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.

    26/1186 (page 10)
    7 November 1913.] Dr. T. H. C. Stevenson. [Cmitinued. cause of death—We should have practically no cases in which syphilis was returned as the secondaiy cause of death. What I was referring to was the conditions mentioned along with syphilis on cei-tificates mentioning syphilis, and therefore listed under that head in oiu- returns. 266. The Commission will be able to have that after a while ?—Tes, we can supply that in a short time. 267. Then you mentioned also the local distribution of deaths from venereal diseases. That also you will be able to supply so far as the figures are availa.jle, at a later date ?—Yes. The figures are at the present moment tabulated for London and the county boroughs, for instance. To-morrow I suppose they will be avail- able for the whole of the country for syphilis. 268. You were asked earlier as to the possibility of improving the certification of deaths due to syphilis, and the influence of notification of the disease upon such certification. I take it the most important means of getting improved certification of deaths from syphilis in order to get a greater knowledge of the disease, would be to have more complete diagnosis, and more available treatment. If, for instance, every practitioner in the country had available for his use a free Wasser- mann test, would that, in your view, be likely to increase the accuracy of the statement as to the cause of death ? ■—I have no doubt it would, but that raises important considerations as to classification of causes of death. How far we could refer deaths from remote consequences of syphilis to syphilis is very doubtful indeed. It is not the practice of the international classification to assign a death to any cause which was not present at the time of death. 269. That is one of the most difficult points in the classification of disease ?—Yes. 270. Take for instance the illustration given by Dr. Mott of angina pectoris. The original disease may have been caused by syphilis ?—Yes. 271. If that syphilis was 30 years ago, and there was no present evidence of syphilis ?—If we have no information as to active syphilis under the rules accepted as regards the classification of causes of death, we could not put the death down to syphilis. 272. In fact the information to be obtained from the pathologist differs very materially from the infor- mation which can ever be expected to be obtained on a national system of statistics ?—Certainly. I tried to make that clear ; we had two different points of view. 273. (Chairman.) I notice in your returns that childbirth does not appear as a cause of death; but you assign various causes to childbirth. That is so, is it not ? It does not appear as a sufficient cause ?— We have a number of deaths for which no other cause was assigned, and other accidents of childbirth, heading No. 136. A death returned as merely due to childbirth would go there. We have a special table relating to childbirth which wiU show the number of those deaths, and the number also in which childbirth is mentioned as the complication of a death from any disease o]- condition. 274. My point is that you do give causes in many of the cases, and you are not satisfied that childbii'th is a simple declaration of death. Is that so ? On page xci there is a table showing the details with regard to deaths of women, classed to pregnancy and child- bearing. 275. (Canon Horsley.) There is an important one on page xcvi. There is a case here where jon have 163 cases of pemphigus, and not a single case due to syphilis. But when you make inquiries you find that 91 of the cases are due to syphilis ?—Quite so. 276. That is very striking. There are more than half due to syphilis. That is what I mean, about the misleading character of this. If it went on like that, it woidd double the number of cases ?—^I am afraid we could find few such fertile fields of inquiry. 277. (Chairman,) To finish the point I am on, you have a number of causes to which deaths from cliild- bii'tli can be assigned ?—Yes. 278. That means that in most cases when looked into, if the cause can be assigned, it is assigned. Then to come to premature birth, you take premature birth as a full and sufficient cause without assigning a real cause ?—I cannot say for certain ; but I exjpect that in the majority of cases it is the only caiise returned on the certificate. 279. That is what I mean. When a prematiu-e birth is recorded, should not a cause to which it can be assigned be stated on the certificate ?—I presume if the practitioner considered there was a disease present which had caused the death, he would return it under the head of this disease, in spite of the fact that the birth was premature. I have no reason to suppose that our deaths assigned to premature birth include the whole of the deaths of infants prematurely born. 280. The certificate of premature birth suffices, subject to certain cases ?—I should have to look into that matter, and it would take a considerable time to do so. It Avould want some organisation to get the material together. But my impression, merely as an impression, is that most of the deaths returned to premature birth are probably certified merely as pre- mature birth. 281. Might it not be an obligation to state the cause of premature birth, if that cause was obviously ascei'tainable ?—The Registrar-General has no power, of course, to do anything more than to make requests, and he does make requests for as great precision as possible. He has made a very elaborate one within the last two or three years, in the form of a memo- randum bound up with every book of certificates of causes of death showing the more important indefinite forms of certificate received, and the manner, in which he would like to have it amended. It would be possible to put in a new edition of that a request with regard to premature birth. 282. My point is this._ We get 17,709 deaths recorded from premature birth. It is probable that a considerable number of those premature births and consequent deaths are caused by venereal disease in some form or another. If in any possible way by the returns it would be possible to analyse those figures, it would be an advantage ?—Certainly. 283. May I take it your general view is, that some form of compulsory confidential notification is prac- ticable f--! have really formed no definite ojpinion upon that subject at all; but judging from our experience with regard to the certification of causes of death, which is compulsory, I should doubt very much the degree of completeness likely to be arrived at. 284. But the enforcement of the compulsory noti- fication must have helped you in the case of other diseases ?—I do not know that the case of other diseases is parallel. 285. No, it is not; but it has helped you in the case of other diseases ?—I really have no information as to that. 286. (Sir Malcolm Morris.) Tubercle ?—I do not know whether it has helped us or not. The nimibers have not been much afflected. (Chairman.) We are very much obliged to you. (The witness withdrew.)