Age is only another number

Old Endeavour: Scientific and Humanitarian Contributions by Physicians over age 65 William C. Gibson; International Association for Humanitarian Medicine Brock Chisholm; 2007 319 pp $30.00 ISBN 978-88-902020-1-8

When do we become old? Answering this question is rather like deciding at what point high blood pressure becomes hypertension, or sadness becomes clinical depression. Age is objective, but old age is subjective. Concepts such as frailty help to describe physical and social vulnerability, but there is no easy way to measure that combination of attitude, creativity, flexibility and openness that separates those who are elderly in spirit from those who are, as we often say, young at heart.

In Old Endeavour, Dr. William Gibson presents short biographies of over 100 physicians who continued to make significant contributions to medical science past the age of 65. The book is a companion to his earlier book, Young Endeavour, published in 1958. Gibson is associated with the Faculty of Medicine at the University of British Columbia, where he contributed to the development of the Department of the History of Medicine and Science. That he completed this book at age 93 shows that important work can be done well into what we think of as old age.

The individual biographies, each fairly brief, include well-known figures such as William Harvey, Oliver Wendell Holmes, Harvey Cushing and William Osler, as well as a number of lesser-known personalities. Accomplishments in the professional sphere are supplemented with personal information, quotations and anecdotes. It is unexpected, and gratifying, to see so many women represented, especially when one considers that becoming a physician at all was an impressive accomplishment for a woman born in the 19th-or early 20th-century. Readers may also be pleasantly surprised to discover that certain widely recognized names in the Canadian medical community are (or at least were at the time of publication) still alive and actively contributing to medical knowledge in some capacity.

In the introduction, Gibson highlights the “wasted intellectual talent due to enforced retirement.” He points out that age 65 was arbitrarily chosen as the age for retirement in the 1880s, when the average lifespan was shorter. Now, the average life expectancy is hovering around 80, and the declining birth rate means that there are fewer young people relative to the number of seniors. As the population of Canada ages, it becomes ever more important to consider how society can continue to benefit from the abilities and experiences of our older citizens.

Interestingly, the renowned Canadian physician Sir William Osler, whose biography is included in this book, was not a strong proponent of productivity in old age. He believed that most significant contributions are made before age 40 and, in fact, at one point was mistakenly believed to be promoting euthanasia for the elderly.1

Most readers of Old Endeavour will probably use it as a reference book. The entries are arranged in alphabetical order, but for some reason, the book lists the names at the end of the book in an index rather than in a table of contents at the beginning. It might have been useful if the index provided additional means of referencing the entries, for example, by specialty or nationality. As well, some of the entries do not clearly indicate what contributions the subject made after age 65. If this information had been provided in point form, for example, this book would be easier to use. In addition, it is unfortunate that the book does not include photographs of the subjects.

As Gibson himself points out, there are important questions about productivity in old age that cannot be answered by a collection of biographies. Does continued activity lead to greater discoveries? Why do some physicians continue to work and do research beyond the point when most of their colleagues have retired to the south of France or the golf courses of Florida? And perhaps most importantly, how can the profession accommodate and encourage senior physicians to remain vital and valued members of the medical community well into the latter part of life?