Once a Week (magazine)/Series 1/Volume 4/The aged: their health
THE AGED.
THEIR HEALTH.
What is Old Age? It must strike thoughtful people, now and then, how very little we consider what the thing really is that we talk about so often, and with so much feeling. The poets, the moralists, persons of strong domestic affections, and dramatic delineators have plenty to say on certain characteristics of the last stage of human existence; so that, as far as description of the condition, and every possible pathetic presentment of it can go, it would be scarcely possible to add to our wealth of literary portraiture. But none of these methods of treatment show us what old age is; and, till we know this, our way of regarding and treating the condition must be mere guess-work.
One who has a Philosopher’s right to speak[1] upon the subject, says, “The general theory of death is certainly in a very backward state, since the ablest physiological researches on this subject have usually related to violent or accidental death.” He adds that even so far the investigation has been anything but thorough; whereas we do but half our business if we study the growth and development of the frame, and neglect the process of its decline. One glimpse has been obtained, the physiologists tell us; and only one, as far as the organic life of the frame is concerned: and that is that the turning point between maturity and decline is the moment when the balance changes between the functions of composition and decomposition; or, in other words, when the frame begins to give out more than it receives.
During the first years of life, the fluids abound over the solids, and the elements which go to expand the frame are received and appropriated very plentifully, while a much smaller amount is exhaled. The stage of maturity is that in which the balance is equal; and this period is supposed to include, at the outside, twenty years of human life. Then begins the process of dying, as the philosophers say; or, as less learned persons express it, we turn our faces towards old age; or, according to the common figure of speech, we begin to go down the hill. The age of forty-five is assigned for this change. The change itself consists simply in the exhalation of particles beginning to exceed the reception of them—the waste becoming greater than the nutrition—nutrition meaning not only the operation of the food swallowed, but that of the gases breathed, and the appliances of every sort which are administered through the incessant action of the frame, and of the materials which surround it. The necessary consequence is a gradual drying up,—extremely gradual, in the case of vigorous frames,—but incessant, till the consolidation becomes too great to admit of vital action. To go through this process without disturbance from disease is to die of old age. This is, we are told, about all that is known about the decline and death of organised bodies. It is enough to guide us in observing the facts and appearances of old age.
It is clear that there has been no noticeable change in the method of human life between the Psalmist’s time and our own. No doubt there has been of late years a considerable diminution of mortality in proportion to numbers, which is the same thing as its proportion to time, as all die at last; but this is owing to the increased power we have over disease, and not to anything we can do in arresting the process of decline. Thousands of men and women who would have died young of small-pox, a century ago, may now live as long as the universal law of the human frame allows; but we have no power over the operation of that law.
Men have dreamed of such a power in all ages,—have longed for it, have striven for it, and have not seldom fancied that they had obtained it. Among the oldest and commonest stories in every nation, and every literature, are those which tell of some medicine for the renewal of youth discovered by a philosopher, and handed down from one person tired of living to another,—always as a secret, and always a burdensome one. The great chemists who used to imagine they had discovered this elixir of life, were not such fools as they are commonly considered. They, as well as the astrologers, and the gold-seekers, had an idea, and a not absurd idea, at the core of their enterprise. Modern science shows us where they were wrong; but we are just like them in the interest we all feel in the subject, differing from them chiefly in being aware that there is no known way of resisting the law of natural decline.
How long is that stage of decline, speaking accurately? It is so long that giddy readers may laugh at the mention of it. To be tending towards death from five-and-forty seems to them ridiculous. So it would be as a matter of sentiment, among people who think about death in such an exaggerated way as we, of this age, do. But I am here speaking of the natural facts which bear upon the condition of old age; and that is my concern with forty-five. In a rough way, the physiological distribution of our life is set down as including five-and-twenty years of growth, five-and-twenty of decline, and twenty of maturity between them. This makes up the three-score years and ten which the Psalmist speaks of as the natural duration of human life. He adds that if by reason of strength, we reach four-score years, yet is that strength but labour and sorrow, and soon cut off.
