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view of legitimate government as the management of a large information system, states produced a proliferation of ever finer classification systems. Along with this, a bureaucracy developed to manage these systems across a wide set of domains of which the medical domain is a chief example. Building the ICD involved building the state as much as developing medical knowledge. |
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This double movementbuilding an information system and building the stateis an intricate one. Bootstrapping is always involved. To create something as basic as an information infrastructure or a scientific standard, much of the infrastructure or standard already needs to be in place. (How else does one organize the data?) Thus, from the early days of the modern state, the need for such a chicken-and-egg operation can be traced with the development of hospitals (e.g., in France after the revolution). Until there was a working classification of diseasessuch that people with one disease would not be mixed in with those suffering from othersthen patients died wholesale. The hospital served as a place in which to share diseases and on that basis was dreaded by most. But a classification could not be developed unless people suffering from a given disease could be isolated. The establishment of working classifications depended on being able to develop specialized information about particular diseases. This in turn could only be obtained through studying cases in a controlled situation where patients were not subject to a wide range of complicating illnesses and infections (Dagognet 1970).
19 To solve this class of problem in establishing and maintaining the ICD, its designers quite explicitly acted as if ICD statistics were already accurate. By so doing, they hoped that the future data gathering would conform to this gamble. Thus when the League of Nations began working on morbidity statistics, it did not try to impose a perfect classification scheme with a functioning bureaucracy. Rather, it admitted: |
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It is fully realized that much of the information called for in this plan is now utterly lacking in international, or frequently even in interurban comparability. This is evidently the case, for example, in regards to the records of school medical examinations, which are frequently not comparable even between two different examiners in the same town. Experience shows, however, that comparability of statistics has rarely, if ever, been obtained before there was a definite demand for it. Rather than omit from the beginning all data which are not yet satisfactory, the authors have hoped, by including them and utilizing them for what they are worth, to create a demand for their improvement and for international definitions and standards which lead to the development of comparability. Wherever possible, checks have been devised to facilitate evaluation of the data. (Stouman and Falk 1936, 904) |
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