COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX641 47720 RC96 .Un37 Relation of physicia RECAP United States £en$w$ Office RELATION OF PHYSICIANS TO MORTALITY STATISTICS *3> THE INTERNATIONAL CLASSI- FICATION OF CAUSES OF DEATH AS ADOPTED BY THE UNITED STATES CENSUS OFFICE AND APPx What disease caused death? What caused the lack of vitality? Obstruction of what ? Name organ affected. This is not a satisfactory return. The influence of age is shown by the statement of age. in years, months, and days. To this the statement of "old age" as a cause of death adds nothing of value. Name the disease to which the old person succumbed. Name the disease or injury requiring the operation. See "Surgical operation." Name disease causing death. Give cause of paralysis, if known, or state definite form, as paralysis agitans, infantile paralysis, etc. Did the pa- ralysis follow cerebral hemorrhage? Did it follow some acute disease? Give the primary cause. 22 Indefinite terms used in reporting deaths. Further information required for proper classification. Paralysis of heart. Pelvic abscess. Pelvic peritonitis. Perforation of bowels. Perimetritis. Peritonitis. Pernicious anemia. Phlebitis. Pneumonia. Poisoning. Pregnancy. Progressive asthenia. Prostration . Pulmonary hemorrhage. Pyemia. Rash . Rheumatism. Rubeola. Riipture. Sarcoma. Scarlet rash. Sclerosis. Scrofula. Senectus. Senile anasarca. Senile asthenia. Senile atrophy. Senile decay. Senile decline, This is usually a mere synonym of "Heart failure" and should never be used nor accepted. See " Heart failure." What was the cause? Was it puerperal? What was the cause? Was it puerperal? See "Intestinal perforation." What was the cause? Was it puerperal? What was the cause of the peritonitis? "Idiopathic peri- tonitis" should be rarely returned. Was it puerperal or traumatic? In the latter case, state mode of injury. If any definite cause can be assigned for the anemia, it should be reported. Anemia due to tuberculosis, syphilis, etc., should be returned under the primary disease. What was the cause? Was it puerperal? Specify definitely whether bronchopneumonia or lobar pneu- monia. If sequel to influenza, state that fact. Name poison, and whether accidental, suicidal, or homicidal. Autointoxication should not be returned in this form, but the disease causing the condition should be named. State cause of death more specifically. Was it due to abortion or miscarriage, nephritis, etc. ? • 4 What was the disease causing the condition ? See "Asthenia." What disease caused the prostration ? See ' ' Debility. " Was it not due to pulmonary tuberculosis ? What caused the pyemia? Was it puerperal or traumatic? If traumatic, state nature of accident causing injury. What was the disease attended by rash ? This is a suspicious return and may indicate scarlet fever, measles, etc. Always state whether acute or chronic. If chronic rheuma- tism, note any organic disease of heart or other organs resulting therefrom. Was this measles or German measles (rotheln) ? Rupture of what ? If hernia is meant, it would be better so written, as "rupture" alone may be misinterpreted. Of what organ or part of the body? Was this scarlet fever? Sclerosis of what organ ? If cancer (scirrhus) is meant, state that fact definitely. A term now fortunately going out of use. State definitely the form of tuberculosis. See "Old age." See " Old age" and " Dropsy." Neither term is satisfactory. Give disease causing death*. See ' ' Old age ' ' and ' ' Asthenia. " Give disease causing death. See " Old age " and " Atrophy." State disease causing death. See " Old age." State disease causing death. See " Old age." Name the disease, if any, that caused the decline. 23 Indefinite terras used in reporting deaths. Further information required for proper classification. Senile degeneration. Senile dementia. Senile disease. Senile exhaustion. Senile marasmus. Senility. Sepsis. Septicemia. Septic infection. Septic poisoning. Shock. Shot. Simple atrophy. Sloughing. Sore throat. Specific disease. Specific infection. Spinal trouble. Stillborn. Stomach trouble. Stoppage. Strangulation. Stricture. Stroke. Stupor. Sudden. Suffocation. See "Old age." Degeneration of what organ? State dis- ease causing death. See "Old age." What was the disease? See " Old age." See "Old age" and "Exhaustion." Name disease causing death. See "Old age "and "Marasmus." Name disease causing death. See " Old age." Name disease causing death. What caused the "septicemia"? Was it puerperal, trau- matic, or did it occur in the course of some disease? Specify fully. What caused the shock? If from injury, state nature of accident. If from surgical operation, state disease or injury requiring the operation. How? Accidental, suicidal, or homicidal? See " Atrophy." Explain fully, stating disease or injury. Was it not diphtheria? Such a return in a fatal case is ex- tremely suspicious, and a definite statement should be insisted upon by registrars. Name the disease. Name the disease. Was this a disease of the spinal cord or of the spine, and, in either case, what was the disease? Was it Pott's dis- ease of the spine? Never report a child as stillborn unless dead at birth. If the child survived any time whatever, the cause of death should be stated. Was it cancer, round ulcer, or other definite disease of the stomach? State fully as this, alone, is very indefinite and unsatisfactory. Stoppage of what? Explain fully and name disease causing death. Was this strangulation from disease (diphtheria) , choking, or hanging? If from disease, state fully. If from hanging, state whether suicidal or legal execution. Stricture of what ? Was it of intestines, esophagus, urethra ? Was this a "stroke of apoplexy" due to cerebral hemor- rhage? What was the cause of the stupor, disease,, or injury? State fully. See also " Coma. ' ' What disease caused the sudden death? If from violence, state means and whether accidental. State very precisely the cause of the suffocation, as this term, returned alone, is very indefinite. See " Asphyxia." 24 Indefinite terms used in reporting deaths. Further information required for proper classification. Suicide. Surgical operation. Surgical shock. Syncope. Teething. Tonsilitis. Toxemia. Tuberculosis. Tumor. Typhoid condition. Typhoid pneumonia. Typho-malarial fever. Typhus. Ulcer. l T remia. Uremic poisoning. A^iolence. Vital degeneration. "Want of vitality. Wasting. Weak heart. Weakness. Wounds. State means of death employed. Always state the disease or injury requiring operation. Un- less the operation was improper orunskillfully performed, it should not be given as the primary cause of death. What caused the syncope? Was death due to organic heart disease? Give disease causing death. Name the disease affecting the teething child. See " Denti- tion." Was death not due to diphtheria? This is a suspicious return. Was this acute or chronic poisoning due to some external agent ? If so, state fully, giving name of poison, whether accidental, etc. Was it autointoxication, due to poisons generated in the body by disease ? If so, state the name of the disease causing the condition which resulted in death. Avoid use of easily misunderstood terms of this character. State organ affected. Do not fail to state as pulmonary tuberculosis if lungs were affected. Was it a cancer? Whether a cancer or tumor, do not fail to specify organ or part of body affected. Avoid this term as it is likely to be mistaken for typhoid fever. Was the primary disease typhoid fever or pneumonia? Was it typhoid fever? Was it malarial fever? A mixture of these diseases rarely occurs, the great majority of cases of so-called " typho-malarial fever " being nothing more nor less than typhoid fever. Was this not typhoid fever? State location and cause. State cause of uremia. If due to an acute disease, the latter should be named as the cause of death. If in Bright's or other organic disease, state fully. Was it puerperal? State form of violence and whether accidental, suicidal, or homicidal. Worthless. State disease causing death. See "Lack of vitality." What was the disease causing : ' wasting " ? See "Atrophy." If orgaric heart disease, so state it. Give the disease caus- ing death. This return may be equivalent to "Heart failure," which see. Name disease causing weakness. See " Deb ility . " What was the cause of the injury, and was it accidental or homicidal? A copy of the list of indefinite returns given above will be sent to every local registrar in the United States with the suggestion that no certificates containing only these or similar terms be accepted, and no burial permit be issued, until the cause of death 25 is accurately specified, in accordance xoith the explanatory notes, or a satisfactory explanation made. It is not to be expected that an entirely definite and accurate statement of the cause of death can be made in every case. There will undoubtedly be cases in which the exact cause can not