Old age, the dusk of life, where people tread on
cautiously down the meandering road of life, thanks to diseases, financial
issues, & other matters that could all cramp out a healthy life. Nearly 75%
of the elderly in our country suffer from one or the other chronic disease, 40%
have a disability & 20% go through issues related to mental health,
revealed the India Report on Longitudinal Aging Study of India in 20211.
Human beings have been looking for ways to break away from vice-like grip of
old age since eons.
Geriatrics is a field of modern medicine dealing with
the health & care of old age. As the aging population is rising rapidly,
this is a field of great impact & importance.
This blog post traces the origins of this field of
medicine from Mythology upto a seminal work in the 1720s..
Mythology..
Mythology is teeming with tales of demigods trying to avoid old age & death. Let’s look at a couple of them..
Gilgamesh, the Babylonian demigod, prayed to gods to
help him to live forever. The gods asked him to avoid sleeping for seven days,
a task at which he couldn’t succeed. The gods, benevolent as they’re meant to
be, gave him another chance. They asked him to get a plant from underwater
& eat the same. He was so amused by the joy derived from swimming around,
that he forgot to eat the plant which he got after much trouble, which was
eventually eaten by a snake. As Winston Churchill observed, death & taxes
are inevitable.
In Greek Mythology, Tithonus was the morning lover of
the goddess of dawn, Aurora. He was apparently so good at what he did for her
that she went to her father, Zeus, and asked if Tithonus could have eternal
life. Zeus, being a doting father, immediately granted Tithonus immortality.
The problem is that she had not asked for eternal youth. So, over time the
aging process took its toll and when Tithonus reached 100, he had mild
cognitive impairment and went around Aurora’s castle babbling incessantly. She
no longer loved him and one day she turned him into a grasshopper2!
Blessings & curses in Greek Mythology need at least two blog posts (maybe
more!!)…Lol..
Walk Like an Old Egyptian..
Ancient Egyptian civilizations had been way ahead of the others. They used orthotic devices or splints, had ways of preserving dead bodies & knew a thing or two about the ravages of old age as well. Old people develop kyphosis due to osteoporosis & have balance issues. The hieroglyphic for ‘‘old’’ in ancient Egypt (2800 B.C.) was a bent person leaning on a staff—perhaps the first depiction of the ravages of osteoporosis. In 1550 B.C., the ‘Ebers Papyrus’ suggested that ‘‘debility through senile decay is due to purulency on the heart.’’2 More on heart, heat & the soul below…
Hippocrates & Aristotle on Aging..
‘The Hippocratic Corpus’ posited that the ageing process resulted from a gradual and progressive loss of heat from the body, which became colder and drier, and so resembled the properties of earth. It promoted the view of old age as a time of increased susceptibility and less resistance to disease, mirroring the current concept of aging as increasing frailty (frailty is now a recognised syndrome).
The ideas recorded in the Corpus were the ones to fuel
the theory of old age expounded by Aristotle (384–322 BC), who postulated the
union of the soul and body, with the heart as the seat of the soul. Heat was
thought to be generated in the left side of the heart and to spread from there
throughout the body. A finite amount of energy was present at birth and this
internal heat or vital spirit was gradually consumed over time, so that little
remained in old age. Though innate heat could be fortified by various means, it
could never be completely restored to its original level. Aristotle recognised
that old age was associated with increased vulnerability to disease processes,
when even minor illnesses could have a fatal outcome in a short span of time3.
Galen, Ibn Sina & Aging Like Fine
Wine..
Galen (131–201 AD) propounded that as ageing is a natural process, & as it was unavoidable, it was definitely not a pathological entity. He had a conviction that it was an interim state between health & illness. Although he seconded that the aging body lost heat, Galen believed the ageing process could be modified by adopting a moderate lifestyle with attention to exercise and diet, which would promote warmth and moisture. He referred to this as the Gerocomic art.
Ibn Sina (980–1037) believed, as Galen did, that the
result of ageing was a cold, dry body. In his first book he devoted a section
to a dietary regimen for older people, which would render the body warm and
moist. He recommended that food should be taken in small amounts and that
fruit, ginger and old, red wine were particularly beneficial3.
Early Search for the Elixir of Life..
The notion of the existence of a place of eternal
youth became embedded in Western thought throughout the Middle Ages, & with
this began the search for the ‘elixir of life’. It is well depicted in Roger
Bacon’s ‘Cure of Old Age and Preservation of Youth’, published in the
thirteenth century. The work was the most important at that time to deal with
the process of ageing, ways to ‘remedy’ it and to describe the clinical
features of ageing such as wrinkling of the skin and shortness of breath. Bacon
believed that the life span could be extended to 150 years or more. How
exactly? By living a life of moderation. By moderation he meant - eating a
controlled diet, proper rest, exercise, moderation in lifestyle, good hygiene,
and inhaling the breath of a young virgin!!2,3
Early Printed Works on Ageing & Health…
The period from late Renaissance to the 16th
century saw many works relating to health and disease in old age appearing in
printed form. Two works which were greatly influenced by Galen’s theory need to
be mentioned:-
Gabriele Zerbi’s ‘Gerontocomia’, in 1489, which
revived the concept of Gerocomy. It emphasised the importance of hygiene in the
elderly, accepted that the diseases described could not be cured &
differentiated between natural death as a result of loss of heat & death
associated with an illness.
In ‘Opuscula Medica (1627’), François Ranchin,
of the University of Montpellier, also distinguished ‘natural senescence’
attributed to a lack of heat from ‘accidental senescence’, which was due to
disease. Like Galen, he considered old age to be a condition between health and
illness, one which was prone to disease. In this work he rallied the cause of
promoting Gerocomia, a field focusing on the promotion of health of the elderly3.
Francis Bacon’s Contribution…
Francis Bacon gave us the scientific method. He also put forth a new concept of aging. In his work ‘History, Natural and Experimental, of Life and Death or of the Prolongation of Life’, published in 1623, he propounded ageing based on ‘spirit, or body pneumatical’ through which the body functioned and which declined in old age as a result of unequal repair to different parts, eventually leading to the decay of the whole body, culminating in natural death. A life of moderation, he believed could prolong life. Among his list of instructions were: do not get excited (well, there was no internet back then!!); avoid the sun’s rays; take baths; eat sweetened but not acid food; take physical exercise, but do not overdo it.3 Suffice to say, his ideas in this field didn’t have much impact…
Medicina Gerocomica…
In ‘Medicina Gerocomica: Or the Galenic Art of Preserving Old Men’s Healths’, published in 1724 by Sir John Floyer of Lichfield (1649–1734), an elaborate description of the current state of medical knowledge of the older people was laid out. What makes it even better is the fact that it was in English, or what it used to be back then!! Although based on the humoral theory, it went out to even offer therapeutic options for various ailments…
"Every man is a fool or becomes his
own Physician at 40 or 50 years of age"- from Medicina Gerocomica.
Despite his asthma, on which he wrote a groundbreaking
treatise, Floyer lived to the ripe old age of 853,4…
To be
continued…
References
2. 2. Journal
of Gerontology: MEDICAL SCIENCES In the Public Domain 2004, Vol. 59A, No. 11,
1132–1152
3. 3. J R Coll Physicians Edinb 2012; 42:368–74
4. 4.Thorax
1984;39:248-254
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