Self, Senility, and Alzheimer's Disease in Modern America: A History

1. The Stereotype of Senility in Late-Nineteenth-Century America

c h a p t e r o n e The Stereotype of Senility in Late-Nineteenth-Century America In February 1905, William Osler, the most famous and idolized physician in the United States, if not the world, delivered what would soon become perhaps the most infamous assessment of aging in American history. Men above 40 years of age were comparatively useless, he claimed, while men over 60 were completely useless and, to the extent that they retained their positions, in fact caused much harm: ‘‘As it can be maintained that all the great advances have come from men under 40, so the history of the world shows that a very large proportion of the evils may be traced to the sexagenarians—nearly all the great mistakes politically and socially, all of the worst poems, most of the bad pictures, a majority of the bad novels, not a few of the bad sermons and speeches.’’ Given this situation, Osler jokingly outlined a proposal, taken from Trollope’s satire The Fixed Period, for mandatory retirement at the age of 60 and, following a year comfortably ensconced at a college created for the purpose, a peaceful death by chloroform. ‘‘The teacher’s life should have three periods,’’ Osler then argued more seriously. ‘‘Study until twenty-five, investigation until forty, profession until sixty, at which age I would have him retired on a double allowance. Whether Anthony Trollope’s suggestion of a college and chloroform should be carried out or not, I have become a little dubious, as my own time is getting so short.’’∞ The occasion of these remarks was Osler’s farewell address to a capacity crowd of colleagues and alumni at the Johns Hopkins University, where for the previous fifteen years he had labored to elevate a fledgling medical school to one of the premiere institutions in the country, a mission in which he was successful. At age 56, Osler, and even more so his wife, felt that the pace at Hopkins was costing him 12 self, senility, and alzheimer’s disease in modern america his health. Osler was leaving Hopkins to become Regius Professor of Medicine— a post that, however prestigious, was essentially to be a sinecure following his cutting-edge work at Hopkins. On a trip to England to consider the o√er, Osler asked a leading British physician, ‘‘Do you think I’m su≈ciently senile to become Regius Professor at Oxford?’’≤ In this context, his comments on aging at his farewell address were clearly intended as a joke to soften the blow of his departure to his colleagues and the school—a self-deprecating suggestion that, as he was clearly past his prime and nearly useless himself, Hopkins would do well to be rid of him. Although his colleagues at Hopkins could not accept the proposition that his departure was anything but a terrible loss to them, they took his remarks in that spirit, and the speech was warmly applauded and followed by heartfelt tributes and the awarding of an honorary degree.≥ But reporters immediately picked up the explosive potential of his remarks, and the next day headlines around the country trumpeted the news that the great doctor Osler regarded men over 40 useless and advocated mandatory retirement and euthanasia for men over 60, creating a public controversy that simmered for months. A steady flow of letters and columns excoriating Osler and defending the virtues of older people appeared in newspapers and magazines. The word Oslerize entered the vernacular, appearing even as the title of a popular song, and he received mounds of abusive letters.∂ Although he was evidently surprised and irritated by the angry reaction to his speech, he weathered the storm with characteristic grace and humor, and although never forgotten by the press, the episode did not lastingly tarnish his reputation. In any event, Osler never recanted the substance of his speech. He responded to the controversy with public statements to the press and a letter to the editor in the New York Times asserting that he had never seriously suggested that men over 60 be chloroformed but nonetheless reasserting his belief that most of the productive work of the world was done by men under 40 and defending his call for mandatory retirement for men over 60.∑ Osler included the ‘‘Fixed Period’’ address with a brief preface in the second and subsequent edition of Aequanimitas, a collection of his popular essays. In this preface he explained again that the chloroform proposal had merely...