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THE HEIGHT of the Korean War, the United States Air Force suddenly found itself seriously interest ed in traffic safety down on the ground: it was losing more men from automobile accidents than from enemy action. A further check revealed this was true of the entire armed forces. Moreover, the automobile injuries were generally more serious and required longer hospitalization than the battle casualties.

In the years since, a growing program of government-sponsored research into the cause of automobile accidents and injuries has produced some more startling information. For one thing, the traffic toll has proved much greater than anyone believed: five million injuries a year, twenty-five million days in bed at the hospital or home-and despite publicity to the contrary, the problem is getting steadily worse.

With each new discovery the uneasiness in Washington grows, for it becomes ever more difficult to avoid the conclusion already reached in important circles of Congress and the American Medical Association: that something more effective than

DANIEL P. MOYNIHAN

simply urging people to stop killing each other must be done, probably through the intervention of the Federal government, to control this disastrous epidemic. The men who have reached this conclusion are any. thing but radicals. They are for the most part conservative Southern congressmen and respected physicians, proponents of states' rights and foes of "socialized medicine" to a man. The main thing that sets them apart from their colleagues is that they have managed to get beyond the slogans to learn some of the facts about what actually causes automobile accidents. In this respect they are almost unique. Certainly the American public at large is almost completely ignorant about what has unmistakably become one of the nation's foremost public health problems. Posting the Odds

It is characteristic of most public health problems that they arise so naturally out of the environment that the population affected usually accepts them as inevitable and will even resist efforts to do anything

about them. Vaccination against smallpox, for example, was violently opposed-and often by doctors as well as laymen. (A contemporary parallel is the controversy over water fluoridation.) Misconceptions about traffic safety are now shared. even by many who are intimately involved with the problem. The National Safety Council is a case in point.

The Council, set up in Chicago some forty-six years ago by a group of industrialists, is undisputedly the official national spokesman for "organized safety." It is best known for its much-publicized predictions of our holiday death tolls. Over the years these pre-holiday pronouncements have lost their necromantic quality and become rather like the posting of odds before a big race: a sure sign that exciting moments and good times are on the way. The deaths, when they come, seem no more real than the weekly television toll of the hired guns.

As a matter of fact, the Safety Council often predicts a holiday toll that is below the day-to-day average for the year. The 390 deaths predict

ed for last New Year's weekend, for example, would have been ten per cent below normal, and the actual toll was 377. The Council, however, gets enormous publicity from its predictions, with no risk whatever to its reputation. If the toll should exceed the prediction, it only proves how right the Council was to warn against carelessness. If it should fall below the mark, it only proves how effective the warnings were.

A Death Fixation

By concentrating on deaths and the death rate, the Safety Council helps sustain an illusion of progress in the field of traffic safety, for it is quite true that the number of deaths per year has tended to decline slightly of late, and that the death rate-defined as the number of fatalities per hundred million miles of travel-has been declining steadily for thirty -years. This phenomenon occasionally gives rise to paeans of self-congratulation among the safety profes sionals. The cover of the March issue of Traffic Safety, the Safety Council publication, proudly proclaims, "1,700 LIVES SAVED!" But what brought about the decline? There is I certainly no evidence that it was accomplished by any form of safety program-or even that the figures will be as low next year.

The most probable explanation of the declining death rate is that doctors are simply getting better at keeping people alive, so that fewer victims die of trauma whether on the battlefield or the highway. Furthermore, the Council's concentration on death distracts attention from the fact that automobile accidents maim their victims much more frequently than they kill them. For every death there are 125 injuries-many of them involving permanent disability. And both the number and the rate of injuries have been rising. The Safety Council not only soft-pedals this disturbing bit of information but continues to publish woefully incomplete statistics with the bland suggestion that they "be interpreted with some caution."

