The Prolongation of Life

MR. HARCOURT: Sir Frederick (Banting,) and Gentlemen: For some months, as many of you know, I have lived in dread of the moment when our President, Major Balfour, would say, "You are to take the meeting of The Empire Club tomorrow." Unfortunately, and yet very fortunately, that moment arrived last evening when he was unexpectedly summoned to Montreal and was thereby deprived of the pleasure and honour of introducing our distinguished guest, a pleasure and honour which he had looked forward to and to which I fall heir.

At the head table we have as our guests, representatives of two classes of the community who work in the utmost harmony for the prolongation of life, the medical profession and the life insurance fraternity. Dr. Fishbein needs no introduction to them or to a large number of the guests and members here today. To the laymen, his reputation is already established as a distinguished author and lecturer on the history of medicine. He is the Editor of the Journal of the; American Medical Association but, above all, he is the friend and protector of the public. He is interested actively in so many institutions for the welfare and betterment of mankind that it is a distinct compliment to us that he 'has found time to be with us today. His subject, "The Prolongation of Life," is of great interest to us all. I have the honour to introduce Dr. Morris Fishbein. (Applause.)

DR. MORRIS FISHBEIN: Sir Frederick, Mr. Chairman .and Members of The Empire Club of Canada: Since the earliest times human beings have been interested not only in the prolongation of life, but also in the idea of adding to their lives more functioning years than have been the common lot of mankind. In other words, we have been interested not only in diving long but in having for the period of the life expectancy of man on this earth a considerable number of years in which we could be useful producers for civilization. As all of you know, Biblical legend assigns to mankind a possible three scare years and ten, but it has only been in very recent times that the majority of human beings have begun to approximate this age. From 1825 to 1835, the life expectancy of man upon the earth approximated 33 to 35 years. Then, with the coming of Pasteur and the establishment of the germ causation of disease and the discovery of new methods of protection of mankind against mass infection; with the advancement in civilization that has occurred and the overcoming of many types of degenerative disorders, life expectancy at birth has greatly increased. Today, in every civilized nation of the world, life expectancy at birth approximates 59 to 60 years. At the same time, life expectancy after reaching 45 to 50 years of age has not appreciably increased. In 1890 the average man on the American Continent, having reached the age of 50 years had an additional life expectancy of approximately 20-2/10th years, and in 1935, a human being reaching the age of 50 years has, in the United States, a life expectancy of approximately 20 years, or 2/10ths of a year less than he had when he reached the age of 50 years in 1890.

Men have always sought some fountain of youth, some elixir that could be purchased in a bottle or some other method of rejuvenating their aged and outgrown tissues after they reached the period when decay and degeneration began. Out of an expectancy of 70 years we recognize 20 years of growth, approximately 30 years of maturity and 20 years of degeneration and decay. It has always been the hope of mankind to find some magical potion, which would turn the last years, the twenty years of degeneration and decay back into the kind of life he lived between the ages of 20 and 35. All sorts of methods were developed and attempted by various human beings to give man this new activity when he reached advanced years. Ponce de Leon sought the fountain of youth in Florida. He found something there that he thought was the fountain of youth. As he advanced in age he was eventually gathered to his fathers. Great numbers of Americans now seek the fountain of youth 'in the same section and find mostly hot dog stands. Perhaps they have a little speedier existence than they had before they went to Florida seeking a lost youth.

Then, after the time of Ponce de Leon, came the famous Brown-Sequard, who thought he had discoverd in the 'injection of certain glands a new method of rejuvenation. He ran happily up a flight of stairs and measured the time required for that performance. He then injected a "shot" of the glands and found he could run up the stairs faster than he had run before. However, he failed to account for what we call the "will to believe." Having injected himself with the gland and being convinced he could run upstairs faster than he had run before he put on a little extra effort and made a little better time. Then Brown-Sequard, like Ponce de Leon, having reached something a little beyond the age of fifty years, was also gathered to his fathers.

