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.

    11/474 (page 3)
    7 November 1913.] 47. And locomotor ataxy would be.an obvious disease which could not escape your observation ?—I should say it must be pretty obvious from the propor- tion of deaths that we get returned in rural districts to those in large towns and London. Our experience is that certification is very much better in towns, especially in. London, than in the country districts, and from the proportion shown by the deaths returned from locomotor ataxy in the two and from other considerations as well of course, as to which others would be more competent to speak, [T presume most of the cases are returned under their proper heading. 48, Then on page 45 we have what you call the “Orude Annual Death Rates from various Causes at all ages to a million living.” You classify venereal diseases together, and you arrive at the figures that you give ?—That is a summary at the beginning of the table. We have the same summary to the previous table. ‘The two tables are on absolutely similar lines, the one giving the facts, and the other the rates based on the facts. 49. But the summary there contains death due to syphilis and gonorrhea alone, and not such diseases as general paralysis of the insane ?—No; that is so. 50. So that those would have to be added ?—Yes. 51. At the top of page 51 you deal with aneurysm as a sub-heading ?—Yes. 52. There is no means to discriminate in that case whether the aneurysm might be due to venereal diseases or not ?—No.. We might possibly get the information that it was in a few cases, but we should not tabulate it. In the great majority of cases we would not get the information, so that tabulation would be useless. 53. And if we get evidence of a large number of eases of aneurysm anda certain proportion was due to venereal disease, would it be right to apply that pro- portion to your figures here and take that as showing an extension of the disease ?—Yes; I think that our figures examined in a certain light show a close corre- spondence between aneurysm and syphilis. 54. That they move together ?—Yes. 55. Then in Table 28 on page 72 you deal with infantile mortality ?—Yes. 56. You have them in five age groups up to one year ?—Yes. 57. And you classify “ All Infants,” “ Legitimate,” and “Illegitimate.””. That information is only given for one year, is it P—Yes, this refers to the year 1911. 58. Would a comparison of previous years be of any advantage to us?—I am afraid I have not sucha comparison. I have here a comparison for five. years between legitimate infants in certain counties that are mainly urban in character and illegitimates in those counties, and between the same two classes of infants in counties mainly rural. Of course the information is obtainable for the whole of the country as well. 59. I see the records of the illegitimate infants ‘stand very far above the others ?—Yes, very. 60. Have you any information as to that ?—I think in part it probably represents the facts, and in part it may be due to the: fact that probably more illegitimate infants die in institutions.. There are certainly more dying under circumstances that leave the medical attendant a comparatively free hand in regard to certification, I take it. ' 61. There is less reluctance to certify illegitimate children ?—I should think so. For instance, 45 per cent. of all illegitimate infants are the children: of ‘domestic servants. I take it the usual story in that case is that the infant is put out to nurse, so that very likely when it dies the doctor does not have to deal ‘with either of the parents at all, and I take it he is likely to feel more free under those circumstances to specify exactly what the child died of than if he were dealing with parents. 62. Of course the majority of deaths, as one sees, ‘are in the first six months ?—Yes. 63. On page 89 you deal with the occurrence of legitimate infantile mortality from any cause,‘and you split that up among the various social classes P—Yes, 64, Those classes are numbered here, and they are ‘really 1, the upper and middle. class, 2. intermediate STEVENSON. [ Continued. between middle and working classes, 3 skilled work- men, 4, men partly skilled and partly unskilled. 5, mainly unskilled labour, 6, textile workers, 7, miners, 8, agricultural labourers, and 3 to 8, working class. What does “3 to 8, working, class” mean ?-—It means the aggregation of all the sub-divisions of the working class. I should perhaps explain what the two intermediate classes mean. They do not represent our choice but our necessity. In a num- ber of cases the occupational classifications of the census are industrial rather than truly occupational, and in those cases it is impossible very often to deduce from the heading under which a man is returned what his exact ‘position is likely to be. We know that he is connected with a certain industry, and that is all. Then he may be a skilled workman in that industry, or he may be an unskilled workman. In that case we have put the occupational heading into Group 4. In other similar cases it has been necessary to put them into Group 2. 65. The unskilled labour seems to come out very very high ?—Yes, I think that is what one would expect. 66. On page 93 you deal with infantile mortality connected with the illegitimate children of female domestic servants, and for that you get syphilis a total under one year of 8°5 ?—Yes. . 67. That is very high ?—Yes, it is just slightly higher than the average for all illegitimate children. 68. Only slightly higher?—Yes, only slightly higher. The average for all illegitimate children is 8:10 given on. Table 28, page 72. 69, That is enormously above the legitimate ?—Yes. It is ‘99 for the legitimate; so that the female domestics’ infants are just very slightly higher than the average for illegitimates. 70. On page 198 you deal with general causes of death at the different age periods. There you have the heading “Syphilis ’* that you have had before, and “Other Venereal Diseases”. as a separate heading. That includes these A, B, and C, I suppose ?—Yes. 71. That is the first time in your general return these subdivisions come in, is it not ?—Yes; it is the first occasion of our using this classification. 72. Has the result of including those extra sub- divisions been to increase the figures ?—It does not increase the figures in Tables 19 and 20, because those are compiled upon the old classification. We took steps to make our new classification convertible into our old, and of course in a historical table we are bound to adhere to the use of the old classification. We can re-arrange the new work, but we cannot re- arrange the old work. The difference would be with regard to C which we should not formerly have classed to venereal diseases. 73. On page 298 you deal with the places of occurrence of deaths from venereal disease and you do that under four heads, 37, 384, 388, and 38c ?— Yes, the same heads as in the previous table. 74, According to that, poor law institutions stand far above any other institutions in furnishing deaths from syphilis P—Yes, and they stand above, of course, with regard to all causes, though not to the same extent, I think. 75. For instance, you have 308 males who died in the year in poor law institutions and in lunatic asylums 21 and 109 in hospitals and nursing homes. So that they supply a very large number of your deaths from syphilis ?—Yes. 76. May those returns made from the Poor Law institutions be regarded as trustworthy P—I should think so,im the main; but as to that it would be well for you rather to depend upon the views of medical officers connected with the various institutions. 77. Then the returns from elsewhere than insti- tutions depend upon coroners’ juries or private practitioners’ certificates ?—Yes. Of course, in the vast majority of cases private practitioners. The deaths from disease in general in Poor Law institutions outnumber those in hospitals, as shown on page 369 at the end of the table. 78. You also split up locomotor ataxy and G.P.I. on page 300 P—Yes, A 2