MOTOR-CAR ACCIDENTS AND HOSPITALS

3133IOTOR-CAR ACCIDENTS AND HOSPITALS.

Correspondence.

MOTOR-CAR ACCIDENTS AND HOSPITALS.

" Audi alteram partem."

To the Editor of THE LANCET.

SiR,-In your issue of Oct. 22nd last you kindlypublished a letter from me asking for details of motoraccidents treated at hospitals throughout the country.Figures reached me from 183 hospitals, representing14,169 beds (rather less than one-third of the totalavailable beds) and it appears that the cost to thehospitals of the country, irrespective of any feesto medical men, must be in the region of half a millionpounds sterling annually. The financial burdenplaced upon the hospitals is unbearable, and in otherrespects almost unbelievable. For instance, I findthat in many small hospitals the medical officers havebeen impelled, as the week-end approaches, to hastenthe discharge of in-patients, most of whom are localresidents for whom the hospital was founded, inorder to have beds ready for motorists from " foreignparts."The Hospitals Motor Accident Policy Association,

of which I am chairman, have placed these statisticsbefore various insurance experts, and I am glad tosay that in a very public-spirited manner the EagleStar and British Dominions Insurance Company,Limited, have established a policy, which for themoderate premium of 5s. guarantees to the hospitala payment of 10s. 6d. per day up to 30 days shouldthe insured be admitted into the hospital as the resultof an accident caused by any moving public or privatemotor, electric, or horse-drawn vehicle, together witha payment of 3 guineas for medical fees, which isincreased to 5 guineas should the patient be detainedbeyond seven days. In the case of patients dealtwith in the casualty department and not admitted,the payment is lOs. 6d. to the hospital and 10s. 6d.to the medical officer. Whilst greatly appreciatingthe action of the Eagle Star Insurance, this Associa-

, tion is not satisfied that the position has beenadequately dealt with, but they feel that a starthas been made to lighten the burden which thehospitals have been obliged by circumstances toshoulder, and they trust that further experiencemay enable them to secure even better provision.Every motorist carries a map and every motorist

should have an M.A.P. (Motor Accident Policy) ; so

also should the " man in the street," and the patronof the motor-bus and taxicab. These policies willbe ready for issue this week, and I am asked to suggestthat intending holders should make their chequein the form of a banker’s order to be paid annually.They will thus avoid personal inconvenience andadd something like 5 per cent. to the amount availablefor distribution amongst the hospitals. The chequeshould be made out in this way :-

"

Pay now and annually on this date to theEagle Star Insurance, 1, Threadneedle-street,E.C., the sum of 2 ."

(and please write plainly) and send it to the HospitalsMotor Accident Policy Association, 6, Duke-street,Adelphi, W.C.One interesting feature is that a motor owner may

take a policy for each seat in his car. Another feature,important for motor cyclists, is that on account ofthe risk the company can only pay half benefit inrespect of motor cyclists and sidecars ; motor cyclistsare therefore urged to take two policies for each seat,which will give them full cover.

I am, Sir, yours faithfully,

Feb. 4th, 1928.

H. W. BURLEIGH,Chairman, Hospitals Motor Accident

Policy Association.

FATALITY-RATES OF SMALL-POX IN THEVACCINATED AND UNVACCINATED.

To the Editor of THE LANCET.

SiR,-Dr. Garrow’s figures are based upon thefallacy of comparing statistical incommensurables.As he must know well, there have been two distincttypes of small-pox occurring in England during thelast few years ; the vast majority have occurred inthe unvaccinated populations of the Northern andMidland counties, and were of the mild type-variolaminor, if he likes so to term it-whilst a very smallnumber of a severe type-variola major-haveoccurred in the south of England, due to infectionintroduced from France, Spain, &c. This distinctionis not apparent in the tables published in theannual reports of the chief medical officer to theMinistry of Health, though doubtless the necessaryinformation is available at the Ministry. By com-paring the information in these tables, from which hequotes, with the accompanying text, and with thefigures given in Table XL. of the Annual StatisticalReviews of the Registrar-General, I have been able toidentify nearly all the deaths. In this manner Iobtain the following table of deaths in Englandduring the years 1923 to 1926 :—

By " northern " is meant the northern and midlandcounties as defined by the footnote to Table IV. of theRegistrar-General’s statistical reviews, less Middlesex,Herts, and Essex, the remainder being the southerncounties.Assuming, then, that all the deaths in the southern

counties were deaths from variola major, we maydeduct them from the total deaths ; this assumptionis quite valid, as these deaths can be identified from.the text ; identification of the cases is not easy, butas those occurring in the south of England were veryfew-about 80-they may be neglected statistically..The amended table is as follows :-

-

* 10 were under 1 year o’d.

These figures are probably accurate as far as they-go, except that the small number of cases of variola;major in the southern counties are included ; thetable gives the fatality-rates from mild small-poxin the vaccinated and unvaccinated, the advantagebeing in favour of the vaccinated, except at ages 15to 30 years, where, the rates being based on a singledeath in each class, no deduction is possible from-such meagre data. The probable error in all classes,except the youngest class of unvaccinated, is veryhigh. Even when corrected there is a further fallacyas two of the three deaths among the vaccinatedat ages over 30 years were of persons aged over 70,whilst only one death at those ages occurred among-the unvaccinated. It is well known that small-poxfatality rises steeply in the later years of life. The-data do not form a basis of comparison for the-

fatality-rates in variola major among the vaccinatecE