334

complex the job, the longer validation takes; anduniversities may perhaps decide that the best hope ofspeedy progress lies in continuing with their presenttechniques, at the same time adopting an alternativeeither as a " shadow " method or for the selection of,perhaps, half their students. One valuable functionof the Medical Research Council’s committee on

selection would be the integration of reports fromeach centre. In this study special attention will no-doubt be given to the student who fails to qualify ;plainly, his failure is less commonly a reproach tohimself than to the system which allowed him to starttraining, and it is the concern of every selector to

find out how the failure might have been predicted.Similarly, it may prove possible to follow up applicantswho have been rejected, and particularly those who areafterwards accepted by another medical school; forall they know, the schools may now be rejectingsome of their best candidates. With many questionsstill unanswered, one thing is clear : in the future,as in the past, each university must be free to chooseits students according to its lights ; but protectionof this right should not prevent them from helpingthemselves, and each other, to find out whether theyare really getting the students they want. Is theirseed the best on the market ?,

OUT OF PRINT

UNDERGRADUATES need no reminder of the book

shortage ; to them this is a recurring obstacle thathas somehow to be overcome each time they enter afresh field of study. The extent of their difficulties isreflected in a report from the Association of Scientific.W’orkers.1 Last spring the association’s Cambridgebranch made a survey to find out what proportion ofbooks recommended by university science teacherscould be had from booksellers, and to what extent theshortage was affecting the demand for American books.Sometimes any of several books are recommended ;so the investigators first grouped recommended booksunder topics, counting the topic as covered if any oneof the recommended books was obtainable. They foundthat no recommended book (whether British or American)was to be had in almost half-44% to be exact-of the128 topics about which inquiry was made ; and, com-menting on the present-day student’s tendency to

cling to books once he has them, they deny that thesecond-hand market provides any major relief.There is nothing new about this impoverishment.

Originating in the war, it has been accentuated by anumber of post-war influences, which we enumeratedlast year.2 Commonly the deficiency is attributed toinsufficient supplies of paper ; actually, it is due ratherto over-all incapacity of the printing and associatedtrades to deal with the demand, which could be met onlyby reorganisation, with further trained workers andenhanced supplies, including more glue and bindingmaterials. The U.S.A., less embarrassed -by these impedi-ments, is naturally bent on filling the gap ; and themeasure of her success is the growth in the proportionof American books among those recommended at

Cambridge from about 10% in 1939 to about 33% atthe present time. As with British books, not all theAmerican ones are to be had, for the import of

"

learned,scientific, and technical books in English " is restrictedto 200% of pre-war value ; as the actual number ofAmerican books ordered has doubled since 1939 and their rprice has risen by half, the current demand is about300% by value of pre-war, and thus about two-thirdsof the American books required are obtainable. Thisis still a higher proportion than that for British works,which in the Cambridge study was only just over half(56%). The report acknowledges that the U.S.A.,with her large industrial and scientific activity generally,has a greater number and variety of specially qualifiedauthors ; and there is no suitable British alternativefor many of her scientific and technological works ofreference. There are, however, other reasons for thepaucity of new British advanced works. In this countryauthors are placed at a, disadvantage by delays in

1. A Survey of the Shortage of Scientific Textbooks in Cambridge.Issued by the Association of Scientific Workers, 15, HalfMoon Street, Piccadilly, London, W.1.

2. Leading article, Lancet, 1947, ii, 471.

publication, whereby a new American book may satisfythe demand while its British counterpart is still with thepublisher ; and additional deterrents are lack of time andof financial inducement. At the universities increased

teaching pressure leaves little time for writing new booksand makes it difficult for those who during the war fellbehind with their reading to catch up. As to financialinducement, publishers try to divide their inadequateresources equally among authors ; and small impressionsfor all mean small royalties for all. With the aim ofminimising these handicaps, the report proposes that theGovernment and universities should-like some indus-trial undertakings-make special provision for readingand writing, perhaps in the form of sabbatical years;and with important books Government subsidies, itis suggested, might make up for the smallness of royalties.Home requirements are not the only reason for foster-

