There was no reaction. So far as I know (I could of course be wrong) the statement never appeared in any traffic safety publication. No one commented on it. No one attempted to refute it. I certainly do not wish to suggest that silence inferred agreement, but it could indicate a measure of indifference. Beyond the question of the reaction, or rather lack of it, to my comments on traffic safety statistics, I think it would be fair to state that there is very little discussion of the subject anywhere on a professional plane. It would seem to me obvious, for example, that a primary issue in this whole area is whether or not such data can best be collected on a universal basis - that is, by recording every event, and adding them all up - or whether it would be best to establish a system of national statistics based upon the now well developed sampling techniques, whereby trained technicians gather data from a small number of situations and extrapolate it to a general statistic. I raise this subject only to illustrate the second and last of the two points I wish to make. I fear we are dealing here with a problem which exhibits a high degree of irrationality. In recent years we have seen a number of startling theoretical advances in the general field of accident causation. I am sure you are aware of the recently published brilliant study, Accident Research: Methods and Approaches, by William Haddon, Jr., M.D., Edward A. Suchman and David Klein. It happens that I have worked with Dr. Haddon for over a decade in this area, from the time he was a member of the New York State Traffic Safety Policy Coordinating Committee. I would like, with your permission, to insert into the record a copy of a review which I recently wrote for The Reporter magazine of this remarkable book. The main thesis of the book, which is a systematic collection of the work of many men, is that the etiology of accidents is not different from that of other insults to the body: they are a health problem to be investigated and controlled by fundamentally the same methods that have worked with other health problems. But the book ends with a warning that this may prove far more difficult that we would normally suppose. I would like to quote from a private communication from Dr. Haddon which makes this point. Accidents are the only remaining major source of major point of departure for theologians and philosophers. If not, at least the educated and especially those responsible for public policy in relation to motor vehicle and many other kinds of accidents, including those among the elderly and the very young, should understand this area in rational terms and act accordingly, that we may terminate our present, annual, blood sacrifice to official, professional, and public ignorance and lack of the professionalization required. BOOKS EXHIBIT 22 A Plague of Our Own' DANIEL PATRICK MOYNIHAN ACCIDENT RESEARCH: METHODS AND AP- It is a poor civilization that adds It is, on the other hand, entirely clear what has produced the necrotic figures. They reflect a recent, sudden, and important change in the human condition: "For more than half of their lives," Dr. Haddon and his associates point out, "the people of the United States and many other West ern countries are more likely to die from accidents than from any other cause. And even in the world as a whole accidents as a cause of death are now outranked only by cancer and cardiovascular disease." There are a hundred thousand accidental deaths a year in the United States and some forty-five million injuries. That's the way we die nowadays. Even more, that's the way we are disabled. problem was solved by banding together, and thereafter the end came mostly through famine, disease, or war. Even these perils man in his pride seems capable of attenuating. The incidence of accidents alone shows no tendency to decline. It is possible to talk about how much they cost, but hardly to the point. It is like talking about how much life costs. The subject is more serious. Because of their heavy toll throughout childhood and the childbearing years, accidents may well be one of the principal contemporary means by which the composition of the population gene pools is chat.ging. More immediately, accidents are the only remaining major cause of human death and disablement still substantially viewed, by educated and uneducated alike, in terms of ignorant superstition. Cultures resort to supernatural explanations for things not understood, and we define accidents as things that cannot be understood. As if men somehow needed an outlet for primitive irrationality. we have fastened on accidents with a kind of stabilized hysteria, persisting in almost pagan practices, both public and private, designed to ward off evils supposedly beyond our control. Anyone who has followed the subject for a time is apt to have despaired of change. The combination of public unawareness and gigantic private interests has seemed too great. There has been not only the fog to peretrate but the fog-making machines to dismantle. Too much. Yet suddenly it seems the fog might lift. What has done it-in the best of all. traditions-is a book: a brilliant, bit At one point, presumably, the common fate of man, as with his fel-ing, rousing good book. low