40. DEATH ON THE ROAD

With about 7,000 deaths a year (and a casualty-rate many times as great), more men die in traffic accidents than from tuberculosis, poliomyelitis, diphtheria, and diabetes together. For youths and men under 30 this is the principal cause of death.

These figures are taken from an invaluable survey by Dr L. G. Norman, who in his Milroy lectures two years ago considered medical causes of accidents, and who has now also reviewed the wider epidemiological and technical aspects. His suggestions for prevention include the establishment of a single authority to investigate and report on each accident; the standardisation and collation of data on accidents; and the more careful assessment of fitness of driver and machine, with investigation and rehabilitation of "accident repeaters". A complementary transatlantic view is offered by Professor R. A. McFarland, whose survey of the epidemiology of motor accidents contains a useful account of psychosocial and personality factors.

As Norman implies, in our motocracy the attitude towards road accidents is grossly irresponsible. An aeroplane drops on a house, or two goods trains collide: the inquiries run on for weeks. Twice the number of people are killed in a pile-up on a motorway, and what happens? The police decide whether there is a prosecution in it; an inquest is held to establish the cause of death; and after that - nothing. How sharp is the contrast between some of our stringent public-health regulations and the sparse and inadequate legislation on road safety. As Normand says, the great majority of road accidents are preventable, provided society really decides to prevent them. The Cornell study showed that of every 10 dangerous or fatal injuries of vehicle occupants, four would be prevented by a speed-limit of under 50 miles an hour; and a speed-limit of even 55-5( (the maximum range in the U.S.A.) would prevent a grew many. There is no possible need for cars that travel at 10C miles an hour and over, except to fulfil unconscious power urges and death wishes. Let us be honest about this: fast cars kill a lot of people, but we go on making them so that the industry can sell cars abroad.

Prevention can perhaps be considered under three headings Firstly, engineering. Motorway-type roads, separating the streams of traffic and excluding pedestrians and slow vehicles, save lives. Then again, much is known about the properties of surfaces, drainage, tyres, lighting, and objects by the road which might be hit; but this knowledge is far from fully applied. Sound engineering of the vehicle itself can contribute even more to safety. The lighter and faster the car, the cheaper the brakes and door-catches, the more bits that project inside and out, and the closer the steering hub to the chest, the more likely is the car to kill its driver or someone else. Each of these features, and others, could be improved: we know how to make cars safer, but manufacturers are not obliged to make such changes and, in a competitive market, seldom do. With speed and economy in materials and fuel as selling-points, design is often anti-safety. The regulations governing construction and use of motor vehicles are archaic and should be rewritten. Meanwhile the Consumers' Association, which is already doing excellent work in testing cars, might make clear in its reports which models are especially likely to kill their owners, and why.

The second approach to prevention is through education; and here we can greet at least one shaft of light - namely, the decreasing numbers of children killed on the roads. Here police, crossing patrols, schools, and the Royal Society for the Prevention of Accidents have cause for self-congratulation: safety propaganda can be effective. On the other hand, campaigns exhorting people, from posters or beer mats, to "Stop Accidents - Honour Your Code" have a quaint boy-scout ring, and we strongly suspect that they are totally useless. Indeed they may even be dangerous by dulling the public conscience and deluding people that everything possible is being done.

As regards legislation - the third approach to prevention - the Royal Society for the Prevention of Accidents might recast itself in a more aggressive role; for legislation is the easiest way to reduce accidents (though unhappily it is perhaps the least acceptable to the public). If we had the will, we could keep small pedal-cyclists off the road and powerful motor-cycles out of inexperienced hands; we could establish that applicants for driving licences were mentally and physically fit; we could limit speeds and change vehicle design; and we could ensure that erring motorists were dealt with more effectively than by juries composed of other motorists.

(from The Lancet, 14th July, 1962)