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In America before World War I, Mr Toad‘s view of motoring was not uncommon: the driver was a wealthy sporting eccentric in the vanguard of modernity; he was free to drive on the public highway; and if people wanted to avoid being hit by a moving vehicle, they had better watch out.
By the 1970s and 1980s, motorized city centres in America and Europe were being replaced by pedestrian precincts and park-and-ride arrangements, thus breaking the link between modernity and motoring. However in the “undeveloped” world the old gung-ho model still held sway, though based on an inappropriate precedent. The hazards on the main highway out of Nairobi today are vividly described in a recent article by Toby Young in the Spectator, and in comments thereto. 
These remarks are provoked and informed by the current issue of Medical History, which contains an article on ‘Road traffic injuries: social change and development’ by Iris Borowy from the University of Rostock in Germany and the Centre Alexandre Koyré in France.  She proposes a narrative of increasing sophistication in the understanding of road traffic injuries on the part of national and international organizations responsible for reducing the burden of morbidity and mortality. One of the most important of those organizations was the World Bank, which is seen as the author of a more considered approach to traffic injuries in the developing world, especially in a 2004 report by the Bank and the World Health Organization. However, there are many subtleties in the changing links between populations, governments, notions of development, notions of acceptable risk, the business interests of car manufacturers, etc. etc. , which are summarized in two tables (pp. 134-136).
Three points might be raised here. The paper presents the beginnings of road safety concerns in Europe and America as occurring in the 1950s. However, if one looks at the road safety posters in the Wellcome Library, the earliest publication (image above) dates from around 1930: at least, it shows a bill written on a slate (amounting to 48 dead and 1062 injured pedestrians) presented by a monstrous skeletal claw and dated Munich 1929, implying that 1929 was a recent date; in any case the designer, Valentin Zietara, died in 1935. Was this an out-lier (perhaps reflecting the stronger safety culture in Germany and Austria, as shown in their journal publications), or a lone survivor from a campaign of wider concern about safety on the roads? There might be more to discover from the interwar period.
Second, in addition to the legal, technological and administrative factors at play, surely the “culture” of driving has a strong influence on individual drivers, leading them to or away from the possibility of injury? Driving is a communal activity after all, and the behaviour described in a comment on the Spectator article mentioned above shows the norms in a particular place: “The frightening death rate on Kenya’s roads has … everything to do with overtaking multiple groups of cars and then colliding head-on with a vehicle coming in the opposite direction. … In central Nairobi there are no road rules at all. Traffic lights, for example, and there are many, are totally ignored”.
Third, the appearance of this article in a journal entitled Medical History shows that “medical history” does not necessarily mean what an outsider might suppose, i.e. the pre-history of what medical staff do today in hospitals, clinics and medical schools. Medical doctors have at most a cameo part in this story: in 1993 the British Medical Journal (following a group of New Zealand intensive care specialists writing in 1987) rejected the use of the word ‘accidents’ for traffic injuries caused by drunk or negligent drivers, and in 2001 banned the “inappropriate use” of the word ‘accidents’ from its pages.
Nevertheless, as the article shows, road traffic injuries have a devastating effect on individuals and populations, and are well worth the consideration of all concerned with the human environment, “medical” or otherwise. Kudos to the journal for publishing such a thoughtful and thought-provoking paper.
Author: William Schupbach
 ‘Kenyan highways’, The Spectator 2 February 2013, http://www.spectator.co.uk/life/status-anxiety/8835401/kenyan-highways/ , with comment by Sean L
 Iris Borowy, ‘Road traffic injuries: social change and development’, Medical history, 2013, 57: 108-138, available free online at: http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8825405&fulltextType=RA&fileId=S002572731200083X