Notes for talk to Yale Medical School ‘lass, April 12, 1919,

 

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1, Define nosology.

2. Explain difference between a nomenclature and a practical working list
or “classification” of causes of death.

| 3. Explain necessity for a working list of causes of death for practical —
office use, Explain why an alphabetical index will not suffice (erysipelas and
St. Anthony's fire, e«e-e<c= Barlow's disease, Yerlnoff's disease and scurvy --=<=
locomotor ataxia and tabes dorsalis), Read at this point paragraph marked a,

page 12, Manualg alse translation of paragraph marked a, page 3, French text.

4, The International List of Causes of Death (more especially the Census
manual idapting it to American usage) is our working list in this country, It is a
not a scientific nomenclature, Read here paragraph marked a, page 13, Manual. ed

a History of International List, Give synopsis of the marked
paragraphs, page 7, Manual, Comment on growth in extent oye
of its use and on the great importance of its adoption by

England and Tales, See marked paragraphs, sage 8, Manual,

p= Comment briefly on the history of neselegy as covered by

pages 13 to 17, Manual, Comment on adoption of the Inter-

national classification by the U. 5, Census Bureau and its
use by state, municipal and corporation offices interested

i : in mortality statistics, S

b = Brief comment on the Census manual itself showing how it covers
thousands of modes of statements of eauses of death which are
not in the original French text (Bellevue, oe French and
Census terme). 4
c « Why it is necessary to have beth a tabular list and en alpha-
betical index, Tabular list is the real classification, |
| The index is simply a guide to the use of the tabular list, os
. Mere reference numbers are meaningless, Cive examples, ’
ge Refer to paragraphs marked b and c, page 12, Manual.

i

d « The International List is a list of causes of death arranged,
for the most ourt, according to the goat of diseases rather
than their pathology or etiology, Thus, it is, in the main, © i
: 2. arranged on an anatomical basis. (Example ~ serebrel hemor-
a T <= rhage: nervous not circulatory). Give exceptions te this j
7 eA (cancer, t.b., violent causes, otc.). Explain what
Ys a? Bertillen claims to »e the advantage of the anatomical basis,

Criticise mildly. | | Ls

Explain that the list is divided, primarily, into two grand —
divisions, First, disease; second, viclence. 11 of the
14 general classes are devoted distinctly to morbid conditions.
Class 12 relates to old age. Class 13 relates to external
< causes, (ecarbolie acid and wood alcohol). The final
~S elass, No. 14, is called Ill-tefined Diseases but under this
— - heading are tabulated many deaths which are probably due to =
vielent causes but which were not reported in such a way as
—~— to be identified as deaths so chargeable,

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f - Explain what a general disease is and what are included in
titles 1 to 59, Do the same for the Diseases of the Ner~=
vous System and for the other classes, (Same for violence,
suicide, homicide and accident), Explain some of the
deficiencies of the International List and point to certain
rather misleading title headings (cerebrai spinal meningitis,
A.AeP., Titles 46, 50, 78, 103, 146, 148, etc.)

/ Vt — g + Explain the difference between the e0tatie’ and abridged lists

pe oN and why it is necessary to have each, Explain also the
= | elasticity of the International List, Give examples, The
—_———___ Cancer monograph; pneumonia; Titles,173 and 175, /G co
—y = FS we o,

5, Importance of statistics of deaths by cause and consequent importance
of their scientific classification. op :
a= This was recognized even before the coffection of mortality x
statistics by Census enumerators was discarded, The Crone Ife
directions to these men emphasized the fact that the state~- 2
ment of cause of death was the most important item on the for
2 This was a step in the right direction
even though the hopelessness of securing accurate statements
by means of enumerators is thoroughly recognized now and was
quite generally conceded then,

b = We measure the comparative healthfulness of communities more
by their death rate for some of the preventable diseases
than by their gross or crude rate; hence, the importance
of impressing on the medical fraternity the necessity of
statin apy Ot hee each gase Le a fact ES Toe ie!
c= aa of a societies which need accurate statistics
of causes of death for the study of many problems, Interest
of the sanitarian who uses statistics of the various prevent«
able diseases in his work far more than he does the crude
death rate, Legal importance of correct statements of cause
of death, Life insurance, Pensions,

 

*, Practical office cause of death classification procedure,

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le Metter te be classified. The henlth officer or vital statistician 4
in classifying causes of death obtains his material for such classification usual»
ly from certificates of death. These statements are made by physicians, usuelly;
also by coroners who, in some instances, ere physicians, elso by midwives and in
a varying percentum of cases by other informants. This oo is often faulty

ee on rats Bieted fo ce mpt caper es used jes EGER Nake ete y sce; ‘,

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2. Explain a is ae by "editing" causes of death (20: nthe Th A

 
  

3. The first step is tc be sure that the cause of death, es stated—
the physician, is not incompatible with other statements on the certificates de® |
(Here Gistribute samples of "Ceuse of Death Check Liste") < Refer to Nose 42, 1265): A
127, 128, 129, 130, 131, 132, 134 te 141 inclusive, alse te 70, 71, 164, 105, 151," 6°"
152, 153. Point out that all above refer to imptssible statements of cause of | 0
death with reference to sex or agée Rae afl!

a« Refer to the titles of the International List which have ab« esi 1a

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solute age limitations. Refer to those which have absolute of #7.
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b = Improbable statements of cause of death, (Go over the
numbers indicated under "cards to be verified" on the
E a Census cause of death check list, Take a number of
FM we e specific instances and bring out clearly why these are
; la suspicious reports, Tell Census Bureau experiences in
connection with several of them, Emphasize necessity
for weeding out a° verifying such statements, Cite
' instance in which a certain city complained to the
Census Bureau because it was charged with a death from
rabies, When this was traced down, it was discovered
that this death was, in fact, caused by Pott's disease
which had been “edited” 23:instead of 32, Tell about
the negro Virginia physician who reported more cases of
relapsing fever in his practise than had eccurred in the
wnole country for years, Comment on ane almost universal
courtesy with which physicians supply © data on sm request
which they have failed to supply on the original certificates,
Mention certain exceptions, For example, the physician who
replied "This man is dead, what in h-=1 difference does it
make what he died of" also the physician from the mountain 3
= districts of Kentucky who replied ‘cussing’ the new demo~ pe
. ‘ cratic administration for asking "fool questions.” 4

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