No. 630] 



IIUMA.X MORTALITY IiATKS 



ification, " Diseases of the circulatory system." The 

 other items of Table I require some special explanation. 



No. 7, "Scarlet fever," appears in the International 

 Classification under "General diseases." It is placed 

 here in the organological classification because in the 

 vast majority of cases of fatal scarlet fever it is the clin- 

 ical form of the disease known as septic scarlatina which 

 is responsible for the death. Spengarn 7 says that "sep- 

 tic scarlatine is responsible for most of the deaths." 

 "The general condition is one of septicemia." It, there- 

 fore, seems best, on the present plan of biological classi- 

 fication, to put scarlet fever with the circulatory system, 

 blood and blood-forming organs, since septicemia is the 

 result of a breakdown and failure to function of the 

 normal defensive serologic mechanism of the body. 



The item 150 in the International Classification is en- 

 titled "Congenital malformations," and there includes 

 the following three subdivisions: Hydrocephalus, con- 

 genital malformations of the heart, and other congenital 

 malformations. The second of these subdivisions, "con- 

 genital malformations of the heart," obviously belongs 

 here, and is consequently included, while the other sub- 

 divisions do not. 



Item 20, "Purulent infection and septicemia," is taken 

 from "General Diseases" and put here on the same rea- 

 soning as that just stated for scarlet fever. 



Item 142, "Gangrene," is placed here because nor- 

 mally in civilian life, under the conditions which pre- 

 vailed when these statistics were taken, most fatal gan- 

 grene is due to impairment of the circulation as a primary 

 cause. The arteries become occluded either from end- 

 arterial inflammation, due either to frank infection, or to 

 various somewhat obscure causes producing local obliter- 

 ative arteriosclerosis, or to trauma, or to thrombosis or 

 embolism, especially in association with cardiac disease. 

 Again some cases of gangrene, in the sense under con- 



7 Spengarn, A., article "Scarlatine," in Ref. Handbook Med. Sci., Vol. 

 VII. p. 658, 1916. 