ing new works. By her books Britain has earned abroada great reputation, which on economic and other groundsmust be maintained and expanded. Nowadays, to getan average-size page of a textbook set in type costsabout El ; and this high cost is reflected in the eventual price of the book. If more books were distributedoverseas, the expense of type-setting would be morewidely distributed and thus the price of the book couldbe reduced. There is also the further point that; forthe cost of manufacture, books yield a higher profitabroad than almost any other article. Moreover,overseas book sales promote trade in other directions;a country which buys its medical books from Britainwill also tend to look to this country for pharmaceuticalsupplies. Less tangibly, books take an importantpart in linking the country of their origin with the placewhere they are read. On each of these scores we shoilldapplaud the association’s restraint in refusing to recom-mend that the allocation of books for foreign marketsshould be impaired for the sake of better suppliesat home. At the same time we should recognise theextent to which the shortage irt this country derivesfrom determination to sell overseas. The report quotesfigures showing that of all books produced here in 1947,valued at over E30 million, 24-5% was exported.3 No

separate figures -for scientific works are given ; but °

the case of a well-known work on bacteriology is cited :6000 copies of this have lately been printed3 and of these4500 were exported ; after a two-year wait a Cambridgebookseller, who had ordered 150, received only 5.As to a remedy, the report is unequivocal: in the

absence of a general increase in book production thereshould be discrimination in favour of " learned, scientific,and technical books." This claim has often beenadvanced,2 and has equally often met with the retort,notably from some branches of the trade, that accessionto it would amount to censorship. But, as the reportpoints out, discrimination is already exercised in thepreference accorded to imported books of learning ;

3. Bookseller, March 20, 1948.

OUT OF PRINT

335MENTAL HEALTH: INTERNATIONAL AND DOMESTIC

and " failure to apply such discrimination to home-

produced books is not only inconsistent, but favourscertain sectional interests at the expense of the nationas a whole."

FILMS FOR DOCTORS

LAST year three-quarters of the general practitionersin this country saw a 20-minute film reminding them ofsome points in the diagnosis of poliomyelitis. Doctors

appreciate the merits of the medical film, and theScientific Film Association has helped by compiling apamphlet on the organisation of programmers 1 ; but

unfortunately few new medical films are being made here.This year the Ministry of Health has issued a further oneon poliomyelitis and another on patent ductus arteriosus ;while the British Council are finishing, for use overseas,films on artificial pneumothorax and on bronchography.The Central Film Library holds the largest collection ofmodern medical films in Britain ; and yet it containsonly eleven besides the well-known series on anaesthesiamade for Imperial Chemical Industries.Expense need be no bar to greater production. The

cost of last year’s poliomyelitis film was equal to 10d.per head of those who saw it within a month of its

completion ; and, for an’annual allocation of 5s. each,general practitioners could have five similar films everyyear, on such subjects perhaps as the management ofrheumatoid arthritis in the home, the early diagnosis ofacute appendicitis, breast-feeding, and the treatmentof septic hands. Experience has already proved thatcolour and animation, though raising the cost, are oftenessential; but whether the duration should preferablybe 20 minutes or, more ambitiously, a full hour is notyet certain. What is certain is that each film must be

designed for a specific audience, whether of practitionersor of specialists in training ; and if a useful series is tobe built up over the years there must be a long-termprogramme guided by a central agency such as the

Ministry of Health or the Postgraduate Medical Federa-tion. (The Scientific Film Association has alreadysubmitted to the Ministry a five-year programme forfilms on health education.)The immediate need could be met if the Central Film

Library were enabled to obtain more films from over-seas. At present this library is empowered to acquirefor all its sections only twenty films a year, though forthe cost of the Ministry of Health’s latest film on polio-myelitis it could get multiple copies of a hundred filmsfrom abroad. The excellence of some of these wasdemonstrated this month at the International Congresson Mental Health. Even twenty-five films from the largestocks in North America would provide much stimulatingmaterial. The E1500 needed for this purpose does notseem too much to spend on the instruction of 20,000practitioners.

