A Conceptual History in the Nineteenth Century German E. Berrios

VIEWS ON AGEING BEFORE THE NINETEENTH CENTURY

Like most other aspects of human life, ageing has also been portrayed in terms of metaphors. Classical views, following the nature-nurture controversy, conceived of ageing as resulting from either internal instructions or from the buffeting of foreign factors^4,8.

The ‘wear and tear’ view happened to be popular during the early nineteenth century, the period on which this chapter will concentrate. It was based, as it had always been, on the ageless observation that all natural objects, whether animate or not, are subject to the ravages of time. Surprisingly enough, the ‘wear and tear’ view has not always generated an understanding attitude. In fact, across times and cultures great ambiguity has existed in regard to the treatment of old folk. Fortunately, a realistic acceptance seems to have predominated although there is plenty of evidence of hostility. The Hebrew tradition, and indeed its Christian offshoot, encouraged much reverence towards the wisdom and value of old age. But even in societies that have made great play of this view, veneration has been reserved for those in positions of power or influence¹². Little is known about attitudes towards elderly women or old men in humbler stations¹¹.

So, it can be concluded that, all in all, a view seems to have predominated that ageing was undesirable and that the identification of wear factors was important to devising ways of prolonging life^5,13.

A second ambiguity can be detected in these earlier writings. It concerns the extent to which the ageing process necessarily involves the human mind. While it was a palpable fact that all human frames decayed, not everyone accepted that this had necessarily to affect the soul or mind. Extant descriptions of the psychological changes brought about by old age suggest that people were aware that the mind also underwent a decline. However, theory and religion encouraged the view that the spirit could or did escape wear and tear, and that human beings grew ever more wise and useful, thanks to the accumulation of experience and knowledge. This belief must have been available in all those societies that felt the need to create adequate spaces for all manner of intellectual and/or sociopolitical gerontocracies². Some seem even to have separated chronological age and functional age in order to justify such concessions. From the point of view of the history of psychogeriatrics, it would be useful to know to what extent this belief was undermined by the occasional case of dementia among those elderly in positions of power¹. Historical evidence seems to show that these situations were neither more nor less perturbing than mental illness occurring at other periods of life. Indeed, fail-safe devices seem to have been available in these societies to cope with the upheavals created by such occurrences.

Men like Buffon, Darwin and Goethe reshaped ideas on ageing during the eighteenth century. Buffon¹⁴ wrote: ‘All changes and dies in Nature. As soon as it reaches its point of perfection it begins to decay. At first this is subtle and it takes years for one to realise that major changes have in fact taken place’ (p. 106). Buffon put this down to an ‘ossification’ process similar to that affecting trees: ‘this cause of death is common to animals and vegetables. Oaks die as their core becomes so hard that they can no longer feed. They trap humidity, and this eventually makes them rot away’ (p. 111).

Erasmus Darwin’s views resulted from the application of yet another metaphor, namely that ageing results from a breakdown of ‘communication’ between man and his environment¹⁵. Darwin suggested that such breakdown followed a loss of irritability (a property of nerve fibres) and a decreased response to sensation:

It seems our bodies by long habit cease to obey the stimulus of the aliment, which support us … three causes may conspire to render our nerves less excitable: 1. If a stimulus be greater than natural, it produces too great an exertion of the stimulated organ, and in consequence exhausts the spirit of animation; and the moving organ ceases to act, even though the stimulus is continued. 2. If excitations weaker than natural be applied, so as not to excite the organ into action, they may be gradually increased, without exciting the organ into action, which will thus acquire a habit of disobedience to the stimulus. 3. When irritative motions continue to be produced in consequence of stimulus, but are not succeeded by sensation. (p. 365)

VIEWS ON AGEING DURING THE NINETEENTH CENTURY

In 1807 Sir John Sinclair¹⁶ published a major compendium on ageing and longevity, which included references to most pre-nineteenth century sources. It was, in a way, the last grand glance to the past. Soon afterwards work started by those who, like Leon Rostan (1791-1866), based their claims on empirical findings. Rostan, one of the most original members of the Paris school, published in 1819 his Recherches sur le Ramollissement du Cerveau¹⁷, where the view commenced that vascular disorders might be as important as parenchymal ones in brain ageing. Even more important was his uncompromising anti-vitalistic position enshrined in the claim that all diseases were related to pathological changes in specific organs^18,19.

During the 1850s Reveille-Parise³ saw his task as writing on ‘the history of ageing, that is, mapping the imprint of time on the human body, whether on its organs or on its spiritual essence’ (p. v). In regard to ageing itself he wrote: ‘the cause of ageing is a gradual increase in the work of decomposition … but how does it happen? What are the laws that control the degradation that affects the organization and mind of man?’ (p. 13). Reveille-Parise dismissed the toxic view defended by the Italian writer Michel Levy²⁰ according to which there was a gradual accumulation of calcium phosphates that led to petrification, to an ‘anticipation of the grave’. This view, he stated, had no empirical foundation and was based on a generalization from localized findings. Reveille-Parise supported the view that ageing results from a negative balance between composition and elimination, which equally affected the cardiovascular, respiratory and reproductive organs.

Finally, the views should be mentioned of J. M. Charcot, who in 1868 offered a series of 24 lectures on the diseases affecting the elderly²¹. Charcot dedicated Lecture 1 to the ‘general characters of senile pathology’; he started by saying that all books on geriatrics up to his time had ‘a particularly literary or philosophical turn [and had been] more or less ingenious paraphrases of the famous treatise De Senectute’ (p. 25). He praised Rostan for his views on asthma and brain softening in the elderly, and predictably also mentioned Cruveilhier, Hourman and Dechambre, Durand-Fardel and Prus. He criticized Canstatt and other German physicians because in their work, ‘imagination holds an immense place at the expense of impartial and positive observation’ (p. 26). Charcot’s own contribution was based on the general principle that ‘changes of texture impressed on the organism by old age sometimes become so marked, that the physiological and pathological states seem to merge into one another by insensible transitions, and cannot be clearly distinguished’ (p. 27).

THE DEVELOPMENT OF THE NOTION OF BRAIN SCLEROSIS

When in 1833 Lobstein²² described the basic pathology of arteriosclerosis, he did not imagine that it would, during the second half of the century, become the mechanism of ‘senility’ par excellence^14,23,24

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