755

The reduced blood-volume in patients with toxsemia isundoubtedly partly due to the deficiency of plasma-proteins. This deficiency might be due to one or more ofthe following factors: renal loss of protein either byleakage or destructionl2; loss of protein into the interstitialrluid by capillary leakage; reduced synthesis of proteinby the liver; and malnutrition. Brewer 8 13 attributes thelow serum-albumin level in his patients with severe

toxæmia to impaired hepatic synthesis brought on bymalnutrition.

Though Brewer’s work brings us no nearer the solutionof the problem of toxxmia, it does draw attention to anaspect which might well repay further study using modernmethods, particularly since it now appears that Dieck-mann’s authoritative statement 4-that hypoproteinaemiais not the cause of the oedema in toxaemia-is at least notcompletely true. And the warning about the dangers ofthiazide diuretics in severe toxaemia is valuable. Pre-

sumably the only safe policy for such patients is to with-hold the administration of diuretics if they have a lowserum-albumin level (less than 3 g. per 100 ml.) and araised hæmatocrit (greater than 40 in the absence of

anxmia). As a rational alternative, the administration ofhuman serum-albumin offers a time-gaining possibilityeither to prolong the pregnancy for the infant’s sake orto give an opportunity to induce labour and await vaginaldelivery. The occasions for using human serum-

albumin are likely to be few. This is fortunate (particularlysince repeated infusions may be necessary) becausehuman serum-albumin is available only in comparativelylimited amounts from the regional transfusion centres.

COMFORTING BUT DANGEROUS

Six senior consultants at London medical schools,asked at random whether they believed in the existenceof accident proneness, answered that they were convincedof it. But Froggatt and Smiley’s review 14 of our admittedlypatchy statistics about accidents casts some doubt on theirbelief.

At the end of the 1914-18 war Major Greenwood andhis coworkers began to study the distribution of accidentsamong munition workers. They found that accidentsdid not follow a mathematically random pattern, and theytried to evolve a formula which would both express and

predict the pattern." To begin with, it was thought thatfirst accidents occurred in a random fashion, but that laterones were biased. This theory was, however, never fullyaccepted. Instead, the idea of accident proneness grewout of Greenwood’s hypothesis of " unequal liabilities ".Until the ’fifties it continued to gather support, butsince then the evidence for it has been examined more

critically.In their survey Froggatt and Smiley have re-examined

figures from past studies, with some instructive results.For instance, they reassessed accident-rates after first

removing the men with the highest accident-rates in thefirst year, or those with poor xstheto-kinetic reactions, orboth. They showed that, though findings such as " less::an 200 of certain groups of drivers report over half theaccidents "seem to confirm the concept of accidentproneness, random distribution can in fact give the sameresults. Again, it may seem as though a small percentage

12. Tovey, J. E. J. Obstet. Gynœc. Brit. Emp. 1959, 66, 981.13. Brewer, T. H. Amer. J. Obstet. Gynec. 1962, 83, 1253.14. Froggatt, P., Smiley, J. Brit. J. industr. Med. 1964, 21, 1.15 Greenwood, M., Yule, G. U. J. R. statist. Soc. 1920, 83, 255.

of people have a large percentage of the accidents simplybecause the mean number of accidents is small, and thisis true of most accident studies.

The search for a measurable feature to account foraccident proneness has led to work on timing reactionsand on personality tests, but here again the results havebeen equivocal. It has never been possible to pinpoint anaccident-prone group and, by excluding it, to change theaccident-rate. Furthermore, the issue is bedevilled byvariables. Third-party vagaries, the intricacy of a task,the experience of a worker, are never constant. Trivialaccidents are sometimes ignored and sometimes reported.In road accidents this may be determined by the type ofinsurance policy. Indeed Froggatt and Smiley concludethat " there are no perfect data extant for a reliable studyof accident distribution ", and if the existence of accidentproneness remains unproven, this may be because it is infact extremely rare and nearly impossible to distinguishamong a welter of unsatisfactory records. Another

possibility is that an individual may have " accident

spells " during which he has a run of mishaps, and this issupported by Froggatt’s own study on transport driversin Northern Ireland 16—an almost ideal group from thestatistical point of view, for they all drove similar vehiclesfor similar shifts over similar routes. These accident

spells have been observed in other groups, such as wartimemunition workers, and may be related to impaired healthor domestic stress.

Anyone who has had six accidents in rapid succession,even though they are statistically random, may feel theneed to find a more personal enemy than blind chance.Perhaps because of this need, the idea of accident pronenesshas been accepted too readily. If it is a superstition whichis effective only in those who believe in it, the more wecan drive the belief into disuse the greater the immunity.Another reason to discard it is that some employers,supervisors, and insurers use it as an excuse for brushingaside their responsibilities and for neglecting safeguards.Froggatt and Smiley believe that the wisest course wouldbe to drop what has proved to be a dangerous catchphraseand to recognise that " variation in human abilities due topersonal and environmental cause is in the nature of

things, and tendency to accident is an undoubted hazardof living ".

UNIVERSITY SALARIES

THE National Incomes Commission, 17 responding to theGovernment’s request to review the salaries of academicstaffs of universities, finds that " over the years there hasbeen a decline in the position occupied by universitysalaries in the overall pattern of relativities and that the

consequences of this decline are already to be found insymptoms which for the future welfare of the Universitiesshould not be ignored". On the other hand, the Com-mission insists that it would be wrong to attempt, bymeans of salary adjustments, to give the universities anadvantage over their competitors; and it sternly opposesextension of differentials in remuneration by faculties orsubjects beyond the existing differential for medicalteachers.

"... we are strongly of opinion that the principle of parityof esteem and of remuneration between all subjects considered16. Cresswell, W. L., Froggatt, P. Causation of Bus Driver Accidents.

London, 1963.17. National Incomes Commission: Remuneration of Academic Staff in

Universities and Colleges of Advanced Technology. H.M. StationeryOffice. Cmnd. 2317. 1964. Pp. 100. 7s.