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It is unfortunate that many of the centres taking part have access only to monoplace chambers and are using pure oxygen at 2 atm while following Fischer's protocol, which he described when using a multiplace chamber.' As Dr Mertin and Professor McDonald point out, leaking face masks can lead to the delivered oxygen pressure falling to 60% so that some of his patients may have received only an equivalent of 12 atm of oxygen. His results showed that better clinical improvement occurred in patients having arterial oxygen pressures equalling those in a monoplace chamber at 1-4-1-6 atm. It is therefore understandable why several centres using monoplace equipment are experiencing no appreciable effect or even deterioration. From his experience of treating over 700 patients, Neubauer advocates the use of variable low pressures starting at 15 atm and titrating each patient according to his response.2 He appreciates that research workers will find it difficult to use a variable regimen in controlled studies and suggests that better results might be attained with a steady pressure of 15 atm throughout when using a monoplace chamber (R A Neubauer. An unpublished open letter to all baromedical physicians, 1983.) Before a final verdict on the treatment is reached it is essential that trials are properly designed so that groups of patients are evaluated who have received comparable treatment regimens. In the multicentre trial being directed by the US Multiple Sclerosis Society the choice of treatment regimen is left to the individual therapist when using a monoplace chamber. If sufficient clinical material becomes available a computer analysis will be able to separate patients into such groups.

Motorcyclists should be encouraged to wear full face crash helmets.