1163BRITISH POSTGRADUATE MEDICAL SCHOOL

progressively from youth to old age, until a merehandful remain ; the age of the individual per sehas nothing to do with the probability of its dying.From that it is argued that the predominatingcause of death is not constitutional, but environ-mental and accidental ; so many individuals percentum are destroyed every day by what theauthors call " major catastrophic environmentalstoppages of the individual life." An approxima-tion to this type of curve is found in certain

aquatic organisms (hydra), which also have thecharacteristic of continuous growth ; they nevergrow old, they just grow bigger till they are

accidentally killed. A third group of curves isintermediate between those two types, and includesthe mouse, the roach, and wild drosophila. Thehuman curve, which is less simple than thosestudied in laboratories, probably belongs here too.From these curves, and kindred data, an attempt

is. made to deduce the factors determining theoccurrence of natural death, and its distributionin time (age). Five of them emerge : (1) endo-genous senescence, or the running down of the

clock ; (2) exogenous senescence, or the accumulat-ing effect of the wear and tear of life, the " environ-mental buffetings " ; (3) the genetic constitutionof the individual-whether he is a " Ford " or a"

Rolls " ; (4) the rate of living, which is takento include all the functional activities of the

organism ; and (5) the risk of immediately lethalaccidents. These five factors may be simplifiedto three-namely, genetic constitution, activity(in the broadest biological sense of the term), andenvironment. In other words, and applied to thehuman species, this means that a man may livelong because he has a strong constitution andcan withstand a severe environmental buffetingand a high rate of living, or alternatively becausehe lives a gentle sheltered life that spares his poorconstitution-always provided he escapes death

by accident in his youth or his prime. Such aconclusion, to the observer of mankind, wouldseem quite obvious and not at all new, but it ismost interesting to find it emerging even imper-fectly from a mathematical study of the vitalstatistics of slugs and flies.

ANNOTATIONS

BRITISH POSTGRADUATE MEDICAL SCHOOL

ON Monday last the King, who was accompaniedby the Queen, declared open the British Postgraduate JMedical School. His Majesty was received by SirAusten Chamberlain, chairman of the governing body,and Lord Snell, chairman of the London CountyCouncil, which is cooperating actively with the Govern-ment and the University of London in the promotionof the institution.

Sir Austen Chamberlain, in asking His Majestyto approve of the efforts made by those engaged inthe creation of the school and to declare the schoolopen, stated the prolonged and laborious inquirywhich had led to the practical result. Fourteen yearsago, he said, a committee on post-graduate medicaleducation, presided over by Lord Athlone, now

chancellor of the University of London, reported thata school attached to a London hospital should bedevoted solely to post-graduate education whichwould be a school for the university and shouldreceive substantial financial assistance from the

treasury. These recommendations of Lord Athlone’scommittee have been exactly carried out and SirAusten described the tasks now before the schoolin the following words : " nrst, to enable medicalmen in general practice to bring their knowledge upto date, and to familiarise themselves with the latestdevelopments in diagnosis and treatment; secondly,to provide instruction for graduates desiring to pursuespecial studies in the higher branches of the profession ;thirdly, to promote research and to advance medicalknowledge." He added that it was the ambition ofthe directors of the school to make of it a great centreof British medical science, drawing students andteachers alike from all parts of the Dominions formutual instruction and the promotion of the reliefof human suffering.The King said, in declaring the school open :—

66 It is with great pleasure that the Queen and I havecome here to-day to open the British PostgraduateMedical School. The provision within the University ofLondon of a new centre for clinical teaching marks anotable advance in the continuous effort of the medicalprofession to increase its capacity for service to mankind.

" I am especially glad of this opportunity to show mygratitude for the skill and care which I and my familyhave received from members of that profession, and notleast from distinguished members of the governing bodyof this school."You have reminded me that a foundation such as

this was recommended by a committee presided over byLord Athlone. A recommendation of the same committeeresulted some years ago in the creation, with generousassistance from the Rockefeller Foundation, of the greatLondon School of Hygiene and Tropical Medicine. LordAthlone must be gratified, as Chancellor of the University,to take part in the realisation of the last stage of hisfar-reaching plan.

