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Is any part of the present decline in the birth-rate cyclical?
100
PUBLIC
and the remedy is the education of the mother." The grant made by the Board of Education to schools for mothers must be thought of as relating to education, and Sir George Newman states that " the central activity of the school is usually the infant consultations," home-visiting being " the necessary corollary of consultations." So, again, the Local Government Board distributes grants in aid for " c o n s u l t a t i o n centres ~' to which expectant mothers and mothers ,aith infants and little children may be referred for advice and treatment. Home-visiting is encouraged, and for this purpose the appointment of health visitors is recommended. There is, therefore, close approach between the action of the two Government departments. The advice given by Sir George Newman and Dr. Newsholme is practically the same, the methods o f a t t a i n i n g t h e desired result are very similar, and the really material difference is in the administration. W e can h a r d l y doubt that when the Government has the opportunity there will be consideration of the duties undertaken by Government departments and local authorities. Under existing circumstances the State is able from time to time to secure for its services men of exceptional mental calibre. It is only necessary to mention the names of Simon, Buchanan, and Power in this connection. With increasing recognition of the public health aspects of work now undertaken by various public departments, the question may well be considered whether a Consultative Committee, on which various branches of knowledge and experience are represented, might not meet the requirements of the present time. The Government has no principal medical officer, although some of its departments have such an officer at the head of their medical services. In view of the wide range of medical science and the numerous problems upon which medical advice is or should be required, this position could hardly be held by one man, and this is not matter for surprise when it is recollected that the advice might have to relate to administration needed to deal with disease in all parts of the world. Such a committee would be able to serve a useful purpose in co-ordinating the work of different departments. It certainly should be consulted before new branches of work are undertaken which involve large national expenditure, especially because it becomes impossible ever to abolish any large administration after it has once been established, however fruitless it may eventually be found to be. This consideration assumes especially large proportions at the present time when taxation for military and naval purposes must necessarily be severely felt.
FEBR~JARY,
HEALTH.
IS ANY PART O F T H E P R E S E N T D E C L I N E IN T H E B I R T H - R A T E CYCLICAL ? BY A . K . C H A L M E R S , M.D, D.P.H., Medical Officer of Health, Glasgow.
query which is used as the title of this T H Epaper is suggested by the editor's introductory remarks in the January number of PUBLIC
HEALTH.
The answer must obviously be mainly conjectural, although even a conjecture must proceed on some assumed or actual basis. Analogy may help, and there are illustrations in plentiful abundance. Many of the common infectious diseases are cyclical in their incidence and there is reasonable ground for thinking that this affects age, season and fatality alike. The periodic recurrence of measles can only be explained by assuming regular waves of activity affecting the organism which causes the disease, while accidental conditions such as age, housing, feeding, etc., and " w e a t h e r " contribute to determining whether we shall have an increased mortality from the disease proportionate to the increase in its prevalence. Changes in virulence no doubt also play a part. The increased prevalence of d i p h t h e r i a in many districts in Scotland during quite recent years suggests increase in the germinal activity of the organism, that is, an increased power to multiply and consequently to infect a larger number of the population than formerly, but that it lacks the concomitant of virulence is suggested by the relatively smaller increase in the fatality which it is causing. The greater incidence of attack at ages 5-15 since 19o6 is one of its most striking features.* Plague again during the last twenty years has displayed germinal activity and Consequent prevalence, which was quite unknown during the interval between the Moscow outbreak in 177o and the reappearance of the disease in 1.894 i.n Hong Kong. These analogies, however, are based on the records of occurrences, which are becoming increasingly accurate as their importance becomes rec0gnised. The present decline of the birth-rate is in a different position. It seems to stand alone-completely detached from any similar movement in the past. Its occurrence over a wide field would appear to be of quite recent date, nowhere I think, in this country at least, * See Paper " On the Increase of DiplRheria in Scotland in Recent Years," read at Congress of the Royal Institute of Public Health, Edinburgh~ July, I914'
1915.
