I

Ilnnual report of

v THE UNITED STATES

v NATIONAL COMMITTEE

v ON VITAL AND

v HEAL TH STATISTICS

v Fiscal Year 1961

Reproduced and distributed for the Committee by the

NATIONAL CENTER FOR HEALTH STATISTICS

IU.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service

The United States National Committee on Vital andHealth Statistics, created in 1949 at the recommendation ofthe First World Health Assembly, includes among itsobjectives the following:

(a)

(b)

(c)

(d)

(e)

(f)

To delineate statistical problems of public healthimportance which are of national or internationalinterest.To promote studies of such problems by other organi-zations and agencies whenever ~ssible, and to makeinvestigations of such problems through subcommitteesappointed for the purpose.To review the findings submitted by other organizations,agencies, and the Committee’s subcommittees, and tomake recommendations for national and/or internationaladoption.To cooperate with other committees or organtiationsconcerned with public health statistics in the UnitedStates in an effort to serve as a clearinghouse foractivities dealing with public health statistics problems.To serve as a link between the organizations in theUnited States engaged in public health statistics and thestatistical secretariat of the World Health Organi-zation and other international agencies concerned withpublic health statistics.To cooperate with national committees of other countriesin the study of problems of mutual interest.

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MEMBERS OF THE UNITED STATES NATIONALCOMMITTEE ON VITAL AND HEALTH STATISTICS

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P. K. Whelpton, Director, Scripps Foundation for Research

I.

in Poptiation Problems, Miami University,. Oxford; Ohio(Chairman)

..:M. Morivarna. Ph. D.. Chief, O.ffiCeof Health “StatisticsAnalysis; National Center for Health Statistics, PublicHealth Service, Department of Health, Education, andWelfare, Washington, D.C. (Secretary)

Odin W. Anderson, Ph. D., Research Director, Health In-formation Foundation, New York, N.Y.

Harold F. Dorn, Ph. D., Chief, Biometrics Research Branch,National Heart Institute, Public Health Service, De-partment of Health, Education, and Welfare, Bethesda, Md.

C. Horace Hamilton, Ph. D., Professor of Rural Sociology,North Carolina State College, Raleigh, N.C.

Albert E. Heustis, M.D., Commissioner, Michigan De-partment of Health, Lansing, Mich.

John P. Hubbard, M.D., Professor of Preventive Medicine,University of Pennsylvania School of Medicine, Phila-delphia, Pa.

Forrest E. Linder, Ph. D., Director, National Center forHealth Statistics, Public Health Service, Department of -Health, Education, and Welfare, Washington, D.C.

111:

Brian MacMahon, M.D., Professor Department of Epide-miology, Harvard UniversityBoston, Mass.

Edward R. Schlesinger, M.D.,Special Health Services, NewHealth, Albany, N.Y.

Margaret Shackelford, Director,Oklahoma State Department ofOkla.

School of Public Health,

Asst. Commissioner forYork State Department of

Division of Statistics,Health, Oklahoma City,

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flctivitics duringFISCAL YEAR 1961

The U.S. National Committee on Vital and Health Sta-tistics 1 devoted, for the third year, a major part of its pro-gram to the preparation of technical revision proposals forthe Eighth Revision of the International Classification ofDiseases. The Subcommittee on Classification of Causes ofPerinatal Morbidity and Mortality culminated its a~tivitiesover the past 4 years by submitting a final draft of aproposal for the classification of diseases peculiar to theperinatal and early infancy periods. The Subcommittee onClassification of Cardiovascular Diseases entered into thefinal phases of its activities after testing and reviewingrevision proposals developed in collaboration with rep-resentatives of the United Kingdom. Significant progresswas made during -the year in developing a classification of

external causes of accidents and other violence and of mentaldiseases., Also during the year, the U.S. National Committeeon Vital and Health Statistics authorized the establishmentof a subcommittee on the classification of congenitalmalformations. This subcommittee will be expected to take/into account the fast developing interests of geneticistsin problems of congenital malformations.