“Labour and sorrow.” Are these the characteristics of old age? I should say the words give a singularly precise description of that stage of human experience. I do not mean that it is complete; for there are antidotes, comforts and pleasures appropriate to the case: but the liabilities of the condition are precisely “labour and sorrow.”
It is rarely understood by persons who have the full use of their animal powers that the worst evil of the absence of any of them is not the pain of privation (bad as that is), but the laboriousness thus occasioned in the act of living. I do not know that I have ever met with any person who had thought of this truth without being told; and certainly no person has ever first mentioned the fact to me. Yet there can be no doubt about it. A “well-favoured” person, as the ancient expression is—a person endowed with health and comeliness, and with the keen senses which belong to thorough health, has a very easy life of it, whatever tricks fortune may play him in regard to his surroundings. Impressions flow in upon him incessantly, setting mind and body to work in a natural way, exercising and entertaining his faculties, and rendering easy and plain what he has to do. One with purblind eyes or dull ears has much harder work to do in the mere act of living on from day to day; and the blind, or the deaf, have a lot so laborious as it would astonish their neighbours to become aware of. Instead of influences of sight and sound flowing in upon them, and working within them, they have either to do without that inestimable benefit and aid, or to seek it with pains and toil. They have to make express and laborious effort, from hour to hour of every day, where others simply receive as a free gift the means of thought, feeling, and action. I could say much about this, but my business here is with so much of the truth as is involved in the experience of old age. The “labour” is of this description. The “sorrow” arises from the trials of the affective nature, chiefly, with considerable additions from other sources.
I remember the way in which, when I was young, an elderly friend of mine reasoned with, and laughed at, himself, about this matter of the laboriousness of advancing age. A man of active mind and habits, he felt the stiffening of his joints, the twinges of rheumatism, and the conflict between mind and body about moving hither and thither, which were growing upon him. He told me he had found himself making long faces at having to mount his horse slowly, and leave off running, and give up waiting on sisters and daughter, like the young fellows. Lying awake with rheumatism, or mere sleeplessness, was worse: but he had remembered that he had been glad to live thus long rather than die earlier, and that it was absurd to quarrel with the conditions. He accepted the “labour,” or, as we commonly call it, the burden of years, as a lot which he would have chosen if a choice had been offered him how long he would live. His merry face and philosophical temper impressed me strongly, though the incident may look very small and commonplace to others.
The failure of the senses is a far graver matter than that of the limbs, involving more labour as well as more privation. To young persons suffering under the loss of a sense there is something frightful, as well as painful, in the process. The sense of exclusion from the sights or sounds (whichever it may be) of nature and society is terribly painful; but yet worse is the converse sense of imprisonment—of being secluded from the life of other people, and more and more helplessly. We all shudder at the story of the octagon prison chamber, one side of which disappeared in the course of each night, till it must become a mere closet—a triangular case to stand in—and then, a crushing machine. The same horror of the imagination seizes on a person who, becoming blind or deaf, is daily aware of losing something of the common influences of life, and is aware that he must go on alone into deeper seclusion, finding the mere act of living more difficult every day. The aged do not suffer so acutely as those on whom the calamity falls untimely; but they can tell what the labour is, while caring less for the privation. It does not matter so much to them, they say, how the remnant of their life is passed: they have not active duties, nor heavy responsibilities resting upon them; their accounts with society are made up, and it is their own affair what they are thenceforth fit for; so, if they are sensible and amiable, they keep themselves quiet, and amuse themselves as well as they can. But still there is the laboriousness! Nothing can relieve that. When they were young, the contact between external objects and their special organ (whichever it be) was so natural as to be unobserved; so was the function of the nervous fibre, and so was the cerebral reception of the impression; and its effect on mind or body followed of course. Now, when the consolidation of the frame has gone too far, there is obstruction somewhere in the process, or everywhere; the impression is faint, or it is spoiled, or it is wholly absent, and a natural stimulant and guide to action or thought is withdrawn. Its loss must be supplied somehow, if thought and action are to go on; and to supply it is a heavy and unremitting task.
