Chapter 21: We Came, We Saw, We Heard, We Chewed
“I have always thought it would be a blessing if each person could be blind and deaf for a few days during his early adult life. Darkness would make him appreciate sight; silence would teach him the joys of sound.”
I can understand why Helen Keller, the famous author and activist who lost both her sight and hearing in infancy, might have “wished” temporary blindness and deafness on young adults when she made the above statement, in the early 1900s. But at that point in history, older adults didn’t need to have similar infirmities thrust upon them as lessons; they were naturally prone to them by dint of aging. Because of a range of age-related ailments, to live into the 70s near the turn of the 20th century was to run a substantial risk of varying degrees of blindness and deafness. Of course, the loss of either of these two prime faculties could be devastating. As Lewis Mumford, historian and philosopher of technology and science, once noted: “A day spent without sight or sound of beauty — is a poverty-stricken day; and a succession of such days is fatal to human life.”
There’s another faculty that in its absence used also to be often fatal to human life, so I’m adding chewing (which enables eating properly and surviving), along with seeing and hearing to the pantheon of critical physical functions. In respect to all three, we’re far luckier today than our forebears were. Considering the relatively new developments that now preserve our sight and hearing and, yes, our ability to chew, it’s not too far a stretch to say that we live in an age of miracles.
There are several serious ocular conditions that can occur as we age – glaucoma, macular degeneration, retinopathy brought on by diabetes or high blood pressure – but, by far, the most common is the cataract. While cataracts occur in only five per cent of people under the age of 65, by 75 the figure reaches a dizzying 50 per cent. A cataract (the word comes from the Greek katarhaktes meaning waterfall) is a clouding of the eye’s lens, which, left untreated, can cause myopia, colour blindness and, ultimately, blindness itself. In much of the undeveloped world today, cataracts are still the leading cause of blindness. In the Rich World, on the other hand, cataracts are today routinely removed in a relatively quick out-patient procedure, with only a tiny incidence of complications.
The first breakthrough in cataract treatment came in 1748, courtesy of a French physician named Jacques Daviel. Dislodging and removing of clouded cataracts had actually been going on since the sixth century BC, involving procedures like “couching” (about which it’s probably more merciful not to go into here), but suffice it to say that they were performed with a hooked needle and a bronze straw (and without anesthetic). More important, the cataract extractions up to Daviel’s time involved removing the lens capsule along with the lens, which allowed foreign particles to fall into the back of the eye and cause inflammation. Daviel’s innovation, which came to be known as Extracapsular Cataract Extraction (ECCE), allowed for the removal of the lens without the capsule, the majority of which remained intact in the eye.
The second innovation didn’t come along till two centuries later, in 1949. Up to this point, after the clouded lens had been removed, nothing was inserted in its place, and patients had to wear classic Coke bottle-thick glasses to correct the lens-less eye’s erratic focus. But Harold Ridley, a British ophthalmologist, who had treated Second World War fighter pilots whose windshields had shattered in dogfights, noticed that it was possible to leave some of the glass fragments in his patients’ eyes without incurring further damage. Using the same windshield material, he created the first artificial intraocular lens, starting an instant industry and liberating cataract patients from their Coke bottle specs.
The third eureka moment, and the one considered the final step into the modern era of cataract treatment, was the introduction in 1967 of phacoemulsification by a New York ophthalmologist named Charles Kelman. Intrigued by his dentist’s ultrasonic drilling tools, Kelman hatched the idea of using ultrasonic waves to emulsify – or break up – the cataract lens into tiny pieces, so it could be removed through progressively smaller incisions. This dramatically reduced both the hospital time and pain involved. It’s sobering to think that, in the early 20th century, the great French artist Claude Monet, had resisted then-onerous cataract surgery for more than 10 years before finally undergoing it at the age of 83 – after which his visual acuity was restored and his paintings bloomed again with vivid colour. By contrast, today, he could have the same thing done in an afternoon.
Hearing starts to deteriorate on average in our mid-40s. It’s no surprise, then, that there are about 28 million hard-of-hearing people in the U.S. today and close to 2.8 million in Canada. What is a surprise is that although the majority could be helped by them, only about 20 per cent, in both countries, actually have hearing aids.
