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Here is a quotation from the official cite of the International Classification of Diseases /ICD/, 10th revision from 1993:

"The history of the systematic statistical classification of diseases dates back to the 19th century. Groundwork was done by early medical statisticians William Farr (1807-1883) and Jacques Bertillon (1851-1922). The French government invoked the first International Conference for the revision of the Bertillon or International Classification of Causes of Death in August 1900. The next conference was held in 1909, and the French government called succeeding conferences in 1920, 1929 and 1938.

The International Health Conference held in New York City in 1946 entrusted the Interim Commission of the World Health Organization with the responsibility of preparing a sixth revision of the International Lists of Diseases and Causes of Death. An Expert Committee of the WHO prepared the revision which was approved by the International Conference for the Sixth Revision of the International Lists of Diseases and Causes of Death, as well as, by the first World Health Assembly in 1948. The Sixth Revision extended the scope of the classification to non-fatal diseases, and WHO has continued to be responsible for periodic revisions of the classification ..."

We shall adopt for the purposes of this review, subsequently, an undetached manner with which to comment on the state of "Nomenclature of Diseases and Causes of Death" in the Republic of Bulgaria, formerly the Kingdom of Bulgaria (abolished in year 1947). The materials are scanty, yet we managed to find separate publications issued by the Directorate of Statistics, MVRNZ /i.e., Ministry of Interior & Public Health with transliteration from bulgarian/. The document follows accordingly to the 5th revision of the ICD from 1938, and published with minor adaptations as "Nomenclature ..." in the State Gazette - viz., № 195 from 4 September 1941.

This tiny brochure is an important document for the Bulgarian medical science and health care administration, in particular. However, I haven't seen any references pertaining to an International Classification of Diseases and coming from the early period between the two World Wars. Such is the case with Bulgaria, which, although in the periphery of Europe and still have played important role in the first half of the 20th century as a strategic partner of Germany in the region. With respect to the League of Nations and its Health Committee, subsequently Bulgarians were a member state in ratifying the Covenant of the League /i.e., although from the defeated side, unfortunately/.

So far, we have scattered evidence for cooperation in the field of "Health Statistics" from that period and strictly speaking this was a job performed by the International Statistical Institute /ISI/ with participatory attendance of several other international agencies, mainly under the guidance of France. We are not going to deal with the topic right now, while obviously it is of great importance and on an international agenda. It is interesting to follow the line of thought from that time and this is evident from the following excerpt, drawn from a document from the "Information Section of the Health Committee. Geneva: League of Nations, 1931",

"When it came to collect and publish morbidity and mortality statistics, the Geneva Epidemiological Intelligence Service realized that, for purposes of comparison, it was necessary to standardize the methods by which they were compiled, and in February 1924, the Health Committee set up several committees of specialists.

Amongst the points on which these committees have succeeded in obtaining the standardization of statistics is that of still-births. A large number of Governments have now adopted the same definition of the term “still-birth” and some common rules for the compilation of statistics relating to still-births. This agreement makes it possible to compare the figures furnished by those countries on the birth rate, fertility and infant mortality; the rates are now calculated in relation to the number of live births and not to the number of total births.

Another committee has drawn up rules for the uniform determination of the cause of death in cases of several concomitant diseases. An example of the absence of rules is the fact that deaths from tuberculosis following on whooping-cough were formerly included by one country in the tuberculosis statistics, and in another in the deaths from whooping-cough.

To promote the standardization of statistical methods, the Health Committee convened in 1923, 1924 and 1925 meetings of the directors of the demographic services in the principal European countries. In study tours through Switzerland, France, the Netherlands and the three Scandinavian countries, these specialists were able to see for themselves the advantage of certain methods employed and, where necessary or useful, to improve the system in force in their own countries. At the 1925 meeting, they agreed to draw up a number of common rules relating to the registration of the causes of death, and laid special emphasis on the necessity for keeping the particulars entered in the civil register quite separate from the medical data given in the death certificates — thus safeguarding professional secrecy, which is essential if the certificates are to be reliable.

In conjunction with the International Statistical Institute, this Committee of Experts played an important part in preparing for the decennial revision of the International List of Causes of Death (1929).

