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POPULATION AGE STRUCTURE
1020 If the absence of the anti-A is attributed to undoubted agammaglobulinaemia, it is surely surprising that the anti-B agglutinins are unaffected. Furthermore, we are unable to appreciate the point of performing the indirect Coombs test with anti-A against the patient’s cells. Groups AI, A2, and A3 would under such conditions be agglutinated by potent anti-A without the use of Coombs reagent, whilst groups Ao, A4, and 0 would remain negative ; so that the reported tests are far from conclusive. C. C. BOWLEY
group 0. the
Director
Regional Transfusion Centre,
I. DUNSFORD
Sheffield.
Senior Scientific Officer.
POPULATION AGE STRUCTURE SIR,—I was interested to read in your annotation of Aug. 7 of the changes likely to occur in the proportion of old people in our population. It seems certain that by 1977 the number of persons over 65 in this country will be about 7 million, and that the ratio of these to workers will not diminish as rapidly as is popularly supposed, but, after attaining a maximum in about 50 years’ time, will gradually tend to a limiting value. In 1937 you published an article of mine on population trends during the next 100 years.1 Diminished mortality in the early years of life and a temporary war-time rise in the birth-rate, both then unforeseen, have since occurred, but my forecast of the population age structure in 1951 did not differ substantially from that disclosed by the census of that year, as is shown in table I. TABLE I-POPULATION AGE
STRUCTURE
1951
IN
AND WALES
Age-
B
1951
group
Males
Females
90 146 43-8 23.3 9-3
Males
Females
(%)
8.0 13-0 417 24-9 12.4
Year 1961 1971 1981 1991
% 17 20 24 26
Yea1’ 2001 2011 2021 2031
% 27 26 26
25
It is improbable that the proportion -of aged will ever fall as low as it did during the latter half of last century. The birth-rate is unlikely to increase much above it, present level, and may well decline further ; the present death-rate should tend to increase as the proportion of aged in the population mounts. Hence the excess of the birth-rate over the death-rate will tend to diminish, and an age structure approaching that of the current life table will, in all probability, ultimately emerge. Accord. ing to the Registrar-General’s abridged life table for England and Wales, 1952, the present life-table propor. tion is 22%, as compared with 16% in the actual
population. C. A. GOULD.
Bromley.
IN ENGLAND
1937 forecast
(%) 0-4 5-14 15-44 45-64 65+
Assuming these trends to continue, I predict that the percentages of pensioners to workers will probably
future be :
A WORD WANTED
-
B
census
(1 % sample)
decrease in mortality over the whole period is reflected in the steady rise in the proportion of people over 6.5 in successive life-table populations. Only in recent years h&s the proportion of persons over 65 in the actual population shown signs of approaching that of the current life table, and this is because the birth-rate has been gradually approaching the death-rate, and the bulge of the high birth-rates in earlier years now operates at the older ages. It will be noted that, after a war-time rise in both rates, they were about the same in 1951 as in 1931.
steady
(%)
7 13 446 6 24 10
I
6 12 44 26 12
SIR,—Unfortunately I missed Dr. Apley’s original letter but I must say, however, that I do not much like his projected neologism-antespective as an antonym to retrospective. Surely we already have more than enough of the jargon which so many of us feel impelled to write in order to appear scientific. I should have thought it possible to find a word to fit any context from among the following : prospective, exploratory, projected, looked for, predicted, forecasted, awaited,
expected, anticipated, anticipatory.
Because changes in the age structure of the existing population depend on variations in both birth and mortality rates, it is useful to compare the actual population with the current stationary life-table population (which depends only on mortality). Table II shows that the low ratio of persons over 65 to those of 15-64 from 1841 onwards was at first due to the excess of a high birth-rate over a high death-rate in the population under 65.
The Medical Press, London, W.C.2.
