SERVICE

In England and Wales the prime purpose of vital registration is the recording of "Acts of Civil Status". In the statutes dealing with the registration of births and deaths there is practically no provision for statistical work. The first legislative enactment dealing specifi­cally with this point is that contained in Section 5 of the Census Act,1920, which prescribes "it shall be the duty of the Registrar General to collect and publish from time to time any available statistical informa­tion with respect to the number and condition of the population in the interval between one Census and another". The development of the statistical work of the General Register Office up to that time was due to

administrative action and not to legislative requirements.

Unlike most European systems of vital registration the system obtaining in England and Wales is national and not local. The organ­isation consists of a comparatively small head-quarters staff numbering about 400 and of local registration officers under the jurisdiction of the Registrar General. For the purposes of the local registration of births and deaths the country is divided into Registration Districts (about 622) with a Superintendent Registrar in charge of each District. The Registration Districts are further sub-divided into one or more Sub-districts with a Registrar of births and deaths for each Sub-district (about 1,715).The Registrar of births and deaths is the officer charged in all ordinary cases with the duty of effecting the record of every birth, still-birth or death occurring within the area covered by his Sub-district. While it is the duty of those persons specified in the Act to give information to the Registrar of any birth, still-birth or death, the Registrar is required by the Act to take measures to inform himself of every such event occurring

in his Sub-district.

Each Registrar is required to forward to the General Register Office at regular intervals, through his Superintendent Registrar, Certi­fied Copies of all the entries of births, still-births and deaths which he has made. These are arranged, examined, bound, into volumes and deposited in the vaults of the General Register Office which contained at the end of the year 1931 about 160,000,000 entries. Copies of these entries are supplied to the public on payment of the prescribed fees, either by the local Registration Officer having the custody of the

Register, or by the Registrar General. To facilitate searching the Records an alphabetical index of Births and of Deaths is prepared quarterly of the names of all persons who are the subject of such entries. The index shows further, in the case of births, the maiden surname of the Mother and the district in which the biruh occurred - in the case of deaths, the age of the deceased and the district in which the death took place.

Registration of Deaths

In every case of Death in which the person dying was attended by a Registered Medical Practitioner, it is the duty of the Practitioner to issue a Medical Certificate of Cause of Death. The Statutory provisions, the suggestions given to the Medical Practitioner as to the method of filling up the Certificate and the form of the Certificate itself will be found in the documents annexed. This contains further a complete list of those persons who are legally qualified to give to the local Registrar of Births and Deaths the necessary information for recording the Act of

Civil Status. The Medical Certificate of Cause of Death is delivered to the Registrar of Births and Deaths by the Certifying Medical Practitioner who is required to give notice in writing of the signing of the Certificate to some qualified informant and the latter must give the necessary information to the Registrar of the Sub-district in which the Death occurred within five days. The Registrar has to record all the particulars in the Death Register (with the exception of the Cause of Death) from the information furnished by the informant, who is required to sign the Register. The particulars as to the Cause of Death and the name and medical qualifications of the Certifying Medical Practitioner are recorded from the Certificate of Cause of Death which the Registrar retains in his possession. On registering a Death the Registrar hands to the informant a Certificate for Disposal of the body which must be produced as the authority for the burial.

All cases of violent death whether attended by a Medical Practitioner or not, and all cases of death at which no registered Medical Practitioner was in attendance during the last illness must be reported to the Coroner. It is within the discretion of the Coroner to decide whether he will hold an inquest or not. If an inquest is held the registration is effected by the Registrar of Births and Deaths as to all the particulars recorded from the Coroner's Certificate which is transmitted

to him.

The Coroners’ (Amendment) Act, 1926, which came into force on 1st May, 1926, provides that where a person has died a sudden death of which the cause is unknown, the Coroner may order a post-mortem examination without proceeding to hold an inquest. In such a case the Coroner issues his authority for burial and reports the cause of death to the Registrar, but all other particulars concerning the deceased are supplied to the Registrar by the informant. Should no inquest be held, the Coroner informs the Registrar of his decision not to hold an inquest and registration is effected in the ordinary way. Copies of the forms used by the Coroner are among the documents annexed.