How this is to be made the best of, depends mainly on the moral strength and temper of the aged person. A superannuated man or woman who sinks under the trouble, or frets under the pain, must be merely humoured and borne with. No other aid is possible, because the sufferer cannot get away from the evil which no one can remedy. A stronger and wiser person has much less to suffer, and for a shorter time. As age advances, the activity subsides, the actual fact of daily existence becomes more acceptable; and monotony itself becomes easiest, while proving anything but dull. One of the characteristics of old age is its susceptibility to old impressions revived, which forms a remarkable contrast to the apathy about new experiences. It is common for aged people to say that the pleasure of the opening of spring is more vivid to them than ever. Granting that they may have forgotten somewhat of the intensity of the pleasure in youth, it is evidently true that they do keenly relish the enjoyments they have known longest. Göthe, whose mental resources might be supposed sufficient for all situations, if any man’s ever were, was in a state of manifest exhilaration every year, when the shortest day was past; and he was like a very wise child, when the first wood anemone, or violet, or brood of chicks, or young lamb came across him, up to the last year of his life. It is the same thing with old music for those who can hear; and old flowers and sunsets for those who can see. The delight is transient in the extreme, after a certain point of superannuation is reached; but, if this is a sign of second childhood, so is the vividness of the enjoyment. If both these chief senses are dulled past exciting, the next question is about the provision of inner material.
If the mind cannot act without the stimulus of external influences, a state of general apathy will ensue on the decay of sight and hearing. If the mental constitution be of a higher order, self-sustaining and self-moving, the aged person himself is surprised to find what complete satisfaction he is still capable of. If his interests have been of an intellectual order, he lives almost as much now as ever. Literature is as charming to him as if he kept the substance of what he reads for use; whereas the impression is now very superficial. Philosophy exalts and chastens his mood, and sustains his habit of composure and patience, though he can no longer lay it down as the foundation of some work of wisdom or beauty. Such a kind of superannuation is too rare and select, however, to be dwelt upon as a sample of this experience of human life. We must look lower among average people, for a lesson for the many.
Average people, if their minds are alive when their senses are shut up, may, if they have but good tempers, take up for themselves that exquisite song[2] intended for a different kind of enforced seclusion:—
Stone walls do not a prison make,
Nor iron bars a cage:
Minds innocent and quiet take
That for a hermitage.
If I have freedom in my love,
And in my soul am free,—
Angels alone, that soar above,
Enjoy such liberty.
If their hearts are warm, and their habits of mind simple, unselfish, and self-respecting, they often show themselves surprised that their “quiet way of life” is so full of amusement, so devoid of dulness, though few sights or sounds reach them, and they have no pleasure in eating and drinking, and seldom have a good night’s sleep. When they are ill, they sometimes say, “Never mind, my dear! What can it signify whether I go now or some months hence?” but perhaps it happens oftener that they say, “I should like to live a little longer, if it had pleased God: but no doubt it is all right.”
This is the saying which shows that the “sorrow”—the peculiar sorrow of old age—is no great burden. There are hours when the sorrows of survivorship are certainly very dreary, as any of us can tell who have witnessed the consternation or the tears of aged persons who say that there is now “not one left” of the companions of their earlier life. But the impression is brief. On the one hand, there is the consolation “I shall not be long after them;” and on the other, there are the interests of the hour—the newer generations round about them, and the wonderful new spectacles of an advancing century. Instead of grumbling old people, who insist that “the former days were better than these,” we now more commonly meet with ancients who are proud, as Humboldt was, of surviving so many of the world’s elders, and of having lived to see the human race getting on so fast with its improvements. This is a pleasanter spectacle than that of the grumblers: but there is a better still. I have seen an aged person who would have bowed her head before the youngest of Humboldt’s order, who yet rose above everybody, philosopher or other, who had any vanity about living so long. She never compared herself with anybody, because she had no self-regards. She was always ready, to a minute, to depart; while she daily triumphed in the spread of education, and of the moral and material arts of life.
Before going on to the remaining case—the one other aspect—of superannuation, we may consider for a moment what is the proper treatment of this decline of human vitality.