The reason for this is probably a combination of vanity and the lingering reputation of hearing aids as clunky totems of old age. The first hearing aids were, in fact, the classic trumpet amplifiers we’ve all seen in pictures, made from seashells or animal horns or, if you were rich enough, precious metals.
The critical breakthrough in hearing-aid tech arrived at the turn of the 20th century, with the invention of the first reliable electrical device by Miller Reese Hutchison, an American inventor (he also designed the first automobile horn) and businessman who ultimately worked with Thomas Edison. In 1901, Hutchison produced the first body-worn working hearing aid, the Acousticon; but now that you could take your hearing aids with you, the impediment was size. In the 1930s, the invention of vacuum tubes led to a further shrinking. Finally, in 1947, the invention of the solid-state transistor by Bell laboratory employees William Shockley, John Bardeen and Walter Brattain brought the hearing aid into true miniaturization (although it was still visible and required a battery pack to be carried). In 1959, the first in-the-canal receiver hid the speaker portion from view. In 1987 came even smaller digital devices; and in March of 2010, the American Food and Drug Administration approved the first completely implanted, completely invisible hearing aid for moderate-to-severe hearing loss in adults. When Denise Westgate, 49, became the first British recipient of an implanted device, she called the difference it made to her life “enormous. Suddenly, there is all this sound that hasn’t been there before, something as simple as the sound of water when I am washing my hair.”
Go figure! Growing up I sort of assumed that my hard parts, my bones, would be the parts that lasted the longest. No one told me that my knees would be the first to go (torn meniscus from playing competitive squash), followed by trouble with my teeth. After wearing my pearly whites down to a nubbin over the years (turns out I’m a nighttime grinder; apparently, so are a majority of people), I finally faced the prospect of losing several of my smilers and masticators. To be toothless as recently as a century ago meant not simply the end of chewing, and the nutrition it provides, and the collapse of the facial features, but the protracted and often agonizing end of life itself, brought on by heart and brain infections associated with dental decay. Even 50 years ago, my options would have been limited: a set of dentures that were inconvenient, uncomfortable and not much good for eating an apple.
But, lucky for me, these were the last decades of the old millennium and the dawn of the new, and all I had to do to solve my problem was to get the teeth root canalled (today pretty much a routine 20- to 30-minute procedure), and then, later, replaced by implants. Flat out, for me, implants are a daily miracle!
Whence did they come? The first cropped up in several ancient civilizations – Mayan and Egyptian among them – where everything from carved seashells to ox bone to cast iron was nailed into jawbones to create artificial teeth. But in 1952, a Swedish orthopedist named Per-Ingvar Branemark discovered that titanium would, in a matter of mere months, fuse perfectly to the broken thigh bones of rabbits. Twenty-six years later, in 1978, he brought out the Branemark Titanium Screw for dental implants; to date, close to 10 million of them have been used worldwide. Mine are included in that number, put there by my long-time dentist and pal, Don Kramer, working with the brilliant Canadian implant innovator, Cameron Clokie.
What dental implants share with hearing aids and cataract lens replacement is that they are amazingly forgettable. Good health is not a presence, but an absence – the absence of pain, of discomfort, of physical inconvenience; the freedom to be heedless of one’s body. Of course, all breakthroughs eventually grow routine, and we come to take these miracles for granted. After the initial dramatic euphoria of receiving them – I can see/hear/chew again! – we quickly forget that they’re there; more critically, we’re able to forget the limitations that eroded our quality of life before the new innovations banished them.
What we shouldn’t forget are the people behind the discoveries. Considering where I’d be if Dr. Branemark hadn’t made his, I owe him. He is co-incidentally the only one of the medical pioneers named above who is still alive (82 at this writing). As such, he’d make a great speaker at one of our next Conferences. The others we’ll have to acknowledge in absentia, maybe with a new twist on an old Latin inscription: Antiquiori te salutant – “We who are about to get older, salute you!”
Moses’ Zoomer Philosophy — which launched in ZOOMER Magazine in October 2009 — is a series of monthly essays on age and aging, and the secrets and the science to living better, longer, healthier and happier lives. The first volume of his collection is now available in e-book format on the Kobo Books website. Click here for more information.