Appendix to the First report of the Commissioners : minutes of evidence 7th November 1913 to 6th April 1914 question 1 to question 12,549.

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

Licence: Public Domain Mark

Credit: Appendix to the First report of the Commissioners : minutes of evidence 7th November 1913 to 6th April 1914 question 1 to question 12,549. Source: Wellcome Collection.

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    7 November 1913.] light on these diseases in their bearing on public health ?—I am afraid I do not quite grasp the question. 16. When the last conditions of the statistics were agreed upon, there was no idea at that time of so framing them that the facts bearing upon these diseases and their relation to public health would be brought out?—I really have no knowledge of the ideas that were in the minds of the revisers of the list. As I say, our Office had not adhered to the use of the list, and so it naturally was not represented on the Committee of Revision. 17. ‘Then your figures depend almost entirely npon death certificates P—Yes. ; Se 18 Hither given by private practitioners or medical officers of the various institutions who return them to you?—Yes; about 7 per cent. founded upon the verdict of coroners’ juries, and about 13 per cent. refer to uncertificated deaths. 19. So that the value of those certificates probably varies considerably in different cases P—Yes. I should say in relation to syphilis the value is very much higher in the case of institutional deaths than in the cease of deaths outside institutions. 20. Now, turning to your tables. On page 37, you give under “Deaths from various causes at all ages rs returns for syphilis and gonorrhea. Would: you tell us how far you think we are able to rely upon those figures >—When I commenced, as I say, two or three weeks ago, to look into the figures, I was under the impression, that I think is very widely shared, that the national statistics in regard to the diseases under the Commission’s review were ina large measure worthless. But the result of my study of the figures has been considerably to modify my opinion, Ithink there is reason to believe that the figures probably bear some relation to the facts. Of course they do not express the facts, but they bear some relation to the facts. 21. According to these returns, the figures have remained fairly constant throughout a period of years, though the last figure for males is higher than in any of the previous years recorded ?—Yes, of the 15 years dealt with. 22. Is there anything in that? Does that mean a small increase, or does the larger figure arise from better returns ?—I think it would be very dangerous to form any opinion one way or the other as to that. 93, A very large proportion of those figures are in relation to infants >—Almost two-thirds in the case of syphilis are under one year. 24. Then in the general return of deaths from all causes, those two items of syphilis and gonorrhea are the only two that bear directly on our inquiry ?—We have deaths also from locomotor ataxy, and general paralysis of the insane, and aneurysm, which I think have a very intimate connection. 25. But those include the disease itself as a direct disease ?—Yes. 26. And that is all we have ?—These are all the deaths that we have certified as due to syphilis and gonorrhea. 27. Do you think there is any considerable re- luctance to certify death—of adults. at all events—as due to one of these diseases ?—I am quite satisfied that there is the very greatest reluctance. 28. And might we believe that the certificates which are obtained from institutions are much more likely to be accurate than those which are obtained from general sources ?—I think there can be no doubt of that. 29. That consideration would very considerably militate against the validity of these figures ?—Yes. As I said, it militates against their expressing the facts; but I think, as I also said, they bear relation to the facts, and a considerable amount of significance must be attached to them as expressing the probable increase or decrease of syphilis, or fatal syphilis of the community during the years under review, or, taking the facts at the present time, its distribution through- out different sections of the community. 30. I understand that for the years from 1897 to 1901, the figures for stricture of the urethra were included in that of gonorrhea ?—That is so. There was a number of changes made in the classification after 1901. oo After 1901 there is a different classification ? -—Yes. 32. And since stricture has been eliminated the figures appear to be smaller?—About one-tenth the size. 33. That has made a marked difference in the figures P—Yes. Of course, substantially from your point of view, I have no doubt that the old arrangement was correct; but there are a certain number of deaths from stricture) that ‘would not be ‘connéctéd ' with venereal disease. PAULO RE Pee 34. As regards these general figures, we must take it they are certainly minimum figures, and the probability is they are largely exceeded ?—Yes; I think so, certainly. \ 35. There can be no doubt on that point P—I have a number of letters from medical men expressing their reluctance to certify. 36. And that is the general feeling in the profession —reluctance ?—Yes, undoubtedly. 37. Does that reluctance extend as much to infants as to adults ?—I could hardly say definitely as to that ; but seeing that the existence of the disease in the infant implies its existence in the parents, I do not see why there should be so much difference. 38. Then on page 39 you deal with two other congenital hydrocephalus. Can those figures be taken as accurate? Would there. be -any reluctance | to certify deaths from that cause?—I should not have supposed that there was. 39. There is not much difficulty in diagnosis in that case, is there P—I presume not. 40. On the same page we come to general paralysis of the insane.. May we regard those figures as to be trusted P—Not entirely, but to a large extent, because most general paralytics end their days in the asylums, and they are of course there certified correctly. But the existence of the word “ insane” as a portion of the title leads to reluctance to certify in the case of the outside deaths in private practice, which form, I think, 17 per cent. of the whole. I have a number of replies that give evidence of that reluctance. 41. Will you let the secretary have those ?—Yes, if they are treated as confidential. They are con- fidential replies, and of course it would be understood that. the names should not be used. 42. Certainly not. Then there must be some cases of general paralysis of the insane which are obviously due to venereal disease which do not get recorded as the cause of death ?—I do not think there are many. The usual course taken when a doctor is reluctant to certify general paralysis of the insane is that he certifies general paralysis or general paresis, and in that case I cannot say how long we have done it, but we at present send a letter of inquiry to ask whether the case was one of general paralysis of the insane, so that those cases are roped in. 43. That means that those cases are looked into again ?—They are classified under their proper head of general paralysis of the insane. The doctor answers confidentially in a letter which the relatives have no cognisance of, that the disease was general paralysis of the insane. : 44, Do you get many of such cases P—Yes, I think a fair number. 45. In any case of doubt of that kind, you would refer 2—When we get the certificate with reference to a private patient certifying general paralysis or general paresis we send the inquiry. If a patient died in the asylum, we assume the disease to be general paralysis of the insane. Our experience shows that we can safely do so. 46. On page 40 we come to locomotor ataxy, of which you give the figures, which seem to show a progressive increase. Can we look upon those figures as being accurate, in the sense, that nobody would mind certifying ?—So far as I know. I have no knowledge of any prejudice attaching to it.