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An International Success
757
sometimes leg ; the rare hemiplegia-are now attributed to constriction of cerebral arteries, and the subsequent headache to arterial dilatation and excessive pulsation-vascular changes which have no counterpart in epilepsy. Despite the clear genetic relation between the two disorders he fee1s that the association between them can be overstressed. Accepted medical ideas about epilepsy have been largely built up on data obtained from what were in fact selected groups of patients. The two obvious groups, institutional and non-institutional, are far from being the only ones ; the epileptics who reach the neurosurgeon’s consulting-room, for instance, would make up a picture very different from that of epileptics in general. As Dr. NATTRASS pointed out, most epileptics of adult age are earning their own living and taking their full place in the community, and he urged that they should be treated from childhood onwards as far as possible like their fellows, and that every effort should be made to curtail limitations, even if some risks are involved. He would not hesitate to encourage suitable patients to take up professional careers, and would rarely discourage marriage or even parenthood. As he said, the development of a fuller life for epileptics generally will depend primarily on the initiative and cooperation of their doctors.
An International Success THE very length of the title of the Conference for the Sixth Decennial Revision of theInternational Statistical Classification of Diseases, Injuries, and Causes of Death, held in Paris at the end of April, indicates the vast effort that has gone into its preparation. The draft proposals for a new international system of recording disease realise a long-felt aspiration of medical statisticians. As so often, WILLIAM FARR has had, if not the first, then the decisive word. " Statistics," he said, is eminently a science of classification ... and any classification that brings together in groups diseases that have considerable affinity, or that are liable to be confounded with each other, is likely to facilitate the deduction of general principles." Up to now the international classifications have been intended only for the causes of death, but as FARR recommended, it is desirable " to extend the same system of nomenclature to diseases which, though not fatal, cause disability in the population." The expansion of health insurance and other plans for medical care, and the present resurgence of interest in scientific studies of the incidence of disabling disease in industrial populations, combine to give point and urgency to the need for internationally agreed standards of disease classification. But this taxonomic problem has agitated the minds of vital statists at least since the 18th century, when SAUVAGES made the first attempt at the systematic classification of disease. When FARR took u phis post at the General Register Office in 1837 he found that the classification in most general use was one by WILLIAM CULLEN, of Edinburgh, published in 1785 under the title Synopsis Nosologice Methodicce. His dissatisfaction with this method led him to evolve a new classification. The general arrangement included the principle of classifying diseases by anatomical site, which has survived as the basis of the present International List of Causes of Death. This work was carried "
by BERTILLON, who was the guiding force behind the 1900, 1910, and 1920 revisions of the list. The need to classify the voluminous records of patients in both Service and civilian hospitals during the war led to the development on both sides of the Atlantic of groupings of diseases causing sickness as well as death. Over here, for example, Dr. PERCY STOCKS and Dr. A. H. T. ROBB-SMITH produced for the Medical Research Council a provisional classification based on the International List of Causes of Death. Meanwhile in America a committee under the chairmanship of Dr. LOWELL REED worked for a compromise between this initial attempt and the various methods in vogue in the United States in 1945. Their proposals were put to the test of practice in various hospitals and government departments, and the results of this experience have been embodied in a final revised draft which formed the basis for discussion in the recent conference. In these proposals the broad framework of the international list has survived ; the main classification has categories for diseases caused by well-defined infective agents, and for neoplastic, allergic, endocrine, metabolic, and nutritional disorders. The remaining diseases are classified according to their principal anatomical site, but there are special sections for mental disorders, complications of pregnancy and childbirth, and certain diseases of infancy and old age. The special problem of injuries has been dealt. with by dividing them either by their external cause or by their anatomical result. In general, the administrative needs of punched-card methods of handling such data are to be served by a three-figure code number for each disease. The first two figures define the broad group to which the particular illness belongs ; the third figure indicates the appropriate subdivision of that major group. Thus pernicious anaemia would be coded. 290, the " 29 " indicating that the disease was one of the blood or blood-forming organs, while the" 0 " differentiates it from, for example, haemophilia, to which the code figure " 5 ? has been allocated. This numbering system results in flexibility and utility, since the first two figures indicate broad groups, while within these broad groups the use of the third digit allows new categories to be introduced without upsetting the basic numbering. Where finer divisions are required a fourth digit can of course be used. The advantages of such a system to hospital or government statisticians are clear, and it is gratifying that the Paris conference, which was opened by Monsieur BIDAULT, the French foreign minister, and presided over by the distinguished permanent secretary ofthe Academy of Medicine, Professor BAUDOUIN, reached complete agreement This ensures that the statistics on the draft proposals. of both mortality and morbidity produced in all the countries bound by this agreement will be comparable, and draft regulations will be submitted, with the new list, to the World Health Assembly meeting at Geneva in June. By combining hard preparatory work with a disposition towards reasonable compromise in negotiation, the United Kingdom delegation, led by Mr. GEORGE NORTH, LL.D., the Registrar-General, played a notable part in securing the success of this important conference. on
sometimes leg ; the rare hemiplegia-are now attributed to constriction of cerebral arteries, and the subsequent headache to arterial dilatation and excessive pulsation-vascular changes which have no counterpart in epilepsy. Despite the clear genetic relation between the two disorders he fee1s that the association between them can be overstressed. Accepted medical ideas about epilepsy have been largely built up on data obtained from what were in fact selected groups of patients. The two obvious groups, institutional and non-institutional, are far from being the only ones ; the epileptics who reach the neurosurgeon’s consulting-room, for instance, would make up a picture very different from that of epileptics in general. As Dr. NATTRASS pointed out, most epileptics of adult age are earning their own living and taking their full place in the community, and he urged that they should be treated from childhood onwards as far as possible like their fellows, and that every effort should be made to curtail limitations, even if some risks are involved. He would not hesitate to encourage suitable patients to take up professional careers, and would rarely discourage marriage or even parenthood. As he said, the development of a fuller life for epileptics generally will depend primarily on the initiative and cooperation of their doctors.