At the end of each month each Registrar of Births and Deaths transmits to the General Register Office Certified Copies of all the entries he has made in his Register of Deaths during that month. A duplicate copy made by means of a carbon is sent and is used exclusively for statistical purposes. Specimen forms showing the exact nature of an Entry of death are appended.

The Medical Certificates of Cause of Death are transmitted to the General Register Office quarterly.

Burials

The Births and Deaths Registration Act, 1926, provides that the body of a deceased person shall not be disposed of before a certificate of the registrar or a coroner's order has been delivered to the person effecting the disposal, unless such person is satisfied by a written declaration in the prescribed form made by the person procuring the disposal, that such certificate or order has been issued.

A stillborn child may not be buried in any burial ground beforethere is delivered to the person who has control over or -who ordinarily buries bodies in such ground either a certificate given by the registrar or, if there has been an inquest, an order of the coroner.

If it is intended to remove the body of a deceased person out of England, notice of such intention must be given to the coroner within whose jurisdiction the body is lying, and the prescribed period of 4 clear days after the receipt of the notice by the coroner must elapse before the removal takes place. Should, however, the coroner state in his

acknowledgment of the receipt of the notice that he does not intend to hold an inquest the body may be removed at any time after the acknowledg­ment has been received by the person to whom it is addressed.

The person effecting the disposal of the body of any deceased person is required to deliver to the registrar in the prescribed manner, a notification as to the date, place and means of disposal of the body, and such notification must be delivered within 96 hours of the disposal.

Transferable deaths

Deaths are registered in the Registration Sub-district in which they occur, but are tabulated according to the borough or urban or rural district in which the deceased person resided. An increasing proportion (about one third in 1929) of the total deaths occurs in institutions of different kinds, and in many cases a deceased person resided in a district other than that in which the institution is situated. In such cases the entry is marked at the time the area code numbers are inserted.Particulars of the death are then copied on to a slip which is forwarded either directly or through the County Medical Officer of Health to the Medical Officer of Health of the district of residence of the deceased person. Details of the method of, and rules governing the distribution, are set forth in the "Memorandum respecting the Distribution of Transferable Deaths".

The distribution of transferable deaths was commenced in 1885 in the case of London, and in the early days the nett deaths from the principal epidemic diseases only were distinguished. The system developed gradually until, commencing with the year 1911, it was applied generally to the whole of England and Wales and to death from any cause.

CODIFICATION

This process consists of the substitution of numbers (sub­sequently to be transferred to the punched card representing the death) against the various statements of the area of death, the occupation and the cause of death of the deceased person, etc.

There are four main coding processes, viz:-

1. Area of assignment of death - column 1 of carbon copy and columns24 to 27 of punched card.

2. Institutions - column 1 of carbon copy and column 23 of card.

3. Occupation, Industry and Status - Column 5 of carbon copy andcolumns 34 - 40 jf card.

4. Cause of Death - Column 6 of carbon copy and columns 41 to 44 ofcard.

No.l. The code numbers refer to Boroughs and Urban and Rural Districts (referred to later as administrative areas) which form the

units for which tabulation is performed and the code numbers are so arranged that the cards for the several kinds of areas can be separated by a single passage through the sorting machines. The labour of coding is lightened considerably by printing on the top of the form for the carbon copy the code number of the administrative area •which constitutes the registration sub-district nr the greater part of it. The code number entered is that of the area of residence of the deceased person, and where this differs from the area in which the death occurred the Entry is marked in the margin of the return. (See Transferable Deaths).

2« The deaths coded are those that occur in Public Assistance andMental Institutions, Hospitals; and Nursing Homes.

3. The Occupation, Industry and Status codes are those used for thetabulation of similar information for the Census. This

tabulation is done normally only for the years around the Census for the purpose of ascertaining the rates of mortality among men engaged in

different occupations.

4 . The list of causes of death is the International List with somesub-division of headings (see Nomenclature). A special code

is used however in order to obtain holes in the card which shall be common to the several causes of death which have to be thrown together to form

the several headings of the short list.

