First Report [with Final Report and Appendices] of the Commissioners.

  • Great Britain. Royal Commission on Venereal Diseases.
Date:
1914-1916
Catalogue details

Licence: In copyright

Credit: First Report [with Final Report and Appendices] of the Commissioners. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

    21/1186 (page 5)
    7 November 1913.] Dr. T. H. C. Stevenson. [Continued. you like. By what process are the figures that are on the page arrived at ?—With regard to deaths ? 115. Take page 37. Syphilis, male, 1.04(3 in the year 1897 ?—The figures are arrived at by a different method now from that by which they were an-ived at in the year 1897. 116. Then we will take the year 1911 against M.; syphilis, 1,052. I am simply taking that as a test in order that 1 may see what kind of value really attaches to the figures. Where do you get the 1,052 from ?— The value is entirely dependent upon the degree of accuracy of certification. That number, 1,052, repre- sents accurately the number of deaths that were registered as due to syphilis. That is all we can say ; the number of deaths that are registered as due to a cause. We are in the same position as you or anybody else when it comes to speculating as to what the number of deaths really due to a cause may be. 117. Then if the Registrar-G-eneral adopting the certificate sees syphilis, he puts it under the heading of syphilis ?—Yes, certainly. The tabulation at present is carried out by a card system. The code number of syphilis which, as you have seen, in some of the tables is 37, is stamped upon a card. The card is perforated in one place at figure 3 and in another at figure 7, and by mechanical means all those cards are assembled together, and then in a further operation they are coimted, and it was foiTnd there were 1,052 in the year 1911. 118. Then apart from the figures founded upon the verdicts of coroners' inquests, the validity or accuracy of the figures depends upon the good faith and skill of the medical practitioner ?—Tes, entirely. 119. I think you referred to coi-respondence. How does this correspondence begin if you rely upon the certificates only ?—Of course, certificates as wi-itten obviously differ in value. They differ, for instance, in definiteness. There is a very large number of certificates which assign indefinite causes of death. In certain of those cases it has been the practice in the Registrar-G-eneral's ofiice for many years to send letters of inquiry asking for further and more definite information, and it was to the replies received to those inquiries that I referred. 120. I do uot quite understand the term in- definite cause. Does that mean that some disease unknown to the Registrar-General is specified ?—No ; it may mean, for instance, that a symptom is specified instead of a disease. 121. Do you mean by that that the certificate bears marks of doubt in the mind of the doctor who attended the deceased ?—Take, for instance, the term brain disease. If we got a certificate specifying brain disease, as we get a few, we should write to know what the disease actually was; and in some cases where we get them specifying merely symptoms such as heart failure or coma or something of that sort, we send inquiries. We cannot do it in all cases, because we have not the staff to cope with it. 122. Is it the custom of medical men to retuim only the proximate cause of death as the cause of death for the purpose of satisfying the department or the general law?—There are all classes of certi- ficates received from various medical men, good, bad, and indifferent. The quality of certification in general is constantly improving. It is very much better now than it was even 15 or 20 years ago, but there is a great deal of room for improvement still. 123. {Sir Eenelm E. Digby.) As I understand, you have made further inquiries when the description is of a very general character ?—In certain cases. Our system is one for sending out inquiries with regard to certain forms of certificates. I thought I had a copy here of the Registrar-Oenerars manual of causes of death. That contains an alphabetical index of all the forms of certificates that we, as a rule, receive, and against certain of those forms a star is printed indicating that a letter of inquiry is sent when that form of certificate is received. 124. But that would not be the case, a? T under- stand, in syphilis ?—No, certainly not. ;M84() 125. You used the expression that that was a clear- cut disease ?—Yes, certainly. No further information could very well be asked for. 126. {Sir Ahneric FitzBoy.) We know, of course, that there is a statutory obligation to certify deaths ; but certification is by no means a universal practice, is it ?—98| per cent, of the deaths in this country ai'e certified. 127. You mean that no appreciable number of deaths escapes the meshes of the Registrar-General's net ?—That is a question of registration, not of cer- tification. We have no knowledge of the deaths that are not registered. We believe them to be very few. 128. You l)elieve them to 1)6 very few, but you do not know ?—Naturally, if we knew of them we should see they were registered. 129. Yes; but you do not think a great number escape ?—No, we think very few escape. 130. It is admitted that your statistics are very incomplete for the causes you have given. Would you be prepared to add conjecturally any approximate percentage to the figures given in the table, so as to bi'ing them to some higher degree of accuracy ?—I did work out rather a fanciful conjecture based upon the proportion of deaths returned as occurring in institu- tions from syphilis, and that, on the assumptions made—which I do not mean to say are necessarily true— would increase the number of deaths from syphilis by some 400 or 500. 131. How do you reach that?—The idea was to assume, for the purpose of estimating, that all the deaths occurring in institutions due to syphilis, or that were recognised as due to syphilis, were re- turned as such, and then to asstime further that the pi-oportion of cases of fatal syphilis that found their way to institutions is equal in the proportion of cases of death from all causes. If those two assumptions could be held as approximately true, then the shortage of deaths outside institutions would be about 400 to 500. 132. In all ?—Yes, in all in a year. 133. {Canon Horsleij.) Per 10,000, or the whole of the population?—The absolute total in a year is 1,700, or something like that. RefeiTing to my notes to refresh myself on that, if we assume the true proj)or- tion of institution deaths to be equal to the average for all causes, 23 per cent., then the real total of syphilis male deaths is 1,466, or 409 in excess of the recorded total of 1,057. I see that estimate refers only to male deaths. 134. {Sir Almeric FitzBoy.) An addition then of nearly 50 per cent. ?—Yes. Of course if the deaths of females on that basis were added in, you would get a considerably larger number than the number I speak of. 135. Is not syphilis a very constant cause of still- births ?—Yes, no doubt. 136. Is there any statistical information obtain;ible on that ])oint ?—We can give the number of premature births, of coiirse. 137. That is not still-births ?—Still-births can be got under the Notification of Births Act, and under the Midwives Act. 138. Yes ; but is the registration of them under those Acts in any way complete ?—I think Dr. News- holme could tell you more as to the completeness of the Notificatication of Births and the operation of that Act than I can. I believe it is between 80 and 90 per cent, of registered births that are notified. 139. Still-births ?—No, registered live births. Of course one ■ could only deduce some idea as to the completeness of the notification of still-lni'ths from the completeness of the notification of live births. 140. Do yoM not think there ought to be registration of still-births ?—Certainly. 141. Why has it never been done; have you any idea ?—There are a great many things we should like to be done. 142. Yes. But it has been recommended by two or three committees. You are aware of that ?—Yes ; and so have other changes in regard to the work of our department.