H3 Book Index:: Chapters 1-29
It is no exaggeration to classify most homes for the aged as brick and mortar limbos, wherein old people in both physical and mental states of dissolution continue their slow degeneration amid the organized monotony of white bedsheets and hushed voices, broken only by the seventh day visit of an impatient relative. Rehabilitation on this basis is an impossibility, and the most that can be hoped for is constant sedation which will relieve the aches and pains, the discomfort and discontent, the feeling of having been forgotten and the frustration of being able to remember.
Nursing homes, of course, but reflect the prevailing
society, as pointed out in 1975 by Dr. Carl Eisdorfer, chairman of the Department of Psychiatry and Behaviorial Sciences at the University of Washington School of Medicine in Seattle. About one million out of twenty million aged in this country are in full-term custodial care-as the U.S. Senate's Special Committee on Aging stated in a report a few years ago, this care, or rather non-care, is costing taxpayers close to five billion dollars a year through Medicare payments to nursing-home owners.
This is not the place to discuss whether such money could be spent more wisely although the evidence would indicate so, or whether it is enough. If, however, we wanted to save money, Prof. Eisdorfer suggests facetiously, we would only have to follow Kurt Vonnegut's idea in Welcome to the Monkey House. "He handles the aging problem very simply.
He pictures, next to some restaurant, such as Howard Johnson's, a parlor where people can go between their sixty-fifth and sixty-sixth birthdays and have their lives terminated. Vonnegut's parlor is staffed by attractive men and women skilled in discovering the best method to do away with people. Sometime before a person's sixty-sixth birthday he walks into this future Howard Johnson's, gets a free meal, then walks next door and, against a background of soothing music, has the death of his choice."
What we have to do, of course, is finally to recognize, why older people are with us and why, even in a country as youth-oriented as ours, they deserve the best possible care, free from indifference, neglect and exploitation. It is an indictment of our society that we are still years away from attaining this goal while elsewhere and even in some poorer countries considerable progress has been made in that direction.
Each of the patients in the Bucharest old age home was, at one time, debilitated, plagued by sickness, and steadily growing weaker in mind and body. Today, not one of the patients who has received the GH3 therapy is
bedridden! That in itself is a remarkable achievement. However, the procaine-treated patients not only walk about unaided; they also function as alert, thinking, industrious men and wome.n who are old without being aged. Almost every one of them has a task: some work in the kitchen, others in the garden; a few are busy carpet weaving, others make handicrafts, and some help in the library. And, most significantly, many of them even atteI1d courses in French. The procaine therapy has helped them to remain mature while they grow older.
The research upon which the whole therapy is based was begun in the Institute in May of 1951. Twenty-five patients, ages 60 to 92 (all of whom suffered from serious degenerative diseases such as extrapyramidal disturbances, hypertension, degenerative joint disease, rheumatism, cirrhosis, etc.), were treated with procaine. After some initial uncertainty, Prof. AsIan arrived at what she believes is the optimal dose and strength for the procaine: intramuscular injections of 5 cc of a 2 per cent solution, three times weekly for four weeks, were administered. A ten-day interval without
further inoculation followed, then a new series of twelve injections, another interval, and so on.
Before treatment was started, possible allergic reaction was tested for with an injection under the skin of
1 cc of GH3 procaine. Few people were found to be sensitive to this substance-in Bucharest only a handful among the thousands of patients (four out of the first
4,800 tested). It can reasonably be expected, however, that a higher allergy rate may be found in the West, where sensitization generally is greater and allergic disorders affect more people than in Eastern Europe.
Sixteen of the 25 old men and women in Prof. Aslan's original group were still alive eight years later, in spite of the fact that the disorders from which they had been suffering (as stated above) would ordinarily have claimed the lives of almost all of them. There was not a single death during the first two years of treatment. In 1954, there was one death due to a spinal accident; in 1955, two deaths occurred, due to chronic bronchitis and myocarditis (an inflammation of the muscular part of the heart wall); in 1956, one death due to a pseudobulbar syndrome, from which this pa.. tient had suffered for six years. Five patients died in 1959-three in a flu epidemic, one due to arteriosclerosis, and one due to an accident.
The number of patients receiving GH3 procaine therapy was slowly increased after the successful results with the first group tested. In 1959, when twice I visited the Institute, 70 of the patients in the old age home received procaine injections, 40 other inmates were used as control group. The table indicates a portion of the impressive results obtained.
The mere prolongation of life was of minor concern to the Bucharest doctors. (Indeed, most of the patients there had already achieved an enviable record of
longevity.) Instead they were interested in developing a method of the preservation and restoration of vitality. Thus, the figures indicating the improved capacity of the procaine patients to do some work and to care for themselves are much more significant than the dramatic figures on mortality. These exciting statistics
are shown graphically in the photo section (pp. 80 -94).