Entrusting the preparation of revision proposals onvarious sections of the International Classification of Dis-eases to independent technical groups working concurrentlyhas given rise to certain problems of coordination. These

lFor review of activities over the past decade, see Annual

IReport for Fiscal Year 1960.

1

problems were dealt with on a current basis bythe See-retariat and by an over-all subcommittee on the Inter-national Classification Revision established for that pur-pose.

Arrangements were made with the corresponding sub-committees of the Medical Advisory Committee of the Reg-istrar General to collaborate on revision proposals oncardiovascdar diseases and on mental diseases. It isanticipated that there will be at least one joint UnitedKingdom-United States proposal to be submitted for theconsideration of the Subcommittee on Classification ofDiseases of the World Health Organization (WHO) ExpertCommittee on Health Statistics scheduled to meet inNovember 1961. The WHO revision pro~sals will be circu-lated to countries for review, and further modificationswill be made on the basis of the comments received. Thepresent revision timetable should provide maximum oppor-tunity for national participation in preparation for theEighth Revision Conference to be held in 1965.

In addition to the activities on the classification ofdiseases, the U.S. National Committee has long been con-cerned with the problems of classifying physical im-pairments. The classification initiated by the Subcommitteeon Physical Impairments has been further developed by asubcommittee of the Association for the Aid to CrippledChildren. This system for coding impairments has beentested by selected agencies in various cities of the UnitedStates. The test results have been evaluated, and publicationof a proposed classification by the Association for the Aidto Crippled Children is expected sometime during the nextfiscal year for broader field tests.

During fiscal year 1961, the Subcommittee on NationalDivorce Statistics completed its deliberation on ways andmeans of developing national statistics on divorces. Also

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during the year, the National Committee indicated itsinterest in a new area by constituting a Subcommittee onHealth Economics. This Subcommittee will explore theneed for developing statistics on the uses of, and expendi-tures for, medical care and health services and will outlinethe needs for such data.

Classification of Causes of Perinatal Morbidity and Mortality

Extensive tests were made in fiscal year 1959 on theapplication of the draft classification to diagnostic in-formation reported on fetal death certificates and deathcertificates for infants in the neonatal period. During thepast fiscal year, further tests were made utilizing morbiditydata from the clinical records of six hospitals in severalareas. On the basis of the test results, the draft classifi-cation was again revised. The draft proposal was then cir-culated for comments to health agencies, schools of medi-cine and public health, and professional organizations andindividuals concerned with problems of perinatal morbidityand mortality. The comments received were studied bythe Subcommittee; further changes were made in theproposed classification; and a final proposal was preparedfor submission to the U.S. National Committee on Vital andHealth Statistics with the recommendation that the revisionproposed be adopted.

In the original assignment, the Subcommittee’ was toconsider also the classification of congenital anomalies andmalformations. The Subcommittee recommended that an-other group be constituted which would be better able toundertake the study of a congenital malformation clas-sification from the standpoint of genetic and other interests.

The Subcommittee also discussed the problem of theseveral definitions of ‘‘perinatal” now in use and recom-

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mended the adoption of the definition of the Committee onMaternal and Child Care of the American Medical Associa-tion for use in computing perinatal rates by vital statisticsoffices.

Classification of Cardiovascular Diseases

An outcome of a joint meeting with the representativesof the United Kingdom Subcommittee on CardiovascularDisease Classification in June 1960 was agreement on asingle classification from the several that had been pro-posed. This draft classification came under study, andfurther modifications were suggested to the British Sub-committee.,

The joint proposal of the United Kingdom-United S@tesSubcommittees was circulated for review to agencies,organizations, and individuals in the United States interestedin the cardiovasctiar disease classification. Responses tothis circularization have been received, and the commentswill be reviewed to determine what further revisions areneeded in the draft classification.

Classification of Mental Disorders

The Subcommittee had been confronted with the difficultproblem of reconciling the basic concepts underlying theclassification of the American Psychiatric Association withthose held by psychiatrists in other countries. As a resultof informal discussions with the Nomenclature Committeeof the American Psychiatric Association, it has beenpossible for the Subcommittee to begin the development ofa classification of mental disorders which has the ~ssibi-lity of acceptance internationally. A first draft of a clas-sification was completed, and an informal exchange of

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views is now being. conducted with the United KingdomSubcommittee on the basis of this draft classification.