PUBLIC ArEA L TH.
earlier in its beginning than the middle " s e v e n t i e s " of last century, selective apparently in the sense that it is more marked in some groups of population than in others, and associated withal with such apparent relaxation in moral and religious standards that every epithet suggestive of racial decadence seemed not only descriptive but deserved. Much valuable work has of late been done to demonstrate the association between this decline and the development of certain social factors, which may be economic in their origin although purely deliberative in their application. Into the middle of this assumption the editor projects a timely query, whether birth and death alike are to be regarded as having normal rates from which any departure is to be ascribed wholly to administrative or deliberate and co-ordinated action. Stated in this way the problem becomes clearer, and analogies from plant as well as animal life may come within the field of discussion. For the moment, however, I am rather concerned to suggest that local sourcc,~ of information may here and there be available extending further back than national records, but capable of being pieced together in such a manner as to be turned to account in the enquiry. Mainly I think they will consist of parish or kirk records of marriages and baptisms with an occasional statement of the population. Some information of this sort is available for Glasgow, which affords glimpses, at long intervals, of the probable birth-rate and fertility of marriage, and it is because they suggest marked fluctuation that they may prove of interest. It is not of course suggested that cyclical variation alone may explain the very rapid decline which we are witnessing, but it is at least conceivable that it may determine the direction of a movement which other and probably more readily demonstrable causes may accentuate or retard. In any case the object of the paper is to suggest an appeal to local records i n the hope that they may .contain evidence'bearing on the"questiorI. It may render the bearing of the earlier records of Glasgow somewhat clearer if I deal first of all with our recent experience. For a considerable number of years after the introduction of registration the crude birthrate of Glasgow was fairly well maintained at or over 40 per I,ooo. Until 1879 indeed it had only fallen below 4 ° in the years 1869, i871 and 1873.
101
In the first year of registration (1855) the rate was only 37, but that is probably to be explained by failure to observe the newlyimposed obligation. Since 1879 the fall has been progressive, and during the last five years (19o9-13) the highest annual rate was 29"6 in 19o 9 and the lowest 27"7 in 191I. These are calculated on the total births Occurring and registered irrespective of the usual place of domicile of the mother. A period of industrial depression in the late seventies marked by the failure of the City of Glasgow Bank coincided with the beginning of the fall, but there was no corresponding and sustained recovery when industrial conditions improved. T h e total decline from the sixties decade may be represented by the difference between a rate of 41 per I,OO0 and one of 28, or somewhere about 32 per cent. This statement of it, however, fails to allow for the varying population of women at childbearing ages, and when the births are applied to this section of the population, the actual reduction of the birth-rate in the last 4 ° years amounts to 37 per cent.
Glasgow--Mean Annual Birth-rate. Calculated as a Proportion' Calculatedas a Proportion per i,ooo on'the N u m b e r of p e r i,o0o on Total Population at All Ages. W o m e n aged 15-45 years.
Rate per l~ooo,
Compared with Rate in I870-7~ token as ioo,
Rate per
i~ooo.
Compared with Rate in 187o-72 taken as ioo.
40'9
IOO
173"5
IOO
188o-82
35'9
88
15o'7
86
189o-92
35"2
86
125"6
72
i9oc-o2
32'1
79
124'2
72
191o-12
28'o
68
io9'2
63
187o-72
Decline i n birth.rate associated with fall in marriage-rate m~d in proportion of marriages contracted at ages under 21 :--Associated with this decrease in the birthrate there has been a decrease in the marriagerate, and a reduction in the proportion of' marriages contracted at early ages. The contrast between the rates calculated on the total p o p u l a t i o n and on unmarried females is shown in the next table, from which it would appear that the actual decline in the rate of marriage of females at marriageable ages during the last 4 ° years has been 12 per
10~
P.U B L I C H E A L T H .
cent. in place of 6, which is the rate of decrease when calculated on the total population. Glasgow--Mem~ Annual Marriage-rates. Calculated on Total Population at All Ages.
Rate per I }OOO.
Compared with Rate in 1870-72as mo.taken
Calculated on the Unmarried Females & Widows, aged 15 years and upwards. Rate per
. i ~ooo.
