Documentary News Letter (1947-1949)

70 DOCUMENTARY NEWS LETTER BRITISH MEDICAL FILMS A study of the evolution of the medical film in this country by Brian Stanford, M.R.C.S., D.M.R., F.R.P.S. cinema and roentgenology both became a practicable proposition at about the same time, and both were applied to medicine early in their evolution; in 1895 roentgenology was discovered and immediately applied in medicine, and in 1897 Schuster recorded the movements of some of his patients while walking in an attempt to analyse their defects. (It is interesting to remember that Muybridge in 1872 made the first attempt at cinematography in order to analyse the leg movements of the galloping horse.) Yet cinematography in medicine did not catch on, for it was of no such value in diagnosis as was roentgenology, and it was not until the early 1920's when the cinema had become a universally accepted ancillary of modern civilisation that medicine again looked at this medium and tried to use it for itself. This renewal of interest was facilitated by the popularization of the substandard gauge film (9.5 mm. was introduced in 1912, and 16 mm. in 1923) which allowed the camera to be made sufficiently small to be handled by one man,, and the cost of film to come down to the range of one man's pocket. Films had been made before this by individual surgeons, but projectors were expensive and so the films were rarely used. Another equally important cause of the re-awakening interest was the increasing use of non-inflammable film (introduced in 1909) which enabled the private individual to give film shows in his home or school without taking the extensive precautions needed for projecting ordinary nitrate film. Two Groups Broadly speaking, two groups of practitioner became enthusiastic supporters of this new medium; the surgeon who wished to demonstrate repeatedly and at ease techniques which he performed only rarely, and the teacher of physiology who preferred the certainty of a film demonstration of an experiment to the vagaries of his biologic material for a demonstration — the subsidiary consideration that a film demonstration saves an animal for another experiment was probably not so important as it might seem. Now these two classes, who make films for much the same basic reason, do so in different circumstances; for the physiologist can take surgical risks, can neglect the finer shades of aseptic technique, can repeat the experiment until an adequate record is made, and can personally supervise the cameraman. Not so the surgeon ; he must place the safety of his patient before everything else, and he must give his undivided attention to the operation, leaving it to somebody else to make the film. And so we have today a number of amateur films which show physiological experiments crudely (in terms of photography) but satisfactorily in terms of teaching; while the corresponding amateur surgical films are in the majority of cases worthless for teaching purposes simply because the cameraman did not know what he was recording — what was significant and what he could leave out. Physiologists, we have seen, bought their cameras and their film, made their records, and were content. Surgeons bought their camera and their film, were unable to make the record themselves, were discontented with the results other men made for them with their apparatus, and so turned to Messrs. Kodak, who had supplied their equipment, for help. In 1929 the Kodak Medical Film Unit was established to make photographic records for surgeons. This pioneer unit, under the direction of Mr. W. Buckstone, did valuable work and made a large number of films. But it suffered from the lack of a medical man on the staff; the records were all made by photographers who learnt medicine as they went along, who were ignorant of what they wanted to photograph, but who were assumed by the surgeon to know their job. Effective liaison between surgeon and cameraman was rare, and the records they made are mostly poor quality; the area of interest in the picture is usually too small to show adequate detail, for the cameramen, feeling ill at ease in an operating theatre, preferred to hold their cameras in their hands than to place them rigidly on a tripod, and were therefore precluded from using long-focus lenses; for the same reason the pictures are often out of focus, .and continuity further destroyed by the film being made from a number of different angles, selected at random. Nevertheless, with purchases from other countries, the Kodak Medical Film Library grew until it is now the largest specialized medical collection in the country, and by the early 1930's substandard cinematography was sufficiently widespread for several drug houses to found small libraries of films which they loaned out to medical meetings, often supplying a lecturer as well. Catalogues In 1933 the League of Nations Health Organization, at the suggestion of the International Institute of Educational Cinematography (formed at the suggestion of the Italian Government in 1928) decided to prepare an international catalogue of films. Great Britain, a participant member of the International Institute, went ahead with this work, and in 1936 the British Film Institute published its first catalogue of medical films, with a supplement issued in 1938. Unfortunately, the rise of Fascism prevented the full programme of the International Institute from maturing, but this B.F.I, catalogue remained until very recently the only available catalogue listing films held by individuals or small groups in Britain (it is now out of print). The Royal Society of Medicine, which had installed a 35 mm. projector as long ago as 1912. acquired substandard projectors in 1930; and by now it was becoming fashionable to illustrate an address to a medical audience with films. Looked at today they appear to have been made, one cannot help thinking, to show surgical skill almost as often as to demonstrate techniques; for instance, there now exist at least four teen films illustrating the operation for Caesarean I section, not one of which shows sufficient detail I for training a student. It is a spectacular opera I tion with an obvious return for one's work ; and | was probably chosen in many instances as a trial I by a surgeon to see what cinema could do, but the results are certainly discouraging. Yet this f experimentation was not without value : lunch j table talk must have roused the interest of the physician, for neurologists were quick to see the | value of this medium for teaching their students. , Getting Going The films they made are often crude, but better than the surgeons, for once again they have time, can supervise the cameraman, and can take a repeat shot if the first is unsatisfactory. A number of useful films were made in this way, both at Edinburgh and Sheffield between 1930 and 1938. And now we are in the immediate pre-war years ; colour film is becoming reliable, and students interested in photography are beginning to take active interest in producing films for teaching themselves and their colleagues. Experimental units at Ashford and Manchester, financed for the most part by a surgeon, staffed and equipped by the students themselves, are producing better films. They know what they are recording; theatre ritual and technique holds no terror for them; they have discussed in detail just what they want to show, and coached the surgeon to make sure he shows it ; and just as they are all set to produce valuable films, it is already 1939. The War Years Now the whole picture alters. Film stock for amateurs is scarce, time scarcer, facilities nil ; the amateur, just feeling his strength, is eclipsed, qualifies hurriedly, and is called-up. But in wartime, the health of the nation is important; "health" films — dealing with vitamins, creches, canteen problems, first-aid — are wanted to inform the public quickly and in an attractive manner of the facilities that are available to them. Professional film units are called in to make these films, and they find the subject interesting, make good films. Almost overnight it becomes obvious that many if not most of the films previously made for medical training are obsolete. The British Council in 1943 finances at great expense two excellent films on medicine, carefully made by film experts collaborating closely with doctors. But the purpose of these films is not clear; beautifully made, they have little use, and the British Council instead of profiting by the experience and going ahead, makes little progress in this field. But I.C.I, sees the value of good film technique coupled to good medicine, and in 1944 sponsors a series of eleven films on anaesthetic techniques, designed for medical students and nobody else; and now the page is finally turned: there can be no going back: medical films will in future 'be judged bv the standard of these Realist Film Unit productions, until an even better series is made. The film profession has invaded medicine, and medicine has invaded film, and that is where we are today. What will follow'.' films of this type are expensive; very expensive by the old standards. A thirty-minute talkie will cost £5.000 at the very least. No individual can afford that, and no group exists to administer joint funds. Some coordinating scheme must be produced on a nation-wide basis. (continued on page 79)