A Brief History of Geriatrics

“History is the high point of advantage from which alone men can see the age in which they are living.” —G. K. Chesterton In the end, each of our endeavors is only a product of those who went before us trailblazing the path to the present. For this reason, I believe it is useful to reflect on the history of the origins of geriatrics. Any such history that is to be compressed into an article must perforce be truncated. In addition, history is always seen as interpreted through one's own perspective, and history is not always as it appears. Finally, I have lived an active role in much of the last two decades of American geriatrics, providing me, to some extent, with a biographer's viewpoint, rather than that of an uninvolved student of the field. “Then the Lord God said, ‘See! The man has become like one of us, knowing what is good and what is bad! Therefore, he must not be allowed to put out his hand to take fruit from the tree of life also, and thus eat of it and live forever.’ The Lord God therefore banished him from the Garden of Eden, to till the ground from which he had been taken. When he expelled the man, he settled him east of the Garden of Eden; and he stationed the cherubim and the fiery revolving sword, to guard the way to the tree of life.” —Genesis 3:22–24 Since the beginning of time, myths concerning the aging process, and the struggle to overcome or accept death, have been a component of the oral history of Homo sapiens. Thus, when Prometheus stole fire from the Gods, and brought it to earth, he was punished by being hung from a cliff where the vultures pecked at his liver. However, because of the regenerating powers of the liver, he survived, eventually to be set free. For accepting the gift of fire, the Gods punished humanity by sending Pandora with her box. When insatiable curiosity caused the box to be opened, plagues, diseases, and old age were released among humans. Another tale is that of Gilgamesh, the Babylonian demigod, who, when he aged, and began to fear death, was told that he could survive forever if only he could master sleep by not sleeping for 7 days. When he failed to do this, the gods told him that he could find a plant underwater that, if he ate it, would make him immortal. Gilgamesh found the plant but was enjoying swimming so much that he left the plant on the shore while he continued swimming. A snake came along and ate the plant. The lesson to be learned was death is inevitable. Both Taoism and Ayurvedic medicine had their anti-aging theories. The Taoists believed that if you learned to undertake effortless action, take vital breaths, “starve the three worms,” and eat magical foods, such as ginseng, you could slow down the aging process. Ayurveda comes from Ayus meaning “life” and veda meaning “science.” Ayurvedic medicine taught that transcendental detachment together with certain herbs would postpone aging. In modern times, Deepak Chopra has utilized these tenets to write a best selling anti-aging book (1). In ancient Egypt, the “Edwin Smith” Surgical Papyrus (600 B.C.) included “the book for the transformation of an old man into a youth of 20.” Mythology has also pointed out the problems of immortality in the story of Tithonus (Figure 1). 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, the god of gods, 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 grasshopper (cicada). So today when we hear the chirping of cicadas, it is just a group of old men babbling incessantly! Three origins of the concept of the Fountain of Youth are found in the literature. The first was the belief that a river of immortality flows from the Garden of Eden. The second was the Indian story of Ayavanna who, in return for teaching religious secrets to the demigods, the Asvins, was shown the Pool of Youth. This legend was the origin of the early 20th century novel about Shangri-la and the more modern story that the people of Hunza lived to an excessive old age. The third story is that of the cook of Alexander the Great who, while preparing a fish in a river, saw it miraculously restored to life. This river became known as the “water of life.” But the cook refused to show it to Alexander and was put to death! Tales such as this led Ponce de Leon, the governor of Puerto Rico, to search for the “Fountain of Youth” on the magical isle of Bimini (Figure 2). Instead, he found Florida, and many of my patients clearly believe he was successful, as during the winter months they eschew the care of the good doctor and flee south to the warmer climate in Florida! In 1975, Alexander Leaf published his book on how persons living in Georgia (Russia), Hunza in the north of the Asian subcontinent, and Villacabamba in Ecuador, lived for extraordinarily long times (2–4). He attributed their survival to exercise and good eating habits, creating the wave of dietary restriction recommendations for longevity. Unfortunately, it turned out that the of these for was in on a and but the to were found to be and age on and The first anti-aging dietary was in in the century by two and their as a that would the of aging and to This was around the that the was that an old age was for anti-aging of during the 20th century that of the who believed aging was to released from the He believed that lived long because they ate He thus as an anti-aging survive today in the modern the of to the for the of aging. is for and thus has to do with aging. The would have been as pointed out by of was by in was by such as and to the aging process. In in a medicine that the aging process. the she from this she the of in in and became a of the In published on the of dietary restriction to life in This anti-aging concept was in by and his have its in and in In the of aging This has many today with that slow the aging process the for the modern of came from that were a of times a could in This eventually became known as the The article by was by the of with a from the that in to have from in the last is that of do so if with the in was eventually published in in was these that in to and This led to the of the first anti-aging by we have seen the of the and that the aging in by a the and their that they a while have not been shown to be the anti-aging is and a of with and by the for the of and medicine and are by persons The have published a of out the of the anti-aging However, it would that, as long as are to into that good the anti-aging to be by The for in ancient B.C.) was a on a the first of the of In the Papyrus that through is to on the that old age was and This was by his of the of and that in old age. were to through many