- Email: [email protected]
ON THE CORRECTION OF DEATH-RATES.
ON THE CORRECTION OF DEATH-RATES.
678
(Rifle) : lst Volunteer Battalion the Northumberland application of this method leads to a corrected death-rate ’Fusiliers, Surgeon-Major and Honorary Surgeon-Lieutenant- considerably higher than that obtained by the Registrar’Colonel Duncan Stewart. Eastern Command (Artillery) : lst Cinque Ports Royal Garrison Artillery (Volunteers), Surgeon-Major James William Thornton Gilbert. In view of the approaching despatch of a draft of Royal Artillery to India, an order was recently issued at Woolwich that officers should ascertain the names of men, women, and children willing to be inoculated against enteric fever. Notwithstanding Lord Kitchener’s recent remarks on the subject at Simla, the only volunteer was one man of the
veterinary department.
The War Office has under experiment a number of ruck sacks-a bag of the Austrian type-which have been submitted to certain committees as a suitable method for the soldier to carry his belongings on service, as well as to replace the valise, which is now practically abolished in -the British army. The finger-print system is to be adopted in the United States Army as a means of identification of soldiers.
Correspondence. "Audi alteram
partem."
ON THE CORRECTION OF DEATH-RATES. To the Editors of THE LANCET. Dr. T. F. Pearse’s article on the " Correction of SIRS,-In Death-rates," assuming the accuracy of his arithmetical calculations, he correctly sums up their result when he points out that the death-rate in Calcutta in 1904, calculated at the age and sex rates of mortality prevailing generally in Bengal, would be equal to 36’ 6 per 1000, whereas the death-rate of the Bengal population calculated at the age and sex rates of mortality prevailing in Calcutta would be ’equal to 38’ 7 per 1000. It is, however, impossible to agree with Dr. Pearse when he asserts that the difference between these two corrected rates proves the insufficiency of the method adopted by the Registrar-General for the correction of the crude recorded death-rate in a town or district for abnormality of the age and sex constitution of the population. It is obvious that in the case dealt with the Registrar-General’s method shows what the death-rate in the Calcutta population in 1904 would have been if the sex and age rates of mortality had been the same as those that prevailed in the standard population of Bengal. The alternative method, on the
hand, shows what the death-rate in the Bengal population would have been in 1904 if the sex- and agerates of mortality had been the same as those that prevailed in the population of Calcutta. Could Dr. Pearse have expected that these two entirely distinct calculations would have yielded identical results ? As a matter of fact, this alternative method is adopted by the Registrar-General other
in his Decennial Supplement, but could not be used for his Annual Summary. Incidentally, the startling excess of the female rates of mortality recorded in Calcutta in 1904, shown in Dr. Pearse’s Table A, suggests the probability either of a considerable under-statement of the femafe population of that city at the census in 1901, or of its rapid increase between 1901 and 1904, or of some other error in the recorded facts, since the Bengal female deathrates, given in his Table B, are considerably below the male -death-rates, as is almost invariably the case in all trust- worthy mortality statistics. I am, Sirs, yours faithfully, NOEL A. HUMPHREYS. .Surbiton, August 27th, 19C6. -
To the Editors of THE LANCET. SIRS,—The method of calculating corrected death-rates described by Dr. T. F. Pearse in THE LANCET of August 25th, 1906, p. 500, is practically the same as that given by Dr. T. W. Hime in his "Practical Guide to the Public Health Acts," second edition, 1901, pp. 544-548. Dr. Hime in a footnote observes that his results for Bradford differ very materially from those of the Registrar-General (23 38 as against 21’ 31 for males) and that the results of the latter are " wrong." In the case of Bradford, therefore, not a very abnormally constituted population, as in the case of Calcutta, the
General’s method. There are, as Dr. Pearse notes, two methods of making the required correction. The RegistrarGeneral applies the mortality-rates adopted as a standard to the various age and sex groups of the population under consideration ; while the other method applies the mortalityrates obtaining in the population in question to a standard population. The latter is the method preferred by Dr. Pearse and by Dr. Hime. Its use is negatived in very many instances by the fact that mortality rates in sufficient detail are not obtainable for the populations under consideration, whereas the age and sex constitution of all important populationsis to be found in the census reports. Dr. Hime, in his application of method No. 2, adopts as his standard population a "standard million," constituted as was the population of England and Wales at the preceding census; Dr. Pearse uses a "miniature population" of 847,796, the census population of Calcutta, constituted as was that of Bengal at the preceding census. The result obtained would have been exactly the same in each case had the total census populations of England and Wales and of Bengal respectively been utilised. If this had been done in the case of Calcutta, for instance, the various age-and-sex group populations in Table D of Dr. Pearse’s article would have been increased in equal proportion (847,796 : 70,000,000, or, population of Calcutta : population of Bengal) and the calculated deaths in the same table would have been in. creased in the same proportion. Consequently the calcn. lated death-rate obtained would not have been affected. The same thing may be shown in the same way for Dr. Hime’s method, whence the practical identity of the two is obvious. If, then, apart from mere variations in detail of application there are two principal methods by which corrected deathrates may be calculated, both apparently at first sight satis-
factory in principle but yielding discrepant results, an important question arises as to which is to be preferred and why ? This matter is, however, beyond the scope of the present letter and, as pointed out- above, practical considerations will generally restrict the statistician to the method of the Registrar-General. I am,