G. E. BREEN.
TREATMENT OF INFANTILE ECZEMA
SIR,—It is ironical that your account last week of Freedom in Mental Hospitals should be so closely followed by a letter describing a strait-jacket for infant, with eczema. Forcible restraint, whether administereti by psychiatrist or dermatologist, increases all’forms of irritation of the ectoderm. I trust that the detailed pattern did not raise false hopes among many harassed mothers and set them losing even more sleep in stitching vulcanised fibre into cotton twill. The management of children in health and disease is the current preoccupation of the paediatricians, and few diseases can give more rewarding evidence of improvement than the correctly- managed case of infantile eczema. The relationship between infantile eczema and domestic emotional stress has been described by Barbara Woodhead.! Although’ in many cases the domestic circumstances, so often basically due to the housing problem, are unalterable, one thing that can be altered is the attitude of the parents to scratching, and. if they possess a modicum of intelligence, it is easy to demonstrate to them that the infant’s scratchingvaries in direct proportion to their concern and attempts at restraint. In this department no child has been splinted o jacketed for the last five years and we modestly think our results are a.s good as anyone else’s. ’
TABLE II-COMPARISON OF ACTUAL AND CURRENT LIFE-TABLE POPULATION _
I Birth-
Year (or
rate
10-year period)
(per 1000 population)
Deathrate (per 1000
popula-
tion)
,
Ratio of number over 65 to number aged 15-64 in England and Wales
Actual i,
, ’I
Current life table
Actual
MaleFemaleMale .
1841-50 1851-60 1861-70 1871-80 1881-90 1891-1900 1911 1921 1931 1951
326 34.1 35-2 35-4 32-4 299 24.4 22-4 158 155
I
22-4 22-2 22-5 21-4 191 18.1 14-6 12-1 12-3 12-5 12.5
7-3 7-3 7-5 7-4 7-3 7-0 7-3 8-3 9-5
8-2
13-9
Female
12-3
13-9
8-2 8-3 8-3 8-3 8-2 8-9 8-8
lie li-7
14:-0 14-3
131
139
11-1
15.9
15-5 18-0
20°2 25-1
18-7
(I
19.3
The birth-rate and mortality-rate have been decreasing since 1871-80, although they remained more or less constant up till then. About 1931 both rates had been reduced by 50% of their value at the beginning of the period, and the
steadily
1. Lancet,
1937, i, 944.
1.
Woodhead, B.
Arch. Dis. Childh.
1946, 21, 98.
group 0. the
Director
Regional Transfusion Centre,
I. DUNSFORD
Sheffield.
Senior Scientific Officer.
POPULATION AGE STRUCTURE SIR,—I was interested to read in your annotation of Aug. 7 of the changes likely to occur in the proportion of old people in our population. It seems certain that by 1977 the number of persons over 65 in this country will be about 7 million, and that the ratio of these to workers will not diminish as rapidly as is popularly supposed, but, after attaining a maximum in about 50 years’ time, will gradually tend to a limiting value. In 1937 you published an article of mine on population trends during the next 100 years.1 Diminished mortality in the early years of life and a temporary war-time rise in the birth-rate, both then unforeseen, have since occurred, but my forecast of the population age structure in 1951 did not differ substantially from that disclosed by the census of that year, as is shown in table I. TABLE I-POPULATION AGE
STRUCTURE
1951
IN
AND WALES
Age-
B
1951
group
Males
Females
90 146 43-8 23.3 9-3
Males
Females
(%)
8.0 13-0 417 24-9 12.4
Year 1961 1971 1981 1991
% 17 20 24 26
Yea1’ 2001 2011 2021 2031
% 27 26 26
25
It is improbable that the proportion -of aged will ever fall as low as it did during the latter half of last century. The birth-rate is unlikely to increase much above it, present level, and may well decline further ; the present death-rate should tend to increase as the proportion of aged in the population mounts. Hence the excess of the birth-rate over the death-rate will tend to diminish, and an age structure approaching that of the current life table will, in all probability, ultimately emerge. Accord. ing to the Registrar-General’s abridged life table for England and Wales, 1952, the present life-table propor. tion is 22%, as compared with 16% in the actual
population. C. A. GOULD.