" While the two schools trace back to the same originthere is a further bond of union between them. Thefoundation-stone of each was laid by the Chancellor ofthe Exchequer, who, as Minister of Health, had so largea share in their evolution, and you, Sir Austen, followinga distinguished family tradition, are chairman of each boardof governors.

" It is my earnest hope that this school, with its happyunion of ward and laboratory, university and localauthority, drawing students and teachers alike from allparts of our Empire, and I trust from regions even morewidely spread, may prosper under God’s blessing. May itplay an imperial r6le in the winning and dissemination ofmedical knowledge, in the relief of suffering among mypeoples in this country and overseas, and in enabling thedoctors of all lands to come together in a task where allmust be allies and helpers."

Following His Majesty’s declaration that theschool was open, numerous presentations of membersof the governing body and others directly concernedin the movement were made by Sir AustenChamberlain. The King and Queen then made acomplete tour of the building, a strenuous task as

will be seen by reference to the description publishedin another column (vide p. 1172). Their Majestiesvisited the clinical lecture theatre, the library, andthe various departments, where the directors were

presented to them : Prof. Francis Fraser, directorof the department of medicine ; Prof. Grey Turner,director of the department of surgery ; Prof. JamesYoung, director of the department of obstetrics andgynaecology ; and Prof. E. H. Kettle, director of thedepartment of pathology. Each director in turn

1164 TUBERCULOSIS IN DOMESTIC PETS

presented his readers, while among others presentedwere Mr. Edwin Bax, F.R.I.B.A., the architect,Dr. Duncan White, radiologist of the hospital, Mr.Leslie Clark, Ph.D., physicist to the London CountyCouncil, and Sir Thomas Carey Evans, medical

superintendent of the hospital.

PROPHYLAXIS AND EXPOSURE IN MEASLES

THAT the results of the sero-prophylaxis of measlesmay depend upon the conditions under which exposureto infection takes place is emphasised by some

observations of Karelitz and Schick.l Serum wasobtained from five adult immunes. The sampleswere not pooled but were injected individually in adose of 6 c.cm. in two groups of susceptible childrenof comparable ages exposed to measles over similarperiods; one group, however, consisted of childrenin hospital and the other of children in their ownhomes. It was found that the protection affordedby each sample was much greater in the institutionalthan in the familial group. The combined groupscomprised 134 children. Comparison of the condi-tions of exposure showed that the protection-rateswere 87 and 29 per cent. ; the attenuation-rates 13and 22 per cent. ; and the failures 0 per cent. and49 per cent. in the hospital and familial groupsrespectively. Similar differences have been reportedin the results obtained from convalescent serum byPark and Freeman, and by Levinson and his co-

workers, and these are quoted by the authors. Thediscrepancies in the results are diminished whenlarger doses of serum are employed in the case ofchildren exposed in their homes. Thus, in furthertrials, 6 c.cm. of serum in an institutional groupproduced results closely similar to those alreadymentioned ; but the injection of 8 c.cm. of adultserum in a familial group afforded a protection-rateof 46 per cent., an attenuation-rate of 43 per cent.,the failures either to prevent or attenuate droppingto 11 per cent. Still larger doses of from 12-25 c.cm.of adult serum produced correspondingly more

favourable results.Contact in home life is more intimate than in

hospital wards where exposure may be very unequal.In hospital some children may escape infection

entirely; others be but slightly infected ; whileothers again are infected intensively and repeatedlythroughout the period of exposure. Karelitz andSchick observe that the differences in degrees of

exposure between familial and hospital groups areaccentuated in those hospitals provided with cubiclesor where an isolation technique is observed. An

