Extract from Observations taken at the Royal Observatory, Greenwich, during the week ending Saturday, 28th July, 1849. XV. REGISTRATION AND CLASSIFICATION OF THE CAUSES Of Death. Under our XVIth recommendation (p. 149,) we have spoken of the importance and necessity of a uniform nomenclature of the causes of disease and causes of death. If diseases, or groups of diseases, are to be usefully compared together, it is indispensable that the same name should be given to the same disease, and that the same diseases should be assigned to the same group or class in each place compared. Registration and classification, then, are both of great importance in any plan for a sanitary survey. Should the subjoined rules be observed by public officers, medical men and others, in carrying the sanitary laws. into effect, many of the imperfections at present existing, in regard to these matters, would be obviated. For a detailed explanation of the principles on which these rules are founded, we refer to the Fourth Report of the Registrar General of England, pp. 144-216; and to his Seventh Report, pp. 249-329. REGISTRATION. The following rules should be observed in giving names to the causes of death, to be entered in the registers : 1. Give such names to the causes of death as afford an exact and clear definition of such causes; and as have the same uniform meaning at all times and in all places. Several different terms have, in some instances, been given to the same disease, and each of these terms has been given to several dif ferent diseases. Vague and inconvenient names have been employed, and complications have been registered instead of the primary disease. Such are the terms "fits," "infantile disease," "inflammation," "decline," ," "sudden death," &c., which are improper without specifying what kind of fits, what infantile disease, what inflammation, the cause of the decline, or of the sudden death. So is consumption, cancer, or other name improper, if the death was not clearly produced by such cause. The same name should also, as far as practicable, be uniformly used for the same disease, in every section of the United States. 2. Give a preference to a single word, or the least possible number of words, which affords this clear definition. A popular name is to be preferred; but if no popular name in a single word can be found, a technical or scientific term may be used. According to this rule consumption is to be preferred to phthisis pul monalis; croup to cynanche trachealis; pneumonia to inflammation of the lungs; enteritis to inflammation of the internal membrane of the bowels; &c. By uniform use the people will soon become familiar with scientific terms. 3. If more than one disease or cause has concurred in producing the death, the names of the different diseases or causes may be written under each other in separate words, and in the order of their appearance. In such cases write the causes of death in the order of their appear ance, and not in the presumed order of their importance. ExamplePrimary disease,-Measles. Secondary disease-Pneumonia. 4. Enter, in figures, as nearly as can be ascertained, the duration of the disease, in years, months, days, or hours; and if more than one disease has concurred in producing the death, make the same entries concerning each disease. Such entries would supersede the use of the words "chronic," "acute," ," "sudden," &c., which are inexact, indefinite and unmeaning terms. The duration of the disease or diseases, in these returns, will always be considered to imply the time intervening between the first appearance of well-marked characteristic symptoms in each, and the death. The following are examples of cases where more than one disease concurred to produce death :-Measles (21 days), Pneumonia (7 days), means that the first evident symptoms of measles appeared 21 days before death; and the first evident symptoms of Pneu monia 7 days before death. So diarrhoea (2 days), cholera (12 hours), means that the first premonitory symptoms of diarrhoea appeared 2 days before death, and the first evident symptoms of cholera 12 hours before death; and scarlatina (4 weeks), dropsy (5 days), angina (2 days), means that scarlatina appeared 4 weeks before death, dropsy 5 days before death, and angina maligna 2 days before death. These suggestions should be carefully regarded. The following are examples of these entries :— 1st case- -Measles, (21 days,) 3d case-Scarlatina, ( 4 weeks.) Pneumonia, (7 days,) 2d case-Diarrhoea, (2 days,) Cholera, (12 ho'rs.) Dropsy, 5 days. The entry should be stated in minutes or hours, if the disease is fatal in less than 48 hours' duration; in days, if fatal in less than 50 days' duration; in weeks or years, if of longer than 50 days' duration. 5. In cases of death by small-pox, measles, scarlatina, typhus, and similar diseases, if the person has sustained more than one attack, state whether it was the second, third, or otherwise. If by ague, epilepsy, convulsions, or other diseases, which occur in fits or paroxysms, state the duration from the first fit, and add that of the last fit separately. Example-Epilepsy (5 years), last fit (6 hours.) 6. In surgical cases terminating in death, the entry should state the primary cause or disease, the operation, and the secondary disease; and also the time intervening between the commencement of each and the death. Example-Fracture (20 days,) amputation (15 days,) mortification (2 days.) 7. In case of death by external causes, or by violence, the nature of the injury and the circumstances under which it occurred should be stated, and whether by accident or design. Example "Killed on railroad," "shot accidentally," "suicide by hanging,' ""suicide by arsenic." 