Each year the Council publishes the "official" figures for motorvehicle injuries along with those for deaths. A few months after its 1957 figure of 1,400,000 injuries was published, the U.S. Public Health

Service revealed that the true figure was nearer five million. New York State's accident figures, which are at least as accurate as most, show a 21 per cent increase in the total number of deaths from 1948 to 1957. This corresponds fairly closely to the Safety Council figure of 19 per cent for the nation during that period. But where the Council shows a mere 27 per cent nationwide increase in the number of injuries, to their 1957 total of 1,400,000, New York State has tabulated a 125 per cent increase-from 114,572 in 1948 to 257,934 in 1957. With 5 per cent of the nation's fatalities, it is fair to assume that New York would have the same proportion of the injuries, indicating a nation wide figure of 5,159,000. This comes amazingly near the estimate of 4,888,000 automobile injuries for 1957 which the U.S. Public Health Service derived from its recent National Health Survey. In other words, the probable number of automobile injuries is at least three and a half times the figure published

by the National Safety Council. The Council definition of an injury as "disabling beyond the day of accident" is somewhat different from that of the Public Health Service, which speaks of accidents involving "at least one full day of restricted activity or medical attendance." But this alone does not account for the inordinate discrepancy of the totals

Moreover, although the death rate

in New York has been declining the injury rate has clearly been s ing. In 1948 there were 404 personal injuries per hundred million mile traveled. By 1957 this had risen 582, an increase of 44 per cent in the injury rate in ten years. Statis tics, though obviously subject abuse and misinterpretation in this field, clearly indicate similar in creases in other states.

Fortunately or unfortunately, death is not very real to most Amer icans: few of us seem to expect 10 die at all, and even fewer by our own hands. Perhaps if the public could be brought to understand that the consequences of automobile accidents are more likely to be a broken back than a broken neck, the de mand for preventive action might be very much greater than it is

Whose Fault Is It?

But the Safety Council's most serious disservice to traffic safety comes from its emphasis on the individual responsibility for accidents. The basic message of the enormous Blood of material, publicity, and informa tion that emerges from the Safety Council is that accidents are caused by individual carelessness and can be prevented if drivers will only pay attention.

Perhaps an individual can reduce to some degree his own risks of be ing involved in a smash-up. But the exposure to accident situations is so great in America these days-with nearly seventy million cars on the highways-that admonishing individuals to drive carefully seems a little bit like trying to stop a typhoid epidemic by urging each family to boil its own drinking water and not eat oysters; that may help, of course, but why not try vaccinations, setting.standards of cleanliness for food handlers, and purifying everybody's drinking water in the reservoirs?

By emphasizing the individual's responsibility in automobile accidents, the Safety Council shifts public attention from factors such as automobile design, which we can reasonably hope to control, to fac tors such as the temperament and behavior of eighty million drivers, which are not susceptible to any form of consistent, over-all controlcertainly not by a bunch of slogans. Very little is actually known about

what causes accidents, but all that is known points to the conclusion that accidents result when drivers find themselves in situations to which they cannot respond correctly, either because their minds don't work fast enough or simply because it's "too late." A good number of these situations arise not from anyone being at fault, but simply and inevitably when enough cars are put in one place at one time. And these situations cannot be changed by any number of well-intentioned national campaigns urging drivers not to kill themselves.

A Canadian physician has summed up what meager research has been done on the subject of driver be havior with the remark that "A man drives as he lives." The number of accidents involving borderline pay, chopathic personalities is disproportionate perhaps, but not especially important in itself, for it accounts for only a small part of the total number of accidents. The great majority of accidents involve people who have never before had an accident or been cited for a traffic violation of any kind. It is quite possible that future research will find that a man who has just had a furious argument with his wife is inclined to knock down pedestrians with his automobile. But how shall we go about preventing husband-wife argu

ments?

This is the dilemma of all ap proaches to the safety problem that are based on influencing driver be havior: the significant personal characteristics seem to be so personal that it is hopeless to think of doing anything about them for the limited purposes of traffic safety. To be sure, some rational and manageable programs, such as driver education, do produce what appear to be good results. But even then the explanation may simply be that the type of person who is apt to have fewer automobile accidents is also the type who takes the precaution of registering for a course in driving.

