One thousand unselected patients with bronchial asthma have been followed up for an average period of 11 years, with extremes of 33 years and three years. The average period from the first symptoms to the date of follow-up was 20.6 years in the 562 males and 22.3 years in the 438 females, with extremes of 72 years and three years. Since throughout the analysis no differences were found between the sexes, they have been grouped together. Terms used, such as asthma, chronic bronchitis, childhood bronchitis, age of onset, etc., have been carefully defined, as have the descriptions of intermittent and continuous asthma. The present state of the patients has been classified as A (good), B (fair), C (poor), and D (dead). Early age of onset (before 16) and intermittent asthma were associated and had a more favourable prognosis, while the childhood bronchitic had a better outlook than the adult bronchitic. Intermittent and continuous asthma have been compared. The incidence of bronchitis initially was higher in the continuous group, and the tendency to develop bronchitis over the years (present in all asthmatics) was also greater in the continuous group. Those with bronchitis were in much poorer health on follow-up than those without.
In the preface to Volume 1 of the 'Annals of Life Insurance Medicine' Dr. MAX E. EISENRING described the goal of this publication as follows: "Any project which aims at contributing substantially to the modern science of medical underwriting can do so only if the many people preoccupied with these problems throughout the world join forces to the ultimate benefit of those most in need of life assurance." In an endeavour to keep the life insurance medical directors all over the world informed of the developments in the field of life insurance medicine, we have decided to publish the papers which were presented at the 11 th International Congress of Life Assurance Medicine in Mexico in 1973 in Volume 5 of the 'Annals'. We are most grateful to Dr. J. REN06N, President of the Organizing Commit tee of the Congress in Mexico for having consented to our publishing the proceed ings of the Congress in a special edition of the 'Annals'. It is a source of great satisfaction to us that in this way a much larger circle of life insurance medical directors can be reached than would have been the case if only the participants themselves were to receive the proceedings of the Congress. Dissemination of the results of medical research on an international basis, in particular those findings that have a bearing on life insurance medicine, is one of our foremost aims.
Today, the integration of life insurance medicine into the framework of general medicine goes without saying. On the one hand, the diagnostic therapeutic knowledge of clinical medical science forms the tools of the insurance medical adviser for the evaluation of life insurance applications. On the other hand, life insurance medicine has been able to pro vide valuable statistical data for long-term prognosis which have become an essential part of the daily medical practice and prognostic appraisal. This mutual engagement and en richment has again distinctly manifested itself in the scientific program of the 13th Con gress of Life Assurance Medicine held in Madrid. Among the broad and varied data available, the insurance problem of cancer and ma lignant diseases of the haematopoietic system were extensively dealt with for the first time. Diagnostic therapeutic progress increasingly allows valuable insurance cover to be granted to formerly uninsurable risks, a group which is particularly in need of, and re quires, life insurance cover. The number of risks which are uninsurable becomes smaller and smaller.
The year in which this first number of "Annals of Life Insurance Medicine" goes to press happens to be the Fiftieth Anniversary of the Swiss Reinsurance Com pany's activity in the field of underwriting and reassuring those risks which later became known as "substandard lives". In retrospect, it is a far cry from the old days when life assurance proposals were either accepted or rejected on medical grounds to the modern principles and methods of rating substandard cases both medically and actuarially. It can be assumed that in the course of the last few decades solutions, or at least approxi mate solutions sufficiently accurate for practical purposes, have been found to most of the numerous and often rather tricky actuarial problems relating to substandard policies, adequate premiums and reserves. No Life Assurer to-day however can fail to recognize that actuarial skill may only be applied to of medical assessment. Even the lay under substandard life risks on the basis writer certainly realizes that the medical and statistical problems inherent in the underwriting of substandard risks are infinitely more complex than any actuarial consequences of a calculated or assumed extramortality. It is primarily this basic fact which has stimulated the Swiss Reinsurance Company's plans to intensify and develop its research work in the field of the medical assessment of substandard lives.