More recently, Steinach and Voronov, noted foreign investigators have also sought in the same glands, these glands so prominently associated with the idea of youth and virility, some hope of rejuvenating mankind after having reached advanced years.

As I go on in my talk I may have to cite certain figures and statistics. I know, as everyone else knows, statistics thrown into any after-luncheon audience are likely to lie there and suffer with the audience. It is not well to cite figures on a heavy meal.

I was recently visiting one of the food companies in Battle Creek, Michigan. One of the men was showing me around the factory where they were packing hay, straw and oats into packages for human consumption. He said, "Doctor, would you believe it? If everybody who eats this breakfast food each morning were placed side by side, they would reach two and a half times around the world." I didn't know what to say. I said, "What a pity!" That seems to have been the wrong answer. (Laughter.)

And I remember a school teacher, lecturing to her class one time in Pennsylvania. She was talking about Niagara Falls and she said, "Children, that great body of water pouring over the rocks is wearing away those rocks at the rate of one inch every hundred years. A little boy at the back of the room burst into tears. The teacher said, "What is the trouble?" and the little boy replied, "I have an aunt who lives in Erie." (Laughter.) I wanted to test that joke here in Toronto. It goes very badly in Kansas City. Out there they don't know where Erie is. Apparently some of you also are a little lame or weak in your American geography.

We have, as you all know, overcome many of the acute infectious diseases which used to seize upon mankind and carry away whole groups of the population. Back in the time of Edward Jenner the unusual person in any community was the one without the scars of smallpox on his face. Today, the unusual person in any civilized community is the one with the scars of smallpox and as he walks about with his scars he is a monument to his own ignorance or his parents' stupidity. Everyone knows today that it is quite possible for civilized man to stamp out the disease .and that it is a duty in aid of his community.

The famous French philosopher, Charles Richet, described human beings as "homo stultissimus," or idiot, man-having knowledge whereby they might stamp out human diseases, they nevertheless permitted many diseases to continue to prevail.

It is quite possible to stamp out diphtheria if we apply all the knowledge available regarding that disease. We know definitely the cause of the disease; we have tests whereby we can determine whether a human being is liable to take the disease if exposed to it; we have an antitoxin which is specific 'in the treatment of the disease and toxin-antitoxin or toxoid with which it is possible to inoculate children and thus establish a resistance against the disease. With all this information we should be able to stamp out diphteria entirely. A considerable number of communities in the United States can show years in which not one death from diphtheria has occurred in those communities. It should be possible for every civilized community to have such a record. But again and again, comes the fact that the human being is "homo stultissimus," and unwilling to avail himself of what medical science has to offer.

Typhoid fever is practically stamped out of the large centers of population. If we had in Chicago this year the amount of typhoid fever that we had in 1890 we would have had 60,000 cases of typhoid fever and 8,000 deaths from that disease. Instead, we had less than 100 cases of typhoid fever and, I believe, three deaths from that disease. Because of that fact many physicians were unable to send their children to college.

In 1890, in New York City, out of every 1000 babies born, 275 died before they were one year of age. Today, in New York City, or in any civilized community, the number of deaths out of every 1000 babies born is from 50 to 70. This is the control of infant mortality. Most of the gain in life expectancy we have achieved is represented by this control of infant mortality. The provision of pure water and pure milk; the understanding of the nature of the diseases that attack infants, our new knowledge of the proper way to feed babies which is, of course, .at best, the old-fashioned way, have made it possible for us to make for most mothers the opportunity of having a healthful living child after passing through the travail which, the woman undergoes during the childbearing period. Knowing all this, we should be able to achieve, eventually, in all civilized countries such results as those achieved in New Zealand which has the lowest infant mortality rate that exists anywhere in the world.