8. If poison be the cause of the death, state, as far as practicable, the time which elapsed between its being taken and the death. Example-Suicide, laudanum, (8 hours ;) accident, oxalic acid, (20 minutes;) murder, arsenic, (30 hours.) 9. The certificate of the cause of death should, if possible, be signed by a physician present during the last sickness; but if this be impracticable, then by some other person qualified to give it. It sometimes happens that the nature of the fatal disease cannot be discovered-even after a post mortem examination of the organs-and still more frequently in the absence of an examination. In such cases one or more of the leading symptoms and peculiar appearances should be stated. P. M. should be added when the causes of death have been verified by a post mortem inspection. 10. The cause or causes of the disease should, in every case, as far as practicable, be ascertained and recorded. A systematic series of accurate and full observations, in relation to the causes of disease, is of the greatest importance. We have already expressed our views on the subject, (pp. 150-153,) and would again repeat our earnest desire that well directed efforts should be made, by public officers, professional men, and private individuals, to obtain and record such observations. The following alphabetical nomenclature of the principal fatal diseases, and causes of death, contains the terms which we recommend to be used in the registers. The number prefixed to the name is the number of the disease, or cause of death, according to the order of its appearance in the classified nomenclature 17. Abscess, (state 91. Accidents, the artery;) 31. Apoplexy, 53. Ascites, 45. Asthma, 18. Atrophy, 54. Bowels, disease of, 2. Cholera Infantum, 41. Brain, dis. of, 46. Bronchitis, 92. Burns and Scalds, 32. Cephalitis, 1. Cholera, 1. Morbus, 20. Debility, mens, 73. Diabetes, 4. Diarrhoea, 21. Dropsy, 93. Drowning, 5. Dysentery, 56. Dyspepsia, 57. Enteritis, 36. Epilepsy, 6. Erysipelas, 94. Execution, 7. Fever, Intermitt't, 8. Fever, Remittent, 9. Fever, Typhus, 86. Fistula, (state where ;) 95. Freezing, 58. Gastritis, 24. Infantile Disease, 99. Intemperance, 69. Liver, dis. of, (state the nature ;) 101. Malpractice, 76. Nephritis, 96. Glanders, 81. Generative Or 103. Necusia, 84. Hip, dis. of, 90. Old Age, 50. Pleurisy, 51. Pneumonia, 104. Poison, (state the 87. Purpura, 80. Puerperal Fever, 62. Quinsy, 82. Rheumatism, 13. Scarlatina, 28. Scrofula, (state where manifested;) 89. Skin, dis. of, 14. Small-Pox, 85. Spine, dis. of, 71. Spleen, dis. of, 105. Starvation, 63. Stomach, dis. of, 110. Still born, 29. Sudden, (state its nature;) 106. Suffocation, 107. Suicide, (state circumstances ;) 5. Syphilis, 64. Teething, 40. Tetanus, 16. Thrush, 30. Tumor, (state 65. Ulceration, 81. Uterus, dis. of, circumstances, the 66. Worms, CLASSIFICATION. The following rules should be observed in classi fying the abstracts of diseases, for sanitary and statistical purposes:1. Under Zymotic diseases, class all such diseases as are known to be epidemic, endemic, or contagious, under any circumstances. The single and convenient word Zymotic is synonymous with, and designed to supersede, the long, inconvenient paraphrase, "epidemic, endemic, and contagious." Diseases of this class are called zymotic, or fermenting, because they are supposed to act like leaven, which, when thrown into a mass, affects a body or article that is prepared for, or is in a condition favorable to, its reception and operation. The existence of a disease of this class indicates the presence of some impure condition of the atmosphere, as the barometer indicates the presence of some of its natural conditions. 2. Under Sporadic diseases, class all such as are known not to be epidemic, endemic, or contagious. 3. Subdivide the Sporadic class, and make a separate class of each subdivision, according as the disease affects the different classes of organs of the body. 4. Diseases which have a general, and not a definite certain seat or effect, should form a distinct class. 5. Deaths from old age, and from external causes, should each form a distinct class. 6. The still born should be classed separately, and never included in the aggregate number of deaths, having never had a separate living existence. The following classification of the diseases named in the alphabetical nomenclature, is given as an illustration of the above rules :— I. Zymotic Diseases. 39. Paralysis, 27. Mortification, 28. Scrofula, 29. Sudden, 30. Tumor. III. Nervous Organs. 31. Apoplexy, 32. Cephalitis, 33. Chorea, 34. Convulsions, 35. Delirium Tremens, 36. Epilepsy, 37. Hydrocephalus, 38. Insanity, V. Respiratory 45. Asthma, 54. Bowels, dis. of, 56. Dyspepsia, 57. Enteritis, 58. Gastritis, 59. Hernia, 63. Stomach, dis. of, 65. Ulceration, 66. Worms, 67. Hepatitis, 75. Kidney, dis. of, 76. Nephritis, 77. Organs, dis. of, VIII. Generative Or gans. 78. Childbirth, 79. Paramenia, 89. Skin, dis. of, 90. Old age, XII. External Causes. 91. Accident, 92. Burns and Scalds, 93. Drowning, 94. Execution, 98. Hydrophobia, 99. Intemperance, 100. Lightning, 101. Malpractice, 102. Murder, 103. Necusia, 104. Poison, 110. Still born. |