J N Morris


Int J Epidemiol. 2007;36(6):1165-1172. 

In This Article

Identification of Syndromes

This use again relates directly to clinical medicine. Broad descriptive clinical and pathological categories often include very different elements. Their different statistical distribution, and their different behaviour among the population, may make it possible to distinguish such elements from each other, and thus help to identify characteristic syndromes. Consider the mortality from 'peptic ulcer' in 1921-23 (Figure 6 ). Clearly there were at least two conditions to be studied—conditions with possibly different causes. My own main interest in this field is in trying to disentangle coronary heart disease form coronary atheroma, by study of their different distributions in the population today, and their different histories in the past 40 years.[26]

Social class differences in ‘peptic ulcer´ mortality in Males, England and Wales, 1921–2318

Table 3 illustrates again from cardiovascular disease. The common lumping together of coronary and cerebrovascular lesions as 'atherosclerosis' is not very strongly justified in clinical or pathological terms. Nor do the two conditions always behave similarly epidemiologically: the recent vital statistics are quite different; and this small experience among doctors ( Table 3 ) is interesting. The natural history of conditions as group phenomena may thus help to define syndromes. The vast unknown field of chronic chest disease—middle-aged men with respiratory symptoms—today offers particular opportunities for this application of the epidemiological method.(The reverse is also true—that the epidemiological method may help to show or to confirm that apparently disparate phenomena are connected, by drawing attention to their related behaviour in the population—for example, malformation and rubella, rheumatic fever and streptococcal infection, zoster and chicken pox. However, I cannot think of any satisfactory illustrations from the non-infectious diseases.)


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