analysis of the results obtained from the injectionof 6 c.cm. of adult serum in a series of 106 childrenof from 2 to 6 years of age all exposed to measlesfor periods of from 2 to 5 days showed that in thecase of children whose home conditions were good,the protection- and attenuation-rates were 58 percent. and 23 per cent., 19 per cent. being failures.Where the home conditions were bad these rateswere 0 per cent., 27 per cent., and 73 per cent. respec-tively, whereas in a hospital group they were practi-cally reversed, protection being attained in 83 percent. and attenuation in 17 per cent., there beingno complete failures. An important factor in main-taining or enhancing the level of immunity to diph-theria amongst those, such as nurses in fever hospitals,who have become Schick-negative as the result ofactive immunisation is the frequent reception ofsmall doses of infection which by acting as stimuli

1 Karelitz, S., and Schick, B.: Jour. Amer. Med. Assoc.,March 23rd, 1935, p. 991.

raise the antitoxic titre of the blood. Karelitz andSchick relate the results of an attempt to increasethe immune antisubstances of adults by re-exposingthem frequently and intimately to patients duringthe first few days of severe attacks of measles. Fourvolunteers were bled before and 8 and 21 days after .

the last of thirteen exposures to the disease of from30 to 60 minutes’ duration. Sera obtained beforeand after reinfection were injected into a largenumber of young children presumably effectivelyexposed to measles. When the group of childrenwas considered as a whole the results appeared tobe greatly in favour of the samples obtained afterreinfection, but on further investigation the samediscrepancy between institutional and familial expo.sures appeared and largely reduced the apparentsuperiority of the reactivated samples. By increasingthe dose of the pre- and post-reactivated samplesemployed in the case of children exposed at homefrom 6 c.cm. to 8 c.cm. the advantage in favour ofthe reactivated samples became inappreciable.

While in institutional epidemics of measles allsusceptible children may develop the disease afterthe first exposure, the authors remark that thisoccurs far more commonly as the result of successiveexposures. This is, of course, quite true, and if itis a question of testing the value of any batch ofconvalescent or adult immune serum, which isusually pooled, doubtless the more rigorous condi-tions provided by familial contact are to be preferredas they suggest, but in the testing much valuableserum must be expended. In any case the medicaladministrator of a sick children’s ward must be

pragmatic ; his main object is to reduce the effectsof cross-infection to a minimum. To this end hewill segregate the infective patient at the earliest

possible moment and without relying unduly upona past history of attack, only too often a brokenreed, use his precious stock of convalescent or adultserum primarily in an attempt to prevent the expectedattack amongst children under 3 years of age. Ifthe serum which he has at hand is of attested potencyso much the better. Whether the success attainedshould in part be credited to ineffective exposure isnot of great practical importance.

TUBERCULOSIS IN DOMESTIC PETS

WHILST intensive study and attention has longbeen focused on tuberculosis in cattle, and the

importance of the bovine type of infection in causingboth abdominal and meningeal lesions in childrenhas been fully recognised, relatively little emphasishas been laid on the possibility of the disease beingacquired from domestic animals. Dr. A. Hjarre andDr. C. W. Herlitz have carried out what may there-fore prove to be a fruitful piece of work 1 in investi-gating a number of cases of associated canine andhuman infection. They point out that tuberculosisis by no means rare either in cats or dogs, animalswhich are frequently the intimates both of childrenand adults. It is difficult to assess the actual inci-dence of the disease in domestic animals, as the

majority die at home without the assistance of adeath certificate. Also, the figures obtainable fromthe various veterinary institutions on the basis ofpost-mortem examinations performed show con-

siderable differences. Thus in Berlin (1925) the

percentage of tuberculous dogs was 0-3, of tuberculouscats 2-0, while the corresponding figures for France(1927) were 5-6 (dogs) and 13-6 (cats). Dogs undertwo years of age are, however, more frequently found

1 Acta pædiat., 1935, xvii., Supp. I., p. 141.