Classification of Accidents, Poisonings, and Violence (Ex-ternal Causes)

A draft classification of the external cause of injury

was prepared. This draft takes into consideration manyneeds of accident prevention programs and provides greaterspecificity regarding the circumstances of the accident,place of accident, and, in certain cases, the activity ofthe injured. Definitions and inclusion and exclusion notesare being prepared for a thorough test of the classificationon morbidity and mortality data. ,,

Quantification of Wellness

After exploring the possibilities of developing sta-tistics on “fellness, ” the Subcommittee concluded that itwas not feasible for optimum progress to be made bycontinuing to pursue this project on a theoretical and abstract

basis. Suggestions were made for empirical field researchwhich might provide answers to some of the questionsraised by the Subcommittee or bring out directional indi-cators which would ultimately lead to such answers.

Fertility and Population Statistics

The Subcommittee considered the needs for a quin-quennial popdation census and prepared a report outliningthe health need for a periodic census taken more than oncea decade. The Subcommittee recommended support forthe proposed quinquennial census of population providedthat the detail data obtained in the decennial censuses arenot affected.

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National Divorce Statistics I

Work was started on the preparation of the final reportincluding recommendations on ways and means of makingpossible tlie central collection of divorce data in each Stateas a step toward developing national statistics on divorces.The Subcommittee report will be based on several surveysthat had ken made to determine the various needs fordivorce statistics and to ascertain the cost of maintainingcentral files of divorce records. The advantages of a systemof central collection of divorce records are not purelystatistical. It will be a matter of great convenience andeconomy to individuals and agencies in securing documentaryevidence of a divorce decree and the time and terms of thedivorce for legal and administrative proceedings.

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S~COMMITTEES AND AD HOC COMMITTEESOF THE UNITED STATES NATIONAL COMMITTEE

ON VITAL AND HEALTH STATISTICS

Fiscal Year Ending June 30, 1961

Militavy Health Statistics

Appointed - September 1949Assignment - To work on the problems of national -and

international importance referred to or un-dertaken by the U.S. National Committee onVital and Health Statistics in which the ArmedForces are expected to have an interest or areable to make contributions.

Members - Eugene L. Hamilton, Chief, Medical StatisticsDivision, Office of the Surgeon General, De-partment of the Army, Washington, D.C.(ChaiFrnanj\

sH. M. C. Luykx, Sc. D., Chief, BiometricsDivision, Office of the Su~geon General, De-partment of the Air Force, Washington, D.C.

W. V. Charter, D. P. H., Bureau of Medicineand Surgery, Department of the Navy, Wash-ington, D.C.

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Fertility and Po@lation Statistics

1Appointed - December 1949Assignment - To outline types of statistics (special and gen-

eral) needed to study various aspects of fer-tility in the United States; to recommend stud-ies of how to obtain these statistics; and tooutline the kinds of population statistics neededfor health study purposes; to study the kindsand methods of providing more detailed birthdata on a current basis than is at presentavailable.

Members - P. K. Whelpton, Director, Scripps Foundationfor Research in Popdation Problems, MiamiUniversity, Oxford, Ohio. (Chairman)..

Harold F. Dorn, Ph. D., Chief, BiometricsResearch Branch, NationaI Heart Institute,Public Health Service, @partment of Health,Education, and Welfare, Bethesda, Md.

Wilson H. Grabill, Chief, Fertility StatisticsSection, Bureau of the Census, Department ofCommerce, Washington, D.C.

Pad C. Glick, Ph. D., Chief, Social StatisticsBranch; Population Division, Bureau of theCensus, Department of Commerce, Wash-ington, D.C.

Robert D. Grove, Ph. D., Assistant Chief,National Vital Statistics Division, NationalCenter for Health Statistics, Public HealthService, Department of Health, Education, and

8 Welfare, Washington, D.C.

Joseph Schachter, Chief, Natality StatisticsBranch, National Vital Statistics Division,National Center for Health Statistics, PublicHealth Service, Department of Health, Edu-

cation, and Welfare, Washington, D.C.

