United States. Bureau of the Census.

Relation of physicians to mortality statistics. The international classification of causes of deaths as adopted by the United States census office and approved by the American public health association .. online

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Online LibraryUnited States. Bureau of the CensusRelation of physicians to mortality statistics. The international classification of causes of deaths as adopted by the United States census office and approved by the American public health association .. → online text (page 1 of 3)
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COLUMBIA LIBRARIES OFFSITE

HEALTH SCIENCES STANDARD



HX641 47720
RC96 .Un37 Relation of physicia

RECAP



United States £en$w$ Office



RELATION OF PHYSICIANS



TO MORTALITY STATISTICS



*3>



THE INTERNATIONAL CLASSI-
FICATION OF CAUSES OF DEATH
AS ADOPTED BY THE UNITED
STATES CENSUS OFFICE AND
APPx<OVED BY THE AMERICAN
PUBLIC HEALTH ASSOCIATION



(READ CAREFULLY AND PRESERVE FOR REFERENCE)




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Digitized by the Internet Archive

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http://www.archive.org/details/relationofphysicOOunit



RELATION OF PHYSICIANS TO MORTALITY STATISTICS.



THE INTERNATIONAL CLASSIFICATION OF CAUSES OF DEATH
AS ADOPTED BY THE UNITED STATES CENSUS OFFICE AND
APPROVED BY THE AMERICAN PUBLIC HEALTH ASSOCIATION.



This circular is issued for the use and benefit of physicians who
have to make out certificates of death in compliance with registra-
tion laws, by acquainting them with the scope and requirements
of the International classification, which has been adopted by all
of the registration states and by most of the principal registration
cities for the compilation of their mortality statistics. Such sta-
tistics, to be comparable, must be uniform ; and to be valuable for
scientific purposes they must be accurate. Their chief value is
in the distribution of deaths by causes, but the cause of death
must be properly stated before it can be properly classified. In
this particular the entire value of the statistics depends solely
upon the lucidity and certainty with which the physicians supply
the information.

In all statistics of deaths by causes there is much too large a
proportion of unknown or indefinite items for which the physicians
alone are directly responsible and which they alone can remedy.

It is probable that the defect in this particular is largely due to
the fact that there has heretofore been no general and comprehen-
sive plan to direct the attention of all physicians to the use of their
certificates for statistical purposes, and to exhibit the necessities
and requirements in this respect by explaining the classification
used and by specifying wherein certain returns are incomplete,
indefinite, or unsatisfactory. This circular is designed to furnish
sUjCh information. It will be sent to every physician in the coun-
try, and it is confidently expected that they will appreciate the
importance of the matter — the purpose for which the circular
is issued — and will manifest their appreciation by making their
certificates conform to the suggestions noted, as far as possible.

It should be considered that the classification, in itself, is but
a selection and arrangement of titles only, under which deaths
reported in thousands of different ways must be compiled, and

(3)



that the assignment of any death to the proper title requires a
definite statement of the course of disease or the sequence of causes
resulting in the death.

The list of titles is given below, and, where necessary, explana-
tory notes are given, which show the essential distinctions to be
made. Some of the titles — indicated by the asterisk (*) — are
themselves indefinite, and it is very desirable that causes of death
be so stated as to permit their classification under some more
specific title.

If physicians will carefully examine the list of titles and observe
the explanations appended, a. vast improvement can be made in
the statistics.

Following the detailed list and explanation of the titles is a list
of indefinite and unsatisfactory terms very frequently used by
physicians, with similar explanatory notes. The terms in this
list can not be properly classified as given, and should never be
used without further explanation.

It is suggested that physicians take a few cases that occur to
them and see whether — if the causes of death are stated in the
terms they usually employ — they can themselves classify the
deaths under some definite and specific (unstarred) title. This
will give them a practical idea of the difficulties in the way, and
of the sufficiency of their statement of the cause of death.



ARRANGEMENT OF TITLES OF THE INTERNATIONAL CLASSIFICA-
TION AS ADOPTED BY THE CENSUS OFFICE.