Compared with Rate in
187o-72 taken as
IO'O
IOO
54'7
IOO
188o-82
88
88
50'7
93
189o-92
9"5
95
46"5
85
~9oo-o2
9"6
96
5 ° "9
93
I9ro-I2
9"4
94
48"4
88
Along with this another factor in the reduction of fertility is supplied by the decrease in the proportion of early marriages, which, however, for other reasons is probably desirable. In Scotland as a whole the proportion of women contracting marriage at ages under 2o and under 25 to the total number marrying fell almost 23 per cent. and 8 per cent. respectively between 1871-8o and 19o1-1o, and in Glasgow the proportion of males contracting marriage under 2o years of age fell 27 per cent., and of females 31 per cent. in the thirty years 1879-81 and 19o8-1o* Having in view the high potential fertility of these ages and the marked decrease which occurs with each quinquennial advance + this reduction in the proportion of persons marrying under 21 and under 25 must largely reinforce the tendency towards a reduction in the number of births, which the falling marriage-rate introduces. FERTILITy
OF
~/[ARRIAGE,
We may exclude the effect of a reduced rate of marriage by considering the number of births in relation to the actual number of marriages which take place. In the following table this has been done for the past 5° years, and in that interval the number of births per IOO marriages would appear to have fallen from 405 to 336, or almost 15 per cent. The ratio in 19o1-1o was, however, 2i per cent. below that of I87I-8O. *To repeat this more shortly, it may be said that in 40 years the proportion of wonlen in Scotland marrying under 20 years of age fell e3 per cent., while in Glasgow over a shorter period (3o years) the reduction has been equal to 31 per cent. It may be suggested also that the '."area of selection" has been reduced, for at the Census of 186I i n G l a s g o w t h e r e w e r e 1 i i w o m e n to e v e r y IOO u l a l e s a t a g e s t5-2o, b u t i n 1911 o n l y xo 4, A t a g e s ?5 t h e s e p r o p o r t i o n s w e r e 121 a n d i i r .
{See Fecundity, Fertility, &c., J. Matthews Duncan, ,ud Edition, z871, p p . 19, ~I8, 246,
Average Amlual Number.
B i r t h s p e r Ioo Msrriages.
Births.
Marriages.
1861-7o
178,383
39,776
405
1871-8o
200,866
47,407
424
I88I-9o
I96,45I
48,833
402
I89I-I9OO
232,399
65,23I
356
19oi-Io
238,936
71,117
336
leo.
I87o-72
THE
Year.
FE~gUAR~,
To some extent this may express the result of postponement of the age at marriage,, and it gains some support from the contrasts presented in comparing the children born per I,OOO married women at ages 15-45 in several towns. The possible error in the following comparison lies in crediting all the births to the married women between these ages, and in assuming that the married women in different populations have a corresponding age distribution. In any case when the number of births is compared with the number of married women, one finds that in Glasgow in 189o-2 for every I,OOO married women at the above ages 3o8 children were born against 232 in 191o-12, that in Edinburgh the corresponding figures were 262 and 188, and in Dundee 276 and 222. In other words, the fertility rate in the 2o years fell 24 per cent. in Glasgow, 28 per cent. in Edinburgh, but only 2o per cent. in Dundee. It is possible that ttie lower rate of decrease in Dundee may have part explanation in a larger proportion of married females at the earlier age periods. Birth-rate a~zd Fertility i~ the Seve~#eeuth and Eighteenth Centuries : The fertility of marriage and the birth-rate in Glasgow during the years 186o-9o, are of interest in relation to some similar figures which exist for the first three decades of the eighteenth century and for two years of the seventeenth. r have taken the information from a 'volume of " Statistical Tables Relative..to the City of Glasgow," published in 1828 by James Cleland, who was superintendent of public works in Glasgow at that time. It would appear that in I6o 9 a register of baptisms in the city began to be kept by order of the Session. The number thereof in the first year quoted (1611) is given as 268. In the preceding year (16IO) a census of the population had been taken under direction of Archbishop Spottiswood (on the resumption of Episcopacy), and was found to number 7,644.
PUBLIC HEA LTH.
1915.
T h i s suggests t h a t the c r u d e b i r t h - r a t e of the p o p u l a t i o n at t h a t t i m e was a b o u t 35 per I,ooo, and this ratio is also t h a t of the y e a r 166o, when the b a p t i s m s n u m b e r e d 52o and the p o p u l a t i o n i4,678. T h i s was at the R e s t o r a t i o n of C h a r l e s I I . Similar b i r t h - r a t e s were recorded during the latter half of the eighties decade of the n i n e t e e n t h century, a n d we h a v e seen t h a t the n u m b e r of births per lOO m a r r i a g e s during this decade was 402, having been 424 during the seventies. I have not been able to discover any corresp o n d i n g figures for t h e s e v e n t e e n t h c e n t u r y o t h e r t h a n those quoted, but d u r i n g the first three decades of the e i g h t e e n t h the information available suggests t h a t the n u m b e r of births per i o o m a r r i a g e s did not differ very materially f r o m those r e c o r d e d in m o r e recent y e a r s ; t h a t is, t h e y n u m b e r e d from 414 to 42o. A v e r a g e Annual Number, Births.
