Final report of Departmental Committee on Maternal Mortality & Morbidity.

  • Great Britain. Committee on Maternal Mortality & Morbidity.
Date:
1932
Catalogue details

Licence: Public Domain Mark

Credit: Final report of Departmental Committee on Maternal Mortality & Morbidity. Source: Wellcome Collection.

    155/160 (page 153)
    APPENDIX VI. SUPPLEMENT TO CHAPTER IV. NOTE BY REGISTRAR-GENERAL. @) Joint Causes of Death, In the case of multiple causes of death upon a medical certificate, one only can be employed under the usual system of statistical tabulation, and this cause is determined by the application of a code of arbitrary selective rules. These codes may be divided into two classes :— 1. Those which enunciate principles of classification without defining their detailed application, and 2. Those which provide for specific combinations met with in the death registers. Codes of the first class are short and simple in form, but in practice often fail to secure uniformity of treatment, the principles laid down being capable of diverse applications in particular cases. The second class affords more precise guidance, but tends to ‘be unwieldy and more difficult of application. The rules in use in this office, which are also used in Northern Ireland, and the Scottish rules, are printed on pages xxi-xxv of the Manual of the International List. The English rules are of mixed type, but the Scottish are of the first class. The rules in use in Germany and Sweden are also of the first class. A code of general rules was adopted by the Commission revising the International List in 1900, and confirmed by the 1920 Conference. The Official French edition of the 1900 Manual also contained a detailed list of rulings for every combination of two diseases not assigned to the same heading of the Detailed International List, but this code has never been revised to bring it into line with later revisions of the International List. This form of code has been adopted by the United States and New Zealand. The rules in use in other countries have not, so far as is known in this Department, been published. Practice of General Register Office. Puerperal sepsis and phlegmasia alba dolens are included in Group 1 on page xxii of the Manual. This high preference results in practically all deaths so certified being classified to these causes; other puerperal causes occurring in conjunction with the non-puerperal diseases specified in Groups I, Ul and IV, and in Rule 9 would be classified to the non-puerperal disease; other combinations of puerperal and non-puerperal causes are governed by Rule 10, which would in many cases give preference to the non-puerperal disease as the disease of longest duration. Tables LXII and LXIV of the Text Volume for 1928 show that of the 3,710 deaths with mention of puerperal condition 2,920 deaths were assigned to puerperal and 790 to non-puerperal causes. In rather more than half of the latter the puerperal condition was returned as “‘ pregnancy ’”’ or “ child- birth,’’ and it is not known in how many of these cases death occurred in the course of a normal pregnancy or puerperium. Prior to 1911, certifying practitioners were asked to include childbirth on the certificates of women dying within a month of parturition, even if it were not a contributory cause of death, and it is believed that this practice is continued by some of the older practitioners, although in 1911 the instruction was amended as follows :—‘* Whenever parturition or miscarriage has been in any way a contributory cause of death, the fact should be mentioned on the certificates. ’’