Medical Inquiries

These inquiries refer to deaths which are certified indefinitely. The aim of the department is to secure as far as possible certificates in terms recognised in the Nomenclature of the Royal College of Physicians of London, which is revised periodically by the College and a copy supplied by H.M. Government to every registered medical practitioner.The suggestions made to certifying practitioners are shown on page ii of the Book of "Forms for Medical Certificates of the Cause of Death" and a List of the indefinite causes about which inquiries are made is shown on pages iv - vi. The number of inquiries is about 7000 annually, and in about 90 per cent of the replies further information is obtained.

Preparation of Cards

The cards are punched by means of the key punches and gang punches. Key punching, operating on only one column of the card at a time begins at column 12 of the cards and follows closely the order in which particulars are entered in the death register. Columns 23 to 27 and 34 to 44 are punched with the numbers entered in the registers by the coders and referred to under "Codification". The Coding for the other columns from 12 onwards (except column 45) is simple and is done mentally where necessary (e.g. column 23, Month, and column 28} Sex) by the puncher. Column 45 is used for information required for several subsidiary tabulation

processes.

The first eleven columns of the card are gang punched, i.e . punched in groups of 12 to 15 at a time. Columns 1 to 4, 12, 13 and 17 to 19 are for the purpose of identifying an entry in the death register, the first four columns being gang punched before the order of the cards is disturbed. Columns 5 - 1 1 are for the purpose of simplifying the tabulation and represent the several groups of ages and of causes of death adopted for the Registrar General’ s Reports.

Tabulation

The general principles of machine tabulation are known and as

a demonstration of the operation of the machines is arranged for, it is hardly necessary to describe in detail the scheme in use in this

Department.

The cards for, say, the first quarter of the year being punched, they are non through the counting machine and the number of cards for each registration Sub-district counted. These numbers are compared with the numbers of deaths reported quarterly by the local registrars, the necessary corrections made where the two numbers differ, and the correct number of deaths during the quarter in the whole country established, without an independent counting process as a check. All subsequent counts of the cards must total to the same number. Much subsidiary tabulation is performed by hand sorting of the cards, in accordance with notes written on the cards at the time of punching.

This includes the detailed tabulation of violent deaths* of death from cancer of different parts of the body, of different complications of child-birth etc., shown in the Registrar General's Reports- as well as the secondary tabulation of complicating or contributory causes of death referred to under "Nomenclature". A specimen of the machine card is

attached.

The results of the several tabulations are set forth in the Registrar General's Statistical Review (Annual Report).

The principal tabulation processes e.g. tabulation of deaths by sex (and in the cases of females by marital condition) and individual years of age, and the tabulation of causes of death by the full inter­national list are made quarterly for London and for the aggregates of County Boroughs, Urban Districts and Rural Districts: other processes being left until the cards for the whole year are available.

CAUSES OP DEATH

With the introduction of the punched card system of machine tabulation in 1911, the change to tabulation by administrative areas and the assignment of deaths to the area of usual residence, it was decided to adopt the International List for the presentation of statistics of cause of death. The publication of these statistics for administrative areas necessitated some means of securing approximate agreement between the national figures and those compiled locally and published in the annual reports of the Medical Officers of Health. This was effected by the preparation of a Manual of the International List based on the "Nomenclatures internationales des maladies et des causes de deces."

In this Manual the office practice with respect to the use of the list is fully stated first by enumerating under each heading or sub­heading of the Detailed List the British equivalents of the causes of death internationally assignable to these titles and secondly by the provision of a general alphabetical index of these terms with a reference to the heading or sub-heading to which assigned.

The Manual also contains a statement of the rules for the selection of one from two or more jointly stated causes of death as recommended by the International Commission of 1900, and those in use in this Office prior to 1911 adapted to the International List. As the former rules had not met with general acceptance by countries using the List, their application in this country would have disturbed the continuity of our records without the advantage of increased international comparability.It was, therefore, decided to continue with the office rules although it is recognised that they are susceptible of improvement•

The question of framing rules for general use was again discussed at the International Conference in October 1929, but no agreement was reached.

