435

Thus deaths were more commonly discovered latein the process of tracing. At follow-up 21 patientswere found to have died. In 8 of these patientseither suicide was recorded or their psychiatric condi-tion could be said to be associated with their deathin a causal way. 6 of these 8 deaths were discoveredin categories 11 and III of tracing.

Often a relatively low tracing-rate has been deemedadequate for a research follow-up. A tracing-rate ofabout 60% is administratively easy to achieve usinga single tracing process with those clues that lead

directly from that process. However, I have demon-strated that a low tracing-rate may give a false impres-sion, with the result that some of the most importantinformation about a group of patients may be missed.A 60% tracing-rate does not necessarily provide a

sample of past patients representative of the wholesample.

I thank the people in various public and government depart-ments who assisted with the tracing, especially Mr K. F. G.Day and Mr L. Wareham of the National Health ServiceExecutive Council, Birmingham. Mrs Barbara Rudge prepareddraft copies, Miss Vivienne Barlow prepared the figure, andMrs Kathryn Gooding helped with the neighbourhood tracingand taught me the practical art of knocking on doors.

REFERENCES

1. Doll, R. Medical Surveys and Clinical Trials (edited by L. J. Witts);p. 78. London, 1959.

2. Sims, A. C. P. Unpublished.3. Laurence, K. M. Lancet, 1959, ii, 208.4. Small, W. P. ibid. 1967, i, 997.5. Farmer, R. D. T., Cross, K. W. Br. J. prev. soc. Med. 1973, 27, 53.6. Harvey, P. Guardian, May 11, 1971, p. 1.

Intercepted Letter

WHAT DO EDITORS WANT?

A leaflet On Writing for The Lancet, which isobtainable by prospective authors from the office ofthe journal, mentions Prof. A. B. See and Dr A.Hammertoe. Recently a personal letter from thelatter was inadvertently enclosed with ProfessorSee’s latest article on Advances in Appendicology-Some Taxonomic Problems. After reflection, DrHammertoe has generously agreed to publication ofthe letter.

Dear Professor SEE,I have just had a paper turned down by The Lancet

and, as this is the nth time, I wonder if you couldhelp me answer the question, " Why is it that they andmany others are so opaque in not letting their potentialclients (if that is the right word) know what it is thatis wanted? " I believe you move occasionally in thecorridors of editorial power, and perhaps you could per-suade some of these men, whose corporate image to meis of headmaster, high priest, and servant of all myscientific competitors, that they could cut our work downconsiderably by being a bit more forthright.Of course, I realise that there are problems. If you

publish your objectives as a weekly, monthly, or quarterlyjournal then you may find yourself type-cast for ever.

If you republish them at intervals so as to preserve

flexibility you can be accused of pretentious self-regard.If you admit to a peer-review system you invite yourcontributors to adopt detective techniques in an endeavourto find out who it was who advised you against publication,and you are thus a party to scientific vendetta. If youpublish the fact that you disdain peers and select papersby stabbing a Steinman pin into the morning’s mail youwill be criticised for the mistakes you make because youhave failed to seek advice. The quick turn-aroundachieved by conscientious editorial selection also seems

to be counter-productive, in that journals who practiseit attract more papers, for clients gamble on the possibilitythat an editor or his assistant will once in a while nod,like Homer, and the paper thus slips through. Further-

more, when you play the odds by sending a paper to a

prestige weekly and are refused, it is not difficult to

cook up a letter to the specialist journal saying that ithas been rejected by the ... on the grounds of

space. A little of the prestige rubs off-or at least theclient thinks so, for he does not necessarily view theeditor of a professional journal as he might a hard-hearted Fleet Street man.°

All these factors go to make up the present longwaiting-lists or the high-speed rejections which may thencreate queues in other editorial in-trays. I sometimeswonder if journal waiting-lists are not as seductive as

surgical ones-they imply a certain status and are also

comforting when one is juggling the balance of the nextissue. But perish the thought that editors are like surgicalconsultants.

It all seems to me to be very wasteful of time, effort,and emotion, particularly the latter, for anyone whohas ever written anything knows how much nervous

energy goes into a paper, and therefore how psycho-logically emasculated one is by failure to publish. Cannotwe have a little guidance from time to time? The Lancettakes a perverse delight in non-guidance: " any paperin English ", it says " is willingly considered ". Well,that’s effectively nonsense, as we all know, although Idon’t doubt that they do look at everything. But theircollective " editorial subconscious ", as they put it withcharacteristic whimsy, must have some constraints built

in, else how, except by using a random number routineon the first author’s name, do they whittle down thestuff? Are there general rules on length? How do theyor others react to data not presented in statistical form?Have they any conscious rules for selecting matters of

general interest? How do specialist editors decide whatis their specialty, and how are its bounds drawn? Whatconditions a man at the helm of a general journal to

espouse a certain area-chromosomes, liver disease, Tversus B lymphocytes-as his particular cause, and whathopes have we as men who deal with piles, cancer of thecolon, and heart-failure of getting our operational researchsqueezed in amongst this august company? These are

complex problems to which there may be no generalanswers, but, as medical publishing becomes ever more

diffuse, with a considerable variety of journals blossomingand fading, I am sure it would do many editors good tothink these matters through.

I have used you, my friend, as an agent for catharsis.I am thinking seriously of founding a Society for thePromotion of Spurned Authors. Its clarion call wouldbe: " Nothing to lose but our rejection letters; nothingto fear but our peers." In relation to the last youwill, I am sure, when next you hob-nob with editors of

repute and raise all these subjects, refrain from mention-ing my name. I do not wish my (n+ 1)th paper to provokethe editorial subconscious.

Your pupil,A. HAMMERTOE.