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Chapter One. History and Demography
- Johns Hopkins University Press
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CHAPTER ONE History and Demography F F F In mid-twentieth-century America, few physicians would have predicted that within decades the modern diagnostic category of osteoporosis would emerge and include millions of Americans, predominantly older women. Prior to World War II, popular attitudes were shaped by a belief that the declining physical and mental health of older persons was irreversible, and that this population had little to contribute. Nor did the medical armamentarium offer much that was of use for coping with the chronic and longduration illnesses of this group. As late as the 1960s, with a few exceptions, no dramatic discoveries had been made in the field of geriatrics.1 With regard to bone health, little was known about the physiological processes that shaped bone resorption (where osteoclasts break down bone), and the subject was of little interest to clinicians or researchers. Yet the growing number of Americans surviving to the age of 65 and beyond was permeating the consciousness of the nation. The increase in their numbers, their emergence as a self-conscious group with distinct interests, and their rejection of the pejorative concept of senescence made them a force that could not be ignored. How would this group manage the vicissitudes of aging? What resources would enable them to survive? How would their pressing health needs be met? The 1 2 Aging Bones answers to such questions still lay in the near future, although the passage of the Social Security Act of 1935 was a portent of change. To understand the emergence of osteoporosis, therefore, requires an understanding of both developments in medical science and those social, intellectual, economic, demographic, and political changes that would transform American society in the decades after World War II. BONES IN HISTORY How did bone loss—a natural concomitant of aging—become pathologized? Interest in both the aging process and the nature and character of bones dates from antiquity, yet neither were defined in pathological terms. Although a long life was highly valued, aging was simply an inescapable feature of human existence . Yet longevity had its dark side. The vigor of youth was often followed by illnesses that created disabilities and diminished mental capabilities. Nowhere was the tragic nature of aging better expressed than in Shakespeare’s “Sonnet 73.” In this poem Shakespeare alluded to the ravages of time on one’s body and the anguish of impending death. That time of year thou mayst in me behold When yellow leaves, or none, or few, do hang Upon those boughs which shake against the cold, Bare ruin’d choirs, where late the sweet birds sang. In me thou seest the twilight of such day As after sunset fadeth in the west, Which by and by black night doth take away, Death’s second self, that seals up all in rest. In me thou seest the glowing of such fire, That on the ashes of his youth doth lie. As the death-bed whereon it must expire, Consum’d with that which it was nourish’d by. This thou perceiv’st, which makes thy love more strong, To love that well which thou must leave ere long.2 [18.209.66.87] Project MUSE (2024-03-28 21:28 GMT) History and Demography 3 Even the ancient world recognized that aging was accompanied by bodily changes. Nevertheless, physicians manifested little concern with the health of older persons, who (until recent times) constituted a relatively small proportion of the population. Moreover , there was little in the medical armamentarium that could arrest the inevitable process of aging and its accompanying ills and disabilities. Nor were there many diagnoses to describe the ills of older persons. Old age itself was generally offered as the cause of death. The absence of specific diagnostic categories did not mean that bones were of little interest in the ancient or early modern world. Bone, as a matter of fact, aroused considerable curiosity. How was it created and what accounted for its differentiation from flesh? What was the relationship between bones and health? A variety of answers were given to such questions. There was a widespread belief, for example, that the oil of the marrow moistened the bone, which in turn gave rise to good health. The Book of Proverbs noted that “a merry heart is good medicine, but a broken spirit drieth the bones.” Similarly, the Book of Job observed that “his pupils are full of milk, and the marrow of his bones is moistened.”3...