Islamset - A mixed blessing

I think that, at least till he got tired, my father quite enjoyed the ninetieth birthday party my wife organized for him. It certainly broke the routine to be surrounded by so many children, grandchildren, greatgrandchildren and assorted collaterals.

He was, I suppose, a case of "successful" aging, for he was still autonomous, doing his own frugal shopping on foot and preparing his own skimpy meals. But his "quality of life" was no longer very good: retinal damage

Prince Albert, who was doubtless well nourished, died of typhoid fever almost certainly transmitted in the palace water supply. Alexander the Great died at 32, probably of malaria, and Cicero's slave Tiro lived to be 100.

due to late-onset diabetes, otherwise well controlled, had forced him to give up tennis in his late seventies, and now reading was becoming very difficult. After ten years' bereavement he still badly missed my mother. Burglars had taken his silver tennis trophies and everything else of value, except books, now as useless to him as to them, and then threatened him with a gun until he managed to convince them that he kept no money in the house. I suppose he was lucky not to be tortured.

We would gladly have helped him move into a comfortable and convenient flat, but he would not hear of leaving his ill-heated house and the wilderness he still called his garden. Myself now in my seventies, I understand him.

Age without death

After cutting his cake (with a little help) and being duly congratulated on achieving such enviable longevity, he murmured to me: "I am a Struldbrugg".

In Jonathan Swift's satire Gulliver's travels (Who reads it nowadays? Everyone should), Struldbruggs, born in the Kingdom of Luggnagg at the rate of only two or three in a generation, and "not peculiar to any family, but a mere effect of chance" (perhaps a rare recessive gene?), are persons recognizable by a distinctive birthmark as endowed, like Tithonus in the Greek myth, with immortality but not with perpetual youth.

In Swift's brief but graphic account of their unending decay, perhaps the most chilling part concerns their physical appearance: "Besides the usual deformities in extreme old age, they acquired an additional ghastliness in proportion to their number of years, which is not to be described; and among half a dozen I soon distinguished which was the eldest, although there were not above a century or two between them."

Here, if you like, is "healthy aging" carried to its logical extreme. A nightmarish prospect, but one that most of us would settle for, if indeed as Swift says everyone desires "to put off death for some time longer, let it approach ever so late". Luckily we shall not be offered the option, because Struldbruggs belong to the domain of fiction. My father died at 93; we grieved for him, but it was time.

The myth of slower aging

Yet, as Dr Darnton-Hi1l says, "never before have so many people lived for so long"; and, according to optimistic popular belief, this is because people are aging not only more healthily but more slowly. In former times, we are told even by professional historians, who really should know better, most people were old at 35 and dead by 40.

The belief that our ancestors suffered from galloping senility appears to stem from a mis-understanding of the concept of life expectancy. The high birthrates with high infant mortality that were once universal naturally translate into low life expectancy at birth. In the improbable case of a society where half the babies died in the first week after birth and all the survivors lived to 80, mean life expectancy would be 40 years, though nobody would be "old", let alone die, at that age. Like half-persons in a society where the average couple has 2.5 children, the elderly 35-year-olds of former times are a" statistical artefact". If life expectancy were reckoned from, say, five years of age instead of from birth our current superiority in longevity would appear less overwhelming.

Of course, our ancestors really were more prone than we to die in middle age; but they died from disease, starvation and violence, not from precocious senility. If we were indeed aging more slowly than they, some of us would be reaching ages never attained before, and that is not happening. More of us are equalling the authenticated records, but nobody is breaking them.

Effects of wealth and poverty

I suspect, on purely anecdotal evidence, that our ancestors' tendency to have numerous offspring, few of whom survived, was at least as marked among the affluent, who left the rearing of their children to wet-nurses, as among the poor, whose fertility was tempered by the contraceptive effect of breast-feeding. Swift's contemporary Queen Anne had 17 children, not one of whom reached adolescence.

More generally, I suspect that in former times longevity was at least as evenly distributed as today. Probably, as Dr Darnton-Hil1 suggests, the affluent "were somewhat better nourished, and more exempt from infections, and therefore lived longer", but was the difference really great? If in the well-to-do countries today we do not suffer much from intestinal infections, surely it is not because we have enough to eat but because we have clean water. Little over a century ago Queen Victoria's consort, Prince Albert, who was doubtless well nourished, died of typhoid fever almost certainly transmitted in the palace water supply. Alexander the Great died at 32, probably of malaria, and Cicero's slave

In Swift's story we see "healthy aging" carried to its logical extreme. A nightmarish prospect.

Tiro lived to be 100. The plague that ravaged Athens in 430 BC killed rich and poor alike, including the great statesman Pericles.

In more recent times, when the causes of infections were still totally unknown and the orthodox therapy for diarrhoeal dehydration was bleeding, those who could not afford a doctor were doubtless safer than those who could. Homoeopathy, whether or not it really "works", at least respects the principle of primum non nocere, and its advent in the late eighteenth century must, by replacing the lethal treatments of the day, have saved many lives.

Nowadays, even in the poorest countries, with mediaeval mortality rates, the affluent few have access to everything they need for the preservation of their life and health, from bottled water and mosquito nets to sophisticated tests and operations. Will the benefits of knowledge be more widely spread, or will the future see such horrific developments, already looming, as the poor serving as walking organ banks for the rich?

Health promotion

In opposition to Medawar's view that our old-age diseases are genetically determined and largely unavoidable, Dr Darnton-Hi1l believes that changes of lifestyle in our latter years can help, "particularly with regard to individual behaviour in matters such as smoking, diet and physical exercise." I have my doubts: according to an article in the April 1995 issue of Scientific American, it is uncertain "whether a man who spends money and time to lower his cholesterol level has done anything to prolong his life", and some examples among my acquaintance suggest that to give up smoking after 40 years' relentless puffing amounts to little more than a belated moral victory.

Lowering blood cholesterol at least has a scientific basis of sorts, but what of the irrational "alternative" regimens that more and more people seem to be following in the hope of prolonging their lives? I fear I may have already given offence by my remark about homoeopathy, so I shall say only that such regimens strike me as very like the "systems" applied by roulette players, whose chances of winning, for all their obsessive counting and calculating, remain unalterably the same as anyone else's. Gamblers who win give the credit to their systems, and long-lived health-cultists to their mystical diets, postures and contortions.

In any case, I strongly agree with Dr Darnton-Hill that people should not be nagged about their lifestyles, especially in their declining years, a time of reaping rather than of sowing, when our quality of life depends on our past more than our present choices, and still more on luck, fate, Providence - call it what you will.

Still, it would be perverse to reject a medically validated reason for doing what one intends to do anyway. A recent report in the British medical journal (1995, Vol. 310, p. 1165) suggests that a daily intake of five glasses of wine (not, apparently, beer or spirits) will make us live longer and more healthily. I'll drink to that, even if some spoilsport isolates the active principle from Vitis vinifera and puts it into a pill.