Marriages,
Births per ioo Marriages.
i7ol-io
500
I2o
417
1711-2o
576
I37
42o
172I-3o
609
I47
4t4
Year.
I t is, u n f o r t u n a t e l y , i m p o s s i b l e to follow these records into the following decades of the e i g h t e e n t h c e n t u r y with a n y feeling t h a t they are reliable, for the s e p a r a t i o n f r o m the E s t a b l i s h e d C h u r c h , k n o w n as the Secession M o v e m e n t , affected a considerable n u m b e r of the i n h a b i t a n t s , w h o declined registering the n a m e s of their children in the parish registers. In Cleland's volume, however, t h e r e occurs this suggestive o b s e r v a t i o n : " A s a r e m a r k a b l e p r o o f of the i n a t t e n t i o n of p a r e n t s (to the p r o p r i e t y of registering the n a m e s of their children) t h e r e were in the B a r o n y P a r i s h of G l a s g o w in 1822 p r o c l a m a t i o n s of 575 marriages, but only 518 registrations of b a p t i s m s , w h e r e a s the n u m b e r of children effeiring to 'these m a r r i a g e s would a m o u n t to a b o u t 2,oo.0." (p. 27). T h e interest of" the suggestion here, I think, is t h a t conside'rably -under 74oo (about 348) children per IOO m a r r i a g e s was the expectation in the third decade .of last c e n t u r y against an actual ratio of 424 in the seventies decade, 3o6 in the nineties, a n d 336 in 19o1-1o. I n a n y case the n u m b e r of children e x p e c t e d to r e s u h from a given n u m b e r of m a r r i a g e s in 1822 was c o n s i d e r a b l y below the recorded n u m b e r a c e n t u r y earlier, and also lower t h a n w h a t o c c u r r e d 5° y e a r s a f t e r w a r d s .
103
I f the figures given are r e a s o n a b l y a c c u r a t e , as I believe t h e m to be, t h e y suggest an e b b a n d flow of fertility over long periods a s s o c i a t e d w i t h and aided, it m a y be, by e c o n o m i c conditiofis w h i c h lower the rate and p o s t p o n e the age of m a r r i a g e s , but are p r i m a r i l y d e p e n d e n t on w h a t m a y be r e g a r d e d as fluct u a t i o n s in g e r m i n a l activity. MEDICAL
SUPERVISION CHILDREN.
OF SCHOOL-
PROFESSOR DOMENICO DELLA ROVERE discusses the question of medical supervision of children at their entry into school and during the course of their school-career. It would appear that attendance at ~chool is obligatory in Italy, and that it c o m m ~ c e s at six years of age. Dr. Rovere is justly indignant at the rigidity with which this regulation is enforced. The child is haled to school as soon as it has attained its sixth birthday, no matter whether or not it has attained a proper degree of development. T h e writer contrasts it to its disadvantage with the other system of compulsion in force in Italy, viz., conscription. In the latter, although it is compulsory for the man to present himself, yet he is passed into the a r m y only if he is proved by medical examination to be fit for it. Dr. Rovere would have the same system in schools. The child on admission should be examined medically, and his admission to school should be postponed for one or even two years if he is not sufficiently developed in physique. I n this connection the interesting fact is noted that in Berlin in 1912-I3, 3,22I out of 36,io4 entrants were found to be unready for school-life, on account of debility, anaemia, rickets, etc., and were hence excluded for a period. Dr. Rovere points out the further and wider advantages whi.ch would follow medical inspection - - a d v a n t a g e s g,hich are familiar in this country.
Giornale della Reale Sociela Italians d'Igiene. June, I9I 4. MILITARY
& NAVAL
No. 6.
APPOINTMENTS.
DR. THOS. E. FRANCIS, medical officer of healJ:h and school medical officer of tl'~ Borough of Llanelly, has been al)pointed temporary surgeon in the Royal Navy. Da. G. C. MOIST,assistant medical officer of health, school medical officer and tuberculosis offÉcerof Burton-on-Trent, has been called up for service in the Navy. DR. NOELWADE, medical officer of health of St. Mellons R.D. and Risea U.D., has been called up to serve as temporary surgeon at'Plymouth Hospital. DR, J. JclUTCIflNSONWOOD. medical officer of health of Biggleswade U. and R.D.'s. has accepted a commission in the 2nd London Sanitary Corps, affiliated to the R.A.M.C. Dm FIaEDE. WYNNE.medical officer of health, chief school medical officer and chief tuberculosis officer of Wigan, now holds a commission in the R.A.M.C.