animals, was to be eaten. This During the past quarter century 'The Reporter, Dec. 31, 1964, p. 32. FEDERAL ROLE IN TRAFFIC SAFETY or so, a small number of men work ing in collateral or even unrelated fields have stumbled onto the problem and have paused to think. And now three such men have brought the work of several dozen others together and made, as Paul Appleby used to say, a mesh of things. Despite the fact that the various contributors have almost all worked outside the present medical, public-health, and safety power structures, despite a shortage of funds and a general lack of professional and public support, they have effected a revolution in knowledge. This period, in retrospect, will be as important for the health and welfare of man as the period in the last century when the groundwork was developed for our present understanding of infections. Accident Research might better have been called by the title of its opening chapter, "Toward a Science of Accident Research." That, very nearly, is what emerges. The authors are William Haddon, Jr., a Harvardtrained epidemiologist; Edward A. Suchman, a sociologist; and David Klein of the staff for the Association for the Aid of Crippled Children. (To which, in passing, all honor. The Association began at the turn of the century as a rather social New York charity providing braces for slum children afflicted with polio and the like. When, in time, it turned out that accidents were the primary source of crippling, the good patricians turned their attention and sup port to the new problem.) The basic question, clearly, is whether the etiology of accidents is different from that of other insults to the body. A person unintentionally swallowing poison is said to have had an accident. Another inadvertently ingesting polio virus is seen as the victim of a somehow different chain of events. Common sense tells you that, but once again common sense turns out to be wrong. As early as 1948. John E. Gordon of Harvard showed how the preven tion of accidents could be brought into the mainstream of scientific medicine. The techniques of epi demiology, he wrote, had been suc cessfully "extended from its original restriction to the communicable diseases." But, he added, "It is not so generally appreciated that injuries. as distinguished from disease, are and that that pathology can be produced in no other way. Thus, such agents as the bacteria that produce tuberculosis and diphtheria are said to be specific and necessary, since in their absence the injuries they produce cannot occur." But think of the many ways there are to get cut. Fundamental advances followed from Gordon, but it remained for Dr. Haddon and James J. Gibson of Cornell, working independently, to perceive that the agent was not the vehicle involved-the car, the knife, the poison, the atomic pile or whatever-but the abnormal energy exchange that produced the injuries. "Each such type of damage is the specific result of a specific type of energy exchange and it can usually be produced in no other way. For example, the crushing, tearing, and breaking of structure, whether of a fender or of a leg, can be produce:! only by the transfer to that structure of a sufficient quantity of mechanical energy. the fundamental problem in accident prevention is seen to be the prevention or mitigation of these abnormal exchanges." Where does this lead us? "Specifically," our authors go on, "it leads to an understanding of the fact that many of the same cultural, social, behavioral, environmental and biological factors that are related to the initiation of infectious and other insults to the body, which have long been the concern of preventative medicine, are also related to the initiation of accidents." • The field now expands beyond that of medicine. This beginning revolution in knowledge about the ways in which chemical and physical hazards come to harm man-and the ways in which their action or results can be blocked-is not an isolated phenomenon. It involves a full range of public issues from conservation through urban planning, water resources, air pollution, waste disposal, fallout, pesticides, food additives, and the various hazards in the chemical compounds we use as drugs. The developmental phase of accident prevention has not proceeded very far. It has awaited a theory, and still awaits financial support. But some work has been done, and Accident Research contains fascinating accounts of the efforts of pioneers. An important and poignant step was taken by Hugh De Haven, whose reports were published in Way Medicine back in 1942. De Haven had served with the Canadian Air Force in the First World War. While in training, his plane crashed with another. Three men died; he survived. He never stopped asking why he had been spared. Investigating "accidents" in which persons had fallen from great heights but somehow survived, he was appar ently considered something of a ghoul, but he persisted. What he discovered was that the human body is not nearly so fragile as had been thought, that given the right structural environment it can absorb enormous amounts of mechanical energy. This was the first significant new knowledge on the subject since Hippocrates. Out of it developed the field of crash-injury research. |