[Titles marked with the asterisk (*) are indefinite and unsatisfactory.]



List of titles.



Explanatory notes.



ALL CAUSES.

I. General Diseases.

(.1. Epidemic disease*.)
Typhoid fever.

Exanthematic typhus.



Of special importance for sanitary purposes, hence only
exact and definite statements should be given for this
class.

Avoid use of " typhoid pneumonia " when pneumonic typhoid
or pneumonia occurring as a complication or form of
typhoid fever is meant. Typhoid pneumonia will be com-
piled under " pneumonia."

Report cases exactly in form of title. Do not write "typhus"
or "typhus fever," which are ordinarily understood as
typhoid fever.



Kelapsing fever
Malarial fever.



Smallpox.
Measles.

Scarlet fever-

Whooping cough.

Diphtheria.
Croup.

Influenza (Grip).

Miliary fever.
Asiatic cholera
Cholera nostras.
Dysentery.



Not a relapse, of fever but the specific disease of this name
is meant.

Do not use the terms "malaria" and "malarial fever" in-
definitely, but employ them only when malarial infection
was actually a cause of death. Never use the term " typho-
malar ial fever. " In the rare cases of mixed infection state
separately, with evidence of presence of both diseases.



When measles caused bronchopneumonia or other complica-
tion, first state measles— and then the complications.

When accompanied by complications or sequelae, as acute
nephritis, do not fail to give this as the primary cause.

In deaths from bronchopneumonia following whooping
cough, the primary cause should invariably be stated.

! Deaths from membranous croup, or croup not specified as
spasmodic, are considered diphtheritic. Sequelae of diph-
theria, as paralysis of the throat, should have their diph-
theritic origin specified.

Only genuine influenza should be reported as such. Do not
use the term to cover every affection of the respiratory
system.



To be used only when true epidemic dysentery is meant. Do
not use this term when ordinary diarrhea is intended.



(5)



List of titles.



Explanatory notes.



Plague.

Yellow fever.

Leprosy.

Erysipelas.

Otlier epidemic diseases.

(JS. Other general diseases.)



* Septicemia .

Glanders and farcy.

Malignant pustttle and char-
boii.

Rabies.

Actinomycosis, trichinosis,
etc.

Pellagra.

Tuberculosis of lungs.

Tuberculosis of larynx.

Tuberculous meningitis.

Abdominal tuberculosis.

Pott's disease.

* Tnberctilons abscess.
"White swelling.
Tuberculosis of otiier organs.
General tuberculosis.

* Scrofula.

Sypbilis.

Gonorrhea of tbe adult.

Gonorrheal infections of
children.

Cancer of month.

Cancer of stomach and liver.

Cancer of intestines and
peritoneum.

Cancer of genital organs.

Cancer of breast.

Cancer of skin.

* Cancer of other or unspeci-
fied organs.

*Tumor (noncancerous).

Acute articular rheumatism .

Chronic rheumatism and
gout.

Survey.



Give the cause, as puerperal, traumatic, etc. If traumatic
state the nature of the injury, and whether accidental, etc.



If pulmonary tuberculosis was also involved always state that
fact.



An objectionable term,
the cause of death ?



Was tuberculosis, and in what form.



Do not fail to specify the seat of cancer, if known. Also state
as carcinoma, sarcoma, etc., if possible, using the definite
pathological term descriptive of the growth instead of
simply ••cancer." Do not write "malignant disease"
when cancer is meant.



Do not write "tumor" when some form of cancer is meant.
Always state organ or part of body affected.



.Always define as acute or chronic.



List of titles.



Explanatory notes.



Diabetes.

Exophthalmic goiter.
Addison's disease.
Leukemia.
♦Anemia, chlorosis.

Alcoholism.

Lead poisoning-.

Other professional intoxica-
tions.

Other chronic poisonings.

Other general diseases.

II. Diseases of the Nervous
System.

♦Encephalitis.
Meningitis.



Locomotor ataxia.