When I first walked among the patients at the Bucharest Institute, I was struck by the fact that some seemed to be merely well preserved, active people for their apparent age, while others had a strikingly vital appearance (I hesitate to use the word 'youthfull a reader misinterpret and think I am implying that some of the patients had grown younger). All of the patients, including those who had been receiving procaine more than 100 times a year for eight years, remained old people. But those who had been on GH3 procaine therapy for some time had a look of vitality that one might characterize as 80-years-young," or even 112-years young" in the case of Parseh Margosian.
Until the flu epidemic in 1958/59, the mortality of
the patients treated with GH3 procaine was 3.2 per cent (and the median age 82 years), that of the people treated with vitamins or gland extracts was 16 per cent, and of those who did not receive any supportive therapy, 27 per cent. Since the patients themselves did not know what treatment they were receiving, the great difference in the mortality of these groups contradicted those critics who ascribe the success of the procaine therapy to some suggestive effect.
The Institute of Geriatrics was founded in 1951 to study the problems of gerontology and geriatrics, as part of the research plan of the Academy of the Romanian People's Republic, thus constituting a portion of the State Scientific Program. Therefore, it is important to note that Prof. Aslan was not, as were most of her predecessors in the application of GH3 procaine, working on an individual basis with the goal of personal symptomatic relief.
Over the years, the Institute of Geriatrics has constantly widened its scope and since 1957 many thousands of people, have been treated on the premises stationary or on an out-patient basis, and, in the case of foreigners, "at the Hotel Pare in Bucharest as well as in two other centers at the Black Sea and in the Carpathian Mountains. (Procaine cures today are also offered by sanatoria in Italy, Spain, Germany, Mexico and even in Egypt.)
In 1972, Prof. Aslan reported to a Congress on Gerontology in Bucharest that during the preceding two years 15,000 people, aged 40 to 62, had been tested at 144 centers in Rumania in order to find out whether GH3 would not only prove an anti-aging factor in the aged-which she felt had been borne out by the research and the results up to that date-but whether it might also prevent aging. Of the 15,000, more than 7,000 were selected for treatment which was identical, except that 4.021 persons received over the two-year period 10 series of 12 Gerovital (the Rumanian procain) injections while 2.905, acting as control group, did not.
The results of this large-scale experiment were significant in several respects: High blood pressure improved in 85 per cent of the procain treated and only in 61 per cent of the control patients; arterial hypertension showed signs of normalization in 83.2 per cent of the Gerovital-treated and 65.8 of the control patients; the pulse rate in persons with tachycardia (a rate of over 90 beats per minute) normalized in 93 per cent of those getting GH3 Gerovital but only in 88 per cent of the control group, of those with brachycardia (low pulse rate) the normalization in the Gerovital-treated group was 9 per cent higher than in the control group. With respect to cardiovascular effect, muscle strength and respiratory capacity there were also greater normalization rates in the Gerovital-treated persons where some abnormalcy existed. Hardly less exciting was the finding that in the course of the two years when due to aging, higher blood pressure and more tachycardia might have been expected, there was no change whatsoever in the normal, Gerovital-treated persons. Also, the number of days the Gerovital-treated persons remained off the job for reasons of health diminished nearly by two fifths, compared with the years before treatment took place. These figures would indicate a strong prophylactic effect of procaine; only when this long-time trial has been terminated in 1980 and the findings published, will it become possible to grasp the
full importance of this previously unexpected results of procaine.
Already as a result of the initial success with the procaine program, the Institute had become physically larger and scientifically a more important place. It is composed of six departments:
1. The nursing home where aged people are cared for under the conditions cited previously. Long-term treatment is provided here.
2. The clinic for the treatment of bedridden aged patients as well as others affiicted with certain diseases which respond to procaine treatments. In this section, the emphasis is more on short-term treatment.
3. The out-patient department, where procaine treatments are administered daily to hundreds of persons, some for therapeutic and other for prophylactic purposes.
4. The laboratories: some for animal experiments, others for clinical, physiological biochemical,
hematological, pharmaceutical and roentgenological research. Each of these laboratories is under the direction of a specialist, some of whom are visiting experts from Rumanian Universities.
5. The department of social hygiene, which is mostly concerned with the sociological problems of old age and relates national statistics to the work of the Institute.
6. Three additional facilities for the treatment of foreigners.
Because the Institute will continue to treat, as well as to investigate, it is distinguished from almost all other existing centers in this field, most of which are devoted exclusively either to the care of the aged or to research into their problems.
"Before and after" pictures are convincing to the medical scientist only when it is obviously the patient who has changed, and not merely the angle of photography, the lighting, or the type of film used.
The four pictures of Maria Tabarcea shown in these pages are excellent documentation of her case history. The improvement in the condition of Tanasalu Mircea is obvious, in spite of the difference in lighting. But as medical documentation, the other photographs of patients are "not entirely satisfactory."
Professor Ana Aslan, M.D.
Today at 80, she still guides the destiny of the Bucharest institute which she has headed for more than a quarter century. Last year alone she traveled to Africa, Asia, the United States and to several European countries, delivering lectures, consulting, treating patients.
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H3 Book Index:: Chapters 1-29
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