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Population statistics
PUBLIC
HEALTH THE JOURNAL OF
THE SOCIETY OF MEDICAL OFFICERS OF H E A L T H No. 6.
MARCR 1943
Vol. LVI. CONTENTS
PAGE
PAGE
OBITUARY
EDITORIAL Population Statistics . . . . . . . . . . . . . . . . . . . . . Child Welfare in the U~S.A . . . . . . . . . . . . . . . . . . . A " Burnham Scale " for Hospital Nurses . . . . . . . . . . . . . . . Cities a n d S h i r e s o f T o - m o r r o w . . . . . . . . . . . . . . . . . .
63 63 64 64
Dr. A. Adams Dr. A. M. Watts Dr. J. W. Fraser
65
A National
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SPECIAL ARTICLES Teaching of Preventive Medicine in the United States. By Prof. J. M. M a c k i n t o s h , M . v . , D,P.H . . . . . . . . . . . . . . . . . . . . . . Training in Public Health, B y J o h n R i t c h i e , M.B., C H . m , M.R.C.P.E., D.P.H. .. . . . . . . .
Some Points abou(~l'uberc'ulosis"inW~r-time~"By john G. Cairns, ~,.s., CH.B., D.P.H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. . . . .
68 70
. . . . . .
72 72 72 72 72
EDITORIAL Population Statistics The decline in the birth-rate and the resulting effect of a reduction of the population have been freely discussed during the past 40 years. But it is only in recent times, probably owing to the sensational methods by which the forecasts of the size and composition of the future population have been illustrated in the daily press, that a wide publicity has been given to this subject. Kuczynski# recently reviewed the fertility statistics published in the Statistical Reviezo of 1938 and also the Memorandum to the Royal Commission, submitted in January, 1939, and published in May, 1942. The author has evidently made a very detailed study of these official statistics, but it is hardly correct to designate this paper as a piece of research, a term which should not be applied to criticism, however good. The author demands greater tabular details in some instances and in others modifications, but it should be remembered that statistical significance is not always synonymous with practical importance. The tabulation of data, in as many permutations as possible, will undoubtedly afford some statisticians an abstract interest, but this does not justify the spending of public money. Let us make a comparison. The tabulation of infant mortality - - w h i c h in the past has been a subject of equal public c o n c e r n - by causes of death has shown clearly which diseases may be described as preventable and which are more or less not preventable. The downward trend of the former indicates the success attained in the attempt to control the waste of infant life and where further improvement can be sought. But in fertility statistics no similar advantage can be gained by such sub'classification. The outstanding fact is that the birth-rate is insufficient to maintain the population, and this has already been known for years. Finer details, interesting as they may be, are of no practical use, as the future births cannot be affected through a knowledge of them. We had already some knowledge of the mother's age, position in family, etc., from the statistics published by medical officers of health. T o cite one instance, the information is given in the Medical Officer of Health's reports for Manchester, 1936-38. T h e Registrar-General's forecast of the possible future population was most probably too optimistic, but perhaps not so wildly extravagant as Kuczynski believes. It is worth * The New Population Statistics.
Is, 6d.
72 72 73
CORRESPONDENCE
BOOK REVIEWS War Injuries of the Chest . . . . . Sex G u i d a n c e i n F a m i l y L i f e E d u c a t i o n Health for the Young . . . . . . . . . Principles of Medical Statistics . . . . . F r o n t L i n e , 1940-41 . . . . . . . . .
~.
Cambridge University P ~ . ~
Health Service.
B y A . N . S i l v e r , B,A . . . . . . . . . . . . .
73
THE SOCIETY OF MEDICAL OFFICERS OF HEALTH North-Western Branch . . . . . . . . . . . . . . . . . Northern Branch . . . . . . . . . . . . . . . . M a t e r n i t y a n d C h i l d We'l'f'are G ' r o u p . . . . . . . . . . Yorkshire Branch . . . . . . . . . . . . . . . . . Southern Branch . . . . . . . . . . . . . . . . . . . . Midland Branch . . . . . . . . . . . . . . . . . . . . Eastern Branch . . . . . . . . . . . . . . . . . . . .
. . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . .
. . . . . . .
73 73 73 74 74 74 74
remembering that all forecasts are more or less guesses, and no certain method of predicting the population growth over so short a period as ten years has been discovered. Kuczynski objects to the omission of mortality at ages under 35 during 1911-20 from the calculations on which the forecasts of the future populations were made, and states that bad years should be included with good despite the official explanation that these were omitted " owing to the exceptional events of the decennium." Anyone with a knowledge of vital statistics must realise the difficulties of obtaining mortality rates at these ages due to the serious disturbance during the war. Kuczynski also objects to the modern practice of constructing national life tables for triennial periods, centred at the census year, instead of the former method of employing decennial periods. '" Formerly the bad years were taken with the good years." Surely every student of population problems must know the chief advantage of the triennial over the decennial period (the triennial period gives a more exact description of the exposed to risk than was possible from the decennial period) and that since the census occurs at fixed intercals there can be no selection of " good " or " bad " years. Although the importance of the future trend of the population can hardly be exaggerated, the tabulation in greater and greater detail of the fertility of women cannot obviously affect the birth-rate. The continuance of these statistics on such a scale in the Statistical Review overweighEs their practical importance. Some of the labour and expense involved in the compilation of the 100 pages could be profitably diverted to other problems in ~ital statistics. It should be remembered by workers on specialised problems that the Statistical Review is not primarily a scientific journal, and that each introduction of technicality curtails its circle of readers and lessens its usefulness. It would be deplorable if the Registrar-General's publications could only be read by persons highly trained in statistical method.
Child Welfare in the U.S.A. It was a happy thought on the part of the Maternity and Child Welfare Group of the Society to invite last month Major Becket to give them his personal experiences of child welfare in the U.S.A. Major Becket is now serving with the Medical Corps, U.S. Army, and was until recently paediatrlc consultant for the Kellog Foundation and consultant for the Michigan State Department of Health. Becker pointed out that it was impracticable to develop on scheme of medical or social welfare for the United ~ta~s a whole, owing to the wide variations in conditions
HEALTH THE JOURNAL OF
THE SOCIETY OF MEDICAL OFFICERS OF H E A L T H No. 6.
MARCR 1943
Vol. LVI. CONTENTS
PAGE
PAGE
OBITUARY
EDITORIAL Population Statistics . . . . . . . . . . . . . . . . . . . . . Child Welfare in the U~S.A . . . . . . . . . . . . . . . . . . . A " Burnham Scale " for Hospital Nurses . . . . . . . . . . . . . . . Cities a n d S h i r e s o f T o - m o r r o w . . . . . . . . . . . . . . . . . .
63 63 64 64
Dr. A. Adams Dr. A. M. Watts Dr. J. W. Fraser
65
A National
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SPECIAL ARTICLES Teaching of Preventive Medicine in the United States. By Prof. J. M. M a c k i n t o s h , M . v . , D,P.H . . . . . . . . . . . . . . . . . . . . . . Training in Public Health, B y J o h n R i t c h i e , M.B., C H . m , M.R.C.P.E., D.P.H. .. . . . . . . .
Some Points abou(~l'uberc'ulosis"inW~r-time~"By john G. Cairns, ~,.s., CH.B., D.P.H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . .
. . . . .
. . . . .
68 70
. . . . . .