PUBLIC
and the remedy is the education of the mother." The grant made by the Board of Education to schools for mothers must be thought of as relating to education, and Sir George Newman states that " the central activity of the school is usually the infant consultations," home-visiting being " the necessary corollary of consultations." So, again, the Local Government Board distributes grants in aid for " c o n s u l t a t i o n centres ~' to which expectant mothers and mothers ,aith infants and little children may be referred for advice and treatment. Home-visiting is encouraged, and for this purpose the appointment of health visitors is recommended. There is, therefore, close approach between the action of the two Government departments. The advice given by Sir George Newman and Dr. Newsholme is practically the same, the methods o f a t t a i n i n g t h e desired result are very similar, and the really material difference is in the administration. W e can h a r d l y doubt that when the Government has the opportunity there will be consideration of the duties undertaken by Government departments and local authorities. Under existing circumstances the State is able from time to time to secure for its services men of exceptional mental calibre. It is only necessary to mention the names of Simon, Buchanan, and Power in this connection. With increasing recognition of the public health aspects of work now undertaken by various public departments, the question may well be considered whether a Consultative Committee, on which various branches of knowledge and experience are represented, might not meet the requirements of the present time. The Government has no principal medical officer, although some of its departments have such an officer at the head of their medical services. In view of the wide range of medical science and the numerous problems upon which medical advice is or should be required, this position could hardly be held by one man, and this is not matter for surprise when it is recollected that the advice might have to relate to administration needed to deal with disease in all parts of the world. Such a committee would be able to serve a useful purpose in co-ordinating the work of different departments. It certainly should be consulted before new branches of work are undertaken which involve large national expenditure, especially because it becomes impossible ever to abolish any large administration after it has once been established, however fruitless it may eventually be found to be. This consideration assumes especially large proportions at the present time when taxation for military and naval purposes must necessarily be severely felt.
FEBR~JARY,
HEALTH.
IS ANY PART O F T H E P R E S E N T D E C L I N E IN T H E B I R T H - R A T E CYCLICAL ? BY A . K . C H A L M E R S , M.D, D.P.H., Medical Officer of Health, Glasgow.
query which is used as the title of this T H Epaper is suggested by the editor's introductory remarks in the January number of PUBLIC
HEALTH.
The answer must obviously be mainly conjectural, although even a conjecture must proceed on some assumed or actual basis. Analogy may help, and there are illustrations in plentiful abundance. Many of the common infectious diseases are cyclical in their incidence and there is reasonable ground for thinking that this affects age, season and fatality alike. The periodic recurrence of measles can only be explained by assuming regular waves of activity affecting the organism which causes the disease, while accidental conditions such as age, housing, feeding, etc., and " w e a t h e r " contribute to determining whether we shall have an increased mortality from the disease proportionate to the increase in its prevalence. Changes in virulence no doubt also play a part. The increased prevalence of d i p h t h e r i a in many districts in Scotland during quite recent years suggests increase in the germinal activity of the organism, that is, an increased power to multiply and consequently to infect a larger number of the population than formerly, but that it lacks the concomitant of virulence is suggested by the relatively smaller increase in the fatality which it is causing. The greater incidence of attack at ages 5-15 since 19o6 is one of its most striking features.* Plague again during the last twenty years has displayed germinal activity and Consequent prevalence, which was quite unknown during the interval between the Moscow outbreak in 177o and the reappearance of the disease in 1.894 i.n Hong Kong. These analogies, however, are based on the records of occurrences, which are becoming increasingly accurate as their importance becomes rec0gnised. The present decline of the birth-rate is in a different position. It seems to stand alone-completely detached from any similar movement in the past. Its occurrence over a wide field would appear to be of quite recent date, nowhere I think, in this country at least, * See Paper " On the Increase of DiplRheria in Scotland in Recent Years," read at Congress of the Royal Institute of Public Health, Edinburgh~ July, I914'
1915.
