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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    diseases. Under the term Hoemorrhage are only tabulated those deaths said to be caused by Ha2morrhage, but in which the organ from which the Ha:morrhage proceeded is not men- tioned. If the organ is mentioned, the death is not tabulated under Haimorrhage, but under Uterine, Stomach, Heart Diseases, etc., as the case may be. T have already remarked as to why Dropsy is in this class. Fistula I also put here; because, in most cases as yet, the Registers only state that the death resulted from Eistula, without saying whether it were anal, or urethral, or vesico-vaginal, or what it was. In the abstracting Table the cases are distinguished on the margin. Mortification is not confined to the skin, nor to one organ, and depends on many different causes ; its proper place is therefore here. There is no other place for Cancer. Purpura (with which we tabulate Scurvy) is in one sense a blood disease; but it is equally a disease of all the tissues, depending on general causes which affect every organ of the body. This is therefore its proper place. The same may be said of Scrofula. We still know too little regarding the pathology of Gout and Rheumatism to refer them with certainty to any one organ. They affect the bursse, the synovial and the white tissues, the membraneous tissues, the muscles, the diaphragm, and even the heart itself. Even when they prove fatal, it is generally through some secondary affection, as Pericarditis, of which we take no note in a Statistical Table of Deaths, seeing our rule is to tabulate the death under the primary affection. There is no other place for them, therefore, than in Class X. Atrophy, the last of this class, I have already remarked on, and given the reasons for its position here. It has no claim to be made a separate class. There is both a propriety and a convenience, however, in making separate classes of Mal- formations, of Debility at Birth and Premature Birth, of Old Age, and of Sudden Deaths. None of these can be strictly referred to any class under the three rules laid down for the construc- tion of the Table, yet they are causes of death under which many persons are registered, and we must find a place for them in a Statistical Classification. Under the Violent and Unnatural Deaths are classed Poison, limiting the term to poisons taken into the Stomach ; Poisoned bites, wounds, stinys, and then one of the consequences of a poisoned bite, Hydrophobia. As this last is not the primary but the secondary cause which led to the death, the bite being the primary, so Hydrophobia is most properly arranged here. In like manner, Intemperance (which is alcoholic poisoning), and its frequent secondary affection. Delirium Tremens, naturally belong to this group. Delirium Tremens, being a secondary affec- tion and not a primary (which is the alcoholic poisoning), has no claim to be arranged under Brain Diseases ; but here it is associated iiith its primary cause. All the other causes referred to the Violent Deaths would be so arranged under any Classification, so that nothing need be said regarding them. The Causes not specified are required to complete the Table, and they ought to form a separate class, as well as the Sudden Deaths. As there is a pressing necessity for a good and easily workable Classification of the Causes of Death for Statistical Purposes being adopted by England, by Scotland, by Ireland, and by the Army and Navy Boards, I trust that the Superintendents of these different departments, and the medical profession generally, will carefully examine the above proposed Classification ; and if they cannot suggest a simpler or a better for statistical purposes, let us have a meeting here, or in London, and agree as to the adoption of this as a uniform system for the Classifi- cation of the Deaths, on which all our Reports will be founded. It will be seen that the number of diseases specified in the above Table is limited. This is necessary in every Statistical Table, so as to bring it within moderate dimensions, both for working it and printing it; especially when we have to deal with large numbers, and with numerous districts. To fit it, however, for the tabulation of the Diseases which occur in civil, military, or naval Hospitals, it only requires to be extended, so as to include every disease. Thus, in the above, and every similar Table, iinder Small-pox are included Varicella, with Vaccinia and its conseqences. Under Typhus are included Typhus proper, Synochus, Gastric, Typhoid, and Infantile Fevers. Under Pericarditis, there are Carditis and Endocarditis. And so on with all diseases. To render the proposed Classification a complete Nosology, therefore, it only requires the same extension that every Statistical Nosology needs, no matter what may be the Classification adopted. Specifying every disease would make no difference whatever in the Classification. JAMES STARK. Genebal Registry or Births, etc., Edinburgh, April 9th, 1864.