Classification of Physical Impairments

Appointed -Assignment -

Members -

February 1951To determine current practices in codingphysical impairments and the type of classi-

fication needed for statistical studies of datafrom hospitals, clinics, disability plans, andpublic health programs.

Eugene L. Hamilton, Chief, Medical StatisticsDivision, Office of the Surgeon General, De-partment of the Army, Washington, D..C.(Chairman)

Louise E. Bono, Nosologist, National HealthSurvey Division, National Center for HealthStatistics, Public Health Service, Departmentof Health, Education, and Welfare, Washington,D.C.

Henry H. Kessler, M. D., Newark, N.J.

Aaron Krute, Bureau of Old Age and SurvivorsInsurance, Social Security Administration,Department of Health, Education, and Welfare,Baltimore, Md.

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Marjorie E. Moore, Ph. D., Chief, DivisionofResearch and Special Studies, Office of Voca-tional Rehabilitation, Department of Health,Education, and Welfare, Washington, D.C.

Maya Rivi~re, Ph. D., Project Associate, As-sociation for the Aid of Crippled Children,New York, N. Y.

Barkev S. Sanders, Ph. D., Chief, CommunityResearch in Public Health Practice, PublicHealth Service, Department of Health, Edu-cation, and Welfare, Washington, D.C.

Classification of Causes of Perinutal Movbidity andMortality

Appointed - June 1956Assignment - To recommend a method of classif ying causes

of fetal death as reported on vital and hospitalrecords; to review existing classifications ofcauses of fetal death and causes of neonataldeati, to develop a satisfactory classificationafter studying the interrelationships of exist-ing classifications; and to determine the needfor a nomenclature to use in reporting fetaldeaths.

Members - Abraham M. Lilienfeld, M. D., Division ofChronic Diseases, Johns Hopkins School ofHygiene, Baltimore, Md. (Chairman)

t

\I Philip S. Barba, M.D., Associate Dean, School

of Medicine University of Pennsylvania, Phil-adelphia,. Pa.

Marian Crane, M.D., Chief, Research Inter-

1pretation Branch, Division of Research, Chil-dren’s Bureau, Social Security Administra-

tion, Department of Health, Education, and

h Welfare, Washington, D.C.

Anthony D’ESOPO, M.D., Professor of Clinical

Obstetrics and Gynecology, College of Physi-cians and Surgeons, Columbia University,New York, N.Y.

James F. Donnelly, M.D., Obstetrics Consult-ant, North Carolina State Board of Health,Raleigh, N.C.

Carl L. Erhardt, Director, Bureau of Recordsand Statistics, City of New York Departmentof Health, New York, N.Y.

Edith L. Potter, M. D., Pathologist, ChicagoLying-in Hospital, Chicago, Ill.

William Silverman, M.D., Associate Pedia-trician, College of Physicians and Surgeons,Columbia University, Babies Hospital, Colum-bia-Presbyterian Medical Center, New York,N.Y. . .. .

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Natioml Divorce Statistics *

Appointed - September 1956Assignment -

Members -

To recommend ways and means of makingpossible the central collection of divorce datain each State as a step toward developingnational statistics on divorces.

Ernest W. Burgess, Ph. D., Director, FamilyStudy Center, University of Chicago, Chicago,Ill. (Chairman)

Jtiius A. Jabn, Ph. D., Professor of Research,School of Social Work, University of Penn-sylvania, 2410 Pine Street, Philadelphia, Pa.

Max Rheinstein, Dr. Utr. Iur., Professor,University of Chicago Law School, Chicago,Ill.

Edwin A. Robson, LL.B., Judge, U.S. DistrictCourt, Chicago, Ill.

Conrad Taeuber, Ph. D., Assistant Director,Bureau of the Census, Department of Com-merce, Washington, D.C.

Melvin R. Wise, Director of Vital Statistics,State Department of Health, Phoenix, Ariz.

Miriam Yeazell, Chairman, Board of Di-rectors, National Association of Clerks andRecorders, Springfield, Ohio

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Classification of Mental Diseases

Ap~inted - August 1957Assignment - To develop a classification of mental illness

with the framework of the InternationalStatistical Classification of Diseases, Inju-

ries, and Causes of Death.

