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The history of the ICD is thus inextricably a history of the formation of the modern stateboth at the small-scale level of the development of particular bureaucratic structures and at the large-scale level of the installing of and justification for methods to keep populations under surveillance. After World War II, this development increasingly involved multinational corporations and the computerized flow of epidemiological and medical information across all manner of organizations. |
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Medical Classification and Information Processing |
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The ICD is a complex information-processing tool. As such it is at any one time associated both with a theory of applied historical knowledge and a particular configuration of technology. It must have an historiographic aspecta theory of historical knowledgein the sense that it embodies an understanding of what information about the past can and should be retained. |
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The historical problem is particularly complex since there has been a secular change in the form that death takes. People no longer die the way that they used to at the turn of the century, as noted above. In 1900, the overriding causes of death were the single great epidemic diseases: tuberculosis, pneumonia, smallpox, and influenza. These tended to attack people indiscriminately, from their prime to old age. Nowadays, with antibiotics and other medicines, people tend to live longer and to break down more slowly. As noted in chapter 2, they tend to be carried off not by a single disease but by a complex of diseases (Israel et al. 1986, 161). Matching this trend, the emphasis in applications of the ICD has changed. It has gone from recording a single underlying cause of death to looking for a complex of causes. |
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Consider for example the standard International Form of Medical Certificate of Cause of Death adopted by the WHO in July 1948 (reproduced in Fagot-Largeault 1989, 72 and discussed in chapter 2). This was the canonical form that was used to apply the ICD so as to produce epidemiological statistics. It locates a single "disease or condition directly leading to death," with space for two antecedent causes ("morbid conditions, if any, giving rise to the above cause, stating the underlying condition last"). There is then free space for "other significant conditions contributing to the death but not related to the disease or condition causing it." |
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