The physical symptoms are familiar enough. Old people are chilly, apt to eat what for others would be too little or too much (generally too little); unapt to sleep at night, and therefore frequently drowsy in the day; apt to forget the time and be unpunctual; or, on the other hand, over precise and jealous of interference. The commonest vanity of old age is very like that of childhood,—the conceit of being able to take care of itself.
Amidst the noblest and sweetest moral graces of old age, some one of these liabilities is pretty sure to appear. The hoary head is indeed a crown of glory to one who is exempt from them all.
In treating them, the best method generally is, indulgence. It is a sad mistake to medicate and discipline old age as one would a morbid condition of earlier life. I once heard a dutiful daughter of a very old mother say, after her mother’s death, that the illness had taught her one lesson,—never to tease an aged invalid to eat, or to do anything undesired by the patient. Even where the food taken is little or none, so that life cannot be prolonged, it is better, we agreed, to let things take their course. “It is of less consequence,” said she, “that one in that condition should live a month more or less than that she should be spared all contradiction and opposition.” Some difficulty there must be with one who has a jealousy of independence, without prudence to justify it, like a certain aged marchioness who wore high caps, and would sit alone, writing and sealing letters, and nodding over the candles. She was burnt, with the great mansion which her high head-dress set on fire. This is the most embarrassing particular, perhaps, in the case of aged people. I have known one who, in the last year, before she became too ill to be left, set herself on fire three times, by choosing to read the newspaper late at night, and falling asleep over it. Another was fond of stirring the fire when unable to see how to do it; and she was perpetually turning the coals back over the top-bar. One night a burning mass fell in that way on the skirts of her dress, and was discovered only by the smell of burning woollen. If it had fallen on cotton or silk, she must have been burnt. I see nothing to be done in such cases but to have locked fireguards, and to explain simply that the family could not be easy to leave their charge without that precaution.
Very like this is the persistence of some aged people in going out alone into the streets—crowded streets where crossing is difficult, and where good sight and some agility are necessary to guard against embarrassments and dangers. I have known more than one infirm septuagenarian who would slip out at a back door, or lie in wait for the hall being empty, to get out unobserved; and in a few minutes, a horse was rearing over the head of one, and a porter was knocking another up against the wall; and the wonder was, when either was safe at home again. They came home in a state of vexation from having been plainly told by their rescuers, “You ought not to be out in the streets alone:” “You should be better taken care of;” and the more obviously true this was, the greater was the irritation.
It is not easy,—indeed I know few things that require more resolution than it does,—to mortify this little vanity in persons to whom we have always looked up with deference, and whose will we have been accustomed to obey. To trench on their personal rights, and invade their liberty, seems something monstrous, no doubt, to all parties: yet, in these instances, it must be done. If possible, the pain with which it is done should be covered over with cheerfulness; and, instead of any solemn remonstrance or announcement, the guardianship should be imposed as a matter of course, and treated like the household customs of regular meals and going to bed. I have witnessed every sort of dutiful and beautiful care of the aged; and none with more respect and admiration than that in which the children—themselves elderly—have been the managers, as well as the nurses, of their parents; yet I have never got over the painful kind of surprise of the spectacle,—the violation of all one’s associations of deference with age, and one’s feelings of the sacredness of the liberty and the will of one’s elders.
The more necessary such offences are, the more scrupulous should be the indulgence in every instance which does not involve personal danger. The aged should be allowed to follow their own prejudices, and live according to their own notions, even to their own disadvantage, since opposition would cause them more pain than their own mistakes. If, when short of breath, they like going about the house on their own errands, let them do so, rather than wait upon them against their will. If they oppose themselves to modern sanitary practices, let them go to their graves as their fathers did. About exercise, food, and hours let them suit themselves. About dress, few would wish to interfere. It is painful to see old ladies in gay or youthful dress; and a little tact may soften the absurdity, in many a case; but the opposite tendency is more common, and quite unobjectionable. I remember more than one old gentleman, in my childhood, who wore pigtail and powder, and knee-breeches for everyday wear; and old ladies in ruffles and long gloves, and outside muslin handkerchiefs, and muslin aprons; and their antique appearance inspired unmingled respect, as the Quaker dress always does. If it did not, we should still wish to avoid interference, and to help our old folks to gratify their taste and judgment in dress to the end. So it should be also in regard to their little hoards of relics,—their worm-eaten furniture, their bits of china, their antiquated sermon-books, and their curiosities in the way of old shoes, and gloves, and trinkets. Let all be tenderly used, and allowed to take up room, however inconveniently. It is not for long; and the one great duty to the aged is to save them from fret, and, above all, from the fret of mortification.
