Some Medical Aspects of Old Age Being the Linacre lecture, 1922, St. John's college, Cambridge
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SOME MEDICAL ASPECTS
OF OLD AGE
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SOME MEDICAL ASPECTS
OF OLD AGE
BEING THE LINACRE LECTURE, 1922,
ST. JOHN’S COLLEGE, CAMBRIDGE
Sir HUMPHRY ROLLESTON, K.C.B.
M.D., D.C.L., LL.D.
PRESIDENT OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON
EMERITUS PHYSICIAN, ST. GEORGE’S HOSPITAL
SOMETIME FELLOW OF ST. JOHN’S COLLEGE, CAMBRIDGE
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The material in this small volume was collectedin connexion with the Linacre Lecture at St.John’s College, Cambridge, and has beensomewhat expanded since its delivery on 6thMay 1922. The introduction is chiefly oflocal interest in connexion with the history ofthe Linacre Lecture. Without attempting acomplete account of old age and its diseases Ihave passed in review some ancient and modernmedical aspects of this subject, but, except forincidental references, medical treatment has notbeen considered.
For ready help, especially as regards theillustrations, my cordial thanks are due toC. J. S. Thompson, Esq., M.B.E., of theWellcome Historical Museum, and for theindex I am much indebted to H. M. Barlow,Esq., Assistant Librarian of the Royal Collegeof Physicians of London.
|II.||Duration of Life||9|
|III.||Onset of Old Age||26|
|IV.||Factors influencing Longevity||32|
|V.||Causes of Senescence, with a note on Senescence and Carcinoma||62|
|VI.||Normal Structural Changes in Old Age||90|
|VII.||The Physiology of Old Age||115|
|VIII.||The Description of Old Age in the Twelfth Chapter of Ecclesiastes||129|
|IX.||Distinction between Healthy and Morbid Old Age||135|
|X.||Diseases in and of Old Age||139|
|1.||William Heberden, M.D., F.R.S.||2|
|2.||Sir Thomas Watson, Bt., M.D., F.R.S.||4|
|3.||Professor John Haviland, M.D., F.R.C.P.||6|
|4.||Henry Jenkins, reputed to have lived 169 years||20|
|5.||Thomas Parr, reputed to have lived 152 years||22|
|6.||Katherine, Countess of Desmond, reputed to have lived 140 years||24|
|7.||Petratsch Zortan, in his reputed 185th year||26|
|8.||Hungarian husband and wife, reputed to be 172 and 164 years old respectively||36|
|9.||Sir Henry Pitman, M.D., F.R.C.P., a medical centenarian||52|
The Linacre Foundation dating from 1524 isthe oldest medical Lectureship in the University,for it was sixteen years later that theRegius Professorship of Physic was establishedby Henry VIII. Formerly this College Lectureshipwas held more or less indefinitely byFellows of the College, with two eminent exceptions,namely, Sir George Paget and Dr.J. B. Bradbury; but in 1908 the Lectureshipwas made an annual and open appointment, anduntil this year no member of the College hasheld this office: I am therefore most deeplyconscious of the high honour that has beenconferred upon me.
Though the statute that the Lecturer shouldexplain Galen’s treatises De Sanitate Tuendaand De Methodo Medendi as translated byLinacre, or De Elementis et Simplicibus, has longlapsed, his first words should be directed to2the pious memory of the founder; but as in1908 the late Sir William Osler1 devoted thefirst of the new series of Linacre Lectures toa sympathetic consideration of his brotherscholar-physician, it would be worse than unwiseto attempt more than the briefest reference.
