Dr Stark's proposed new classification of diseases for statistical purposes : (new Scottish classification).

  • Stark, James, 1814-1883.
Date:
[1864]
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Licence: Public Domain Mark

Credit: Dr Stark's proposed new classification of diseases for statistical purposes : (new Scottish classification). Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    REMARKS. • The Statistical Classification of Diseases adopted a few years ago in the English Registrar- General's Reports has proved a failure, as I anticipated (see my remarks regarding it in the Edinburgh Medical Journal for June 1860), and already calls loudly for amendment. A movement is therefore being made to amend that Classification. But as I am fully persuaded that that Classification, from being drawn up on no fixed principles, is unimproveable, I venture to offer one which I Icnow from experience will be easily workable, which panders to no medical theory which may be popular to-day and be refuted to-morrow; but is a Classifi- cation drawn up on fixed, intelligible principles, which can be understood by the mass of man- kind, as well as by the medical profession. As we now have Acts for the Registration of Births, Deaths, and Marriages in England, Scotland, and Ireland, and as the Army and Navy Boards also publish Statistics of Deaths, it is extremely desirable that all should adopt the same Classification. At the present moment, three Classifications are in use, because the one now used by the Registrar-General of England will not answer for all purposes. For statistical purposes, however, all should follow the same Classification ; and when once a good and intelligible Classification is adopted, no change should hereafter be made on it, otherwise all accurate comparison with the results of previous years is lost, and endless confusion generated. As great misapprehensions exist regarding the diff'erence between a Scientific Nosology and a Statistical Classification of Deaths,—most persons imagining them to be the same,—a word of explanation seems requisite. A Scientific Nosology being a purely theoretical classification of diseases, takes it for granted that every disease is with certainty recognised, and can be referi'ed to its exact class and species. Hence, in such a Nosology, every disease is arranged under its primary affection, and not under the secondary complications which may arise in the course of the disease. No vague terms are therefore used in a Scientific Nosology, nor ought any place be assigned to purely symptomatic or secondary affections. A Statistical Classification of Deaths, on the other hand, must be a practical one ; and it must he so drawn up as to give an accurate abstract of all the Causes of Death which are entered on the Registers. It ought therefore to take as its basis the best, the simplest, and the most intelligible Nosology on which its framers can lay their hands ; and must also adopt as one of its leading principles that every death must, so far as practicable, be tabulated under the primary disease, and not under its secondary complications. That is to say, that a case of Phthisis proving fatal by an attack of Pneumonia, or of Bronchitis, is tabulated as Phthisis, and not as Pneumonia, or Bronchitis ; while a case of Measles proving fatal by a supervening attack of Bronchitis is tabulated as Measles, and not as Bronchitis. To this extent, therefore, there is no difference between a Scientific and a Statistical Nosology. But as a Statistical Classification has to deal with facts, and not with theories, and as the Statistical Tables must exhibit the whole Deaths in the Registers, else they are of no use, and all these Deaths must, as far as ptacticable, be arranged under their proper heads, it requires to make additions to almost every class of diseases, in order that all those Deaths, whose definitions are given too imperfectly in the Registers to enable them to he assigned to their exact species, may, at all events, be tabulated under their proper class. Hence, for instance, after exhausting all the great leading species of Brain Diseases, such as Cephalitis, Apoplexy, Paralysis, etc., the Statistical Classification requires to add the vague term Brain Diseases, meaning thereby all the Diseases of the Brain and Nervous System, so imperfectly defined in the Registers that they were not able to be assigned to their exact species. The same additions require to be made to the Lung, Stomach, Kidney, Uterine, and other diseases. . , , But still further alterations require to be made in every Statistical Nosology. Many Deaths are recorded as being caused by secondary complications, while the primary cause has not been ascertained, either from there being no medical attendant, or from the medical attendant being himself at a loss as to the primary affection. Dropsy is of this nature. In a Statistical Classification of Deaths, therefore. Dropsy must have a place; though it would have no place in a Scientific Nosology, seeing it is but the symptom of an organic lesion. But in the Statistical Nosology only those Deaths are tabulated undcr Dropsy in which the organ primarily affected was not distinguished; otherwise, had the Death been entered on the Register as Dropsy from Heart Disease, or Dropsy from Diseased Liver, the Death would have been tabulated under Heart Disease, or under Liver Disease, and not under Dropsy. me principle applies to many other diseases, or classes of diseases. 1 hus Atrophv is not a disease but a symptom-a consequence of more than one organic lesion in some vital organ, which even the ablest medical men will fail to trace to its primary cause in every case. Yet we must have a place for Atrophy. Such is also the cas-c with Old Age etc. For most practical purposes it is only important to know the total number of Deaths in