Bromley.
IN ENGLAND
1937 forecast
(%) 0-4 5-14 15-44 45-64 65+
Assuming these trends to continue, I predict that the percentages of pensioners to workers will probably
future be :
A WORD WANTED
-
B
census
(1 % sample)
decrease in mortality over the whole period is reflected in the steady rise in the proportion of people over 6.5 in successive life-table populations. Only in recent years h&s the proportion of persons over 65 in the actual population shown signs of approaching that of the current life table, and this is because the birth-rate has been gradually approaching the death-rate, and the bulge of the high birth-rates in earlier years now operates at the older ages. It will be noted that, after a war-time rise in both rates, they were about the same in 1951 as in 1931.
steady
(%)
7 13 446 6 24 10
I
6 12 44 26 12
SIR,—Unfortunately I missed Dr. Apley’s original letter but I must say, however, that I do not much like his projected neologism-antespective as an antonym to retrospective. Surely we already have more than enough of the jargon which so many of us feel impelled to write in order to appear scientific. I should have thought it possible to find a word to fit any context from among the following : prospective, exploratory, projected, looked for, predicted, forecasted, awaited,
expected, anticipated, anticipatory.
Because changes in the age structure of the existing population depend on variations in both birth and mortality rates, it is useful to compare the actual population with the current stationary life-table population (which depends only on mortality). Table II shows that the low ratio of persons over 65 to those of 15-64 from 1841 onwards was at first due to the excess of a high birth-rate over a high death-rate in the population under 65.
The Medical Press, London, W.C.2.
G. E. BREEN.
TREATMENT OF INFANTILE ECZEMA
SIR,—It is ironical that your account last week of Freedom in Mental Hospitals should be so closely followed by a letter describing a strait-jacket for infant, with eczema. Forcible restraint, whether administereti by psychiatrist or dermatologist, increases all’forms of irritation of the ectoderm. I trust that the detailed pattern did not raise false hopes among many harassed mothers and set them losing even more sleep in stitching vulcanised fibre into cotton twill. The management of children in health and disease is the current preoccupation of the paediatricians, and few diseases can give more rewarding evidence of improvement than the correctly- managed case of infantile eczema. The relationship between infantile eczema and domestic emotional stress has been described by Barbara Woodhead.! Although’ in many cases the domestic circumstances, so often basically due to the housing problem, are unalterable, one thing that can be altered is the attitude of the parents to scratching, and. if they possess a modicum of intelligence, it is easy to demonstrate to them that the infant’s scratchingvaries in direct proportion to their concern and attempts at restraint. In this department no child has been splinted o jacketed for the last five years and we modestly think our results are a.s good as anyone else’s. ’
TABLE II-COMPARISON OF ACTUAL AND CURRENT LIFE-TABLE POPULATION _
I Birth-
Year (or
rate
10-year period)
(per 1000 population)
Deathrate (per 1000
popula-
tion)
,
Ratio of number over 65 to number aged 15-64 in England and Wales
Actual i,
, ’I
Current life table
Actual
MaleFemaleMale .
1841-50 1851-60 1861-70 1871-80 1881-90 1891-1900 1911 1921 1931 1951
326 34.1 35-2 35-4 32-4 299 24.4 22-4 158 155
I
22-4 22-2 22-5 21-4 191 18.1 14-6 12-1 12-3 12-5 12.5
7-3 7-3 7-5 7-4 7-3 7-0 7-3 8-3 9-5
8-2
13-9
Female
12-3
13-9
8-2 8-3 8-3 8-3 8-2 8-9 8-8
lie li-7
14:-0 14-3
131
139
11-1
15.9
15-5 18-0
20°2 25-1
18-7
(I
19.3
The birth-rate and mortality-rate have been decreasing since 1871-80, although they remained more or less constant up till then. About 1931 both rates had been reduced by 50% of their value at the beginning of the period, and the
steadily
1. Lancet,
1937, i, 944.
1.
Woodhead, B.
Arch. Dis. Childh.
1946, 21, 98.