I have seen a very self-complacent and sentimental woman do a thing which put me more in mind of King Lear than I could have wished. An aged and infirm relative had lent, as a privilege, some beautiful verses of a close personal interest, to be read, enjoining care of this her only copy. For many days she modestly asked for them back again, till, the self-complacent lady being induced to search, the precious document was found torn by the children; and the only apology offered was a snub about “making such a fuss about a sheet of paper.” If, instead of being a thing of real value like this, it had been a page out of a copybook, it ought to have been respected as prized by one whose smallest wish should be honoured.
A sympathy which is sufficient for these things should naturally be more ready than it usually appears to be, to enter into the immediate prospect of the aged. It is natural for persons on the verge of life to speak sometimes of leaving it: but nobody responds. Few have a word to say on what so closely concerns their charge; they make haste to talk of something else, or go away; or even, as in an instance which I remember, say, “Oh, nonsense; don’t talk so. You are no nearer death than ever you were.” They would not have done so about a voyage to Australia, twenty years before; and the departing one would like some sympathy now, even better than then. The fault lies mainly, no doubt, in the common exaggerated view of the importance of death. The exaggeration still influences the younger nurses, and is detected by the elders as they approach their departure; but the departure is their prospect, and it is a failure of sympathy to shrink from speaking of what the waiting one thinks of with freedom and cheerfulness. One meditative old man whom I knew was self-sufficing in this respect. He had on his table—the table at which he read and wrote daily—a pretty cast of a sleeping child. His friends wondered at his constancy to this cheap bit of art; but one of them soon divined its meaning. When weary, as such very old people are, and longing for rest, it soothed him to see the image of rest. I suspect he might have waited long for any one to minister to his need by speech. Who ever does say to the aged, except as comfort under bereavement, that they have not to wait long, and that their end is perceptibly approaching?
One consideration remains—the case of failing faculties in the aged. Of course, this is by far the most painful aspect of the case; but there is something to be done; and where there is something to be done there should be something said.
Most elderly persons among us must have read Dugald Stewart’s writings when they were young, and none who read them can have forgotten the following description:—“One old man, I have, myself, had the good fortune to know, who, after a long, an active, and an honourable life, having begun to feel some of the usual effects of advanced years, has been able to find resources in his own sagacity against most of the inconveniences with which they are commonly attended, and who, by watching his gradual decline with the cool eye of an indifferent observer, and employing his ingenuity to retard its progress, has converted even the infirmities of age into a source of philosophical amusement.”[3]
This old man was Dr. Reid; and his noble use of an opportunity of studying phenomena through his own bodily failure reminds us of Sydenham, the physician, whose last moments were employed in noting his own pulse, for a scientific object—a death which I have heard Dr. Channing declare to be the most enviable he knew of. How indeed can there be a nobler close to life than providing light for others out of one’s own eclipse?