that old age was and on old age in He much and was first to the of of people (Figure a a book on aging where he that old age could be by eating a in good and the of a This belief came from the story of sleeping two when he was old to his youth. in published the the of the and in and on the of a book from the on aging in He that had in for the of the (Figure This during the first of the on and is as being a in geriatrics. I is more to the of than the of the a of on aging published through the of the 20th the of the the concept of of aging began to In that persons and that could in was a who did the first for and the to the He also a role in the of from at the age of found that he was at and the first for (Figure This led to at the of The of to a to be led to to the aging In are the to the modern of for the was with the of the by (Figure was from the a group of men over who the of was in in He as a in and his from in He a of on and a published in The of and He in at the age of in and his of for persons came from to where care of people was at the in is more as he was a of the who was of medicine at in to be as shown in his where he that men over were as they were the age of to over were and was not a for this age This is to have been for a of or not his to be is He was a who, as a of such as in which the the not it to is much for the of modern geriatrics. In she took over the at the her was to the active and on the of the She on was an who in in He became at persons for was is The first was in in the The problems with were in a by one of his (Figure at in the concept of for of while at the published his on the of aging in in a book while at the in a of old which he published in his book The of in He and to A in in when Lord and the of on the care of the and This led to the of the care of the as of the The of the care of people in the have been in a article in the The first of the for the of the was by The in included and Lord was and in that for the first In the its to the The first for in the was the at to in was and who the of in their for the modern not only led the of but also the the of to the and more as a and for The of was the for aging in in the of the 20th century early was on aging in and He to of aging In he became the of Thus, while the had been in the it was the who the of the However, it was to take in the to the of the and the in the of the of geriatrics. the of modern in the it is of to a of early in the of with the in with the The Great led to of in the in and by This was by the of the in In the first of was by and it was in by the on this time, the on was but only in In and were providing to care for was in (Figure He his from the of in and from the of in In he was a of at the in He was active in aging as it to In he The of and and two The of the and He was a of the of persons and the American by care for The for in was in with from the When the she aging as one of the to be on for included and an who was in in also a role in the of in by Lord and his to at and we the of has on of of this group The of which was in with was the first The of was first published in in was into one the of the In it was into two with and as one and and as the The was first published in The of the are in The American was on at the in by The first was in with of as In the of the American was published the of had been first published in with an with the American but the to the and the to be published The of the for in by the American are in In was the first of the on with the of at the of The was by a from the The the to the of This to the of the on in For many this was led by who a of In the the on In the was the had to have an of with as a but this as a to the on we to do is into the and what has been This with own first before his death in would you that we were and in the belief that the we was of have some of I would that our be and by the of our on the of aging In was the first of the on of the of the on the on with the first became the second in was for before became the third in The first two of the had a a has been much on the The of in the was clearly (Figure in at the and for the He was for creating the first in medicine at of in He in and a teaching in the in the of in the has been the This was to the in aging and its on the care The first and were in was for the of the a role in and at the also the first in and were for in geriatrics. and in the have a role in the of care teaching were in the The first in was at in In the first of was at with as its first In the first in medicine was at the time, the for medicine and to of these were extraordinarily and had a of the two of The east of the at and In began to the by This had the advantage of being with two and This the of geriatrics, at has the of in of and has been with the of in The can for the In the the of the of the at and the of The was in to this, it had one of the and a the of The has a role in the with its and its The at the of was in The and in on the and are in In the was to This was by the of and I on as this because I and that it longer than a to a and that it would the of in medicine believe that this has been a the has that we have failed to a for and to with this of were with first and second the were to the the the of has been the in the of early on was an that early in the of of allowed many at to the student has allowed many to that with their also to to for the many of this was the of the at in has also been successful, their for The has to to In this in the of the on at the of a at the of The of through its and its and more the has been an in care for persons is by have been in providing and care In the American a group on that led to the of the group in The first were published in This led to the of have a and have become in care in The of and has a role in for persons to a in the for the of The modern of was in a in the The concept of and for the old comes from the and for the from the the these had led to the of in and to the to this, during the the care of persons was in known as In the of In this was on that for the is no more than the of those who have their best and their in the of the The was to make the old and as as they can and the if as as they The of was to make life for those living in so that they would to be In the that the of to and that persons be in to their care The concept of was in with the of in and the The first in the was in in The first in the were by or of the in in in the for and in and the of the of a in In a was as a for the in to of the persons were people were in or In for were put in In to were the of in was a of was in for