The form of Statement of multiple causes in the new form of Medical Certificate in use in this country since the 1st July, 1927s; was designed in the hope that at some future date it might be found possible to abolish the use of any set of arbitrary rules in favour of the opinion of the medical attendant who is most competent to state which of several diseases contributed in the largest measure to the death.

A new edition of the Manual is necessary for each of the deconnial revisions of the List. The first edition compiled for use during the decennium 1911-1920 related exclusively to England and Wales, while the second edition for 1921-30 was extended to include corresponding information for Scotland and Northern Ireland. A third edition based on the 1929 revision for use during 1931-40 has been issued.

The "Short List'* of the Registrar-General differs in some respects from that of the International Commission. This was the case also during 1911-20, liberty to adapt the headings of this List to national requirements having been formally granted by the 1920 Commission to countries using the Detailed List. The relation of the Short Lists in use in England and Wales, Scotian- and Northern Ireland to each other and to the International Short List is shown in the Manual.

In adopting the International List in 1911 the continuity of our records was effected by sub-dividing many of the headingtof the Detailed List (see Key to the relation of the Detailed List to the Office List of 1901-10 in the first edition of the Manual). Other sub-divisions many of which have since been adopted interm tionally were made to provide for the separate presentation of deaths from individual diseases of special importance.

Tabulation by the Detailed International List is extended in English practice by the provision of special supplementary tables showing greater detail than is practicable in the main list of causes of death.The seven cancer headings of the Detailed List are sub-divided according to a scheme approved by the Director of the Imperial Cancer Research Fund; similarly the violent deaths headings are analysed according to the particular means of violence, ecg ,, deaths from poisoning according to the various kinds of poison and deaths from vehicles by the particular kind of vehicle, etc.

Other causes of death are of such importance that it is desirable to tabulate every instance of their occurrence even as contributory to deaths primarily due to scsne other cause. Thus deaths associated with the administration of anaesthetics for operation for cancer or other diseases are primarily classified to the disease for which the operation was necessary, but it is equally desirable to know the number of deaths from anaesthetics and this can only be done by means of subsidiary tables, since classification in the principal tables must be by the cause assumed to be primary when two or more are returned. Similar tables are compiled in respect of all deaths associated with childbearing and alcoholism and from tumours not returned as malignant.

Provision has also been made for noting the particular diseases listed to the residual titles of the several groups, e .g ., "other diseases of the nervous system, etc." Diseases coded to these headings are underlined in the death register to indicate that they must be written on the machine card. By hand sorting the cards it is possible to ascertain the number of deaths from any disease listed to these titles.

In order to obtain a complete record of certification, a special tabulation of secondary causes has been undertaken by which the various combinations of diseases are set out under the head of each primary cause. As publication on this scale is necessarily laborious the scheme was designed to cover the whole of the headings of the Detailed List in ten years by dealing with selected groups each year. The associated secondary causes are copied on the cards and at the end of the decennium the tabulation will show the complications of the deaths assigned to each of the headings of the Detailed List and also the total cases in which each cause appeared in certification.

*

In the United States the tabulation of secondary causes is made for one year in each decennium for the complete list but only one secondary cause is selucted for tabulation.

Registration of Births and Stillbirths

Every birth or stillbirth occurring in England and Wales must be registered within 42 days with the Registrar of Births and Deaths for the Sub-district in which it occurs. The persons charged with the duty of giving information to the Registrar are primarily the parents and failing those, the occupier of the house in ■which the birth takes place or some person present at the birth. The particulars to be recorded in the entry are shown in the specimen form attached and are furnished by the informant who signs the Register.

(There is in addition s. statutory obligation, requiring the parent, or the Medical Practitioner or Midwife in attendance at the confinement, to notify the birth or stillbirth within 36 hours to the Medical Officer of Health. A system is in general practice by which lists of births and stillbirths notified and of births and stillbirths registered are exchanged between the local Registrar and the local Medical Officer of Health. For this service a fee is paid to the Registrar by the Local Authority).

