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if duty requires, but remember that a busy, successful physician and a politician are never one and the same person. Your profession must be your first and chief occupation—your true vocation. That does not mean, however, that you should not have an avocation as well. Take time to live. You owe it to yourself, to your family, friends, everybody. The time has now come to say to you as students, Farewell, but by your leave I will say instead, Welcome, members of a noble profession. We wish you Godspeed.
LESSONS IN LONGEVITY.*
BY JOHN S. CAULKINS, M. D., THORNVILLE, MICHIGAN.
MANY physicians know that the writer of this paper is very old, and some know that his era dates back to 1822, the long stretch of eightythree years lying behind him. From the knowledge of this fact an expectation has arisen that he ought to have something to say relative to old age which might have a modicum of value. This feeling is doubtless stimulated by the observation of another fact, which contemplates the retention of a degree of vigor and activity (physically at least) perhaps somewhat greater than usually falls to the lot of those who reach his advanced age. Therefore, in compliance with repeated requests this paper has been prepared and is submitted for what it is worth. What is to be said on the subject will be formulated under these two heads:
(1) Is it desirable to attain the age of eighty-three years? (2) If so, how is that objective point to be reached?
For lack of time only the first question will be considered today, the second being reserved for subsequent papers.
Is it desirable to attain the age of eighty-three years? This question is to be considered from two points of view-the personal and the sociological, and viewed from either the answer depends. It is the surroundings that must determine. Aside from the instinctive clinging to life, which is natural to most of the human race, a rational and dispassionate view would lead one to answer this question in the negative, and to add that there cannot be much left to tie an octogenarian to earth. Youthful friends and associates have one by one gone and left him, and he is "a pilgrim and a stranger." Things in this world being so unevenly divided there is for the most want and poverty to be endured, while infirmities of age being many, there is pain to suffer. All this for the very old makes life not worth living. There are, of course, exceptions to this. Where a temperate and well-spent youth
*A paper read before the LAPEER COUNTY (Michigan) MEDICAL SOCIETY by its oldest member.
and middle age have stored up a reserve of health and vigor; where there yet remains a good degree of interest in things and events, and there is money enough to supply all reasonable wants, life may be quite enjoyable long after reaching the age at which, according to Osler's new gospel, persons should be chloroformed.* It is an old proverb that a man is no older than he feels. It is not the lapse of years but the breakdown they bring that counts.
Examined from the other point of view, that of the community in which the old man lives, it will still be seen that the answer depends. If he can yet perform some useful work better than younger men he will of course be tolerated, and even if his usefulness is over, if he has money enough to pay his way he will be accorded tolerance; but if he is helpless, and poor, too, very little interest is manifested towards him, however useful he may have been in his youth and manhood. Society is as ruthless in this humanitarian age regarding the treatment of the infirm old as it was in the stone age, when the custom prevailed of killing such as could no longer take care of themselves. That indeed looks cruel to us and we are apt to shudder at such barbarity, but a little reflection will demonstrate that it was not invariably, and probably not generally, barbarity which caused the act, but that a stern necessity of the savage state compelled it, and sometimes made the apparently merciless procedure one of the greatest humanity possible. Suppose a case where winter was at hand and provisions were scarce. The tribe must migrate and find some place where hunting and fishing are better, and the long journey must be made on foot. What must be done with the lame, sick, and bedridden? The choice lies between leaving them to die of hunger or to the still more horrible fate of being eaten alive by wolves, or giving them the "happy dispatch.". Certainly humanity dictates the latter, and the victim himself having always anticipated the inevitable end, unless war or accident intervened, and having served his father the same way, would invoke his barbarian fortitude and willingly submit to his fate.
Methods vary but results are about the same in every age. The primitive method has much to recommend it. It is quick and easy. One bounce on the head with a big stick in muscular hands, one sharp, short pain, one quiver and the old grandfather was off to the happy hunting grounds, and the bread he would have eaten helps to feed the grandchildren through the winter.
We no longer use the club or any similar instrument to "shuffle off" incapables, but we confine them in houses, generally unsanitary, where the minimum amount of care and comfort is found and let them
*This allusion to Osler is, like what he himself said in his valedictory at Johns Hopkins, merely jocular. Perhaps no little, casual utterance ever made such a commotion in a community as that. Every magazine and paper has had its fling at it and its author, and most of them have made the mistake of taking him seriously. That he was very wrong in the assertion will be shown further on, some good having been done, with the most far-reaching good results, after seventy and eighty were past.
live as long as they can. Very little interest is felt in them and they are not missed when dead. In our present imperfect state of human society we cannot look for anything else. It is the law of Nature that whatever is born must grow old and die, and the law is necessary and beneficent, for otherwise the earth would become overcrowded and unable to support its inhabitants. The unavoidable conclusion follows that the old must give place to the young, since the natural rights of every human being are equal. The old have had their turn, and it is proper that they should not stand in the way of those who come after them. Since this is so, it is not strange that many who have the care of the very old grow indifferent to their want of comfort, and look at them as a burden of which they would gladly be rid. This indifference is not unfrequently felt by its victims so acutely that a resort to suicide is the only way to escape from the intolerable condition.
Concluding this part of our discussion we repeat what was said at the outset, that the answer to the query, "Is it desirable to live eightythree years?" is dependent on the surroundings of each individual, adding the remark that probably with the most of those who reach that advanced age it is wholly undesirable.