PUBLIC ArEA L TH.
earlier in its beginning than the middle " s e v e n t i e s " of last century, selective apparently in the sense that it is more marked in some groups of population than in others, and associated withal with such apparent relaxation in moral and religious standards that every epithet suggestive of racial decadence seemed not only descriptive but deserved. Much valuable work has of late been done to demonstrate the association between this decline and the development of certain social factors, which may be economic in their origin although purely deliberative in their application. Into the middle of this assumption the editor projects a timely query, whether birth and death alike are to be regarded as having normal rates from which any departure is to be ascribed wholly to administrative or deliberate and co-ordinated action. Stated in this way the problem becomes clearer, and analogies from plant as well as animal life may come within the field of discussion. For the moment, however, I am rather concerned to suggest that local sourcc,~ of information may here and there be available extending further back than national records, but capable of being pieced together in such a manner as to be turned to account in the enquiry. Mainly I think they will consist of parish or kirk records of marriages and baptisms with an occasional statement of the population. Some information of this sort is available for Glasgow, which affords glimpses, at long intervals, of the probable birth-rate and fertility of marriage, and it is because they suggest marked fluctuation that they may prove of interest. It is not of course suggested that cyclical variation alone may explain the very rapid decline which we are witnessing, but it is at least conceivable that it may determine the direction of a movement which other and probably more readily demonstrable causes may accentuate or retard. In any case the object of the paper is to suggest an appeal to local records i n the hope that they may .contain evidence'bearing on the"questiorI. It may render the bearing of the earlier records of Glasgow somewhat clearer if I deal first of all with our recent experience. For a considerable number of years after the introduction of registration the crude birthrate of Glasgow was fairly well maintained at or over 40 per I,ooo. Until 1879 indeed it had only fallen below 4 ° in the years 1869, i871 and 1873.
101
In the first year of registration (1855) the rate was only 37, but that is probably to be explained by failure to observe the newlyimposed obligation. Since 1879 the fall has been progressive, and during the last five years (19o9-13) the highest annual rate was 29"6 in 19o 9 and the lowest 27"7 in 191I. These are calculated on the total births Occurring and registered irrespective of the usual place of domicile of the mother. A period of industrial depression in the late seventies marked by the failure of the City of Glasgow Bank coincided with the beginning of the fall, but there was no corresponding and sustained recovery when industrial conditions improved. T h e total decline from the sixties decade may be represented by the difference between a rate of 41 per I,OO0 and one of 28, or somewhere about 32 per cent. This statement of it, however, fails to allow for the varying population of women at childbearing ages, and when the births are applied to this section of the population, the actual reduction of the birth-rate in the last 4 ° years amounts to 37 per cent.
Glasgow--Mean Annual Birth-rate. Calculated as a Proportion' Calculatedas a Proportion per i,ooo on'the N u m b e r of p e r i,o0o on Total Population at All Ages. W o m e n aged 15-45 years.
Rate per l~ooo,
Compared with Rate in I870-7~ token as ioo,
Rate per
i~ooo.
Compared with Rate in 187o-72 taken as ioo.
40'9
IOO
173"5
IOO
188o-82
35'9
88
15o'7
86
189o-92
35"2
86
125"6
72
i9oc-o2
32'1
79
124'2
72
191o-12
28'o
68
io9'2
63
187o-72
Decline i n birth.rate associated with fall in marriage-rate m~d in proportion of marriages contracted at ages under 21 :--Associated with this decrease in the birthrate there has been a decrease in the marriagerate, and a reduction in the proportion of' marriages contracted at early ages. The contrast between the rates calculated on the total p o p u l a t i o n and on unmarried females is shown in the next table, from which it would appear that the actual decline in the rate of marriage of females at marriageable ages during the last 4 ° years has been 12 per
10~
P.U B L I C H E A L T H .
cent. in place of 6, which is the rate of decrease when calculated on the total population. Glasgow--Mem~ Annual Marriage-rates. Calculated on Total Population at All Ages.
Rate per I }OOO.
Compared with Rate in 1870-72as mo.taken
Calculated on the Unmarried Females & Widows, aged 15 years and upwards. Rate per
. i ~ooo.