The standardization of statistics can sometimes be effected merely by agreement between the specialists in the various countries as to the definition of certain terms, but considerable difficulties are frequently encountered in practice owing to the changes in legislation and custom which this would involve. It must also be remembered that progress in the direction of standardization is of recent growth and that the principal material at the disposal of investigators consists of documents compiled during the last fifty years according to rules which vary widely in different countries. To enable specialists to employ with a minimum of error old tables published abroad, the Committee of Experts has prepared manuals giving for each country the guiding principles followed in collecting and presenting demographic data; this has made it possible to interpret correctly the statistics of some twenty countries without the necessity for lengthy research in libraries.

The remaining field of activity of the Committee of Expert Statisticians is morbidity statistics. It devoted its attention to the question of the notification of contagious diseases, and in 1922 it organized a study tour; the problem was re-considered later from a different standpoint, when an attempt was made to draw up a list of diseases in relation to the special needs of social insurance. As the lists of causes of death are obviously inadequate for the classification of the numerous and frequently benign causes of incapacity for work, the principal social insurance institutions use empirical lists which in many cases have no proper medical basis and are not of any great value. Considerable information has been collected by the Committee, and it may be possible to draw up a list which will give satisfaction both to insurance and public health services ..."

The whole document is available on-line from the site of WHO. Considering the importance of the topic, we preclude right here. In the next issues of the bulletin and we are going to expand our narrative with the further revisions of the ICD, which goes right to its latest edition in 1993 /10th revision of ICD/.


Addendum: To complete the picture of mortality statistics in this country and we present a bridge-table, that is compiled according to the Almanac of the Kingdom Bulgaria /1941/. The data is adapted with the "Nomenclature ..." from year 1941, which gives causes of death in 18 principal groups and comprising 200 nosological entries.

Table 1: Bridge-table on causes of death, according the 5th revision of the ICD from 1938, rates per 1000 deaths.

Diseases and Causes of Death








1. Infectious and Parasitic Diseases ~ # 1 to 45 189.8 184.4 187.3
2. Cancer and Neoplasm ~ # 45 to 57 55.5 63.2 59.0
3. Rheumatic Diseases, Endocrinology and Nutrition ~ # 58 to 71 10.1 12.1 11.1
4. Hematological Diseases ~ # 72 to 76 3.3 3.0 3.5
5. Chronic Poisoning and Intoxications ~ # 77 to 79 2.3 0.1 1.3
6. Neurological and Sensory Diseases ~ # 80 to 89  94.8 105.0 99.4
7. Circulation Diseases ~ # 90 to 103 138.5 149.4 143.5
8. Respiratory Diseases ~ # 104 to 114 149.0 135.6 142.8
9. Gastrointestinal Diseases ~ # 115 to 129 105.5 91.5 99.1
10. Genital and Urinary Diseases ~ # 130 to 139 27.4 23.6 25.6
11. Obstetrics and Gynecological Diseases ~ # 140 to 150 - 17.9 8.3
12. Dermatological Diseases ~ # 151 to 153 3.7 3.1 3.4
13. Bone and Motility Diseases ~ # 154 to 156  1.1 0.6 0.9
14. Inborn Malformations, without Still-Births ~ # 157 3.0 3.1 3.0
15. Pediatric Diseases and Trauma ~ # 158 to 161 72.1 65.8 69.2
16. Geriatric Diseases ~ # 162 56.2 90.0 71.9
17. Accidents and Violence Deaths ~ # 163 to 198 59.0 23.6 42.7
18. Undefined or Ill-Defined Causes of Death ~ # 199 to 200 28.7 28.0 28.4


Second Addendum: We have tried to supplement our brief report on ICD, subsequently, with as much actual information as possible. This is a difficult task insofar as, firstly, there is much unclassified material on the topic and secondly, there are constant revisions. For instance, as of year 2004 and there has appeared a new form of WHO collaboration - viz., the WHO Family of International Classifications /WHO-FIC/, which is more than a single oriented approach towards International Classification of Diseases /ICD/. Here are some links,



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