Members - Benjamin Pasamanick, M.D., Professor ofPsychiatry, Columbia Receiving Hospital andState Institute of Psychiatry, University HealthCenter, Columbus, Ohio (Chairman)

Henry Brill, M.D., Deputy Commissioner, NewiYork State Department of Mental Hygiene,Albany, N.Y. ~

Leon Eisen@rg, M.D., Children’s PsychiatricService, Harriet “Lane Home for Children,Job!s Hopkins Hospital, Baltimore, Md.

Moses M. Frohlich, M.D., University Hospital,Veterans Readjustment Center, University ofMichigan, Ann Arbor, Mich,

Morton Kramer, SC, D., Chief, BiometricsBranch, National bstitute of Mental Health,Public Health Service, Department of Health,Education, and Welfare, Washington, D.C.

Joseph Zubin, Ph. D., Principal Research

Scientist (Biometrics), State Department of..Mental Hygiene., New York, .N.Y.

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Classification of Cardiovascular Diseases

Appointed - January 1958Assignment - To study the problems in revising within the

framework of the present classification thesection of the International Statistical Clas-sification of Diseases, Injuries, and Causesof Death relating to Diseases of the Circu-latory System.

Members - George Baehr, M.D., Mt. Sinai Hospital, NewYork, N.Y. (Chairman)

Thomas R. Dawber, M.D., Medical Director,Heart Disease Epidemiology Study, NationalInstitutes of Health, Framingham, Mass.

Charles E. Kossmann, M.D., New York Uni-versity College of Medicine, New York Uni-versity Bellevue Medical Center, New York,N.Y.

Dean Krueger, National Heart Institute, PublicHealth Service, Department of Health, Edu-cation, and Welfare, Bethesda, Md.

Harold E. B. I?ardee, M.D., New York, N.Y.

David D. Rutstein, M.D., Department of Pre-ventive Medicine, Harvard University MedicalSchool, Boston, Mass.

David M. Spain, M.D., Director of Labora-tories, Beth-El Hospital, Brmklyn, N.Y.

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Jeremiah Stamler, M.D., Director, Heart Dis-ease Control Program, Chicago Board ofHealth, Chicago, Ill.

Quantification of Wellness

Appointed - August 1958Discharged - January 1961

Assignment - To exploremeasures of

ways and means of obtainingpositive health beginning with

an examination of the material availablefrom the National Health Survey.

Members - Eugene L. Hamilton, Chief, Medical Statis-tics Division, Office of the Surgeon General,Department of the Army, Washington, D.C.(Chairman)

Harry .Auerbach, M. P.H., Division of Bio-logical and Medical Research, Argonne Na-tional Laboratory, Lemont, Ill.

Col. Taylor Drysdale, Chief, Research andAnalysis Division, D/Development Planning,DCS/D, Department of the Air Force, Wash-

ington, D.C.

Bernard G. Greenberg, Ph. D., University of’North Carolina, Chapel Hill, N.C.

Lawrence E. Hinkle, Jr., M. D., Cornell Uni-versity Medical College, New York, N.Y.

(resigned January 1960)

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Sidney M. Jourard, Ph. D., The J. HillisMiller Health Center, University of Florida,Gainesville, Fla.

Herbert Ratner, M.D., Director, Departmentof Public Health, Village of Oak Park, Ill.

Intermtional List Revision

Appointed -Assignment -

Members -

May 1959To coordinate activities in the United Stateswith regard to the Eighth Revision of theInternational Statistical Classification of Dis-eases, Injmies, and Causes of Death.

Harold F. brn, Ph. D., Chief, BiometricsResearch Branch, National Heart Institute,Public Health Service, Department of Health,Education, and Welfare, Bethesda, Md. (Chair-man)

Benedict J. Duffy, M.D., Professor and Chair-man of the Department of Preventive Medi-cine and Community Health, Seton Hall Collegeof Medicine and Dentistry, Jersey City, N.J.