Other diseases of spinal cord.

Apoplexy.

Softening of brain.
♦Paralysis.

General paralysis of insane.



Other forms of mental dis-
ease .

Other diseases of brain.

Epilepsy.

* Convulsions (nonpuerperal) .

* Convulsions of children.

Tetanus.

Chorea.

Other diseases of nervous
system.



If anemia is due to tuberculosis, syphilis, or other disease, so
state. Give the cause of the anemia whenever possible.

Always state the organic disease resulting from alcoholism.,
as cirrhosis of liver, etc.



Never use this term or its English equivalent, " brain fever."

Always specify fully all deaths that occur from epidemic
cerebro-spinal meningitis. Never omit the word epidemic
or shorten to cerebral, spinal, or unqualified meningitis.
When meningitis results from tuberculosis, traumatism
etc., do not fail to specify the cause of the meningitis.



Do not report as " spinal disease" or the like, but state the
definite form of disease of spinal cord, if known.

Only deaths from cerebral hemorrhage should be so reported.
Do not include all sudden deaths with undefined causes.
Avoid the use of the term " congestion of brain " as a
cause of death.



Give the cause. If from cerebral hemorrhage, that fact
should be stated. If due to an affection of the spinal
cord, name the specific form.

Do not fail to include the full title, as otherwise the death
may be included among deaths from paralysis of unde-
fined character.



JGive the disease causing the convulsions, and in females of
childbearing age do not fail to state whether pregnancy
was the exciting cause. In infants, pains should be taken
to report diarrheal diseases, and in adults the presence of
epilepsy or Bright's disease.



List of titles.



Explanatory notes.



Diseases of tlie eye and its
adnexa.

Diseases of tlie ear.



111. Diseases of the Circu-
latory System.

Pericarditis.
Endocarditis.
Heart disease.



In otitis media, its cause, as scarlet fever, should be given, if
known.



The special form of heart disease should be stated whenever
possible. Never return "'heart failure" when organic dis-
ease of the heart was the cause of death ; in fact, never use
the expression "heart failure" on certificates of death in
any case.

Angina pectoris.

Diseases of arteries.

Embolism and thrombosis.

Diseases of veins.

Diseases of lymphatics.

* Hemorrhages (except of Always state the cause of the hemorrhage. If after a surgical
lungs) . operation, state the disease or injury for which the opera-

tion was undertaken.

Otner diseases of circulatory
system.

IV. Diseases of the Respir-
atory System.



♦Diseases of nasal fossa.

Laryngitis.

Other diseases of larynx.

Diseases of the thyroid body.

Acute bronchitis.

Chronic bronchitis. |

Bronchopneumonia.



If diphtheritic, do not fail to say so.



Pneumonia.

Pleurisy.
♦Congestion of lungs.



Gangrene of lungs.
Asthma.

Emphysema.



Always specify definitely as acute or chronic. Do not report
chronic bronchitis when pulmonary tuberculosis was the
disease causing death.

Report fully as bronchopneumonia, not as pneumonia un-
qualified.

Report definitely as lobar pneumonia or croupous pneu-
monia. Avoid use of term "typhoid pneumonia," as it
frequently misleads.

If tuberculous, do not fail to state the fact.

Never use this term on a certificate of death. If death is
due to pneumonia, either catarrhal or lobar, so state. If
the condition was passive congestion of the lungs, pul-
monary edema, or hypostatic pneumonia, name the dis-
ease in which this condition occurred as the cause of death.



List of titles.



Explanatory notes.



♦Hemorrhage of lungs.

Other diseases of respiratory

system.

V. Diseases of the Digest-

ive System.

Diseases of mouth.

Tonsilitis.

Diseases of pharynx.

Diseases of esophagus.

TTlcer of stomach.

♦Gastritis.

Other diseases of stomach.

♦Dentition.

Diarrhea and enteritis (un-
der 2 years).

Diarrhea and enteritis (3
years and over).

Intestinal parasites.

Hernia.

Obstruction of intestines.

Other diseases of intestines.