Thomas Linacre (1460–1524) was born atCanterbury of parents who have eluded research,and his connexion with the old family thattook its name (Linacre = flax farmer) froma hamlet near Chesterfield in Derbyshire wasregarded by J. F. Payne as merely an assumption.Believing that those devoted to learningshould be free from the obligations of themarried state Linacre remained single, so thathe had no direct descendants; his will2contains references to his brother, who had thesame Christian name—Thomas—as himself,two sisters Alice and Joan, two nieces Agnesand Margaret, and two cousins Robert Wrightof Chester and Richard Wright; but accordingto Payne3 the family history cannot be tracedany further. I recently had a faint hope that3I had got on the track of collateral descendants,but on enquiry it was courteously made clearthat though the family in question was descendedfrom a Mrs. Linnecar, her connexion withT. Linacre rested on tradition only and thatno documentary evidence or genealogical treeexisted to justify any claim. It may beremembered that Linacre was one of theearliest English students (circa 1488), morethan a century before William Harvey, tostudy medicine and take the doctorate at theancient University of Padua, which celebratedits seven-hundredth anniversary in May 1922.It is, next, natural to look back to the firstholder of this Lectureship, and to wonderwhat manner of man he was and what he taught.To the Master of St. John’s College I amindebted for the few details that are knownof Christopher Jackson (B.A. 1524–25, M.A.1527), who was buried in the old Chapel onJuly 2, 1528, his death according to a brasserected to his memory in the new antechapelbeing “e sudore britanico.”4 Some of theLecturers were without a medical qualification,and of these Matthew Prior (1664–1721), the4poet and diplomatist, who was a “MedicalFellow” for life and Linacre Lecturer fromJuly 5, 1706, to July 7, 1710, was the mostfamous. That he ever lectured is more thandoubtful, but he appears to have thought outreasons for not doing so: at any rate his Almaor the Progress of the Mind (written about 1715)contains in its third canto the lines:
The various labyrinths of the brain!
Surprise my readers whilst I tell them
Of cerebrum and cerebellum!
How could I play the commentator
On dura and on pia mater!
Three of the Linacre Lecturers underthe old dispensation stand out for specialremembrance on account of their influenceon Medicine:
William Heberden the Elder (1710–1801),the author of the Commentarii de MorborumHistoria et Curatione, published posthumously(1802), held office from 1734–38, and wasdescribed by Sir William Osler as the “EnglishCelsus.”5
5Sir Thomas Watson (1792–1882), whoseLectures on Physic held its place longer thanany medical text-book of modern times andset an example of style that still commandsour admiration and imitation, was Lecturer1822–26, and in the first year of office wasalso a Proctor. Subsequently (1862–67), hewas President of the Royal College of Physiciansof London, the most magnificent of Linacre’sFoundations; this appropriate association wasshared by William Baronsdale (P.R.C.P. 1589–1600),by Thomas Gisborne, who was Presidenton three separate occasions (1791, 1794, 1796–1804)alternately with his senior Sir GeorgeBaker, and by Sir Norman Moore of St.Catherine’s College (P.R.C.P. 1918–22), whogave the Linacre Lecture under the newregulations in 1913 on The Physician inEnglish History.6
John Haviland (1785–1851), the only oneof these three who remained in Cambridge,and the only one who did not become a nonagenarian,was Linacre Lecturer for two periods(1817–22, 1826–47), Sir Thomas Watson6intervening. As Professor of Anatomy (nothuman anatomy) from 1814–17 he deliveredthe first regular course of lectures on humananatomy; and when he succeeded Sir IsaacPennington (also Linacre Lecturer, 1767–1816)as Regius Professor of Physic (1817–51)he was the first to give courses in pathologyand the practice of medicine, thus rousing thepost from the sleep of a sinecure, and to makethe medical examinations a real and rigid testinstead of little more than a farcical formconsisting of a few viva voce questions. Further,had it not been for his influence and insistencethe medical faculty might have been abolished,and it was said7 after his death that the subsequentsuccess of the medical school was dueto his exertions. He wrote little and perhapsfor that reason his name is seldom mentionednow, but if the work that has since been doneby this medical school be his monument hecould hardly have a greater.
The somewhat neglected subject of Old Agehas a very pertinent connexion with the mostessential aim of medicine as a whole, namely,the prevention of disease. For when the idealof the prophylaxis of infection and of othercauses of morbid action is attained, a healthy7old age and physiological death without attendantdisabilities and horrors should be the commonlot of man instead of being somewhat exceptionalin the case of the first and extremelyrare as regards the final act. The conditionsfavouring longevity and mens sana in corporesano are those necessary to make the futureof the human race a happy and beneficentprospect instead of a problem inspiring doubtif not pessimism; or in Descartes’ words,“we might be free of an infinity of maladiesboth of body and mind, and even of theinfirmities of old age, if we had sufficientknowledges of their causes and remedies.”But in addition to this broad ground of interestthere are reasons why a discussion of thissubject has a special claim for considerationin Cambridge.