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either attenuated (infectious, but of greatly diminishedpathogenicity) or non-infectious. But here the difficultyis to decide whether a particular strain of rubella virus issufficiently attenuated: at present, this can be settled onlyby human experiments that would be impossible to justifyethically.Many people believe that live virus preparations are

intrinsically better immunising agents than killed ones. If

so, the reason is more likely to be related to the effectiveantigenic mass provided by replication of the virus thanto any special virtue associated with infectivity. Assuming,therefore, that the inactivating process does not damage theantigenicity of the virus, a vaccine containing a highenough concentration of antigenic particles should conferprotection, though the duration of such protection cannotbe foretold. As the immunity engendered by a killedvaccine wanes with time, subclinical natural infection mayreinforce the immunity and prolong the period of protec-tion. This seems to be the pattern in vaccination againstmeasles. Children given killed measles vaccine will veryprobably be exposed to wild measles virus in the nextepidemic within two or three years. The period betweenrubella epidemics being longer, a killed vaccine given to achild or an adolescent may simply delay until child-

bearing age the natural challenge by rubella virus, whenthe immunity may be insufficient to prevent a full-blownattack with rash, especially if reinforcing doses have notbeen given.The finding by Brody et al. that the serologically

susceptible did not get clinical rubella, but did haveantibody after the epidemic, suggests that serological con-version induced by vaccination may protect against floriddisease after natural challenge. In the few years sincerubella virus was first isolated, however, there has notbeen time to test this by field observations. An early" breakthrough " towards active protection againstrubella is not to be expected. Meanwhile, passiveimmunisation by y-globulin given to pregnant women atrisk may save some fcetuses from the destructive effectsof the virus.

TRANYLCYPROMINE IN MULTIPLE SCLEROSIS

LAST year Komesaroff reported that 7 patients withmultiple sclerosis treated with tranylcypromine forbetween one and eleven months improved in speech, gait,vision, and muscular power within six to fourteen days.He later described the results of this treatment in a totalof 31 patients, all of whom, without exception, showedstriking improvement. Three double-blind controlledtrials have now been conducted. Lance et awl. treated37 patients randomly allocated to treatment and controlgroups. 21 patients received tranylcypromine (30 mg.daily) and 16 were given placebo tablets over twenty-eightdays. The effect of treatment on mood and subjectivedisability was assessed, and objective and quantitativemethods of assessment of neurological abnormality (basedon those of Alexander 4) were also used. No significanteffect of the drug on physical disability was observed, butthe depression which affected several patients was usuallyrelieved, so that many of them became more active andwere subjectively improved. A similar trial in 10 casestreated for fourteen days by Simpson et al. also gave1. Komesaroff, N. Lancet, 1964, ii, 1395.2. Komesaroff, N. Med. J. Aust. 1965, i, 92.3. Lance, J. W., de Gail, P., Preswick, G. ibid. p. 410.4. Alexander, L. Archs Neurol. Psychiat., Chicago, 1951, 66, 253.5. Simpson, C. A., Vejajiva, A., Miller, H. G. Lancet, April 10, 1965, p. 817.

negative results so far as objective changes in neurologicalsymptoms were concerned. In the third study 6 in 19patients a " crossover " technique was used in 14 of the19 cases, so that, in all, 15 received the drug and 18placebo at some stage. In doses up to 40 mg. daily, nostatistically significant difference was found between thetwo groups (4 out of 15 improved with tranylcypromineand 3 out of 18 with placebo).These results seem to justify repetition of the plea that

trials of treatment in chronic diseases such as multiplesclerosis should invariably be judged by careful and

objective methods of assessment, preferably with thedouble-blind technique. Not only are false hopes raisedin the minds of sufferers by premature and unjustifiedclaims for the efficacy of treatment, but the time andenergy of research-workers which could be used muchmore profitably are diverted to the design and executionof fruitless trials of ineffective remedies.

PORTRAIT OF AN ERA

ANYONE can observe, but it takes genius to recognise,and interpret, the observations that matter. The currentexhibition at the Wellcome Building, Euston Road,N.W.1, to celebrate the 90th birthday of Sir Henry Daleon June 9, is an intimate portrait-a miniature, but nonethe worse for that-of genius at work. It is also a portraitof medical research from the beginning of this century-that is to say, almost the whole of applied experimentalmedicine, for when Dale began his clinical studies in 1900the physiological research of the 19th century had hardlybroken the crust of clinical tradition.The exhibition is an unpretentious display of photo-

graphs (most of them from Sir Henry’s own album), andof documents and the sundry objects that a man gathers inhis working lifetime; each implying a paragraph if not achapter of medical history. Here are Dale’s teachers:

Bayliss, Gaskell, Langley, Starling (whose centenary fallsthis year). In 1904 Dale is working in Frankfurt withEhrlich, who a few years later was to introduce’ Salvarsan ’, and so to launch the science of chemo-

therapy. In 1914 salvarsan again comes into the story, forGerman supplies were cut off and it was left to Dale to

find substitutes.Still in his twenties, Dale was invited by Wellcome to

direct his research laboratory, and the new pattern ofcommercially subsidised medical research was set. Hiswork on ergot brought no immediate direct results, butthe associated studies of pituitary extracts were a part ofthe foundations of endocrinology. Years later, Dalereturned to the study of hormones, and helped to set upinternational standards for the assay of insulin. But the

ergot studies also led directly to the work on acetylcholineand the chemical transmission of nervous impulses, forwhich he and Loewi won the Nobel prize for medicine in1936. This work was a prerequisite of the great advancesin the pharmacology of the nervous system which havebeen made in the past few years.

If it is true that a genius is often unrecognised in his owngeneration, that is only because being a genius he isahead of his time; he plants a seedling, but until it hasflowered other people are not sure what it is. The seed-lings that Dale has planted will continue to grow andflourish, but happily he has lived long enough for us toknow many of them for what they are.

6. Barrow, C. G., Rischbieth, R. H. Med. J. Aust. 1965, i, 414.