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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    a population caused by certain Classes of disease ; say, for instance, of the Respiratory Organs. But were a purely Scientific Classification followed, a great number of Lung Diseases, whose names were too vaguely defined in the Registers to enable them to be referred to their exact species, would be thrown out, and be altogether lost to Science, because they would be thrown into the class termed Causes not Ascertained. By following a purely Scientific Classifica- tion, therefore, the population would seem to be much more free from Lung Diseases tlian they really were ; and an entirely false conclusion would be arrived at, because we were so foolish as to adopt a purely Scientific Nosology. By converting the Scientific, however, into a Statistical Classification, and adding these vague terms at the end of every class, the Deaths from each Class of disease, at all events, are accurately ascertained, and correct conclusions arrived at relative to the comparative freedom from, or susceptibility to, certain classes of disease in certain populations. But a Classification of Deaths for statistical purposes ought to be constructed on quite diiferent principles from a Scientific Nosology. A Scientific Nosology should alter with the pro- gress of medical literature, and be in each age a correct representation of the prevalent theories of the day regarding the origination or supposed causes of disease. But a Statistical Nosology being for an entirely different purpose, ought to be drawn up on a few known and intelligible principles, of which the most important is that given in the new Scottish Classification, as Rule III., viz., So far as practicable,, every disease causing death must be tabulated under the organ of the body which was primarily or chiefly affected. A Statistical Classification of Deaths drawn up on such a clear and intelligible principle never could clash with any Scientific Nosologies. Whatever were the theories relative to disease. Tables drawn up on such a principle could be consulted with advantage, and all the facts deducible from them be easily made applicable to any Theoretical Nosology of the day. Such a Classification would, however, possess the immense advantage over every other, that besides being intelligible and easily worked, it pandered to no medical theory which was fashionable to-day, but refuted and abandoned to-morrow. Once adopted, therefore, such a Classification would never hereafter require to be amended or departed from ; so that the most exact comparisons could be made as to the prevalence of any class of diseases in former years with the year under consideration; changes in the form or prevalence of different diseases ; the circumstance of one disease taking the place of another,—all could be traced ; and then the most important consideration of all would be, that the Vital Statistics of all the various departments of Government, and the different divisions of this kingdom, would adopt the same Classification. A few words of explanation seem requisite relative to the proposed new Classification itself. In every Statistical Classification of the Causes of Death, the number of diseases must be limited, in order to come within such limited space as we can afford for printing. All the rare diseases, therefore, have their names left out of the Classification, because they are in- cluded in the vague terms appended to each class. In the Tables themselves, however, they are all entered as side notes, so that nothing is lost. In the above Classification, it has been attempted to carry out to its fullest extent the third Rule, viz., that every disease causing Death must be tabulated under the organ of the body which was primarily and chiefly affected. A distinct class of diseases, however, affects every organ of the system simultaneously ; but as these are always attended with that morbid affection to which we give the term Fever, all such diseases conveniently arrange themselves under Class I., to which is applied the term Fevers. One disease alone is provisionally put under Fevers, viz.. Diphtheria. This disease chiefly proves fatal through its extension to the Respiratory Organs ; but it is not primarily an affection of these, but of the mucous mem- brane of the mouth and throat, dependent on a general derangement of the whole system, of a nature entirely similar to that of one of the eruptive fevers. According to the rule laid down, therefore. Diphtheria must either be classified under Diseases of the Organs of Diges- tion, or, where I have provisionally put it, under Fevers. It seems to me to be so closely allied to Cynanche Maligna and Cynanche Tonsillaris, both of whicii are undoubted forms of Scarla- tina, that it seems to me we have no choice left us but to place it after Scarlatina. For statistical purposes there can be no such class allowed as the Tubercular; it would violate all our rules. Every disease now put under that class must be referred to the organ of the body chiefly affected ; so Phthisis must be referred to Diseases of the Respiratory Organs; Hydrocephalus to Diseases of the Brain ; Tabes Mesenterica to Diseases of the Organs-of Digestion. Hooping-cough and Croup are so purely Diseases of the Respiratory Organs, the wonder is they were ever put elsewhere. Diarrha3a, Dysentery, and Cholera, may be called the lead- ing Diseases of the Organs of Digestion, and that is their undoubted proper place. Metria, itself a secondary affection, seeing it never can occur but during child-birth, can only stand under Diseases of the Organs of Generation. Were it a primary disease, its proper place ^yould have been under Fevers ; but being merely one of the modes in which the normal operation of nature, child-birth, proves fatal, it can have no other position than where I have put it. The above remarks will prove the necessity which exists for having, in a Statistical Classifi- cation of Deaths, a class which shall include diseases which occur in various organs, which attack no one unvarying seat or organ, or which are mere symptoms of the existence of other organic affections, whose nature was not satisfactorily ascertained. Class X. includes these