There are few, perhaps, who could do this; and certainly not many could be expected to think of doing it. But there is a preparation for that peculiar trial and difficulty which it is in the power of most aged persons to make, who are happily placed in regard to home and friends. Most who have advanced far in the “labour and sorrow” of old age must be conscious of more or less failure; and all are aware of the liability they shall be under if they live so long. Is it not possible—is it not even easy—to predetermine our own welfare in that condition? Can we not make a resolve, too determinate to be ever forgotten by the feeblest memory, to put ourselves entirely into the hands of some guardian whom we can trust in such circumstances better than ourselves? Do we not know that we cannot be judges in our own case as to whether our judgment is as sound as ever, and our temper as calm and strong, and our understanding as clear? From the moment when any failure is probable, or is recognised by anybody, it should be our plan, long formed and dwelt upon, to resign ourselves to decisions more trustworthy than our own, and to yield obedience to a better guidance. There can be no doubt of the benefit of this course to health, peace of mind, and serenity of the daily life. It is not always easy, of course, for it requires a resolute repression of self-love and self-will; but, when the work of repression is mainly done beforehand, there is no pain remaining that can for a moment compare with that of conflict, internal or external, with that of making mistakes, discrediting ourselves and disconcerting others—of sinking, in short, under infirmity, instead of conquering its worst liabilities. What can be more painful and humbling to witness, than the struggle which a failing mind keeps up; arguing in favour of its own abilities with saddened friends whom common humanity keeps from replying; quarrelling with the comrades of old times, or resenting their refusal to quarrel with him; fidgeting about everybody’s opinion of him, and straining his mind to show how sharp he still is; refusing all suggestion as to what he shall do, and how he shall live; subject to exploitation by those who will flatter him about his independence and his dignity; and at last humoured in his tempers and caprices because “it is his way,” and “he cannot help it now!” What can be more consoling than the spectacle, on the other hand, of the old man or woman who, however weakened, is still noble—however dulled, is still venerable—from the good sense and unselfish considerateness still pervading the course of daily life! He has engaged some trusty friend or friends to tell him plainly when it is time for him to retire from work and the competitions of life; and the moment he is told, he settles his accounts with the world, and gives himself to the interests and amusements of retreat—not seclusion, but leisure. He is wholly tractable in the hands he has chosen to guide him, and is thankful for guardianship, instead of resenting it. By thus depositing his cares, he reduces care all round to the minimum. His own life and its remaining powers are well husbanded; for there is no needless irritation to chafe his temper by day, or spoil his sleep at night. He has no more to bear than what Dr. Johnson called “the natural force of the evil” of his superannuation. And when he is gone, survivors will not have to put away the impression of his latter days, in order to think of his life as, on the whole, it deserves.
No doubt it may be objected, that this is requiring from the aged exactly what they are disabled from doing. This would be true if it was proposed that the failing should choose their course at the moment of failure, and hold it from choice when the power of choice is gone: but the actual suggestion is the widely different one, that the resolve should be made in anticipation of the need, and the habit of amenableness formed in good time. I cannot help thinking that such a purpose and such a habit may spread their influence far into the season of infirmity, and generally carry the meek philosopher through in safety and honour.
There will be little difficulty about passing the latter hours pleasantly if there is wisdom enough to follow a natural course. Let the aged person read or be read to, however soon he may forget. This is not a time for getting knowledge for use, but why not for pleasure? The chief delight will always be in old poetry—old divinity—old music—old history: but if there are new discoveries—new views—which can be understood for the moment, let them be enjoyed, even if lost again in an hour. The object is the calm entertainment of each passing day: no use beyond this need be considered; and here, as usual, the most thorough humility is the completest wisdom.
I need not speak of the opposite condition. The fret and passion of imbecility, unchastened by self-control, are speedily fatal to the worn-out frame. Apathy may last long; serenity is highly conservative in its influence; and folly and self-love together create a constitutional irritation, under which the low vital powers soon give way. It is a dreary and terrible mode of dying. The contrast of the two courses taken by old age is the contrast between the child under possession at the foot of the Mount, and the sleeping child which the old sage set before him, for his daily admonition and solace. No one can say that he has no power of choice between the two.
Beginning with the earliest stages of life, and ending with the latest, I have pointed out some of the causes of the needless mortality and the prevalent imperfection of health, for which society is answerable. Slight and superficial as my treatment of the subject must be in a series of essays like these, I believe I have exhibited facts enough to show that we have all something to do in checking untimely death, both in our own persons and in those of our neighbours.
If half the thought and sentiment that are spent on the subject of Death were bestowed on the practical duty of strengthening, lengthening, and ennobling Life, we should be more fit to live worthily and die contentedly. Let us prepare the way for the next generation to try whether it is not so.
- ↑ Auguste Comte.
- ↑ Sir William Lovelace.
- ↑ Stewart’s Philosophy of the Human Mind, Chap. VI. Sec. I.