This Article Full Text (PDF) Services Download to citation manager PubMed PubMed Citation

Morley's "A Brief History of Geriatrics"

Graduate School of Social Work, University of Houston, Texas.

Address correspondence to W. Andrew Achenbaum, Graduate School of Social Work, University of Houston, Houston, TX 77204. E-mail: achenbaum{at}uh.edu

Commentators could not possibly encapsulate the wealth of information in "A Brief History of Geriatrics" (1). Instead, I shall add more detail to the biosketch of a single figure who John Morley (1) rightly credits "with the invention of the word ‘geriatrics.'" Ignatz Leo Nascher (1863–1944) was truly a polymath and a pioneer, whose ideas and efforts were underappreciated by his peers.

The early years of Nascher's career were spent mainly practicing medicine. Some of his initial publications attest to his eclectic interests: "A Young Living Fetus" published in 1889 in the Medical Record of New York (2) and "Tissue Cell Evolution" in the New York Medical Journal (1910) (3). A 1908 article on prostitution demonstrated Nascher's interest in medical sociology. A year later, he published his first book, The Wretches of Povertyville: A Sociological Study of the Bowery (4). There, Nascher made passing references to older characters he dubbed "Duddy Ward" and "Old Shakespeare" (5,6).

Unquestionably, Nascher's most important article appeared in 1909 in The Medical Record of New York (7). He not only coined a new medical specialty, "Geriatrics," but Nascher made two assertions there about the nature of senescence that he would amplify for the rest of his life. First, "senility is a distinct period of life," claimed Nascher, "a physiological entity as much so as the period of childhood" (7). By emphasizing physiological processes and mechanisms of senescence, Nascher challenged aspects of the pathological model of aging, then the primary focus of medical researchers, including Nobel Laureate Elie Metchnikoff. Second, believing that geriatrics, like pediatrics, was "a special branch of medicine," Nascher attempted to create an infrastructure to legitimize the field of inquiry.

In 1914, Nascher elaborated his case in a hefty textbook, Geriatrics: The Diseases of Old Age and Their Treatment, Including Physiological Old Age, Home and Institutional Care, and Medico-Legal Relations (8). In the preface to the first edition, he acknowledged his debt, primarily to French and German investigators such as Jean-Martin Charcot, whose Clinical Lectures on the Diseases of Old Age (1881) systematically identified localized lesions in late life (9). Nascher contended that his classification was distinctive insofar as it distinguished between diagnoses of "normal senile conditions and pathological conditions" (10).

To underline the connections between geriatrics and pediatrics, he invited Abraham Jacobi to write the Introduction to Geriatrics. "The world is entitled to demand of every one of us a complete knowledge and profound interest in the physical life both of the young and the old," the father of American pediatrics declared. Then, Jacobi wondered: "Now why is it that the growing interests in many of the branches of medical science and practice has not equally been extended to the diseases of old age?" (11). In the corpus of his text, Nascher acknowledged a flaw in the analogy between pediatrics and geriatrics: "While the dependence of the child arouses sympathy, in the aged the repugnance aroused by the disagreeable facial aspect and the idea of economic worthlessness destroys the sympathy we bestow upon the child and instills a spirit of irritability if not positive enmity against the helplessness of the aged" (11).

Nascher persisted, continuing to promote geriatrics in peer-reviewed journals. He inaugurated a feature in the Medical Review of Reviews. In 1915, Nascher founded the New York Geriatrics Society. He spoke on institutional care for the elderly at the National Conference of Social Workers. Nascher made all the right moves, to little avail. He admitted being the nation's only full-time geriatrician in 1926.

Even though Nascher could not attract talented women and men to the specialty, he knew that it was essential that physicians know something about the normal processes of aging as well as the acute and chronic diseases associated with advancing years. He extolled the field's multidisciplinary dimensions. Hampered by ageism within his profession and society at large, Nascher deployed the best tools available: research and training. "La plus ça change, la meme chose."

References

1. Morley JE. A brief history of geriatrics [History]. J Gerontol Med Sci. 2004;59A:1132-1152.
2. Nascher IL. A young living fetus. Medical Record of New York. 1889;36.
3. Nascher IL. Tissue cell evolution. N Y Med J. 1910;92:918.
4. Nascher IL. The Wretches of Povertyville. Chicago: Jos J Lanzit; 1909.
5. Freeman JT. Nascher: excerpts from his life, letters, and works. Gerontologist. 1961;1:17-26.
6. Achenbaum WA, Albert DM. Profiles in Gerontology: A Biographical Dictionary. Westport, CT: Greenwood Press; 1995:37.
7. Nascher IL. Geriatrics. N Y Med J. 1909;90:358.
8. Nascher IL. Geriatrics. Philadelphia: P Blakiston's Sons; 1914.
9. Achenbaum WA. Crossing Frontiers: Gerontology Emerges as a Science. New York: Cambridge University Press; 1995:37.
10. Nascher IL. Geriatrics. 2nd Ed. Philadelphia: P Blakiston's Sons; 1916:ix.
11. Jacobi A. Introduction. In: IL Nascher. Geriatrics. Philadelphia: P Blakiston's Son & Co; 1916[1914]:xviii:12–13.

This Article Full Text (PDF) Services Download to citation manager PubMed PubMed Citation