The wonderful one-hoss shay

Philip J. Goscienski, M.D.

December 2010

It is more than a century and a half since Oliver Wendell Holmes, Sr., physician and literary great (and father of an honored Supreme Court justice) wrote a poem that symbolizes an ideal human life's course. In The Deacon's Masterpiece or, The Wonderful "One-Hoss Shay," Holmes describes a horse-drawn wagon "so wonderfully built" that it lasts for a century, falling to pieces "All at once, and nothing first, Just as bubbles do when they burst."

When Holmes wrote this piece in the mid-nineteenth century life ended quickly, if not suddenly, for most persons. Infections, especially pneumonia, seldom allowed their victims to survive more than a few days. Most strokes were of the hemorrhagic type that resulted in death within a day or two. Diabetes, almost all of which was due to lack of insulin, led to death within weeks or months. Like Holmes' carriage, human life in the nineteenth century was characterized by usually robust good health and ended with a rapid decline to death, what is referred to as compression of morbidity.

Morbidity, a state of ill health, can last for decades in a world that has conquered most infectious diseases through good sanitation, vaccines and antibiotics. Tragically, the average American can expect to spend roughly ten percent of his or her lifespan burdened by diseases that physicians rarely encountered a century ago.

There is no better example of this than type 2 diabetes. Its causes, lack of exercise and a diet high in refined grains, are obvious but the medical establishment focuses on treatment, not prevention. No medical regimen can reverse the disease. Barely half of its victims are able to keep their blood sugar within a reasonable range, allowing expensive, lifestyle-shattering complications to proceed. Type 2 diabetes is an important factor in the development of heart disease, stroke, blindness, kidney failure and dementia.

Where can we find human examples of the Wonderful One-Hoss Shay? A few population groups come to mind but the oldest generation of Okinawans is among the best-documented and thoroughly studied. The many centenarians among them are robust, physically active, socially involved and clear-minded. There is nothing unique about their genetic pattern, for their Westernized children and grandchildren are among the most obese in Japan, with high rates of heart disease and type 2 diabetes.

And when these oldest finally pass on, it will be "All at once, and nothing first, — Just as bubbles do when they burst."

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at