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The equation can be brutal. One doctor responded in 1984 to a questionnaire on missed diagnoses (believed from autopsy analyses to be about 10 percent of all cases) that these "be quantitated on the basis of functional units, for example, number of productive work-years lost or number of symptom-free months lost" (Anderson 1984, 492). Or the equation can be martial: "By studying the causes which are injurious and fatal to men in our countries and in our cities, statistics will contribute to the removal of evils that shorten human life and to the improvement of the race of men, so that Citizens of a civilized State may be made to excel barbarians as much in strength as they do in the arts of peace and of war" (Farr 1885, 218). It can also be richly paternal, as shown here: |
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In 1974, New Zealand became the first country in the world to accept responsibility for the safety of its inhabitants for 24 hours every day, 365 days every year, from birth until death. At the same time, the Accident Compensation Corporation became the first organization in New Zealand, and possibly in the world, to become responsible for the prevention of accidents to all inhabitants as well as for compensating, and where necessary rehabilitating, those who suffered personal injury by accident. (Heidenstrom 1985, 69) |
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In each of these cases, the state pits itself against the passage of time and tries, in its own interest, to legislate immortality for its citizens. The benign side of this process is improved health, social justice, and quality of life. Its darker side, of great concern now in medical policy circles about genetic disease risks and conditions such as AIDS, is surveillance and medical discrimination. |
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Much has been written about the state's role in classifying and monitoring mental health (Kutchins and Kirk 1997); much less about classifying and monitoring physical health. Yet this latter work has been just as politically fraught and just as imbricated in the rise of the modern state. As mentioned above, the ICD was developed following an international event in 1893 in Paris. This conference in turn followed a series of conferences to deal internationally with cholera. |
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Why cholera? There were a number of cholera epidemics in nineteenth-century Europe; one series in the latter part of the century being caused by pilgrims returning from a pilgrimage to Mecca infected with the cholera bacillus (see figure 3.1). In early years, returning on foot and by sailboat, infected pilgrims had died before they returned to France. As noted in the introduction, now they were returning by rail and steamboat, and they were able to bring the disease with them back into the metropolis before dying. So as |
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