We have controlled typhoid by eliminating infected water and infected food and by controlling the typhoid fever carriers. The control of the typhoid fever carrier is one of the most romantic illustrations in modern medicine's control of infectious diseases. It is interesting to repeat, "Typhoid Mary." "Typhoid Mary" was a woman who not only carried typhoid fever but who followed the occupation of cook. She was not only a cook in ordinary households but she achieved for herself a job as cook in the Sloan Hospital for Women and Children in New York City. Many of the people who came into the hospital had to suffer not only the disease for which they came but also typhoid fever which they got from "Typhoid Mary." After a while it was realized that "Typhoid Mary" was a menace to any community. For a good many years she has been confined on one of the islands in New York City devoted to the public interest. She lives at the expense of the state in comfortable circumstances, simply because she is too dangerous to have loose anywhere in the community.

There is another interesting woman in New York City, a woman who had four daughters. Each married a nice young man. Every one of them, as soon as the daughter married him, developed typhoid fever. The mother, herself, was a typhoid fever carrier. When they came to the home to visit their mother-in-law they found her a double menace. That was the most dangerous family, probably, ire the world for a young man to marry into.

A most romantic story, as Dr. Alan Brown and Dr. Tisdale and some others can tell, is medicine's fight against rickets. Rickets is a modern disease. Before window glass was introduced into our civilization we had no trouble with rickets. Then window glass was introduced and it shut out the ultra-violet rays of the sun. Great tenements and buildings were erected for human beings to live in, instead of living out-of-doors. When all the ultra-violet rays were cut off, rickets began to appear as a condition that would attack every baby in the community. Steps were taken to overcome rickets. It was found that we were not only shutting off the rays of the sun by new methods of living but also by the building of great factories that were pouring smoke across the horizon. Thus were obliterated such rays of the sun as might have come through. Finally, when every child in the community was affected with some rickets, ways to overcome rickets were looked for. It was found that the shortage of ultra-violet rays was contributing to the constant development of rickets in children. What steps did modern civilization take to overcome the evil? Modern civilization didn't go at once to getting the sun back on children. It looked for an artificial way of getting the ultra-violet rays of the sun on the children. Sun lamps, such as quartz mercury vapor 'and carbon arc ultra-violet ray machines were sold with the idea of putting artificial sunlight in the home. Many mothers put their babies outdoors to get what they thought was the ultra-violet rays of the sun. We discovered that there are only enough ultra-violet rays through two hours a day, three months of the year, to be of any real use in preventing rickets. Then we looked about to see in what other way we could obtain vitamin D. Scientists rediscovered cod fiver oil, a very interesting substance, which is of very real importance to medicine.

In 1803 Thomas Percival wrote an interesting essay on cod fiver oil. Then when we learned about calories we discarded cod liver oil as a too expensive fat. Then in 1910 we found out about vitamins and we brought back cod liver oil, and we began to realize its full value. Many times the experience of mankind will teach that what science may indicate is not really fact. We brought back cod liver oil. However, even the smartest and kindest baby may revolt against cod liver oil. If the baby doesn't, the mother may. This created the proposition of getting codliver oil in a finer form. We looked for other ways and we found that the active principle in cod liver oil was viosterol. Cod liver oil tablets were made and the babies ate the candy tablets.

It was found, possible to get vitamin D in foods by irradiating foods. Then they looked for ways to get ultraviolet rays in something else and they found that Farina is among the first solid foods fed to infants. But no one knew how much vitamin D to put in farina so they put in just a little. Then .a baby specialist sat down with a pencil and a paper and found that if you wanted to give enough of vitamin D in farina to be equivalent to three teaspoonsful of cod liver oil daily, you would have to give four and a half pounds a day. That was too much farina. It was half .as much as the baby weighed to start with, and you can't get that much farina into a baby.

Now, we are putting Vitamin D in the babies' natural food, in milk. There is, the great problem of how much to put in milk and how to put it in. Commerce became interested in the problem of getting Vitamin D in milk. There are many ways of getting Vitamin D in milk. You can irradiate milk or add viosterol to it. You can feed a cow irradiated yeast and it will give Vitamin D milk. You can; shave the cow and expose it to ultra-violet rays, and thus obtain irradiated milk. That's a difficult and roundabout process. All of these methods have certain values. They represent how science goes back. We trace the history of each development; we first develop a new disease and later 'discover methods to control it.

