Myasthenia Gravis
Authors: H. Garland, A. N. G. Clark
Journal: BMJ (1956)

The reasons for singling out the motor-cyclist from among other road users have been given.He rides unprotected and runs a particular risk of injury.The importance of head injury in the mortality rate is obvious, and it is clear from the present trend of figures that any reduction in the mortality rate from head injury among motor-cyclists would not only benefit the group but have a very favourable effect on accident mortality as a whole.One further point which should be mentioned is the economic loss to the country of these young men.In this series of motor-cyclists with head injuries, 56% were between 16 and 25 years of age and 95% were between 16 and 45.This may be compared with an incidence of 27.9% in the 16-25 year group and 55.8% in the 16-45 year group among an unselected consecutive series of 1,000 closed head injuries from all causes.The country can ill afford the injury to and loss of life among these vigorous young men, many of whom are skilled or in training.During 1955, for example, 149 motor-cyclists were admitted to the male accident ward of the Radcliffe Infirmary alone with injuries of all kinds.There were nine deaths.All had head injury, which was the cause of death in seven.The evidence in this paper, together with earlier work on this subject, seems to leave little doubt that an efficient crash helmet will prevent many minor concussions and lessen the effect of severer injuries.The risks of severe and complicated skull fractures are considerably reduced.It is surely significant that among the number of civilian motor-cyclists admitted in the last two years there have been only two deaths from head injurv where an efficient helmet has been worn, and in both cases there were multiple injuries and evidence of severe impact.There are several lines for further study.The Road Research Laboratory is continuing its work on the design and construction of helmets, and the possibilities of many of the newer synthetic materials available for both the shell and th.e inner padding need testing.The standards of an efficient helmet for motor-cyclists also require review with their particular problems in mind.Starks (1952) made a useful survey of motor-cycle accidents based on statistics for the immediate preceding years, and a further field survey on the resultant injury to motor-cyclists when the head is struck would be particularly valuable at this period to estimate how useful a helmet is in preventing concussion altogether.In other cases, as suggested in this paper, a study of the brain injury sustained may also yield further useful information.It is estimated that at the present time not more than a third of motor-cyclists over the country are wearing helmets.Every encouragement should be given to motor-cyclists to wear them.The Government could give a useful lead by removing the remaining purchase tax from these helmets.It should not be supposed, however, that this would be by any means the complete answer.The relief of a few shillings is unlikely to influence a young man who is prepared to pay a high pruLe for a modern machine.Indeed, cost is rarely given as a reason for not wearing a helmet.The usual comment is that they are too hot or uncomfortable, or give rise to an unpleasant drumming in the ears.We rather sus- pect the real reason to be in many instances that a helmet detracts from the freedom and verve of riding an open machine.The motor-cyclist needs to be assured of the value of a crash helmet, and work should continue to produce a cheap, comfortable, and efficient helmet ready for his use.Parents and employers, motor-cycle clubs, and " ace" riders can all help to encourage and popularize their use.