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1219 Fortunately for the schools, two new sources of help have appeared: in December, 1950, the American Medical Association established a foundation with an initial appropriation of$500,000 to help the medical schools, and last week, in New York, another organisation was formed for the same purpose. This organisation, the National Fund for Medical Education, is being sponsored bv the medical profession, educational and scientific foundations, a group of university presidents, industry, agriculture, and organised labour, and its chairman is Mr. Herbert Hoover. Its objectives are to inform the public of the plight of the medical schools and to raise from private sources a minimum of$5 million annually for their benefit. The Fund will be helped by the founda- tion set up by the A.M.A., which has agreed to merge its funds with those of the new organisation. All money collected will go to the schools, because the costs of administration will be borne by twelve foundations. PANIC IN THE STREETS THE possibility that an atomic attack on a modern city might cause widespread panic is exercising official brains, and in this country a Home Office working party is pursuing inquiries, partly by means of questionaries issued to the police about the estimated movements of population. From the U.S.A. comes an article reviewing the causation and prevention of panic and measures for its control. Panic, says this article, occurs when overmastering fear, especially of the unknown, causes a group to lose its sense of solidarity and to disintegrate into a disorganised mass of individuals, whose behaviour may be antisocial and lacking in the essentials for individual self-preserva- tion. Contributory factors are those lowering morale- tension, insecurity, rumours, imitative behaviour due to heightened suggestibility, lack of previous information about the nature of the danger, and strong sensory stimuli such as noise. To these might well be added such physical factors as hunger, fatigue, exposure, and pain. Preventive measures should be based on organisation to maintain essential services : communications ; police and fire ; rescue, first-aid, and medical ; sanitation ; welfare ; civil defence, including anti-radiation or anti-chemical- warfare ; engineering and demolition ; and transport, both for maintaining the foregoing and to effect any necessary evacuation of survivors. In general, the higher the standard of education and intelligence among a popu- lation, the less is the risk of panic reactions. Cantril et al.,2 in their investigation of the famous mass-panic following the Orson Welles Invasion from Mars broadcast in 1938, found that college graduates were more resistant to the general alarm than people who had been educated at grammar school ; even so, 28% of the panic-stricken sample interviewed were college graduates. Specific information beforehand about a possible danger would help people by removing the unknown element in their fears. Such information should be accompanied by allocation of active roles to members of the threatened community, to give them a sense of increased solidarity. They should be warned about spreading rumours and told how to deal with them, and instructed in the various physical and mental reactions that acute stress may evoke, so that they may better understand and tolerate such reactions in themselves and their fellows. Methods of handling crowds, blocking routes of mass flight, and segregating panic-reactors would be a matter for the civil authorities. The American workers recommend that psychiatric casualties should be dealt with, as far as possible, without removing the patient from his family or group setting. 1. Caldwell, J. M., Ranson, S. W., Sacks, J. G. U.S. Armed Forces med. J. 1951, 2, 541. 2. Cantril, H., Gaudet, H., Hertzog, H. Invasion from Mars. Princeton, 1940. The secondary gain of neurotic illness should be minimised and the suggestion of disability avoided. Screening of psychiatric casualties should be carried out at casualty- collecting points where sedation can be given and shock, exposure, and fatigue treated. Psychotherapy should be brief, consisting of reassurance, support, and exhortation ; this should be enough for most patients, who would then be fit to return to the population. Others would need to be evacuated, preferably to hospitals not far removed, for more intensive psychiatric care. The detail in which the latter is discussed, and the comparatively ample facilities debated as makeshift measures, would bring a sardonic smile to the Asiatic face, for they call to mind MacCurdy’s 3 remark that Westerners cannot face the prospect of misery : " Except in the coldest of winter months, in the absence of available buildings, adequately heated tents will constitute acceptable facilities. Folding canvas cots would be acceptable in lieu of beds." For the average man, morale depends upon his feeling himself to be under the protection of some accustomed figure of authority, whether this be Providence, the Government, Mr. Herbert Morrison’s signature on a passport, or merely the shadowy " They " whom he alternately reckons on and reviles. The solidarity of a group, according to Freud,4 results from its members being identified with one another by virtue of their common emotional bonds with the " leader." If the leader or his surrogates are lost or demonstrably impotent to cope with the situation, the group falls to pieces and the individual feels atomised and abandoned. The external danger then becomes overwhelming because he is facing it in a state of agonising mental loneliness comparable only to the terror of a young child separated from his mother. That all the individual members of a group do not get into this state of panic is presumably because the more fortunate of us, even if physically sundered from our leader-figures, feel enough self-confidence, through having taken them and their precepts into our moral being, to cope with whatever danger confronts us as we imagine what they would do ideally. Paradoxically, it appears that the essence of a true democracy is for each one of its citizens to be able to slap himself on the chest and exclaim, in the words of le Roi Soleil : " L’Etat, c’est Moi ! " PREVENTION OF TETANUS TETANUS is not notifiable in England and Wales, but the General Register Office records that 48 males and 21 females died of the disease in 1948. Conybeare and Logan 5 have shown that the death-rate among males is now about half what it was during the years 1931-40, while the female death-rate has declined little. Of the 36 children who died from this cause between 1938 and 1947, 29 were under a month old ; most of these infants were. males. Three times as many fatal cases occur in rural areas as in Greater London and the large cities : and the east and south-west of the country suffer more than other regions. Although the over-all risk of tetanus is small, the disease is so distressing and the mortality so high that the question of when to give antitetanic serum must con- stantly be faced. The decision usually depends on the extent, nature, and depth of injury ; but Pratt 6 showed that of 56 Boston children who developed tetanus 80% had only minor injuries or superficial scratches. Unfortunately A.T.S. may cause serum-sickness or severe hypersensitivity reactions, so the practitioner’s dilemma in treating minor injuries may be very real. Since the 3. MacCurdy, J. T. Structure of Morale. London, 1943 ; p. 13. 4. Freud, S. Group Psychology and the Analysis of the Ego. London, 1949. 5. Conybeare, E. T., Logan, W. P. D. Brit. med. J. March 10, 1951, p. 504. 6. Pratt, E. L. J. Amer. med. Ass. 1945, 129, 1243.