We will now discontinue the discussion in this pessimistic way, and from a wider point of view look at it as applicable to the whole human family, and restate the question like this: "Is it desirable that the average duration of human life on our planet should be made longer than it now is?" Stated this way the unanimous answer will be in the affirmative, and we may add that it is not only desirable but necessary and indispensable if the world is ever to be rid of the evils by which it at present is infested. Ignorance is the evil and the mother of evils. Her children are poverty, crime, war, and pestilence, and there is mutual reaction between them tending to enlarge the circle of malign influence of which each is the center. There is a remedy for every evil caused by ignorance. This none can be stupid or inconsequent enough to deny. The remedy is the discovery of scientific truth and its application to the affairs of men: the discovery of the true laws of Nature and obedience to them, whether physical, mental or moral. Truth is in her well and must be hunted for and drawn from its recesses. This needs time, which we do not have in our short term of life-our three score years and ten. The years for doing good work are too few. We must stop and die before our plans are half executed. The time for study being so limited progress is slow. Some say that nothing of real value is performed after sixty is reached. There is reason to believe this limit an underestimate, but we must admit that the time is very short at the best. There is a great loss where one man has to take up the unfinished work of another. He cannot begin right where the other left off, but must go through all the preliminary work that his predecessor has already mastered. It is a great waste and, besides, not very safe. Youth is available in adventuring into new paths and noting new facts,
but is too volatile, self-conceited, quarrelsome and vindictive to do anything but one-sided work. The effervescence and querulousness of youth must subside and be replaced by the calm modesty of the sage and philosopher who has burned the midnight oil in his search for the truth till it stands irrefutable and apparent to every inquirer.
Suppose the short working period doubled. It would far more than double our product. Instead of our present slow progress the potential of human endeavor would increase in geometrical proportion. When the time arrives that the octogenarian, instead of being counted as at present, hardly belonging to the living, but looked askance at as merely a wreck or derelict on the ocean of time, will be, as the Germans say, in his best years, then this earth will be a good place in which to live out a long life. The remedies for poverty and crime will be found, wars will cease and be replaced by arbitration, and the cause of every disease will be hunted down and stamped out, old age included, which, according to the discoveries of Metschnikoff is, like the most of human ills, a microbic disease and can no doubt like the rest be avoided.
It has been truly said that no chain is stronger than its weakest link. But why have a weak link in the chain. Let the smith look to his work and make every link out of the same flawless iron and every weld perfect and then there would be no break anywhere, the chain would hold all the team could draw, and all would wear out together, like the "one hoss shay." Lives are the links in the chain of human existence, and although most of these links are very weak there are now and then notable exceptions that have grown up with sufficient cellular stability to outlast three or four ordinary lives. These exceptional cases have of course reasons and causes that account for them since every result is the effect of a cause, and the uniformity of Nature's laws teaches us that like causes produce like effects. What man has done man may do. It is the business of the philanthropist and philosopher to study and learn what these causes are as fast as possible and teach them to the rest of mankind. Some work has already been done along this line, more is being done, and much remains to be done.
It is to be expected that here the pessimist will step forward to urge that it is chimerical to believe that lengthening the span of human life can have any good influence toward lessening the sum of our ills but might instead prove a damage by lengthening the term of the undesirable classes, the criminals, and weaklings, equally with the best. This is easily answered. It is equivalent to asserting that there is no human progress, and we know there is. The race has always followed the best light it had, otherwise we would still be wandering savages like our ancestors of the stone age. Poverty is the prolific mother of most crimes and they will die with their mother, and as for the weaklings who now mostly die in infancy, if they live to grow up, it will not be to propagate their own degeneracy. Among the discoveries of the future there will be one for the humane, easy, painless and complete steriliza
tion of such as are not fit to propogate the species. Why should not man be improved by applying to him the methods that govern improvement in other animals? It would puzzle anyone to say why not. Suppose this work done and the improvement of the animal Man placed on a sound and strictly scientific basis, what would the result show his natural term of life to be? The other animals have a limit at which, if they escape disease and violence, they die from sheer old age, their stock of vitality being exhausted. It is not likely that the genus homo is an exception to the rule. Several students of nature have treated this subject, basing their conclusions on comparisons between man and other animals relative to the ratio between the whole length of life and the period of certain stages of it, such as gestation, dentition, lactation, and growth, the last attracting the most attention. Cornaro, in Italy, Buffon, the naturalist of France, and Hufeland of Germany have written on this subject, the latter the most elaborately. His book, "Macrobiotik," has been translated into all the European languages and into several Asiatic. Of these three, Cornaro only contends for a hundred years, Buffon for one hundred and forty, but Hufeland says, page 149 (Erasmus Wilson's edition), "We may with the greatest probability assert, that the organization and vital power of man are able to support a duration and activity of two hundred years." He goes on to say, "This assertion acquires some weight by our finding that it agrees with the proportion between the time of growth and the duration of life. One may lay it down as a rule that an animal lives eight times as long as it grows. Now, man in his natural state, where the period of maturity is not hastened by art, requires full twenty-five years to attain his complete growth and conformation, and this proportion will give him an absolute age of two hundred years." Chapter V of his book (first part) is devoted to instances of long life, considered by countries and professions. He says the medical makes the poorest showing among the professions. In a table which he gives of the ages of distinguished physicians there is only one above the one hundred mark. It is the name of our great founder, Hippocrates. He says, page 25, "Mortality is greater among practical physicians than perhaps among men of any other profession. * * The greatest mortality prevails during the first ten years of practice. A physician who has luckily passed his time of probation may become an old man."
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This paper is quite long enough for the first of the series, and the discussion will be dropped now with the understanding that it shall be resumed later. I may as well admit that besides willingness to please, by complying with your repeated requests for the paper, there was a little "motif" of my own hidden behind its preparation, and here it is. You remember Robbie Burns' lines:
"O wad some power the giftie gie us,
To see oursel as ithers see us,
It wad frae mony a blunder free us