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Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death

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INTERNATIONAL CLASSIFICATION OF DISEASES MANUAL OF THE INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASES, INJURIES, AND CAUSES OF DEATH Based on the Recommendations of the Ninth Revision Conference, 1975, and Adopted by the Twenty-ninth Wodd Health Assembly Volume 1 WORLD HEALTH• ORGANIZATION GENEVA 1977 Reprinted 1974, 1980, 1986 Volume 1 Introduction List of Three-digit Categories Tabular List of Inclusions and Four-digit Sub- categories Medical Certification and Rules for Classification Special Lists for Tabulation Definitions and Recommendations Regulations Volume 2 Alphabetical Index ISBN 92 4 154004 4 © World Health Organization 1977 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or translation of WHO publications, in part or in toto, application should be made to the Office of Publications, World Health Organization, Geneva, Switzerland. The World Health Organization welcomes such applications. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its fronti.:rs or boundaries. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. PRINTED IN SWITZERLAND 86/6847 - Presses Centrales - 7000 (R) TABLE OF CONTENTS Page Introduction General Principles VII Historical Review . VIII Report of the International Conference for the Ninth Revision. XIII Adoption of the Ninth Revision XXIV Manual of the Ninth Revision . xxv Adaptations of the ICD xxx WHO Centres for Classification of Diseases XXXI References XXXII List of Three-digit Categories . 1 Tabular List of Inclusions and Four-digit Subcategories 47 I. Infectious and Parasitic Diseases . 49 II. Neop~asms. 101 III. Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders . 145 IV. Diseases of the Blood and Blood-forming Organs. 167 V. Mental Disorders . 177 VI. Diseases of the Nervous System and Sense Organs. 215 VII. Diseases of the Circulatory System 259 VIII. Diseases of the Respiratory System . 283 IX. Diseases of the Digestive System . 301 X. Diseases of the Genitourinary System 329 XI. Complications of Pregnancy, Childbirth, and the Puer- perium . .. 355 XII. Diseases of the Skin and Subcutaneous Tissue . .. 379 'XIII. Diseases of the Musculoskeletal System and Connective Tissue . .. 395 XIV. Congenital Anomalies . .. 417 XV. Certain Conditions originating in the Perinatal Period 439 XVI. Symptoms, Signs and Ill-defined Conditions 455 XVII. Injury and Poisoning . .. 473 IV TABLE OF CONTENTS Page Supplementary Classification of External Causes of Injury and Poisoning ..................... 547 Supplementary Classification of Factors influencing Health Status and Contact with Health Services . 635 Morphology of Neoplasms. 667 Classification of Industrial Accidents According to Agency . 691 Medical Certification and Rules for Classification 697 Special Tabulation Lists . 743 Basic Tabulation List. 746 Mortality List of 50 Causes . 757 Morbidity List of 50 Causes . 759 Definitions and Recommendations. 761 Regulations . 769 • INTRODUCTION INTRODUCTION General principles A classification of diseases may be defined as a system of categories to which morbid entities are assigned according to some established criteria. There are many possible choices for these criteria. The ana­ tomist, for example, may desire a classification based on the part of the body affected whereas the pathologist is primarily interested in the nature of the disease process, the public health practitioner in aetiology and the clinician in the particular manifestation requiring his care. In other words there are many axes of classification and the particular axis selected will be determined by the interest of the investigator. A statistical clas­ sification of disease and injury will depend, therefore, upon the use to be made of the statistics to be compiled. Because of this conflict of interests, efforts to base a statistical classi­ fication on a strictly logical adherence to anyone axis have failed in the past. The various titles will represent a series of necessary compromises between classifications based on aetiology, anatomical site, circumstances of onset, etc., as well as the quality of information available on medical reports. Adjustments must also be made to meet the varied requirements of vital statistics offices, hospitals of different types, medical services of the armed forces, social insurance organizations, sickness surveys, and numerous other agencies. While no single classification will fit all the specialized needs, it should provide a common basis of classification for general statistical use; that is storage, retrieval and tabulation of data. A statistical classification of disease must be confined to a limited number of categories which will encompass the entire range of morbid conditions. The categories should be chosen so that they will facilitate the statistical study of disease phenomena. A specific disease entity should have a separate title in the classification only when its separation is warranted because the frequency of its occurrence, or its importance as a morbid condition, justifies its isolation as a separate category. On the other hand, many titles in the classification will refer to groups of separate but usually related morbid conditions. Every disease or morbid condi­ tion, however, must have a definite and appropriate place as an inclusion in one of the categories of the statistical classification. A few items of the statistical list will be residual titles for other and miscellaneous conditions which cannot be classified under the more specific titles. These miscella­ neous categories should be kept to a minimum. - VIl- VIII INTRODUCTION It is this element of grouping in a statistical classification that distin­ guishes it from a nomenclature, a list or catalogue of approved names for morbid conditions, which must be extensive in order to accommodate all pathological conditions. The concepts of classification and nomenclature are, nevertheless, closely related in the sense that some classifications (e.g. in zoology) are so detailed that they become nomenclatures. Such classi­ fications, however, are generally unsuitable for statistical analysis. The aims of a statistical classification of disease cannot be better summarized than in the following paragraphs written by William Farr! a century ago: .. The causes of death were tabulated in the early Bills of Mortality (Tables mor­ tuaires) alphabetically; and this course has the advantage of not raising any of those nice questions in which it is vain to expect physicians and statisticians to agree unani­ mously. But statistics is eminently a science of classification; and it is evident, on glancing at the subject cursorily, that any classification that brings together in groups diseases that have considerable affinity, or that are liable to be confounded with each other, is likely to facilitate the deduction of general principles . .. Classification is a method of generalization. Several classifications may, there­ fore, be used with advantage; and the physician, the pathologist, or the jurist, each from his own point of view, may legitimately classify the diseases and the causes of death in the way that he thinks best adapted to facilitate his inquiries, and to yield general results . .. The medical practitioner may found his main divisions of diseases on their treatment as medical or surgical; the pathologist, on the nature of the morbid action or product; the anatomist or the physiologist on the tissues and organs involved; the medical jurist on the suddenness or the slowness of the death; and all these points well deserve attention in a statistical classification . .. In the eyes of national statists the most important elements are, however, brought into account in the ancient subdivision of diseases into plagues, or epidemics and endemics, into diseases of common occurrence (sporadic diseases), which may be conveniently divided into three classes, and into injuries, the immediate results of violence or of external causes. " Historical Review Early history Fran<;ois Bossier de Lacroix (1706-1777), better known as Sauvages, first attempted to classify diseases systematically. Sauvages' compre­ hensive treatise was published under the title Nosologia Methodica. A contemporary of Sauvages was the great methodologist Linnaeus (1707- 1778), one of whose treatises was entitled Genera Morborum. At the beginning of the 19th century, the classification of disease in most general use was one by William Cullen (1710-1790), of Edinburgh, which was published in 1785 under the title Synopsis Nosologiae Methodicae. INTRODUCTION IX The statistical study of disease, however, began for all practical purposes with the work of John Graunt on the London Bills of Mortality a century earlier. In an attempt to estimate the proportion of liveborn children who died before reaching the age of six years, no records of age at death being available,
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