Diseases are continually changing; mankind is continualy changing. The diseases that carry off human beings are no longer chiefly the acute infectious diseases. These are largely under control. Today, the diseases of middle life, or the degenerative disorders, carry off most of mankind.

It is interesting to study the changes that have taken place in the causes of death as they have developed from time to time. The insurance actuaries are much mare interested in the matter of when you die than you are yourself. With you it is a casual matter; with them it is a matter of dollars and cents. They want to know when you are going to die with a reasonable degree of certainty. With you, it is a matter of a little disturbance in the family circle-we shall miss your kindly voice, and so forth.

Most interesting is the way in which our civilization introduces new causes of death with which formerly we did not have to concern ourselves. For instance, the automobile does not appear in the fist of the causes of death in 1900. Today, along with deaths from diabetes, it is about tenth in the list of causes. The motor car has become a regular part of our daily lives. With the coming of the motor car there are just two classes; of the population left, the quick and the dead. (Laughter.) We have about 38,000 deaths a year in the United States, and approximately 2,000,000 people injured by motor cars.

Back in, 1890, tuberculosis led all of the causes of death with a rate of 202 for each 100,000 people in the population. Today, the rate for tuberculosis has been cut 'down to approximately 60 to 70 in practically every civilized community. The rate for tuberculosis has been cut down, not by any particularly great scientific discovery in relationship to tuberculosis, but by a few simple facts. Physicians discovered the cause of the disease, the great importance of rest to the tuberculosis lung in enabling it to recover from the disease; that each case of tuberculosis that occurs in a child is probably transmitted, either through infected milk, causing mainly tuberculosis of the bones or joints, or by an older person with whom the child lives, the older person having tuberculosis.

Pneumonia used to carry off the next largest number. That was 180 for each 100,000 people. We have not gone a great way in overcoming the pneumonia death rate. It still appears high in the list of the causes of death, but it has been overcome to such an extent that the rate today represents a little less than half what the rate used to be back in 1900.

We have almost completely controlled the deaths of infants that used to result from infected milk and the wrong handling of children, conveying to them the diseases that largely concern adults.

Another form of disease now rises high in all lists, that is heart disease. Today heart disease leads all others 'in the list of causes of death. There are various reasons for the increase in the number of deaths from heart disease. In the first place, heart disease represents the wearing out of that organ. The heart begins to work before the child is born and it goes on working continually until the time when it stops and the human being dies. There is only one way in which you can really rest your heart, that is to discontinue all muscular activity and lie absolutely fiat on your back. In such circumstances, your heart will slow down somewhat in its rate and the amount of work it is compelled to do. But it 'is quite impossible to stop the heart entirely and rest it as you would a muscle in some other portion of the human body, including for example, the muscles of the gastro-intestinal tract. It is not at all surprising that in an era when we have greatly speeded up human activity and when the strain and stress on all of us is far greater than in any period of civilization, that the list of deaths from heart disease should quite definitely rise. Incidentally, the nature of deaths from heart disease has changed also in this period. Whereas in 1900, children and young adults were not largely affected by heart diseases of the type represented by angina pectoris and coronary thrombosis, if you read the newspapers and watch the histories of great men you will see that these diseases are carrying off one great man after another, one leader after another. They are beginning to be called the disease of the great, the disease of the statesman, the disease of the leader. Coronary thrombosis carried off Senator Walsh, it carried off President Coolidge, it has carried off one great leader after another. When we come to advise men how to dodge coronary thrombosis, you will be interested to know that recent research shows two methods to dodge this heart disease. One is to do less work and under a fighter strain and to take, perhaps, two vacations a year instead of one. In addition, shorten the working days and thus put less work on, the heart than formerly.

Another interesting piece of work was developed by a group of doctors in Boston. They found that by taking small doses of alcohol, as represented by cocktails and highballs, a considerable amount of strain had been removed from the mind. In that way a man was relieved from some of the stress under which he formerly labored. This is a method of preventive medicine that should not be indulged in to excess. If you have started to prevent coronary thrombosis in that manner, prevent it in a small way. Do not try to prevent all of your coronary thrombosis in one evening. The end result of that is likely to be a little different from what you anticipated.