Eugene L. Hamilton, Chief, Medical StatisticsDivision, Office of the Surgeon General, De-partment of the Army, Washington, D.C.

F. K. Mostofi, M. D.$ Armed Forces Insti-tute of Pathology, Walter Reed Hospital,Washington, D.C.

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Revision of the Classification of Accidents, Poisoni~s, ad

Violence

Appointed -Assignment -

Members -

.

May 1960To review the present section of the Inter-national Statistical Classification dealing withaccidents, poisonings, and violence (externalcauses) to determine the needs for revision.

Arthur J. McDowell, Chief, Health Examina-tion Survey, National Health Survey, NationalCenter for Health Statistics, Public HealthService, Department of Health, Education, andWelfare, Washington, D.C. (Chairman)

Robert A. Calhoun, Ph. D., Director, PublicHealth Statistics, State Board of Health, 1330West Michigan St., Indianapolis, Ind.

Albert P. Iskrant, Chief, Operational Re-search, Accident Prevention Program, PublicHealth Service, Department of Health, Edu-cation, and Welfare, Washington, D.C.

Frank S. McElroy, Chief, Industrial HazardsDivision, Bureau of Labor Statistics, De-partment of Labor, Washington, D.C.

Jules V. Quint, Supervisor, Occupation andAccident Statistics, Metropolitan Life Insur-ance Company, New York, N.Y.

J. L. Recht, Senior Statistician, NationalSafety Council, Chicago, U1.

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Joseph W. Spelman, M.D., Medical Examiner,● City of Philadelphia Department of Public

Health, Philadelphia, Pa.

H. C. Steed, Jr., Director; Accident Preven-tion Section, Environmental Health Branch,State Department of Health, Atlanta, Ga.

John H. Vinyard, Jr., Chief, Biostatistics andHealth Education Division, District of Colum-bia Department of Public Health, Washington,D.C.”

...

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Repovts of ~he

UNITED STATES NATIONAL COMMITTEEON VITAL AND HEALTH STATISTICS

United States National Committee on Vital, and HealthStatistics, October 1949 ‘ ~‘ “

International Recommendations on Definitions of Live Biyth

ad Fetal Death, Public Health Service Publication No. 39,1950

“Statistics Needed Concerning Fertility, ” National Office ofVital Statistics, Vital ”Statistics—Special Repovts, Vol. 33,No. 11, 1952

“Major Problems in,’Fetal Mortality,’” National Office” ofVital Statistics, Vital Statistics—Speciii ~Re@ovti, Vol. 33,

. No. 13, 1952 .,

Proposal for Collection of Data on Illness an.dImpaivments:United States, Public Health Service ~ublication No. 333,1953

.1.,,.<,

“Using Hospital Morbidity Data to Study Morbidity in Com-munities, ” Hospitals, Vol. 27, No. 9, 1953

“Recommendations for the Improvement of Fetal Death~ Statistics, ” Public Health Repoyts, Vol. 70, No. 11, 1955

. “Progress in Development of Fertility Statistics andPopulation Estimates, ” National Office of Vital Statistics,Vital Statistics —Special Repovts, Vol. 39, No. 8, 1956

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“National Vital Statistics Needs,” National office of VitalStatistics, Vital Statistics—Special Reports, Vol. 45, No. 11,1957

“Fertility Studies Based on Data for the 1960 CensusPeriod, ” National Office of Vital Statistics, Vita2Statistics—Special Repoyts, Vol, 47, No. 5, 1959

Medical Certification of Medicolegal Cases, Public HealthService Publication No. 810, 1960

The First Amal Repovt of the United States NationalCommittee on Vital ati Health Statistics, Fiscal YeavE&ing June 30,1950, Public Health Service Publication No.40, 1950

knual Report of the United States National Committee onEtalandHealth Statistics, Fiscal Year EdingJune 30, 1956

Annual Repoyts for:.

Fiscal Yeav Ending June 30, 1957Fiscal Year Ending June 30, 1958Fiscal Year E&ing June 30, 1959Fiscal Year E&ingJune 30, 1960

20*U. S. GOVERNMENT PRINT3NG OFFICE :19620-632262