Acute yellow atrophy of
liver.

Hydatid tumors of liver.

Cirrhosis of liver.

Biliary calculi.

Other diseases of liver.

Diseases of spleen.
Peritonitis (nonpuerperal).

Appendicitis.

Other diseases of digestive
system.

VI. Diseases of the Genito-

urinary System.

Acute nephritis.

Bright's disease.

Other diseases of kidneys.
Calculi of urinary tract.



Nearly always pulmonary tuberculosis should be stated as
the cause of the pulmonary hemorrhage.



If diphtheritic, say so.

Often used very indefinitely. Stale cause, if known.
Not a proper cause of death. State disease.



Avoid use of indefinite terms, " disease of liver," " liver com-
plaint," and the like, which are very uncertain evidence
of actual disease of the liver.

Do not fail to specify cause of peritonitis, if known, and in
females of childhearing age always state definitely
whether puerperal or not.



If due to acute infectious disease, as scarlet fever, do not
fail to specify origin of condition.

Specify definite form. Do not report uremia alone without
explaining its cause.



10



List of titles.



Explanatory notes.



Diseases of bladder.

Diseases of urethra, urinary If due to gonorrhea, so state.
abscess, etc.



of



Diseases of prostate.

No n venereal diseases
(male) genital organs.

Metritis.



Uterine hemorrhage (non-
puerperal).

Uterine tumor (noncancer-
ous).

Other diseases of uterus.

Ovarian tumors.

Diseases of tubes.

Other diseases of female gen-
ital organs.

Nonpuerperal diseases of the
breast (cancer excepted).

VII. Childbirth.

Accidents of pregnancy.

Puerperal hemorrhage.

Other accidents of labor.

Puerperal septicemia.

Puerperal convulsions.

Puerperal phlegmasia alba
dolens.

Other puerperal accidents.

Puerperal diseases of the
breast.

VIII. Diseases of the Skin.



Specify definitely as puerperal or nonpuerperal.



Gangrene.
Carbuncle.



Give cause and part affected.



* Abscess.

Other diseases of skin.



Give cause and part affected. Note especially tuberculous

abscesses.



IX. Diseases of the Loco-
motor System.



Diseases of bones.
Diseases of joints.
* Amputation .



Other diseases of organs of
locomotion.



Specify cause, as tuberculosis, etc., whenever known.

Amputation for what— disease or injury? Specify fully, and
if from injury, note the nature of the injury.



11



List of titles.



Explanatory notes.



X. Malformation.
Hydrocephalus.



Congenital malformation of
heart, cyanosis.

Other congenital malforma-
tions.



Specify as congenital hydrocephalus. If acute hydrocephalus
from tuberculous infection is meant, specify the tubercu-
lous character of the disease deiinitely.

Report as congenital malformation of heart rather than as
cyanosis, the latter term being rather indefinite.



XI. Early Infancy.

Premature birth.
•Congenital debility.

Other diseases of early in-
fancy.

Liack of care.

XII. Old Age.

•Old age.



XIII. Violence.



Give cause, if known.

What disease caused the debility ? This return is little more
definite than to say from unknown cause.



Name the disease causing death in the old person. Tht
statement "old age," in the vast majority of cases, is simply
equivalent to unknown, and shows lack of observation and
precision of statement.



Suicide by poison.

Suicide by asphyxia.

Suicide by hanging or stran-
gulation.

Suicide by drowning.

Suicide by firearms.

Suicide by cutting instru-
ments.

Suicide by jumping from
high places.

Suicide by crushing.

Other suicides.

Fractures. i

Dislocations. )

Burns and scalds.

Burning by corrosive sub-
stances.

Heat and sunstroke.



Cold and freezing.



State the cause of the fracture or dislocation.



State heat or sunstroke only when the direct cause of death.
Deaths of infants from cholera infantum or of elderly
persons from heart disease, etc., although accelerated by
warm weather, should rather be reported from the disease
causing death.