THE EPILEPTIC AT COLLEGE" FOR the epileptic, hindrances to climbing the educa-

tional ladder increase with its height." Discussing thistext, Lennox, McBribe, and Potter 2 note that in the U.S.A.epileptics now receiving a college education are only atenth of the proportionate number in the adult popula-tion. A questionary sent to 1676 colleges producedreplies from 79%. Asked whether they had any ruleabout the admission or refusal of epileptics, 55% of thosereplying said they had no rule ; 27 % admitted epilepticsconditionally and 18 % refused them. All military collegesrefused them, which means (Dr. Lennox and his colleaguespoint out) that they would reject such military leaders asJulius Caesar, Peter the Great, and possibly Napoleon.Roman Catholic seminaries reject them because a canon1. Notes for the Secretaries of Medical Societies on Organising

Medical Film Programmes. Issued by the Scientific FilmAssociation, 34, Soho Square, London, W.1. Pp. 11. 1s.

2. Lennox, W. G., McBribe, M., Potter, G. Epilepsia, 1947, 3,182.

of the church requires it, perhaps because of the oldbelief that epilepsy meant demoniac possession. In

general the smaller the college the greater the reluctanceto accept epileptics : 40% of colleges with more than 2500students take them, but only 14% of colleges with lessthan 100. The number of epileptics per 1000 studentsin the colleges studied was 0-48, which makes a totalof 480-500 (allowing for unrecognised cases) in American ’

colleges and universities. Four reasons for this small

(by American standards) enrolment are considered :

colleges may be rejecting epileptics as a general policy ;or epileptics as a class may be below the necessarystandard in intelligence, personality, or means ; or theirattacks may be severe, and frequent ; or some may havetaken a chance and succeeded in concealing their condi-tion from the authorities. The writers of the articlehold that the intelligence of epileptics not segregated ininstitutions is mainly good and often above the average ;and’ they believe there is no distinctive " epilepticpersonality " among intelligent epileptics. Severe andfrequent fits must necessarily debar an epileptic froma college career ; but thanks to better drugs and moreaccurate assessment by means of the electro-encephalo-graph, epilepsy is becoming a controllable disorder inmany cases. The college, they suggest, needs to beassured of three things about an epileptic : that he

requires education, that he can and will profit by it, andthat he will not be too great a responsibility for theadministration. The third is the only one likely to

present difficulties.

MENTAL HEALTH: INTERNATIONAL ANDDOMESTIC

’’ There is already a world community, at least in embryo.There are already world citizens...." .

THE Preparatory Commission 1 appointed to make

ready the way for the International Congress of MentalHealth, having considered the group studies of mental-health problems sent from 27 countries, see the worldas a unit in the sense that events in one country haverepercussions in all, that the food-supply in producercountries affects consumer countries, and that nationsdepend on one another for raw materials and manu-factured goods. In their statement they discuss thehesitant steps mankind has taken towards forming aworld community : joint action over famine and disease,trade and shipping conventions, a postal union, andscientific and cultural exchanges were all in being beforethe 1914-18 war ; and between the wars which dividepeoples other factors were at work to draw them closertogether-easier transport, radio, and the deliberatecreation of world institutions, some of which are nowseveral generations old. The United Nations’ specialagencies, such as the Food and Agriculture Organisation,the Educational, Scientific and Cultural Organisation,the World Health Organisation, and the InternationalLabour Organisation are well established. A body of" world servants " are growing up who combinenationality with a wider loyalty ; a growing number ofscientists and writers have a

" world outlook." Whetheror not this view is too optimistic, progress towards worldcitizenship is one of the most promising auguries ofworld peace and should be fostered. The sessions of thecongress ended appropriately with the formation ofa World Federation for Mental Health, which will haveoffices at Geneva and will collaborate closely with W.H.O.About 150 of the delegates to the congress from 42countries were responsible for forming this body, which ishowever interprofessional rather than international.Dr. J. R. Rees, elected the first president of the federa-tion, explained that membership will be open, not tocountries or individuals, but to societies and bodies whose1. Statement by the International Preparatory Commission.

Published by the International Congress on Mental Health,’August, 1948. Pp. 44. And see Lancet, Aug. 21, p. 298.