THE REFUGEES

88 in motor-vehicle drivers or passengers (most of the other deaths are among pedestrians and only about 1% each among cyclists and motor-cyclists). But in Britain only a sixth of those who die are motorists ; nearly half are pedestrians, a quarter motor-cyclists, and the rest pedalcyclists. The American findings can be used in this country and may save the lives of motorists (though different road conditions and styles of vehicles may lead to different injuries here), but it is important to find Some research ways of protecting other road users. has been done in the nature of their injuries (thus, in motor-cyclists most deaths are due to head injury and the legs are damaged more often than the arms, while in pedal-cyclists the arms suffer more than the legs), but there is much more to be learned. Three phases of research, similar to those undertaken in the United States, are planned ; the first has begun on a small scale in Slough. Protective clothing, improved external design of vehicles to protect pedestrians, and alterations to motor-cycles to protect the riders are foreseen. Everything that can be done by improved design of vehicles must be done, but more might be gained by improving the roads and changing the laws governing those who use them. It is even more important to realise (and constantly remember) that no big reduction in the number of dead and injured can be expected until more care and skill are shown by those who use the roads. FAST VITAL CAPACITY THE measurement of lung volumes has long been used in the assessment of respiratory disease, and the determination of vital capacity not only is easy for the patient to understand and perform but also requires only a The introduction of spirometer for its execution. rate and into respiratory capacity lung-volume tests came with the measurement of maximum breathing capacity (M.B.C.) ; this measurement was designed to estimate the patient’s over-all ability to move air into and out of the lungs, and the result therefore depends on the muscular effort achieved as well as on the physical properties of the lungs. More recently the " timed vital capacity " has been advocated ; in this test the patient makes a maximum volume shift of air into or out of the lungs as rapidly as possible, and the volume is recorded against time. These manceuvres give the inspiratory fast vital capacity (i.F.v.c.) and expiratory fast vital capacity (E.F.v.c.) respectively, and from the resulting curves information can be obtained about the state of the lungs ; the curve itself is interpreted in one of two ways, either directly These interpretations or as it relates to the M.B.c. have been discussed by Bernstein and Kazantzis1 and by Shephard.2 The direct interpretation of the curve relies, for example, upon the measurement of the onesecond volume, while the interpretation of the M.B.c. is more closely connected with the maximum flow-rate achieved-on the hypothesis that the M.B.c. test allows the respiratory effort to operate over the optimal parts of the E.F.v.c. and I.F.V.C. curves in such a way that the shift of air is a maximum. Such tests, depending as they do on the measurement of rapidly changing quantities, require apparatus that can respond quickly and without " overshoot " if the results are not to give rise to misleading interpretations. Indeed, some of the earlier work on F.V.C. was carried out on the conventional heavy spirometer bell and gave More recently a lightweight spirometer false results. bell or the pneumotachograph has been used to measure volume shift in F.V.C. The pneumotachograph measures air-flow rate and requires integration over time to give volume ; it has been used by Shephard 2 to investigate r.v.c. Both these types of apparatus offer little resistance 1. Bernstein, L., Kazantzis, G. Thorax, 1954, 9, 326. 2. Shephard, R. J. Ibid, 1956, 11, 223.

to

respiration,

and both

seem

suitable for

rapid

measurements ; interference from such factors

as

F.v.c.

inertia. gas is

of the bell and the temperature of the respired of little significance. Shephard points out, however, that the complex resonating system, made up of the spirometer bell and the U-loop of the water seal, linked together by the elastic gas volume, introduces certain errors when the F.v.c. is recorded by the spirometer. These errors include the failure to indicate the true starting-point of the manoeuvre, and the obscuring of the end-point of the one-second volume capacity by bell oscillations. Shephard considers the volume delivery over the first second to be the most useful measurement derived from the F.v.c., provided that it is related to the total time of delivery, and he admits that for this measure. ment the errors introduced by the lightweight spirometer bell are unimportant clinically. Thus, for this purpose the more complex apparatus needed for pneumotacho. gram recording and integration is unnecessary. It is claimed, not without reason, that the F.v.c. test is much less exacting for the patient than the M.B.C., and that the F.v.c. can be made to give as much informa. tion as, or more than, the M.B.c. Though these claims are probably true, it must be remembered that it is only the volumes of gas shifted and the rate of shifting which are being measured, and not the pressures required to produce the movement. When volumes only are measured there can be no indication of the respiratory work involved, which is determined by both pressure and volume changes during respiration. In so far as respiratory work is important, as in emphysema, F.V.C. by itself provides an incomplete assessment of the respiratory state of the patient ; and this view accords with the conclusions of Attinger et al. to which we lately preferred3 Nevertheless, the F.v.c., when properly performed and interpreted, can give valuable information, and it is a satisfactory compromise between the extent of the measurements required and the increasingly complex and specialised apparatus necessary for the collection of important data. THE REFUGEES

WHATEVER their plans, Hungarian doctors who have reached this country are eager to learn English without

delay.

.

Many education authorities run courses in English for foreigners, and some propose to start special courses for Hungarians. In London application should be made to the education officer at County Hall, S.E.1, in writing or in person (room 76) or by telephone (Waterloo 5000, extension 441). The county council is waiving fees. The B.B.C. has a series of quarter-hour English lessons, for those who already know some English, each day on its European service (232 metres) starting at 5 and 6.45 Ajt. and 12.15, 5.15, 7.15, and 9.15 P,M. The 9.15 P.M. transmission is likely to be heard best ; and at this time classes at elementary level are given on Mondays, Wednesdays, and Fridays. Two special long-playing records to teach English from the start have been made for the B.B.C. These are obtainable at 15s. each, and two corresponding textbooks at 2s. each (or 3s. 6d. for the two), from the B.B.C., English by Radio, Bush House, London, W.C.2. Cheques should be made payable to the B.B.C. Club. Alternatively, copies of the records and books may be borrowed from The Lancet office. A series of five books for instruction by the direct method is published by Berlitz, and is obtainable from K. Sussapfel. Publisher, 36, Maiden Lane, Strand, London, W.C.2. The first of these costs 6s. 6d. (plus 9d. postage).

Further offers of temporary homes for Hungarian doctors may be addressed to this office and are likely soon to be taken up-especially those from the London area. The fund established by The Lancet to meet special immediate expenses of medical refugees and their families is being distributed. Applications-and further <

contributions-are invited. 3. See Annotation,

Lancet, 1956, ii, 1034.