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involved in each case. At the same time, we will examine some associated problems drawn from the list's history. |
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One value of a list like the ICD is that it can be used in transnational comparisons, especially where there are radical local differences in belief, practice, and knowledge representation. This is necessary for epidemiology in that one may trace specific environmental and nutritional factors involved in particular diseases, track epidemics, and impose quarantines. |
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These advantages can only be fully exploited if the various suborganizations agree on how to collect and code information. A continuing problem has been that different countries have sent their information in to the central collection agency more or less promptly (a problem finding its parallel with the reports sent to central office by subsidiaries). During the 1920s, France and Portugal were notably slack. And once the information comes in, it is often of variable qualitycountries with large rural populations find it difficult to give the same sophisticated medical treatment of each case as do heavily urbanized, western countries (Réunion de Conseil 1923). At one stage in the USSR, no attempt was made to compute causes of death in places with less than 10,000 inhabitants (CH/experts stat/78). |
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Different states have different bureaucratic structures. In the nineteenth century, for example, the statistical system was run by a central service for the whole country in Italy but was broken down by province in France (Bertillon, 1887). The regulations regarding the use of death certificates have made an appreciable difference to the type of results the ICD achieved. Thus in Germany during the 1920s there was no separation between the civil statement of the cause of death and the cause of death issued for statistical purposes. In Switzerland, the statistical cause of death was confidential, making it much easier for doctors to cite causes that might distress relatives (and upset insurance companies). When Holland switched over to the confidential system in 1927: ''There was a considerable increase in Amsterdam of cases of death from syphilis, tabes, dementia paralytics, aneurysm, carcinoma, diabetes, diseases of the prostate, and suicide, while deaths from benignant tumors and the secondary diseases such as encephalitis, sepsis, peritonitis, and so forth showed a falling-off" (League of Nations 1938, 10). More recently, a similar artifact was reported as a result of physician terminology preference in ICD-9 on coronary heart disease |
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