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Designed and standardized in the 1930s, the death certificate echoed the positivist analytic philosophy of the time. Now the trend is toward fractured, postmodern, multiple causation. (Nordenfelt 1983 has an excellent discussion of this philosophical history.) The history of philosophy, the history of ways of dying, and the history of death classificationare these three histories or one? This question makes no sense unless we look at the ways the ICD as an information infrastructure knits together temporal, philosophical and scientific concerns. Earlier in this century, historians in general effected closure on the past by bringing what we now see as problematic single historical actors ("great men") before the tribunal of history. Similarly, the original ICD also tried to effect closure: to provide a single, centralized record of the great epidemic diseases. Modern historians constantly point to the openness of the past. The past, we are told, is recreated afresh at each instant in the present; one role of the historian is to honor this openness while telling the best story one can (Serres 1993, C. Becker 1967). Modern medical classification systems, most particularly the ICD rival SNOMED (Système de Nomenclature Médicale) strive in precisely the same way to keep the past open. Ideally, they would become topological, but with an ease of management, data entry, and controlled vocabulary preserved. Thus far, this goal has proved elusive. |
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To tell the story as one internal to the history of medicine, consider the problem of tracking AIDS through history. AIDS achieved recognition as a disease in a slow process. Gay and sexual politics, medical profit making, and medical research were embroiled together in both its definition and its control. From the public health side, researchers at the Centers for Disease Control began to notice increased requests for a drug used to treat Kaposi's sarcomaa rare condition previously afflicting certain localized or well-defined population groups, such as elderly men of eastern European descent. Intensive epidemiological work revealed that sufferers were largely male homosexuals. Transmission to hemophiliacs indicated that it could be passed on in the blood. Then Luc Montaignier and others located a virus that is generally believed to cause the disease (although for some both causal and priority questions remain open). |
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Statistics compiled before the epidemic used ICD categories without reference to AIDS-related conditions. It is thus virtually impossible to search back through the historical record to find earlier instances of AIDS. The old statistics do not record what were believed to be con- |
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