72 72 72 72 72
EDITORIAL Population Statistics The decline in the birth-rate and the resulting effect of a reduction of the population have been freely discussed during the past 40 years. But it is only in recent times, probably owing to the sensational methods by which the forecasts of the size and composition of the future population have been illustrated in the daily press, that a wide publicity has been given to this subject. Kuczynski# recently reviewed the fertility statistics published in the Statistical Reviezo of 1938 and also the Memorandum to the Royal Commission, submitted in January, 1939, and published in May, 1942. The author has evidently made a very detailed study of these official statistics, but it is hardly correct to designate this paper as a piece of research, a term which should not be applied to criticism, however good. The author demands greater tabular details in some instances and in others modifications, but it should be remembered that statistical significance is not always synonymous with practical importance. The tabulation of data, in as many permutations as possible, will undoubtedly afford some statisticians an abstract interest, but this does not justify the spending of public money. Let us make a comparison. The tabulation of infant mortality - - w h i c h in the past has been a subject of equal public c o n c e r n - by causes of death has shown clearly which diseases may be described as preventable and which are more or less not preventable. The downward trend of the former indicates the success attained in the attempt to control the waste of infant life and where further improvement can be sought. But in fertility statistics no similar advantage can be gained by such sub'classification. The outstanding fact is that the birth-rate is insufficient to maintain the population, and this has already been known for years. Finer details, interesting as they may be, are of no practical use, as the future births cannot be affected through a knowledge of them. We had already some knowledge of the mother's age, position in family, etc., from the statistics published by medical officers of health. T o cite one instance, the information is given in the Medical Officer of Health's reports for Manchester, 1936-38. T h e Registrar-General's forecast of the possible future population was most probably too optimistic, but perhaps not so wildly extravagant as Kuczynski believes. It is worth * The New Population Statistics.
Is, 6d.
72 72 73
CORRESPONDENCE
BOOK REVIEWS War Injuries of the Chest . . . . . Sex G u i d a n c e i n F a m i l y L i f e E d u c a t i o n Health for the Young . . . . . . . . . Principles of Medical Statistics . . . . . F r o n t L i n e , 1940-41 . . . . . . . . .
~.
Cambridge University P ~ . ~
Health Service.
B y A . N . S i l v e r , B,A . . . . . . . . . . . . .
73
THE SOCIETY OF MEDICAL OFFICERS OF HEALTH North-Western Branch . . . . . . . . . . . . . . . . . Northern Branch . . . . . . . . . . . . . . . . M a t e r n i t y a n d C h i l d We'l'f'are G ' r o u p . . . . . . . . . . Yorkshire Branch . . . . . . . . . . . . . . . . . Southern Branch . . . . . . . . . . . . . . . . . . . . Midland Branch . . . . . . . . . . . . . . . . . . . . Eastern Branch . . . . . . . . . . . . . . . . . . . .
. . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . .
. . . . . . .
73 73 73 74 74 74 74
remembering that all forecasts are more or less guesses, and no certain method of predicting the population growth over so short a period as ten years has been discovered. Kuczynski objects to the omission of mortality at ages under 35 during 1911-20 from the calculations on which the forecasts of the future populations were made, and states that bad years should be included with good despite the official explanation that these were omitted " owing to the exceptional events of the decennium." Anyone with a knowledge of vital statistics must realise the difficulties of obtaining mortality rates at these ages due to the serious disturbance during the war. Kuczynski also objects to the modern practice of constructing national life tables for triennial periods, centred at the census year, instead of the former method of employing decennial periods. '" Formerly the bad years were taken with the good years." Surely every student of population problems must know the chief advantage of the triennial over the decennial period (the triennial period gives a more exact description of the exposed to risk than was possible from the decennial period) and that since the census occurs at fixed intercals there can be no selection of " good " or " bad " years. Although the importance of the future trend of the population can hardly be exaggerated, the tabulation in greater and greater detail of the fertility of women cannot obviously affect the birth-rate. The continuance of these statistics on such a scale in the Statistical Review overweighEs their practical importance. Some of the labour and expense involved in the compilation of the 100 pages could be profitably diverted to other problems in ~ital statistics. It should be remembered by workers on specialised problems that the Statistical Review is not primarily a scientific journal, and that each introduction of technicality curtails its circle of readers and lessens its usefulness. It would be deplorable if the Registrar-General's publications could only be read by persons highly trained in statistical method.
Child Welfare in the U.S.A. It was a happy thought on the part of the Maternity and Child Welfare Group of the Society to invite last month Major Becket to give them his personal experiences of child welfare in the U.S.A. Major Becket is now serving with the Medical Corps, U.S. Army, and was until recently paediatrlc consultant for the Kellog Foundation and consultant for the Michigan State Department of Health. Becker pointed out that it was impracticable to develop on scheme of medical or social welfare for the United ~ta~s a whole, owing to the wide variations in conditions