Compared with Rate in
187o-72 taken as
IO'O
IOO
54'7
IOO
188o-82
88
88
50'7
93
189o-92
9"5
95
46"5
85
~9oo-o2
9"6
96
5 ° "9
93
I9ro-I2
9"4
94
48"4
88
Along with this another factor in the reduction of fertility is supplied by the decrease in the proportion of early marriages, which, however, for other reasons is probably desirable. In Scotland as a whole the proportion of women contracting marriage at ages under 2o and under 25 to the total number marrying fell almost 23 per cent. and 8 per cent. respectively between 1871-8o and 19o1-1o, and in Glasgow the proportion of males contracting marriage under 2o years of age fell 27 per cent., and of females 31 per cent. in the thirty years 1879-81 and 19o8-1o* Having in view the high potential fertility of these ages and the marked decrease which occurs with each quinquennial advance + this reduction in the proportion of persons marrying under 21 and under 25 must largely reinforce the tendency towards a reduction in the number of births, which the falling marriage-rate introduces. FERTILITy
OF
~/[ARRIAGE,
We may exclude the effect of a reduced rate of marriage by considering the number of births in relation to the actual number of marriages which take place. In the following table this has been done for the past 5° years, and in that interval the number of births per IOO marriages would appear to have fallen from 405 to 336, or almost 15 per cent. The ratio in 19o1-1o was, however, 2i per cent. below that of I87I-8O. *To repeat this more shortly, it may be said that in 40 years the proportion of wonlen in Scotland marrying under 20 years of age fell e3 per cent., while in Glasgow over a shorter period (3o years) the reduction has been equal to 31 per cent. It may be suggested also that the '."area of selection" has been reduced, for at the Census of 186I i n G l a s g o w t h e r e w e r e 1 i i w o m e n to e v e r y IOO u l a l e s a t a g e s t5-2o, b u t i n 1911 o n l y xo 4, A t a g e s ?5 t h e s e p r o p o r t i o n s w e r e 121 a n d i i r .
{See Fecundity, Fertility, &c., J. Matthews Duncan, ,ud Edition, z871, p p . 19, ~I8, 246,
Average Amlual Number.
B i r t h s p e r Ioo Msrriages.
Births.
Marriages.
1861-7o
178,383
39,776
405
1871-8o
200,866
47,407
424
I88I-9o
I96,45I
48,833
402
I89I-I9OO
232,399
65,23I
356
19oi-Io
238,936
71,117
336
leo.
I87o-72
THE
Year.
FE~gUAR~,
To some extent this may express the result of postponement of the age at marriage,, and it gains some support from the contrasts presented in comparing the children born per I,OOO married women at ages 15-45 in several towns. The possible error in the following comparison lies in crediting all the births to the married women between these ages, and in assuming that the married women in different populations have a corresponding age distribution. In any case when the number of births is compared with the number of married women, one finds that in Glasgow in 189o-2 for every I,OOO married women at the above ages 3o8 children were born against 232 in 191o-12, that in Edinburgh the corresponding figures were 262 and 188, and in Dundee 276 and 222. In other words, the fertility rate in the 2o years fell 24 per cent. in Glasgow, 28 per cent. in Edinburgh, but only 2o per cent. in Dundee. It is possible that ttie lower rate of decrease in Dundee may have part explanation in a larger proportion of married females at the earlier age periods. Birth-rate a~zd Fertility i~ the Seve~#eeuth and Eighteenth Centuries : The fertility of marriage and the birth-rate in Glasgow during the years 186o-9o, are of interest in relation to some similar figures which exist for the first three decades of the eighteenth century and for two years of the seventeenth. r have taken the information from a 'volume of " Statistical Tables Relative..to the City of Glasgow," published in 1828 by James Cleland, who was superintendent of public works in Glasgow at that time. It would appear that in I6o 9 a register of baptisms in the city began to be kept by order of the Session. The number thereof in the first year quoted (1611) is given as 268. In the preceding year (16IO) a census of the population had been taken under direction of Archbishop Spottiswood (on the resumption of Episcopacy), and was found to number 7,644.
PUBLIC HEA LTH.
1915.
T h i s suggests t h a t the c r u d e b i r t h - r a t e of the p o p u l a t i o n at t h a t t i m e was a b o u t 35 per I,ooo, and this ratio is also t h a t of the y e a r 166o, when the b a p t i s m s n u m b e r e d 52o and the p o p u l a t i o n i4,678. T h i s was at the R e s t o r a t i o n of C h a r l e s I I . Similar b i r t h - r a t e s were recorded during the latter half of the eighties decade of the n i n e t e e n t h century, a n d we h a v e seen t h a t the n u m b e r of births per lOO m a r r i a g e s during this decade was 402, having been 424 during the seventies. I have not been able to discover any corresp o n d i n g figures for t h e s e v e n t e e n t h c e n t u r y o t h e r t h a n those quoted, but d u r i n g the first three decades of the e i g h t e e n t h the information available suggests t h a t the n u m b e r of births per i o o m a r r i a g e s did not differ very materially f r o m those r e c o r d e d in m o r e recent y e a r s ; t h a t is, t h e y n u m b e r e d from 414 to 42o. A v e r a g e Annual Number, Births.
