demographic yearbook annuaire demographique 1951

These regulations are as binding on each member government
ofthe World Health Organization as any international
treaty or convention unless a note of rejection or reservation
is formally transmitted to the World Health Organization
within a specified time period. The provisions of Nomendature
Regulations No.1 came into force on 1 January
1950. It is therefore expected that, for the next decade,
countries will publish statistics on causes of death classified
according to the Sixth Revision, beginning with data for
the calendar year 1950.
Principles of classification
The International Lists of Causes of Death have followed
the basic principles laid down by Dr. William Farr and
summarized in his statement that: "The primary divisions
of a Statistical Nosology should evidently be founded upon
the mode in which diseases affect the population; whether
they are generated and prevail only in particular localities
(endemics), extend like cholera over nations (epidemics),
or are propagated by contagion; whether they arise in an
isolated manner (sporadically) from ordinary causes, and
sources existing in the organization itself; or whether they
are caused by violent means". 3 Because neither medical
science nor registration practice had succeeded in producing
clear-cut criteria for characterizing many of the diseases of
the organs and systems of the body, Farr proposed that these
"sporadic diseases" be grouped according to the anatomic
systems affected. Thus, his classification gave five broad
categories: (1) epidemic diseases; (2) constitutional (general)
diseases; (3) local diseases, according to anatomical site;
(4) developmental diseases; and (5) deaths from violence.
Although this classification was not adopted when first proposed,
the general arrangement has been followed throughout
the various revisions of the International List of Causes
of Death.
Farr further proposed that the principles quoted below
should be followed in determining what diseases or conditions
should be specified as separate categories within the
five broad groups.
1. "Diseases distinctly specified in the returns, although
not offrequent occurrence, like diabetes, have each a
place in the tabular form; so that the facts thus fully
laid before the public may be separately compared,
and classified in any way likely to lead to useful
results. Where a particular disease occurred very
rarely, it was classed under a general head and
referred to in notes."
2. "The number of groups has, however, been diminished,
because no general principles can be deduced
from small numbers, accidental irregularities destroying
the results, according to the well known
doctrine of probabilities. Besides it was useless to
keep up distinct heads, which, although distinguished
in some, were confounded in other returns.
3. "When after whooping cough it was stated that the
patient died of pneumonia, the case has been referred
to the primary disease; and the same principle
has been adhered to in similar instances." 4
These principles also have been generally followed in the
International Lists of Causes of Death. Specific categories
are set up for the various diseases and conditions on the
3 Humphreys, Noel A. (Editor), Vital Statistics. A Memorial Volume
of Selections From the Reports and Writings of William Farr, Offices of the
Sanitary Institute, London, 1885, page 232.
4 Ibid, page 233.
basis of frequency of occurrence, importance as a cause of
death and the facility with which they lend themselves to
characterization as separate disease entities. Separate categories
are provided for diseases which can be readily differentiated
but which are grouped together because of small
frequencies. Other categories are provided for less well
defined conditions, being composed of diseases which are
closely related, but not identical. There are also residual
categories for conditions that cannot be differentiated sufficiently
to warrant the creation of separate rubrics. Since the
primary purpose is to provide a basis for compiling statistics,
not every condition or diagnosis is shown as a separate category,
as would be the case in a medical nomenclature.
However, there are provisions for the proper statistical classification
of every medical term that may be reported.
Each succeeding revision of the International List of
Causes ofDeath has reflected the advances in medical science
by the inclusion of categories for new disease entities. Also,
more and more emphasis has been given to the etiology of
disease. However, it has not been found practicable or
desirable to shift the classification completely to an etiological
base. Such a shift would result in the separation of
allied diseases, or the breaking up of meaningful disease
entities into many fragmentary etiological components which
would not have much significance from the statistical point
of view.
Fifth (1938) Revision
The Sixth (1948) Revision has not been in force long
enough for statistics utilizing the new classification to be
generally available. Consequently, the data presented in
this volume are based on the Fifth (1938) Revision of the
International List which became effective in many of the
signatory nations early in the 1940-1949 decade. This list
is composed of 18 major groups sub-divided into 200 numbered
titles. Many of these numbered rubrics are further
divided into subtitles designated by letters (a, b, c, etc.)."
In addition to the detailed list of 200 titles, an intermediate
list of 87 titles and an abridged list of 44 titles were
approved by the Fifth Revision Conference in 1938. (The
statistics given in this volume are based on the abridged
list). The intermediate list is a condensation of the detailed
list and provides information concerning each of the 18
major groupings of the detailed list. The abridged list is a
further condensation in which a number of the 18 major
groups have been combined. For the most part, this abridgement
has not resulted in any important loss of specific information
concerning the significant causes of death for international
comparison.
Although the intermediate and the abridged lists were
designed to provide a convenient, uniform basis for the publication
rather than the coding of national data for international
comparison, a number of countries have also used
one of these lists for coding purposes. This severely limits the
availability of detailed information on causes of death needed
for national use. However, in view of the quality of
medical information usually obtained in these countries,
these limitations do not appear to be particularly serious.
Sixth (1948) Revision
The Sixth (1948) Revision adopted for use by many
nations starting in 1950 represents a rather sweeping change
"L'Institut International de Statistique, Nomenclature Internationale
des Causes de Dec""" 1938, La Haye 1940.
19