August 31st,
Sirs,
yours
faithfully,
T. H. C. STEVENSON.
1906.
THE ROYAL BERKSHIRE HOSPITAL. To the Editors
of
THE LANCET.
SIRS,-Some few years ago I was appointed physician to the Royal Berkshire Hospital under the following rule: "No person shall be eligible for the office of physician to the hospital unless he be a medical graduate of one of the universities of Great Britain or Ireland and his name entered on the Medical Register; neither shall any person be eligible who practises or is connected in partnership with anyone practising surgery, pharmacy, or midwifery." Recently this rule was altered to the extent that the practice of mid. wifery was to be allowed if desired. At the same time it was decided that two assistant physicians should be elected who were to have beds allotted to them and to have charge of the out-patient department and a physician was to be elected to form a skin department. This matter was never brought before the staff as a whole, neither were the physicians asked if they were prepared to give up beds or to give up their out-patients. At the election of the assistant physicians neither of the two conformed to the mode of practice demanded for the physicians and subsequently a rule was passed to meet their mode of practice, and at the same time they retain beds and have charge of the out-patient department, and one takes charge of a skin department so that by no
chance does
a
physician have a skin case under his care.
I should be glad to have your opinion whether the physicians have been fairly treated in this matter and whether the governors are acting within their rights in taking away from the physicians the rights and privileges under which they came to take up the appointment in Reading. I am, Sirs, yours faithfully, FRANCIS HAWKINS. Reading, August 1st, 1906. An officer elected under one set of regulations has a ** distinct grievance if during his term of office the regulations are changed so as to affect his position. So far we are with Dr. Hawkins. But if in the opinion of the authorities the change is in the nature of a reform (i.e., if the authorities v
678
(Rifle) : lst Volunteer Battalion the Northumberland application of this method leads to a corrected death-rate ’Fusiliers, Surgeon-Major and Honorary Surgeon-Lieutenant- considerably higher than that obtained by the Registrar’Colonel Duncan Stewart. Eastern Command (Artillery) : lst Cinque Ports Royal Garrison Artillery (Volunteers), Surgeon-Major James William Thornton Gilbert. In view of the approaching despatch of a draft of Royal Artillery to India, an order was recently issued at Woolwich that officers should ascertain the names of men, women, and children willing to be inoculated against enteric fever. Notwithstanding Lord Kitchener’s recent remarks on the subject at Simla, the only volunteer was one man of the
veterinary department.
The War Office has under experiment a number of ruck sacks-a bag of the Austrian type-which have been submitted to certain committees as a suitable method for the soldier to carry his belongings on service, as well as to replace the valise, which is now practically abolished in -the British army. The finger-print system is to be adopted in the United States Army as a means of identification of soldiers.
Correspondence. "Audi alteram
partem."
