First Report [with Final Report and Appendices] of the Commissioners.
- Great Britain. Royal Commission on Venereal Diseases.
- Date:
- 1914-1916
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.
25/1186 (page 9)
![7 November 1913.] Dr. T. H. C. Stevenson. [Continued. in regard to it, that we receive a cei-taiu number of letters from practitioners asking us why we do not take steps to get such a system introduced. They are evidently wi-itten by men who would welcome such a system, as relieving them from an emban-assing situation. 240. Then you suggest that many of the doctors in this counti-y would be willing to perform this duty gratuitously in order to relieve them from their present obnoxious position of having to put marasmus say, instead of syphilis ?—I l)elieve some of them would. I have no means of estimating the probable number of these. 241. But are you of opinion that a much larger number would not resent vei'y strongly having to give a confidential certificate to the State without any pay- ment whatever for it ?—I think that the profession would probably welcome the opportunity of tiying to get payment for a service which it has hitherto had to render without payment. 242. Supposing 2s. 6cZ. were charged for each death certificate, that, I believe, would amount to something like 52,000L per annum for England and Wales ?—I thought it was a trifle more. 243. I am not sure, but it is somewhere thereabouts. That is not, to your mind, a prohibitive sum ?—I have genei-ally heard the sum of 2s 6d. suggested in con- nection with the proposed duty of the practitioner to view a body and certify to the fact of death. I do not think it would be at all too large a fee if that duty were imposed upon him. {Dr. Newsholme.) I am not suggesting it is too large a fee. 244. {Sir Malcolm Morris.) That is a very important point of inspecting the body. A ceitificate is given to the person who applies, in the ordinary way, for 2s. 6d. ? I think for the mere putting in the post of a certificate, which at the present time a practitioner has to write out in any case, 2s. 6d. would be rather large. I should have thought a smaller sura would have sufficed. 245. {Dr. Neivsliolme.) You have expressed the opinion that although the official figures as to syphilis do not represent the whole truth, they are not desti- tute of value and they can be used to some extent ? —I think they have a comparative value. I have been rather impressed with that fact by my study of them. I started with as great a prejudice against their value probably as anyone else could have, but I have modified my opinion. 246. I may say I share that opinion, and I should like for a minute or two to take you over the comparison between the past and the present time. If you look at the general curve of syphilis per thousand of the population for the whole of the population, it shows a very marked decline ?—Of late years. There was a period, of course, when it showed a very high rise I have the chart here. 247. I have a chart here also, but perhaps you would hand yours afterwards to the Chaii-man ?—Yes. 248. Take from 1891 onwards. I think there has been a reduction of 25 per cent, in the death-rate from syphilis at all ages ?—Yes, I think so. 249. You may take that from me ?—Yes. 250. Then take the death-rate from infantile syphilis between 1891 and 1911. There has been a decline of about 13 or 14 per cent. P—I have not that figm-e. 251. If you look at the two curves, although they do not show the same amount of decline, they both point definitely in the same direction ?—Yes. 252. If I turn away from your figures for the moment and compare those with the army statistics, either taking recruits or taking the whole army, you will find there a somewhat similar but greater decrease? —Ye.s, .so I understand. 253. Do you attach any importance to the fact that in the army there is a decline, and in yoiu- statistics there is a decline, both sets of curves pointing in the same direction ?—Of course, I am not in a position to form any estimate of the degree to which the decline in the anny figiires may be attributable to improved treatment. 254. There is one other point as bearing on the decline. I suppose you would agree that the fact that the proportion of deaths occuiring in institutions has enormously increased would tend, other things being equal, to increase the registering of deaths from syphilis ? —Yes, certainly. I think if there had been no other change but that, the mortality from syphilis, as returned, would have increased. 255. And the fact that the percentage of deaths in institutions has greatly increased and the registered death-rate of syphilis has gone down, would militate strongly against any notion that syphilis has increased in this covmtry ?—I do not know that I should think it absolutely inconsistent if there were evidence strongly in the other direction; but to my mind it certainly points in the direction of decrease. 256. There is prima facie evidence ui that direction . —Yes; and there is a, further point parallel with the increase in institutional deaths, that is, the increase in the lU'banisation of the population ; because we have abundant evidence that syphilis is a disease of large towns. 257. I would like to take that point next. A few days ago you handed to me a very valuable taljle dealing with the mortality from general paralysis and locomotor ataxy in England and Wales as a whole, in London, the aggregate of the county boroughs, the aggregate of urban districts and the rui-al districts ?— Yes. 258. Could you conveniently hand that in to the Commission now ?—I have a condensed form of that table which embodies all the information that I should care to supply at the present time. I may say with regard to that table, which differentiated social classes, it is only possible at the moment to supply it in the form of mortality at all ages, and in a comparison of mortality between different classes of the community whose age distribution obviously is liable to variation such a comparison is unsafe: and therefore I should like the opportunity of supplementing this table at a later date. 259. But stibject to these very important correc- tions which you have named and which you will supply later, the crude figures of death-rates per million living. I think I am right in saying, show a larger death-rate from both these diseases of locomotor ataxy and general paralysis of the insane in London than county boroughs, in county boroughs than in other virban districts, and in urban districts than in rural districts —Yes. The death-i-ate from syphilis in London is over four times as high as in the rural districts, and the decline from the London to the rural districts is progressing as you go down the scale. 260. You attach importance to those figures as dealing with the present day ?—Yes. 261. And showing the real state of the facts ?—^Yes; I think they must. I think the retm-ns with regard to syphilis have a veiy definite comparative value. 262. (Sir Malcolm Morris.) Is there not a possibility that rural people come to London for treatment and then die ?—Very few syphilis deaths in the rural areas occur in institutions. 263. {Dr. Newsholme.) I was coming to that point; we will expand it at once. The Registrar-General in this report for 1911-12 has adopted a system of distri- buting all institutional deaths of people who reside in other districts than the towns ?—Yes ; that is carried out so far as practicable. It is carried out in the vast majority of cases. The death is referred to the area of residence. 264. Your general conclusion from these figm-es which you have would be, that venereal diseases are more fatal, and probably also more prevalent, in London and the largest towns than in inu-al districts—I can conceive of no circumstances which would make it so much more the practice for the doctors in rural districts to conceal the fact than in the large towns. 265. You have indicated certain additional Infor- mation that you might supply from your department. Can you tell us how soon the Commission might have your information as to the deaths in which syi^hilis is returned as a secondary cause of death. I think you said you were beginning a classification of the secondary](https://iiif.wellcomecollection.org/image/b21361101_0025.jp2/full/800%2C/0/default.jpg)
