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to the inherently conservative nature of reform of large-scale data collection efforts. To maintain comparability of items in the classification from one revision to the next, and thence to carry out large-scale longitudinal public health and epidemiological surveys, changes must be minimized from one edition to the next. Thus the preface to the ICD's fifth revision (1938) notes: |
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The Conference endeavored to make no changes in the contents, number, and even the numbering itself of the various items, so that statistics based on the successive Lists should be as comparable as possible, and employees of the registration and statistical services of the different countries should have their habits of work changed as little as possible. Many possible improvements in matters of form and order were abandoned to achieve this practical object. (League of Nations 1938, 947) |
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As smallpox was eradicated from the face of the earth, its archives swelled. On the other hand, as the ICD grew larger, the archives disappeared. The list folded its history in on itself, however, becoming ever more ramified and complex, involving larger numbers of people in the processes of revision. The complexity of the artifact itself can be summarized as follows: |
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Increased detail in data collection |
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Increased cross-referencing by cause (occupational, disability-related, safety, morbidity as well as classical mortality) |
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Conservatism in abandoning categories due to the need for historical comparability, leading to the preservation of anachronistic categories |
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Links between the ICD and other state information systems, such as social security |
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Preserving the ever more complex concerns of the governments involved in developing the ICD in category contents |
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The health of the citizen is central to the modern state, as François Ewald (1986) and others have shown: |
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In the earliest dawn of the nation the English inquired into the causes of death with a view to discovery and prevention. The protection of life was a fundamental principle of their laws. It was as much an object of their political organization as national defense or war. . . . The plagues of the sixteenth century proved that human life is exposed to invisible enemies more deadly than the mechanical forces of nature, the ferocity of animals, or the malignity of manslayers; and toward the end of Queen Elizabeth's reign the London Bills of Mortality were commenced. (Farr 1885, 218) |
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