As in the case of deaths each Registrar forwards at periodic intervals certified copies in duplicate of the entries of birth made in his Register in the preceding month. The carbon copy is used for

statistical purposes only. For stillbirths certified copies are forwarded quarterly.

Provision for the registration of stillbirths was made by the Births and Deaths Registration Act, 1926, which came into operation on 1st July, 1927, and defines "stillborn" and "stillbirth" as applying "to any child which has issued forth frou its mother after the twenty- eighth week of pregnancy and which did not at any time after being completely expelled from its mother, breathe or show any oi;her signs of life ."

Transferable Births

Transferable births are the births of children born in a district other than that of the parents' usual residence. As in the case of deaths these births are deducted from the total for the district in which they occur and added to those in the district of residence. The same degree of accuracy, however, is not aimed at on the ground of expense. Copies of the transferred entries axe not submitted to the Medical Officers of Health concerned for their acceptance as in the case of transferable

deaths. At the end of the year the Medical Officers of the metropolitan and county boroughs are furnished with a numerical statement distinguishing sex and legitimacy of the registered births and of the inward and outward transfers, and the Medical Officers of Urban and Rural Districts with a similar statement in respect of nett births.

Transferable births are identified from the statement of the parents' home address in the Register and certain particulars of the birth are entered on a slip. The number of slips for each area of registration is then counted, giving the number of the outward transfers to be deducted from the total births registered. The slips are then sorted according to the area of previous residence of the parents and counted, giving the nunfrer of inward transfers to be added the total Wrfths registered,: In some areas containing lying-in hospitals the number of outward transfers is great. The total transferable births for the whole country numbers about 50,000 annually. The information is distributed to Medical Officers of Health about the end of February.

56542-1 7

Counting and Tabulation of Births

Births are counted separately for each quarter of the year, sex and legitimacy being distinguished. For registration sub-districts containing more than one administrative area, the births in each portion of the sub-district are counted. These counts are compared with the numbers returned quarterly by the local registrars, accuracy of the count is established in cases where the two numbers differ and the correct total of births for the country as a whole determined. Here again the use of the figures furnished by the local registrars effects a large saving in the work of the central department. The numbers of births in each portion of an administrative area are then entered on to a card, totals are formed, corrections for inward and outward transfers (see Transferable Births) are made, and the total for all administrative areas are balanced against the total for all registration sub-districts previously obtained. The machines are not employed upon the work of birth tabulation.

NOTIFICATION OB’ INFECTIOUS DISEASES

Each Medical Officer of Health, acting under instructions from the Minister of Health, compiles a statement of all cases of smallpox, scarlet fever, diphtheria> enteric fever, pneumonia, cholera, plague, puerperal fever, puerperal pyrexia, cerebro-spinal fever, acute polio­myelitis, acute polio-encephalitis, encephalitis lethargica, typhus fever, relapsing fever, continued fever, dysentery, ophthalmia neonatorum erysipelas, tuberculosis (respiratory or other forms), lialaria (believed to be contracted in this country), lualaria (believed to be contracted abroad), chicken-pox, measles (excluding Gern&n measles), whooping- cough, which have been notified to him during the week. This card is despatched to the Registrar-General so as to reach the General Register Office not later than the following Tuesday morning. On receipt of the cards they are sorted into geographical order, summarised for each separate administrative district and printed in Table 3 of the Registrar General's Weekly Return. This Return is posted to each Medical Officer of Health. In the case of a 'Nil' Return no entry is made in the Table; in any case in which a Return is not received in time for publication the name of the area is given in the Table with a series of asterisks in lieu of numbers.

The Registrar General’s functions in regard to the Notification of Infectious Diseases is limited to the collection, tabulation and publication of these Returns.

Publications

(l) Weekly Return (specimen attached).

Table 1 is compiled from the weekly cards furnished by the local registrars concerned (see specimen card).

Table 2 is compiled from the special return made by the registrars for the sub-districts comprised in the London area, (specimen attached).

Table 3 is compiled from the cards furnished by the medical officers of health.

Table 4 is, as will be seen, a summary extracted from Tables1 and 3.