Marriages,
Births per ioo Marriages.
i7ol-io
500
I2o
417
1711-2o
576
I37
42o
172I-3o
609
I47
4t4
Year.
I t is, u n f o r t u n a t e l y , i m p o s s i b l e to follow these records into the following decades of the e i g h t e e n t h c e n t u r y with a n y feeling t h a t they are reliable, for the s e p a r a t i o n f r o m the E s t a b l i s h e d C h u r c h , k n o w n as the Secession M o v e m e n t , affected a considerable n u m b e r of the i n h a b i t a n t s , w h o declined registering the n a m e s of their children in the parish registers. In Cleland's volume, however, t h e r e occurs this suggestive o b s e r v a t i o n : " A s a r e m a r k a b l e p r o o f of the i n a t t e n t i o n of p a r e n t s (to the p r o p r i e t y of registering the n a m e s of their children) t h e r e were in the B a r o n y P a r i s h of G l a s g o w in 1822 p r o c l a m a t i o n s of 575 marriages, but only 518 registrations of b a p t i s m s , w h e r e a s the n u m b e r of children effeiring to 'these m a r r i a g e s would a m o u n t to a b o u t 2,oo.0." (p. 27). T h e interest of" the suggestion here, I think, is t h a t conside'rably -under 74oo (about 348) children per IOO m a r r i a g e s was the expectation in the third decade .of last c e n t u r y against an actual ratio of 424 in the seventies decade, 3o6 in the nineties, a n d 336 in 19o1-1o. I n a n y case the n u m b e r of children e x p e c t e d to r e s u h from a given n u m b e r of m a r r i a g e s in 1822 was c o n s i d e r a b l y below the recorded n u m b e r a c e n t u r y earlier, and also lower t h a n w h a t o c c u r r e d 5° y e a r s a f t e r w a r d s .
103
I f the figures given are r e a s o n a b l y a c c u r a t e , as I believe t h e m to be, t h e y suggest an e b b a n d flow of fertility over long periods a s s o c i a t e d w i t h and aided, it m a y be, by e c o n o m i c conditiofis w h i c h lower the rate and p o s t p o n e the age of m a r r i a g e s , but are p r i m a r i l y d e p e n d e n t on w h a t m a y be r e g a r d e d as fluct u a t i o n s in g e r m i n a l activity. MEDICAL
SUPERVISION CHILDREN.
OF SCHOOL-
PROFESSOR DOMENICO DELLA ROVERE discusses the question of medical supervision of children at their entry into school and during the course of their school-career. It would appear that attendance at ~chool is obligatory in Italy, and that it c o m m ~ c e s at six years of age. Dr. Rovere is justly indignant at the rigidity with which this regulation is enforced. The child is haled to school as soon as it has attained its sixth birthday, no matter whether or not it has attained a proper degree of development. T h e writer contrasts it to its disadvantage with the other system of compulsion in force in Italy, viz., conscription. In the latter, although it is compulsory for the man to present himself, yet he is passed into the a r m y only if he is proved by medical examination to be fit for it. Dr. Rovere would have the same system in schools. The child on admission should be examined medically, and his admission to school should be postponed for one or even two years if he is not sufficiently developed in physique. I n this connection the interesting fact is noted that in Berlin in 1912-I3, 3,22I out of 36,io4 entrants were found to be unready for school-life, on account of debility, anaemia, rickets, etc., and were hence excluded for a period. Dr. Rovere points out the further and wider advantages whi.ch would follow medical inspection - - a d v a n t a g e s g,hich are familiar in this country.
Giornale della Reale Sociela Italians d'Igiene. June, I9I 4. MILITARY
& NAVAL
No. 6.
APPOINTMENTS.
DR. THOS. E. FRANCIS, medical officer of healJ:h and school medical officer of tl'~ Borough of Llanelly, has been al)pointed temporary surgeon in the Royal Navy. Da. G. C. MOIST,assistant medical officer of health, school medical officer and tuberculosis offÉcerof Burton-on-Trent, has been called up for service in the Navy. DR. NOELWADE, medical officer of health of St. Mellons R.D. and Risea U.D., has been called up to serve as temporary surgeon at'Plymouth Hospital. DR, J. JclUTCIflNSONWOOD. medical officer of health of Biggleswade U. and R.D.'s. has accepted a commission in the 2nd London Sanitary Corps, affiliated to the R.A.M.C. Dm FIaEDE. WYNNE.medical officer of health, chief school medical officer and chief tuberculosis officer of Wigan, now holds a commission in the R.A.M.C.