Status of Older People: The Ancient and Biblical Worlds

While the afflictions old age may bring were well appreciated by the ancient writers, the literature is less pragmatic regarding the causes of such afflictions. Medical writers also attributed aspects of old age to bad habits in one’s youth, but they realized that aging is inevitable. The most common theory to be found in the extant ancient literature, both medical and philosophical, on the cause of aging is that in time the body loses its innate heat and fluid—its life force, or pneuma (like a lamp running out of oil). Hence, the infant is warm and moist while the older person—like a corpse—is cold and dry. In other words, aging is a cooling and drying process, and the desiccation of the heart and liver leads to death. Just as during an illness, in old age the balance of the four humors has been lost: blood and yellow bile are lacking, phlegm and black bile [melancholy] are abundant. As heat dissipates, the body takes longer to recover from illness and injury, but for the same reason symptoms such as fever become less acute in older people, as does activity in general.

Twice in the Hippocratic corpus there appears another theory, namely that the elderly person is cold, but humidor moist (rather than dry). This countertheory is soundly and insistently refuted by the later medical writer Galen (129–199 C.E.): The mistake is due, he remarks, to the external appearance of moisture about the old person—coughing, runny nose, and the like—but these are merely an abundance of external, phlegmatic secretions, or the residue of humidity, and are not to be taken as an indication of the innate condition of the elderly individual.

This idea that old age is cold often recurs in general literature as well. As for its dryness, old age is regularly described as having been drained of the moist (and hot) humor of blood (note, for example, the image of the dry and shrunken Sibyl). What blood the aging body does have is thin and icy cold, an image Virgil evokes in the person of Entellus: ‘‘My blood is chilled and dulled by sluggish old age,’’ (Aeneid 5: 395–396). Galen noted that the coldness of old age affects not only the body but also the mind: ‘‘So why do many people become demented when they reach extreme old age, a period which has been shown to be dry? This is not a result of dryness, but of coldness. For this clearly damages all the activities of the soul’’ (Kühn 4: 786–787) Old age, it was concluded, destroys everything.

Furthermore, because aging was conventionally seen as a process of desiccation, those who were by nature very humid were held to have the greatest chance of a long life. With similar logic it was stated that men, being warmer, age more slowly than women and hence live longer (the latter observation may well often have been accurate in the ancient world, though for other reasons). At any rate, physical exertion dries one out, and so hard-working people age more quickly. For the same reason it was believed that excessive indulgence in sexual intercourse is deleterious to the aging frame.

It was a literary commonplace, adopted by the Pythagoreans in a system of four ages (which mirror the four humors), that old age is like winter, at least in its coldness. Part of the theory was that one felt best in the season appropriate (that is, complementary, or opposite) to one’s age. So it was observed that summer and early autumn were the seasons in which older people might thrive, and winter was the season to avoid as best one could.

To counter the dryness and coldness of old age, it was thought to be necessary to restore the balance of the humors, by giving warmth and humidity to the body. Finding a means to warm and moisten the body was the chief aim of what geriatric medicine there was in the ancient world. It was common in antiquity to state that old age was itself a disease; in fact, Seneca the Younger (Epistles 108: 28) stated that old age is an incurable disease. In the second century C.E., Galen, for one, disagreed vigorously: while diseases are contrary to nature, he claimed, old age is a natural process, just as to die of old age is natural. Therefore, Galen insisted, old age, is not a disease; though it is also not complete health either. Rather, old age has a state of health peculiar to itself, and this may be maintained through a moderate lifestyle. It was apparently a common practice for physicians to recommend a particular regimen or ‘‘diet’’ that older individuals should follow. Dietetics was one of the main traditional divisions of ancient medical therapy, the others being pharmacology and surgery.

In the fifth book of his work On the Preservation of Health, Galen provided abundant material on the subject, considerably more detailed than anything that preceded it and of considerable influence on treatments of the subject over the following centuries. Galen’s concern was with lifestyle, not just diet: his recommendations incorporated massage and gentle exercise—not too much and not too little, depending upon the constitution of the patient. If strong enough, the elderly patient was advised to engage in horse riding and ball throwing, or travel on a ship or in a litter; if bedridden, reading aloud could be highly beneficial. Galen recommended for the older patient the right amount of sleep (good for moistening and warming the body), and tepid baths (two or three times a month, but never if bedridden). Blood-letting, according to Galen, is good for stronger patients up to the age of seventy years, though it was not recommended for the very elderly, who, Galen added, need every drop of blood that they have. As to diet, he believed older people need little food, which was perhaps just as well since many food items were not recommended or permitted. Some foods he considered to be beneficial (plums are good as laxatives for the older patient, according to Galen), but he thought many others to be dangerous (such as cheese, hard-boiled eggs, snails, lentils, mushrooms, and many vegetables). Also recommended were fish, some types of soft bread, and lean meat—especially young goat’s flesh—but not pork.

Regarding beverages, water was not recommended, nor was milk, which was believed to rot aged teeth and gums. For older individuals, however, Galen did specifically recommend human breast milk and warm donkey’s milk, or milk mixed with honey. One farmer is mentioned who survived beyond the century mark thanks to goat’s milk mixed with honey and wine. Wine, the gift of Dionysus, was particularly commended, and in the name of science Galen devoted much study to the question of which wines were best for medicinal purposes. Wine was thought to have positively rejuvenating effects. Indeed, it was proverbial in antiquity that wine makes an old man dance, even against his will. Wine makes the body warm, and, Galen added, it also serves to counter the sadness and anxieties that long life may bring.