Perspectives in Biology and Medicine

SOME THOUGHTS ABOUT AGING FROM A NINETEENTH-CENTURY CONNECTICUT YANKEE JANNIFER STROMBERG,* JOEL D. HOWELL,t and W. ANDREW ACHENBAUM** Almost 200 years ago a Connecticut physician, Vine Utley (17681836 ), started to keep detailed notes on each aged patient whom he saw. He titled his handwritten, 89-page manuscript "Old Age . . . Observations on People Who Have Passed the Eightieth Year of Their Lives." Now in the collection of the William L. Clements Historical Library of the University of Michigan, Utley's previously unpublished work contains descriptions of 18 women and 24 men (including his own father) whom he examined between September 9, 1809, and April 15, 1824. To be sure, Utley's document contains the observations and thoughts of just one practitioner and, being written for private use, could not possibly have had the broad influence of Benjamin Rush's 1812 book, Medical Inquiries and Observations, upon the Diseases of the Mind. Utley's work is an important document just the same. For, roughly a century before American physicians began to claim that geriatric medicine should be designated a distinct specialty, we find this practitioner expressing concepts of old age and theories of senescence widely held not only by his fellow American practitioners but also by Americans of all walks of life. Some of Utley's early-nineteenth-century ideas about what determines longevity will strike a familiar chord in late-twentieth-century readers. He embraced the prevailing sentiment that "where parents live to a great age, it is an evidence . . . that the children will live to an advanced life" (Vine Utley Manuscript, henceforth VUM, 17, 55). When writing about an 85-year-old farmer whose father had lived to 104 and whose mother had lived into her 70s or 80s, Utley noted that his own observaSupported in part by a grant from the Medical Student Research Fund. *Medical School, University of Michigan. !Departments of Internal Medicine and History, University of Michigan Medical Center , 3116 Taubman Center, Ann Arbor, Michigan 48109-0376. "Department of History and Institute of Gerontology, University of Michigan.© 1991 by The University of Chicago. AU rights reserved. 0031-5982/92/3501-0746$01.00 140 Jannifer Stromberg et al. ¦ Thoughts About Aging tions confirmed Rush's supposition that long life in ancestors was associated with longevity (VUM 68—69). However, heredity alone was no guarantee of long life. Life-style also contributed. Utley commented, in reference to a 100-year-old woman whose ancestors died at an early age, that "Her original stamina, being laid in firmness and her strict temperance and sobriety and economy in the management of her health, must be the principle [sic] cause of promoting her longevity" (VUM 87). Thus we find that eating right, drinking in moderation, and maintaining discipline over one's behavior—key elements of preventive medicine today—were considered the foundation of healthful longevity in an era before many therapeutic interventions were widely practiced. Utley correlated a good diet with a long, healthy life, but he did not formulate definitive causal relationships. Although excessive intake of alcohol was not conducive to long life, Utley advocated "a little spirits after the close of the day . . . , [valuable because they] preserved health" (VUM 1-2). In the "alcoholic republic" of the early 1800s, where the average annual per capita consumption of spirits exceeded five gallons —more than ever before or later in U.S. history—his advocacy of a plea for moderation must have seemed prudent [I]. Utley clearly would have agreed with our current concepts regarding excessive intake of fat, for he noted in several places that his elderly patients chose not to eat animal fat (VUM 1-2) or were fond of fresh fish (VUM 81) and were usually "lean" or "not fleshy" (VUM 2, 4, and passim). Appetite was an important prognostic marker for Utley; if the appetite failed after age 60, he thought that people would not live much longer (VUM 6-7). Although today we would point out that anorexia can be caused by a wide variety of disorders, we still consider loss of appetite an important sign. While Utley did not formulate a causal relationship between a poor appetite and the absence of the will...