be ascertained and others in which an accurate diagnosis is impossi- ble, but an observance of the suggestions made in this circular will very largely reduce the number of deaths that must neces- sarily be classed as unknown or ill-defined. COMPLETE RETURNS. THE STANDARD CERTIFICATE OF DEATH. "What has been said above relates wholly to the statement of the cause of death, which is always furnished by the physician. But while this is the most important item, a complete return of any death requires the statement of other personal and statistical par- ticulars concerning the 'death, and the blank certificate or return used for reporting deaths is simply a specification, in convenient form, of the legal requirements in the case, all of which are intended to be observed. The relation to and influence upon the mortality from different diseases, of age, sex, color, conjugal condition, nativity, parent nativity, and occupation, are of the utmost importance, and the preparation of uniform statistics for all registration states and cities requires that these items, and others necessary for record, shall be given just as fully and as accurately as the cause of death. It is, therefore, very desirable that the forms of certificates used shall, as far as possible, be identical in substance. To promote uniformity. in this direction, the "Standard Certifi- cate of Death" (copies inclosed) has been prepared, in conjunction with the Committee on Demography and Statistics of the American Public Health Association, and has been approved by resolution of the Association. This form of certificate has been adopted by the states of Colorado, Illinois, Indiana, Michigan, New York, and Vermont, and will be adopted by other states and cities as soon' as the change can conveniently be made. In some of the states and cities the law requires the physician bo supply all of the information called for by the form of certificate used, and attention is therefore directed to the "Standard Certifi- 3ate" as indicating the detailed information generally required. So far as the form in local use corresponds to the Standard Cer- tificate, the facts should be stated as called for in the latter. 26 Particular attention is directed, to the items relating to conjugal condition, birthplace, birthplace of father and mother, and occu- pation, as these are the items most frequently omitted in the returns. They all constitute principal factors in some of the statis- tical tables, and should be supplied in every instance if they can possibly be ascertained. Age should be stated exactly, not in "round numbers." Widowed or divorced persons should not be reported as "mar- ried" or "single." Birthplace of. person, of father, and of mother are very important. Occupation should always be reported for any person who has any remunerative employment — women as well as men — and in reporting occupation particular care should be taken to express it in such a way that it will not be confounded with other occupations. Civil, mechanical, and mining engineers should be distinguished from locomotive engineers, and locomotive engineers and firemen from those of stationary engines. Commercial travelers or salesmen should be distinguished from clerks or salesmen in stores. Miners should be distinguished as coal, iron, lead, etc. Mill and factory operatives should be distinguished according to the product of the mill, as woolen, cotton, silk, carpet, etc. Agricultural laborers, railroad laborers, and ordinary day labor- ers should be distinguished from each other. Married women, female heads of families, and girls who are employed only in their own homes should not be reported as "housekeepers," "housewives," or "housework." This circular is one of a series designed to secure uniformity in the return, classification, tabulation, and presentation of mortality statistics, which should be of greater importance and value to physicians than to any other class, as contributing to the advance- ment of medical science; and the basis of the statistics is the returns made by the physicians themselves. W. A. King, Chief Statistician Approved : for Vital Statistics. Wm. R. Merriam, Director. & COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special arrange- ment with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE SfP6 im SB '•Aft OQfo ,OCf) A dfip 8 B 95 5fp 3p /yy$> ■-* i MM 1 ft V J96 Jul ao* • C28(ll4l)M100 COLUMBIA UNIVERSITY LIBRARIES "6037569945 RC96 U.S. Bureau -of- the census. Un57