Both the British Medical Journal and the Journal of the American Medical Association (JAMA) participate in the charming and instructive activity of reprinting short sections from their pages of 100 years ago. These pieces are often quaint, always entertaining and frequently outdated--but not always.
Many a time, and oft, in fact, they still speak to the heart of our clinical practice, even from over a century in which both the practice and face of medicine have changed so dramatically. For example, published in a recent issue of JAMA (Volume 182(17):1606i), and penned over a century ago by Dr. J.W. Bell in his prime as Professor of Physical Diagnosis and Clinical Medicine at the University of Minnesota, was an impassioned "Plea for the Aged".
It should be pointed out that, in 1899, geriatrics did not yet formally exist as a specialty and that Ignatz Naccher's seminal work, "Geriatrics: The Diseases of Old Age and their Treatment" would not come out in print for another 14 years. Marjorie Warren, considered the founder of modern hospital geriatrics in the UK for work in the 1940's, was then barely three years old.
Bell acknowledged that, despite the paucity of current American literature on the subject of the elderly, the French (Charcot, Pine) and British (Day, McLachlan) authorities had helped "to furnish the nucleus of our present knowledge of senile pathology". However, despite the interest of these eminent authorities, Dr. Bell offered a criticism that unfortunately is still quite relevant today: "The want of interest, as indicated by the scanty and fragmentary character of the literature on the subject, is largely responsible for the apathy existing today in our medical schools".
As we enter the new millenium, it must be acknowledged that there has been a modest improvement in the number of Canadian medical schools offering a course in geriatrics. Still, the growth is not at all proportional to the increase in the numbers of elderly. In 1899, less than 5% of the continent's population was over the age of 65. Today, that percentage has almost tripled and life expectancy has increased significantly throughout the developed world.
Despite his critique of the system, Bell understood the circular wars of the medical schools that still rage today. He offers that "It would seem criminal to even suggest that addition of another distinct course to the already overcrowded college [medical] cirriculum (sic)
." But he does offer two suggestions, the first of which still makes sense: "That the chairs of anatomy and physiology impart to the student the necessary primary instruction
". To the contemporary reader, his second suggestion may seem a bit quaint but it was obviously born out of desperation and the faint hope that colleagues might heed his plea. Here, Bell suggests that the "The chair of practice [Internal Medicine], or if deemed best, in order to contrast disease, the chair of pediatrics enlarge its scope and furnish the necessary
instruction
"
Were Dr. Bell to survey the situation today, he would also still have much room and justification for complaint. Despite improvements in our field, his words from one hundred years ago ring true today: "[the medical student] scarcely recalls reference by one of his teachers to old age, unless suggested in mitigation of the failure of some brilliantly planned but misjudged operation or equally ill-timed drug treatment".
JAMA's recent '100 Years Ago' column has helped us to realize that despite some improvement, at least in the field of treating the elderly, 'plus ça change; plus c'est le meme chose".
Dr. A. Mark Clarfield is the Chief of Academic Affairs at the Herzog Hospital in Jerusalem and on staff in the Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal.