ON THE CORRECTION OF DEATH-RATES. To the Editors of THE LANCET. Dr. T. F. Pearse’s article on the " Correction of SIRS,-In Death-rates," assuming the accuracy of his arithmetical calculations, he correctly sums up their result when he points out that the death-rate in Calcutta in 1904, calculated at the age and sex rates of mortality prevailing generally in Bengal, would be equal to 36’ 6 per 1000, whereas the death-rate of the Bengal population calculated at the age and sex rates of mortality prevailing in Calcutta would be ’equal to 38’ 7 per 1000. It is, however, impossible to agree with Dr. Pearse when he asserts that the difference between these two corrected rates proves the insufficiency of the method adopted by the Registrar-General for the correction of the crude recorded death-rate in a town or district for abnormality of the age and sex constitution of the population. It is obvious that in the case dealt with the Registrar-General’s method shows what the death-rate in the Calcutta population in 1904 would have been if the sex and age rates of mortality had been the same as those that prevailed in the standard population of Bengal. The alternative method, on the
hand, shows what the death-rate in the Bengal population would have been in 1904 if the sex- and agerates of mortality had been the same as those that prevailed in the population of Calcutta. Could Dr. Pearse have expected that these two entirely distinct calculations would have yielded identical results ? As a matter of fact, this alternative method is adopted by the Registrar-General other
in his Decennial Supplement, but could not be used for his Annual Summary. Incidentally, the startling excess of the female rates of mortality recorded in Calcutta in 1904, shown in Dr. Pearse’s Table A, suggests the probability either of a considerable under-statement of the femafe population of that city at the census in 1901, or of its rapid increase between 1901 and 1904, or of some other error in the recorded facts, since the Bengal female deathrates, given in his Table B, are considerably below the male -death-rates, as is almost invariably the case in all trust- worthy mortality statistics. I am, Sirs, yours faithfully, NOEL A. HUMPHREYS. .Surbiton, August 27th, 19C6. -
To the Editors of THE LANCET. SIRS,—The method of calculating corrected death-rates described by Dr. T. F. Pearse in THE LANCET of August 25th, 1906, p. 500, is practically the same as that given by Dr. T. W. Hime in his "Practical Guide to the Public Health Acts," second edition, 1901, pp. 544-548. Dr. Hime in a footnote observes that his results for Bradford differ very materially from those of the Registrar-General (23 38 as against 21’ 31 for males) and that the results of the latter are " wrong." In the case of Bradford, therefore, not a very abnormally constituted population, as in the case of Calcutta, the
General’s method. There are, as Dr. Pearse notes, two methods of making the required correction. The RegistrarGeneral applies the mortality-rates adopted as a standard to the various age and sex groups of the population under consideration ; while the other method applies the mortalityrates obtaining in the population in question to a standard population. The latter is the method preferred by Dr. Pearse and by Dr. Hime. Its use is negatived in very many instances by the fact that mortality rates in sufficient detail are not obtainable for the populations under consideration, whereas the age and sex constitution of all important populationsis to be found in the census reports. Dr. Hime, in his application of method No. 2, adopts as his standard population a "standard million," constituted as was the population of England and Wales at the preceding census; Dr. Pearse uses a "miniature population" of 847,796, the census population of Calcutta, constituted as was that of Bengal at the preceding census. The result obtained would have been exactly the same in each case had the total census populations of England and Wales and of Bengal respectively been utilised. If this had been done in the case of Calcutta, for instance, the various age-and-sex group populations in Table D of Dr. Pearse’s article would have been increased in equal proportion (847,796 : 70,000,000, or, population of Calcutta : population of Bengal) and the calculated deaths in the same table would have been in. creased in the same proportion. Consequently the calcn. lated death-rate obtained would not have been affected. The same thing may be shown in the same way for Dr. Hime’s method, whence the practical identity of the two is obvious. If, then, apart from mere variations in detail of application there are two principal methods by which corrected deathrates may be calculated, both apparently at first sight satis-
factory in principle but yielding discrepant results, an important question arises as to which is to be preferred and why ? This matter is, however, beyond the scope of the present letter and, as pointed out- above, practical considerations will generally restrict the statistician to the method of the Registrar-General. I am,
August 31st,
Sirs,
yours
faithfully,
T. H. C. STEVENSON.
1906.
THE ROYAL BERKSHIRE HOSPITAL. To the Editors
of
THE LANCET.
SIRS,-Some few years ago I was appointed physician to the Royal Berkshire Hospital under the following rule: "No person shall be eligible for the office of physician to the hospital unless he be a medical graduate of one of the universities of Great Britain or Ireland and his name entered on the Medical Register; neither shall any person be eligible who practises or is connected in partnership with anyone practising surgery, pharmacy, or midwifery." Recently this rule was altered to the extent that the practice of mid. wifery was to be allowed if desired. At the same time it was decided that two assistant physicians should be elected who were to have beds allotted to them and to have charge of the out-patient department and a physician was to be elected to form a skin department. This matter was never brought before the staff as a whole, neither were the physicians asked if they were prepared to give up beds or to give up their out-patients. At the election of the assistant physicians neither of the two conformed to the mode of practice demanded for the physicians and subsequently a rule was passed to meet their mode of practice, and at the same time they retain beds and have charge of the out-patient department, and one takes charge of a skin department so that by no
chance does
a
physician have a skin case under his care.
I should be glad to have your opinion whether the physicians have been fairly treated in this matter and whether the governors are acting within their rights in taking away from the physicians the rights and privileges under which they came to take up the appointment in Reading. I am, Sirs, yours faithfully, FRANCIS HAWKINS. Reading, August 1st, 1906. An officer elected under one set of regulations has a ** distinct grievance if during his term of office the regulations are changed so as to affect his position. So far we are with Dr. Hawkins. But if in the opinion of the authorities the change is in the nature of a reform (i.e., if the authorities v