Deaths from diseases aggravated by cold weather should not
be reported under this title. Specify definitely as freezing
whenever this was the case, or report as exposure to cold.
Do not write cold without qualification, as this may be
mistaken for some respiratory disease.



12



List of titles.



Explanatory notes.



Lightning.
Drowning.
Starvation, privation, etc.



Inhalation of poisonous
gases.



Other accidental poisonings.

Accidental gunshot wounds.

Injuries hy machinery.

Injuries in mines and quar-
ries.

Railroad accidents and inju-
ries.

Injuries by horses and vehi-
cles.

Other accidental trauma-
tisms.

Suffocation.

Injuries at birth.

Other external violence.

Homicide.

XIV. Ill-defined Diseases.

* " Dropsy."

♦Sudden death.
*Heart failure.



♦Inanition (over 3 months), a
♦Debility (over 3 months), a

♦ Marasmus (over 3 months) . a

* Fever.

Other ill-defined diseases.
Unknown .



Specify as accidental or suicidal in every case.

Do not include inability to take food or exhaustion resulting
from disease under this title, but state the name of the
disease causing the condition. Only deaths from inability
to procure food should be here included.

Specify nature of gas and whether accidental or suicidal. If
an anesthetic used In surgical operation, and properly
given, state the disease or Injury for which the operation
was undertaken.



Do not return without full explanation as to cause, stating
whether by gas or poisonous vapor, in mine, etc.



Give the cause of the dropsy, thus enabling the return to be
removed from ill-defined causes.

Give the cause of the sudden death, if known.

A thoroughly worthless return. Never give it as the sola
' cause of death. Name the disease which occasioned the
"heart failure."

What was the cause of the inanition?

What was the cause of the debility?

What was the cause of the marasmus ? If due to tubercu-
losis or other wasting disease, specify definitely.

What fever was it? If not a specific fever, what was the
disease in which the fever occurred?



a Deaths reported from this cause under 3 months of age are compiled under " congenital debility."



LIST OF INDEFINITE TERMS FREQUENTLY USED BY PHYSICIANS
IN STATING CAUSES OF DEATH, BUT WHICH SHOULD BE
AVOIDED.



Indefinite terms used in
reporting deaths.



Further information required for proper classification. .



Abscess.

Accident.
Acute gastritis.
Acute hydrocephalus.
Advanced age.
Albuminuria.

Amputation.

Anasarca.
Anemia.

Anesthesia.

Angina.

Ascites.
Asphyxia.



Asthenia.
Atrophy.

Autoinfection.

Bad cold.
Bed sores.

Bilious attack.



What caused the abscess? What organ or part of the body
was affected? Was it tuberculous or resulttif injury? If
of lung, was it not pulmonary phthisis ?

What was the nature of the accident?

State cause. Was it due to some irritant poison ?

Was this due to tuberculous meningitis?

What disease caused death ? See " Old age."

Name the acute or chronic disease causing the albuminuria.
Was it due to scarlet fever or Bright's disease?

What was the disease or injury requiring the amputation to
be performed? State fully, and if due to injury from
violence, state nature of the accident.

Name disease causing anasarca. See "Dropsy."

State cause of the anemia, if known. A death should not be
reported thus when the cause of the anemia was pulmo-
nary tuberculosis or other wasting disease.

Name the anesthetic and state whether it was administered
for a surgical operation, in which case give the disease or
injury for which the operation was undertaken.

Was it due to scarlet fever or diphtheria? This is a sus-
picious return and one to be carefully scrutinized by
registrars.

Name disease causing ascites. See " Dropsy."

How? Was it accidental? If so, state fully the nature of
the accident. If by gases or poisonous vapors, give par-
ticulars. Was it a case of "overlying" (child)? If in a
mine, it should be so stated. Physiologic asphyxiation
(mode of death) by failure to eliminate C0 2 should not be
given as a cause alone. What disease caused this con-
dition ?

A practically worthless statement. See " Debility. " What
was the cause?

What caused the atrophy? Was it tuberculous wasting
(phthisis)? Was it syphilis? What organ or part atro-
phied ?

