseen bodily infirmities it is needless to enumerate. Secondly, look on the still more painful failure of the spirit; the loss of memory for the most important things of the day, the mind dwelling only in the far past, the dulness of perception, and the inability to take in any new ideas; the childish irritability and impatience, unrelieved, as in childhood, by intervals of sanguine hopefulness. Many, men especially, sink into anecdotage, and when that anecdotage becomes a perpetual encore, they become the worst of bores. To quote Fothergill again on this dismal state : " The prattling child becomes once more the most highly appreciated companion; and the garrulous age loves to pour into uncritical ears long tales of a far by-past time. In habits, thoughts, taste and food, age approaches youth. The process of evolution has given place to a reversed action, or involution. The higher processes, which are slowly developed, and which are to a large extent outcomes of training and education, gradually fade out and lose their controlling power—the last to develop and the first to go—and the most vivid and enduring impressions of the doting brain are the experiences of its early days, the impressions of childhood."
This is not a cheerful outlook: it is worse, it is humiliating; but surely such an unhappy and untimely ending to our earthly existence cannot be in accordance with the Divine purpose. We see it not in the animal kingdom (except in the over-fed, pampered domestic pets who share our vices). The true cause, without doubt, is in our ignorance of the physiological laws of health (laws which the animals seem to know by an instinct which we have lost) ; in intemperance, in overindulgence, and still more, perhaps, in the great strain of social or business ambitions. Our lives are far too intense and complicated. The mad and ineffectual race for life becomes too often the triumphant race for death.
A thoughtful reader will soon say something like this : " I have known men and women who have lived the most exemplary lives as regards morality and temperance, but whose old age has been clouded and miserable "; and doubtless such is the case, but further inquiries will show that one or both of the causes are morbid constitutions inherited from erring forebears or an ignorant neglect of the primary laws of health.
Some years ago I knew a man who spent his whole life in philanthropic and religious work, travelling the country, preaching, speaking, and organizing; but in his devotion to his work he entirely neglected his body. He would leave home immediately after breakfast, and return late at night, having taken no food, unless some friend had made him share his meal. At a little over sixty he became first a physical wreck, partially paralyzed; and later his unusually fine religious mind became that of a degraded animal.
The thoughtful regard for the body which has been given us is just as much a duty as the care of the soul. When one looks around and sees these good religious and unselfish souls breaking down prematurely and their lives ending in apparent failure and disease, one is tempted to cry out against the injustice of it all; but God's laws and punishments must not be judged by a few individual cases. These poor sufferers are like those on whom the tower in Siloam fell—not sinners above all men that dwelt in Jerusalem, but they are guide-posts to show that all God's laws must be obeyed, and not only a chosen few of them.
In face of these degenerative changes which bring about the final tragedy of so many valuable lives, we must not sit still, unhelping and impotent spectators. Such an attitude surely is both unscientific and unworthy of our great profession. And yet how many of us, doctors and laity alike, regard the maladies and diseases of old age as inevitable and unalterable. Modern medicine is disproving these conclusions every day, but we are yet only at the beginning of our knowledge in matters relating to the cause and prevention of decay.
I have used the above words " maladies " and " diseases of old age " purposely, for it is the maladies that are diseases in their infancy, and it is in this early stage that progress may be arrested and in not a few cases a return to normal health be obtained. The functional error precedes, often for a long time, the structural alteration that we call disease, and it is in this stage, of course, that our curative measures will be the more successful.
If we wish, as all of us must do, to further the work of God, the great Creator of all life, and to be with Him a co-worker, we must fix in our minds that His watchword and method is progress; not death or destruction. The tragedy, as we call it, of death is a delusion; there is no death and so no tragedy.
Progress will continue after we cease to live here, but to use our earthly life to the best purpose and to prolong it to the uttermost should be our manifest duty and delight. In evolution we see the unfolding of the Divine Will, the power and the beneficent design, all marching, in spite of wars and cataclysms, harmoniously for the good of our race. Evolution, apart from religion, is God's gospel to the world; it is the history of our past, the explanation of our present, and the hope and glory of our future.