Most prominent cause of death after heart disease is that menace of all mankind known as cancer. As men tend to grow older and live longer lives, they think increasingly of cancer. Cancer is a disease that affects primarily the aged. More than ninety per cent of the cases of cancer occur in human beings past forty-five years of age. The more human beings we continue to keep among us so they will pass the age of fifty years, more and more is the death rate from cancer likely to increase unless, sooner or later, we discover some specific method for preventing cancer or some new method for its treatment or control which will abolish the disease from among mankind all over the world. As most of you no doubt know, men are busy in research laboratories, endeavouring to find a specific cause for cancer and endeavouring to find at the same time the specific method for treatment. And, at the same time while scientists are working in research laboratories in an endeavour to find a specific cause and a specific treatment of the disease, charlatans all over the world, who know how human beings fear cancer, promote new cures and methods of unestablished value, from which they line their own purses. Of all the ghouls feeding on the bodies of the dead and dying, the cancer quack is the most heartless and the most malicious. He takes from people who are confronted intimately with the fear of death the money with which they would be able to purchase a reasonable amount of freedom from pain during the period when they are quite certain to have, for a year or perhaps two or three years, a great deal of suffering. Then, we have among our other causes of death, as you all know, coming quite prominently to the surface and rising more and more during recent years, the diseases of the kidneys and of the blood vessels, like high blood pressure and the condition known as diabetes mellitus. Here we find it necessary to emphasize, for the human being is quite frequently "homo stultissimus," that science has given methods of control over diabetes and diseases of the kidneys. All that it is necessary for the intelligent human being to do is to take advantage of the method. He must find at the earliest moment that he is likely to have one of these diseases and then, to take the necessary steps for prevention. Scientific medicine offers to all the people of the world a simple method, known as periodic physical examination. Human beings have not only bodies but also various secretions and excretions which should be examined to reveal the very earliest evidence of disease of the kidneys and of diabetes. If human beings were examined at regular intervals, science could be assisted in its task to do a great deal of good. The scientists went further than that and made a great concession to human beings. They became sentimental and suggested that the periodical examinations be made on our birthdays. The idea didn't quite catch on. Apparently big business men are too busy on their birthdays even to remember them. It remained for the insurance companies to remind men of their birthdays and to have this examination looked after. To the insurance companies finding little disorders in the excretions and secretions is a serious matter. They have bet so much that you will live longer than you think you will and they want to win. You don't seem to care whether you do or not.

We recognize today other diseases, exceedingly common among mankind, that do not carry off great numbers of human beings but still are a menace. The two leading causes of disability are influenza--the diseases of the respiratory organs, affecting the nose and throat and lungs--and then rheumatism. I mention them at this time merely to remind you that whey we come to consider the ways in which quackery has invaded the medical field, we find that the greatest invasion by quackery has taken place in the less severe type of disease. Most times the patient gets rid of a cold in from three to five days. He begins to feel better after taking the new remedy and he gives the remedy or the quack, the credit for the benefit or the improvement he has sustained. You find your newspapers and magazines full of remedies for a cold. Since the time of Hippocrates, the common cold has been recognized as a self-limiting disease.

In the case of rheumatism, there are hundreds if not thousands of remedies. Probably in the days to cone we shall still have hundreds if not thousand's of remedies, until some specific cause for rheumatism is discovered and it is treated according to the specific cause. Today, rheumatism is treated by electric pads, by electric lights, by people pulling your legs, stretching your arms and jerking your feet. All sorts of peculiar people are willing to give anything they may happen to have available for the treatment of your rheumatism, and persuade you to give them a little of something to enable them to rejuvenate themselves in Florida.

