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The pattern is clear. The railway authorities needed to keep track of the number of bodies of suicides they had to recover and manage. The London underground introduced "suicide pits" between the rails (still in use today). They wanted to know the efficacy of these pits in capturing and saving the life of the attempted suicide. Equally, mines, quarries, and war were tracked and managed by different government departments. Thus, it was useful for them to keep these statistics separate, even though the lay observer might see no difference between electrocution on a battlefield and electrocution at home. Again, the typological-topological problem of encyclopedic knowledge reappears. Who will be able to recover which knowledge? Finally, categories about which nothing could be done (medical "fait divers" of all sorts) could not demand detailed treatment: ''cataclysm" (as a residual category) would do for them all. |
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This government pressure on medical authorities to develop useful classifications has been a constant theme. To take but one example, in Norway in 1981 the Government Action Committee for the Prevention of Child Accidents and public servants dealing with the 1976 Act of Product Control on working with consumer products asked the health authorities for a registration scheme. In this fashion all consumer products could be brought under a standard classification scheme (Lund 1985, 84). Thus the health authorities got into the business of classifying not only diseases (natural kinds) but also manufactured articles (social kinds) that might become causal agents in morbidity and mortality. The horizon of detail expands again. |
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It is clear then that a history of the ICD is only in part a history of medical progress, strictly speaking. Indeed, it must inevitably lag behind the field of medicine. To maintain historical comparability of statistics, the ICD is necessarily conservative with respect to changes. Even at ten-year intervals, a new disease entity may take more than twenty years to be included since the pace of medical discovery and the uncertain process of consensus can be very slow. As shown in chapter 1, some diagnoses may only by achieved with advanced medical technology. In turn, this technology may be slow to spread around the world to become available and familiar to revision centers. In the advent of a new epidemic such as AIDS, diagnostic, nosological and epidemiological tangles have persisted for more than a decade, spanning the implementation of ICD-9 and ICD-10 among affected countries. |
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