In the of a of in This led in to a of being on to the of included the for and and on The on have those set out by in In addition, the of a that is utilized the In many were to be by the of the in to and the of the 20th had found to be a ground where on and because they in than became their in some in and has become a on the and time to The with the much (Figure for the of to the more has of its as a that is useful for care The American was in in by and with from Georgia being its first In it to has a which of but no or the of the American for a time, the of The is the of the American has a of which is the of of the aging The care was in from the which went on to become In the the was by the was and by 1975, was geriatrics. the of this into the for care by a In and had a with in found that to patients at day to to a day for A was the for the of care in the which were to be the care of the for persons with the of the for care In the the of This care had patients with an age of a century of by this had to of The has seen the of for the in in The of this led to the of the care known as for of the as a of care for the was first in when was by in In the was in in In the first care was at the in in The was in care to in the with being by and has been a to care from the last months of life to persons in the last of their life. Unfortunately, are at the time to death, this a to The to and for and of has shown in our to care The concept of was to by the in his he went to and his of and to in to the high it In the concept that was an for care In the early began to on the of for and In and an in the of the American as an in for In and the a on in This led to the of in in A to to be useful for persons led to the of for care the of the and has the role of in had its in with the by in his that persons who are it because to the of In with and that could with persons was on in in He his in and at the in where he with on In he with to the in He in first with the that was eventually to his was a She with to her the of the and In in the in his of that be to do this was by a to to his rather than had been clearly by and were first in in and by the group and In pointed out that of life were not to He the first of from In a at published his The of was as a at in He a to persons than who had In the of to in In the at in the led this that and among was by the on began to be published in from to the of as of the of he a This was for the of such as and The group for the of published the first of the in the in In the the American the on the time, the for was in began to the of The American of was the of in The was out of the which had been as of a on by The and is a in which has a role in and for patients with for the have had a on of the of patients with are The and and A to and was in the and to the and to one of the The of in has been with and on the the of the 20th was a of the of was the that to the The were by in his which was published in He that the of aging were problems with to and of the of the He that being and a religious belief were in life. He pointed out that in be as a for the and the the of were to the Finally, he that no would so the of old age in as In the first and of care medicine was at in the and the second at in the and a for was first in The of persons of age was in in The of this was to and In the in the in these an to care for and persons which was the the beginning of the 20th to care for and persons were were to be of death for In the of the 20th these were with the of and day and in the the of The in was in the of in have a of of aging in are the on on more the in In was by in who became the first of In an de was This was by the of the de in In the of was and this into the of in the of also a role in the for of in has been in the and in and The of and was in In a of persons care from and care was as a in The is of has not a role in the first was in the of The has been the of and in The of The was by the of and the care on and was in the of medicine and the at has a role in In the had as led to the of a in The of was in medicine was as a of medicine in in have out for has been a in has been slow to the of geriatrics, the that it has the life and over persons are in where the of has been have for the care of the are at The of was in This on on with two being in the and the in and The is with the In the of was aging in is with being in The of the by at has been a to aging have been useful for are good of and The to its to an of can be from the and I have from of The of was in the of on had a role in its were from This first on the of the aging and and the of aging. The second was in in the of were from included from who had their in is also in of the such as and is also an for in the of the The first in modern has been the of the into a of The first of these was by a at in in patients at the had the to a of it as the for and the in the of the American and the of that have been or more a of the that have had the from the literature. be that of the on or have been published in these The that and are and that in the also can the component of the of in the last of the 20th the of for of the and to the of to be the the viewpoint, the of exercise would to be the The role of and has a of the time I believe that the of the of the of has been the of the the of its and the of the of the of modern geriatrics, I believe we of of and aging and the of as a Finally, the of medicine in in the of from to has had a on the care of the In this we the medicine to us to make for and The on the and that to age be one of the in the is that this of the history of geriatrics, together with the that a for of the century to their this one is on the last However, in the of geriatrics, this is of a as the of has been a For those more of more I of and of and by by This history on the and is clearly an is a for a history that a Finally, this history is on the of to some extent, a is that the to some of these goddess of the morning and of by de in the with of the of or the of aging Ponce de of and her and together with the first a of aging. to old age as it has in good and more in good and a from his book of and a from his article on the of and his for the of the by in on the of and an early of The with his in it teaching in a A of the as by us in on the of the 20th on the of the 20th on in the of the 20th on in the of the 20th to of our of to of our of The of the of The of The of the of The of The for in by the American The for in by the American in for and in for and for for in the of The American or in the of The American or in The of or in The of or to of of