What in general can you do to prolong your lives? Human beings are beginning to add more weight in relation to their height and years thane human beings used to weigh. As insurance companies looked over statistics they suddenly began worrying about overweight. They say that overweight after middle life is the most serious thing they find in relation to the onset of degenerative conditions, the onset of heart diseases, diseases of the blood vessels and high blood pressure. It was put more simply by a old farmer in Indiana who said, "Pigs would live a lot longer if they didn't make hogs of themselves." It takes longer to state the scientific evidence of the life insurance company that out of 15,000 men who died of degenerative diseases most were overweight. That kind of figure does not click with you like the warning of the Indiana farmer.

Overweight after middle life is a serious thing. It is interesting to see why it is we have become overweight. I relate it quite definitely to the coming of the machine age. Motor cars came in and elevators. Walking became a lost art. Ditch digging machinery was invented and two mere could do the work fifty men did formerly. The need for calories disappeared but the consumption of calories went on. Throughout the world men and women began developing large masses of flesh in places where it was most unsightly.

There has been a gradual reduction in the amount of caloric intake in human beings in the United States. We are, on an average, consuming a thousand less calories per person per day than used to be consumed in 1900. That is the way economics, medicine and business tie themselves together.

Besides being examined regularly in order to determine the onset of diseases at the earliest possible moment, what Should we do for hygiene and personal care. In addition to having a certain amount of rest and recreation and a certain amount of cutting down of diet, what shall we do? I ought to mention, as all good mental hygienists do nowadays, the avoidance of worry. Worry invariably reflects itself on the human being in an unfavourable manner. It is a well established fact, as Sir Frederick will agree, that whenever the stock market falls, the number of cases of diabetes increases. Men rush into doctors' offices carrying little packages. It is significant as showing definitely the relation of worry to the onset of degenerative and disabling disease.

In addition to avoidance of worry, what next? All would like to be rejuvenated. I am sorry to say scientific method does not know today any way human beings can be rejuvenated and reactivated as they get older and as they pass the maturity of their middle years. All we can say is that the average human being should try to live out his declining years with the greatest amount of usefulness he can.

For that particular period the dentists have done a great deal by giving sound sets of teeth that you may carry with you to your grave-unless somebody wants to inherit the teeth. They can be taken out without much trouble. No one has been able to, give a full set of intestinal works to come up to those teeth.

You will want to know about tea and coffee and tobacco and alcohol. Scientific medicine will tell you that there is not the slightest evidence that tea, coffee, tobacco or alcohol, taken in moderation, ever appreciably shortened any normal man's life. There is the possibility that all of these things may be taken to excess. Away back in the Middle Ages, in the school of Salerno, the greatest advice given was to practice moderation in all things. It is hard to be moderate nowadays when there is the constant urge of modern advertising to do everything to excess. In 1915, in the United States, we used seven billion cigars a years and ten billion cigarettes. In 1935, in the United States, we used six billion cigars, but we used one hundred and forty-five billion cigarettes, instead of ten billion cigarettes. That advance in our civilization, if you care to think it is that, was no doubt due to what modern advertising has done in the development of that peculiar, and for many people, pleasant vice.

There is still one great rejuvenation quack among us. I believe he annoys you here more than he annoys us. He interferes, I believe, with your wavelength. We thought we had rid ourselves of that greatest rejuvenation quack of aril time when Brinkley, the apotheosis of American quacks, was asked to depart from his radio station in Kansas. But he went to Mexico! He transferred his transplanting of goat gland activities in the United States as a whole to the little spot in Texas known as Del Rio, on this side of the Mexican border. He transplants the glands of goats, no doubt because of the credit assigned to the activity of the great god, Pan, in pursuing nymphs in ancient mythology. There is not the Tightest scientific evidence that the transplantation of these glands will give any more than the thought in the mind of man that he leas improved himself beyond, what it was he had before. (Prolonged applause.)

VICE-PRESIDENT HARCOURT: The greatest tribute a speaker can have, I think, is not the remarks of the Chairman but the attention and interest manifested by his audience. You, Sir, observed that rapt attention and interest. We shall long remember your interesting and instructive and humorous address and we hope your visit with us has been a pleasant one. On behalf of the Empire Club and the great unseen audience listening in, I express our great appreciation and grateful thanks to you. The meeting is adjourned.