Table 5 is supplied by the Meteorological Office and Table 6 by

the Astronomer Royal.

Quarterly Return (Specimen attached).

The text and tables on meteorology are furnished by the Meteorological Office. Tables 1, 2, 3 and 4 are made up and calculated from the quarterly return received from every registrar of Births and Deaths (specimen attached). Table 5 is made up and calculated from the aggregate of the 13 weekly returns received from the registrars concerned. Table 6 is made up from the quarterly cards received from the Registrars concerned. Table 7 is made up from the return received periodically from the statistical or registration departments in the various countries.Table 8 is a summary with any necessary corrections of the weekly cards received from medical officers of health.

Annual Statistical Review

With the year 1921 a new series was commenced with the issue of a Statistical Review in place of a former Annual Report. The ground now covered by the Review is somewhat wider than has been the case hitherto and an endeavour has been made to re-group the statistical matter accord­ing to its distinctive character. The tables are issued in two parts, ''Medical" and "Civil" -while the explanatory text is issued separately.The method of compilation has been shown in the various sections of this Memorandum and the index to the tables themselves is a sufficient indication of their nature and contents.

Decennial Supplement

A Decennial Supplement has been prepared for the last seven decades. Its essential character is that it takes advantage of the decennial Census to present statistics based upon the combination of censal and inter-censal material. The bulk of the tabular matter in the Supplements published hitherto has consisted of an analysis of the deaths, tabulated by age groups and a short list of causes of death in each registration district, together with death rates at the several ages and from the several causes based upon an estimate of the mean population during the decennium, determined from the Census population at the beginning and end of the decennium. There are other tables showing the death rates from several causes, at different ages and for different areas, some relating to the one decennium only and others to a series of decennia. The last published Supplement shows an analysis by age and by sex of the total deaths registered in England and Wales during the years 1911 to 1920 from the full list of causes of death shown in the

Annual Reports for these years.

The Decennial Supplements contain also a series of Life Tables or Mortality Tables setting out the calculated rates of mortality, the numbers of survivors and the expectation of life at each age. A series of Abridged Life Tables for many parts of the Country, calculated by a method specially devised for the purpose, ms published in Part II. of the Supplement to the 75th Annual Report. A special feature is the series of investigations of the mortality of men engaged in different occupations. Two other investigations of a decennial character relating to the birth rates in different occupations and the infant mortality among the children born to persons in different occupations are published in Part II of the Decennial Supplement 1921, and for an earlier period in the Annual Reports for 1911 and 1912.

These reports are of special value and may be said to be of standard interest because the death-rates shown in them depend upon estimates of mean population based upon two census enumerations, thus differing from those in the Annual Reports (now the Statistical Review)

which are based upon predicted populations and prove so far as local areas are concerned to be in many cases very wide of the truth, especially towards the end of the intercensal period.

Informatiun supplied to Medical Officers of Health for their reports

Reference has been already made to the particulars of trans­ferable deaths furnished quarterly to Medical Officers of Health for this purpose (see Transferable deaths), and to the statements of births sent to them annually about the end of February. At the same time, they are furnished with a copy of Table X of the Quarterly Return summarising the vital statistics of the year for the country as a whole, for London and for the aggregates of the "Great" and "Smaller" Towns, and with the follow­ing particulars relating to their areas

(a) Mid-year estimate of population

(b) Causes of death as per Short List distinguishing sex, and

(c) Deaths of children under one year of age distinguishingsex and legitimacy.

(d) Notified cases of certain infectious diseases, with caserates for the same diseases in England and Wales.

The Medical Officers of Administrative Counties, Metropolitan Boroughs and County Boroughs receive a more detailed analysis of the deaths in their areas showing the number from each cause of the Short List by sex and age as published in Table 20 of Part I of the Statistical

Reviews, 1921-30.

Medical Officers of Health are asked to bring to the notice of the Registrar-General any serious discrepancy between the figures tabulated in this Department and those taoulated locally and such differences are investigated with-the view of securing as accurate results as possible.

Collection Number: AD843

XUMA, A.B., Papers

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