An International Success THE very length of the title of the Conference for the Sixth Decennial Revision of theInternational Statistical Classification of Diseases, Injuries, and Causes of Death, held in Paris at the end of April, indicates the vast effort that has gone into its preparation. The draft proposals for a new international system of recording disease realise a long-felt aspiration of medical statisticians. As so often, WILLIAM FARR has had, if not the first, then the decisive word. " Statistics," he said, is eminently a science of classification ... and any classification that brings together in groups diseases that have considerable affinity, or that are liable to be confounded with each other, is likely to facilitate the deduction of general principles." Up to now the international classifications have been intended only for the causes of death, but as FARR recommended, it is desirable " to extend the same system of nomenclature to diseases which, though not fatal, cause disability in the population." The expansion of health insurance and other plans for medical care, and the present resurgence of interest in scientific studies of the incidence of disabling disease in industrial populations, combine to give point and urgency to the need for internationally agreed standards of disease classification. But this taxonomic problem has agitated the minds of vital statists at least since the 18th century, when SAUVAGES made the first attempt at the systematic classification of disease. When FARR took u phis post at the General Register Office in 1837 he found that the classification in most general use was one by WILLIAM CULLEN, of Edinburgh, published in 1785 under the title Synopsis Nosologice Methodicce. His dissatisfaction with this method led him to evolve a new classification. The general arrangement included the principle of classifying diseases by anatomical site, which has survived as the basis of the present International List of Causes of Death. This work was carried "
by BERTILLON, who was the guiding force behind the 1900, 1910, and 1920 revisions of the list. The need to classify the voluminous records of patients in both Service and civilian hospitals during the war led to the development on both sides of the Atlantic of groupings of diseases causing sickness as well as death. Over here, for example, Dr. PERCY STOCKS and Dr. A. H. T. ROBB-SMITH produced for the Medical Research Council a provisional classification based on the International List of Causes of Death. Meanwhile in America a committee under the chairmanship of Dr. LOWELL REED worked for a compromise between this initial attempt and the various methods in vogue in the United States in 1945. Their proposals were put to the test of practice in various hospitals and government departments, and the results of this experience have been embodied in a final revised draft which formed the basis for discussion in the recent conference. In these proposals the broad framework of the international list has survived ; the main classification has categories for diseases caused by well-defined infective agents, and for neoplastic, allergic, endocrine, metabolic, and nutritional disorders. The remaining diseases are classified according to their principal anatomical site, but there are special sections for mental disorders, complications of pregnancy and childbirth, and certain diseases of infancy and old age. The special problem of injuries has been dealt. with by dividing them either by their external cause or by their anatomical result. In general, the administrative needs of punched-card methods of handling such data are to be served by a three-figure code number for each disease. The first two figures define the broad group to which the particular illness belongs ; the third figure indicates the appropriate subdivision of that major group. Thus pernicious anaemia would be coded. 290, the " 29 " indicating that the disease was one of the blood or blood-forming organs, while the" 0 " differentiates it from, for example, haemophilia, to which the code figure " 5 ? has been allocated. This numbering system results in flexibility and utility, since the first two figures indicate broad groups, while within these broad groups the use of the third digit allows new categories to be introduced without upsetting the basic numbering. Where finer divisions are required a fourth digit can of course be used. The advantages of such a system to hospital or government statisticians are clear, and it is gratifying that the Paris conference, which was opened by Monsieur BIDAULT, the French foreign minister, and presided over by the distinguished permanent secretary ofthe Academy of Medicine, Professor BAUDOUIN, reached complete agreement This ensures that the statistics on the draft proposals. of both mortality and morbidity produced in all the countries bound by this agreement will be comparable, and draft regulations will be submitted, with the new list, to the World Health Assembly meeting at Geneva in June. By combining hard preparatory work with a disposition towards reasonable compromise in negotiation, the United Kingdom delegation, led by Mr. GEORGE NORTH, LL.D., the Registrar-General, played a notable part in securing the success of this important conference. on