Temperament seems to have much more to do with accident experience than physical abilities. Teen-age drivers are at the peak so far as most sensory, physical, and co-ordinative functions are concerned. Yet motor-vehicle accidents are the leading cause of death for both

males and females from fifteen to twenty-four. One out of seventeen in this age group gets injured in an automobile every year. Dr. Ross McFarland of Harvard University has concluded that the high accident rates must be regarded in terms of "inexperience, emotional and social immaturity, and temperamental qualities associated with youth." This might be a reason for not allowing young people to drive cars. It hardly serves as the basis for a propaganda campaign urging them to "drive safely." In fact, pointing out dangers actually invites some drivers to try their luck.

The involvement of alcohol in serious injuries is probably still underestimated. One recent study showed that over an eight-year period forty-nine per cent of the drivers killed in single-car accidents in Westchester County, New York, were legally drunk (0.15 per cent alcohol content in the blood) and another twenty per cent were either well on their way or suffering from hang

overs.

Is There a Safe Speed?

These discouraging facts are recog nized in the most common prescription for traffic safety: enforce the law. In practice this comes to mean: enforce the speed law. Unfortunately, there is no evidence that cracking down on speed has much effect on traffic safety. The best-known effort in this direction is that of Governor Abraham Ribicoff of Connecticut. Late in 1955, the year he took office, he announced a crackdown on speeders, including suspension of speeders' licenses for thirty days on their first conviction. Speeding suspensions went from 372 in his first year in office to 10,055 in his second. This was an act of high political courage; and to their credit, the people of Connecticut backed their governor in his campaign. But what were the results?

After a bad year in 1955 before the program got under way, the number of deaths went down slightly, as it did in the rest of the nation but it never got down to the level of the year before Governor Ribicoff took office. The death rate declined slight-, ly, but less than in the nation as a whole. Yet the number of accidents and the number of injuries went up

despite the crackdown. Most significant of all, the injury rate went up sharply. In 1955 there were 210 injuries per hundred million vehicle miles traveled in Connecticut. This rose the next year to 212, the year after that to 223, and last year to 227. In other words, the chance of getting seriously injured in Connecticut increased 8 per cent for every mile traveled during Governor Ribicoff's campaign against speeding.

The basic fallacy behind the crackdown-on-speeders approach is in the unspoken assumption that the legal speed limits somehow define the safe speeds. This is not true. John O. Moore, director of Automotive Crash Injury Research at Cornell University, has reported in the American Journal of Public Health that "Approximately 74 per cent of the cars involved in injury-produc ing accidents were traveling at speeds under 60 mph.... Complete and absolutely controlled top speed limits would afford relatively limit ed reduction in the expectancy of dangerous or fatal injuries in injuryproducing accidents; strict maintenance of a top traveling speed of 49 mph would still have seen the occurrence of 60 per cent of the dangerous or fatal injuries." Dr. R. Arnold Griswold, chairman of the Subcommittee on Traffic Injury Prevention of the American College of Surgeons, reports that two-thirds of road deaths occur at speeds under fifty miles an hour. And the United States Bureau of Public Roads recently found that more accidents occur on high-grade roads in open country at thirty-five miles an hour than at any other speed.

One problem in dealing with such statistics is that the public does not really understand what constitutes speed in an automobile. Anyone who has stood on the bridge of a ship doing fifteen knots realizes that he is streaking through the water. But the lady motorist, cool and comfy on the soft divan of her new hardtop convertible, completely cut off from all vibrations and outside sounds, feels that she is practically standing still at fifteen miles an hour. If she came to a sudden stop against a telephone pole she would find out how fast fifteen miles an hour is— if she lived, that is. Incidentally, Mr. Moore of Cornell found only slight