What caused the autoinfection? This term should not be
used when cholera infantum or other diarrheal disease is
meant.

Was it bronchitis, pneumonia, or pulmonary consumption ?

What was the disease causing death and during which the
patient contracted bed sores? Was it rheumatism, par-
alysis, etc. ?

Very indefinite. Name disease causing death.

(13)



14



Indefinite terms used in
reporting deaths.



Further information required for proper classification.



Bilious fever.
Blood poisoning.

Bottle feeding.

Bowel disease.
Bowel trouble.

Brain disease.
Brain disorder.

Brain fever.
Breaking down.
Briglit's disease.

■Bronchitis.

Cachexia.

Cancer.

Carbuncle.

Carcinoma.
Cardiac asthma.
Cardiac asthenia.
Cardiac debility.
Cardiac failure.
Cardiac weakness.
Caries.
Casualty.
Catarrh.

Catarrh of bowels.
Catarrh of lungs.



Was it malarial, typhoid, or other form of fever? State
definitely.

Do you mean septicemia, syphilis, or any other definite
disease? If septicemia, what was the cause? Was it
puerperal?

This return is valuable but only in connection with the disease
causing death. Was the disease resulting from improper
feeding diarrheal in character?

What disease of the bowels? If cholera infantum or diar-
rheal disease of infants, state definitely.

What was the " trouble " ? Name a definite disease. Was it
diarrhea, dysentery, enteritis ? Was it cancer or colic or
strangulated hernia? All these are "troubles," besides
some others.

Was it a tumor of the brain? Was it meningitis? Name
disease causing death.

What was the disease causing death? Was it paralysis,
apoplexy, etc. ? Was it caused by tuberculosis or syphilis ?
Be definite.

This term is thoroughly discredited. Was it meningitis?
Name disease causing death.

A worthless return. What disease caused the breaking
down ? See " Debility. "

State whether acute or chronic. Acute nephritis following
scarlet fever or other infectious disease should be reported
under the primary cause.

Was it acute or chronic? If it extended to pneumonia, the
death should be reported from bronchopneumonia. See
also "Chronic bronchitis."

What disease caused the cachexia? Was it cancer, syphilis,
tuberculosis? State cause definitely.

What organ or part of the body did the cancer affect?
Always state this.

Was this anthrax or malignant pustule ? Was it caused by
diabetes?

What organ or part of the body did the carcinoma affect?

Name the form of heart disease causing death.



These returns are generally equivalent to " heart failure," a
return which should never be made nor accepted. See
"Heart failure."



State location and cause. Was it tuberculous?

Give nature of accident.

An unsatisfactory statement. Give location and preferably
make a proper statement of disease causing death.

Was this diarrhea or enteritis ?

Was this acute or chronic bronchitis, bronchopneumonia, or
pulmonary tuberculosis ?



15



Indefinite terms used in
reporting deaths.



Further information required lor proper classification.



Catarrh of stomach.
Cellulitis.
Cerebral coma.

Cerebral exhaustion.

Childbirth.

Choking.

Chronic bronchitis.

Chronic pneumonia.
Chronic senility.
Cirrhosis.

Cold.

Colic.
Collapse.

Coma.

Complicated disability.
Complications.
Concealed hemorrhage.



Concussion of brain.
Congenital causes.



Congestion.



Congestion of brain.



Very indefinite and frequently secondary to other diseases
Name disease causing death.

Give location and cause. Was it erysipelas? Was it. puer-
peral or traumatic?

"Coma" is necessarily cerebral as resulting from interfer-
ence with the functions of the brain, but the cause, of it
may vary widely. Was it from cerebral hemorrhage,
Bright' s disease, etc.? Was it due to violence? If so,
give nature of accident.

A more definite statement is desirable in place of this return.


1 3

Online LibraryUnited States. Bureau of the CensusRelation of physicians to mortality statistics. The international classification of causes of deaths as adopted by the United States census office and approved by the American public health association .. → online text (page 1 of 3)