1489CONSTITUTION AND DISEASE

regulated by the house-mother and all questionsof their discipline and management are referred toher. As they learn to adjust themselves to life,they return into the general life of the Community.An analysis of 46 children who have passed throughthe Community is inserted in this year’s report ;the girls include a doctor, a nurse, a domesticservant, a shop assistant; the boys, a draughtsman,a waiter, a laboratory assistant. Only two boysare out of work ; of these alone unsatisfactoryreports have been received. All these children havehad a hard struggle for existence, and many areknown to have shown courage and resourcefulnessin the teeth of poverty and other difficulties. These

qualities may well have been fostered by the success-ful efforts of the Community itself not only to survivebut greatly to expand without adequate endowment.

CONSTITUTION AND DISEASEIT is reasonable to suppose that, just as human

beings differ innately in their physical and mentalcharacteristics, they differ innately in their capacityfor health and their resistance to disease. To theolder writers this was a mere truism, but in thelast half century, with the growth of pathology andbacteriology, the problem of the " diathesis "has been largely neglected, if not discredited,and until lately attention has been concentratedon the external agents of sickness. So far,however, bacteriology and immunology have notprovided a solution of the problem of differencesin reaction of persons exposed apparently to anequal risk of infection-why one escapes and onesuccumbs. If the more important factor is an

acquired immunity these sciences may eventuallyprovide a measure of this in each infection, but,on the other hand, it may be that " the summationof the morphological, physiological, immunological,and psychological characters with which an

individual is born " largely determines his success-ful or unsuccessful reaction to his environment.

Certainly of late years there has been a revivalof interest in these inborn characteristics in relationto disease and a realisation that such constitutionalfactors may be of as much interest and as much

importance as the maladies themselves and theircausative agents.The quotation above is taken from a paper 1

describing an elaborate statistical study of this

aspect of disease, undertaken by Dr. MATTHEWYouNG in the Institute of Anatomy, UniversityCollege, London. His material consists of anthro-pometric measurements and observations of

physical characters made by Dr. A. BONNARD

(working under the Medical Research Council)on 1212 children between the ages of 6 and 12years attending the Hospital for Sick Children,Great Ormond-street. Of these children, 368were attending the special clinic for asthma,459 the special clinic for rheumatism, and 385the out-patients’ department for minor or trivialailments but with no history of rheumatism orasthma or obvious impairment of general health.This last group serves as a control to the asthmatic

1 Jour. of Hyg., November, 1933, p. 435.

and rheumatic. Some 30 anthropometric measure-ments were made of each child, and the hair andeye colour were noted, as well as the posture andbodily habitus. Distinguishing sex and three

age-groups-namely, 6-8, 8-10, and 10--12 years-the comparisons between the three sets of childrenfall into three groups : (1) the absolute measure-ments, such as stature, length of arm and leg,girth, and diameters of the chest; (2) percentageratios or indices which give expression to the

shape or form or relative proportions of the differentparts of the body, such as the ratio of stem lengthto standing height, cephalic, and facial indices ;and (3) the qualitative characters, such as colouringand posture. Consideration of the frequencydistributions, the mean values and the variabilitiesof the absolute physical measurements leads tothe conclusion that the contrasted groups ofasthmatic and rheumatic children show no signifi-cant difference in their general dimensions, andthat both groups in comparison with the controlseries also reveal no differences which are sufficientlyconsistent at the various ages and in the two sexesto be regarded as indicating a real divergencefrom the normal. Similarly with regard to theindices there is no definite evidence that thechildren suffering from the two diseases differfrom each other or from the normal children in

morphological type. On the other hand, certainsignificant differences are suggested by the figuresrelating to pigmentation. In distribution of haircolour the rheumatic children do not differ fromthe normal, but both the asthmatic boys andgirls show a relatively greater excess of the blonde-haired type, and a greater deficiency of the darkhaired, than might reasonably be expected to havearisen by chance. In eye colour, however, neitherthe asthmatic nor the rheumatic children can besaid to differ from the normal, and the sameequality is found in the distribution of grades ofposture, the proportions of relatively long andslender and short and thick-set types, and in theform of face. The distinction between these types-slender or asthenic, thick-set or pyknic-is set outconvincingly by Prof. RAYMOND PEARL in a recentstudy of the relation between constitution andhealth reviewed on p. 1485 of our present issue.He also comes to the conclusion that in the groupof women studied bodily habitus was not signifi-cantly correlated with general health. Dr. YouNG’sown conclusions are set out thus :

" The differences in the three groups of children,the asthmatic, the rheumatic, and the normal, inrespect of the aggregate of physical charactersbrought under review are relatively so slight thatthey cannot be considered to support the view thatasthmatic and rheumatic children really differ onthe average from one another or from the generalpopulation of children from which they are drawnin bodily conformation or physical type, thoughthey may possibly, indeed probably, differ in otherconstitutional traits."

The verdict of not guilty does not detract from thevalue of an obviously very laborious and carefulpiece of work, and will not, it is to be hoped,discourage the collection of similar data concerningsufferers from other diseases.