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tributing causes of death. As a thought experiment, people with AIDS from the 1920s might have died of any of a number of opportunistic infections now associated with AIDS, such as pneumocystis carinii. Their deaths, by the then current ICD, would be widely distributed throughout the classification system, and some would be buried as simple pneumonia. |
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Further complicating the historical retrieval problem, "rare" contributing diseases are often deliberately excluded from the kept record. The ICD is after all primarily a statistical classification. Biostatisticians and epidemiologists are most interested in regular patterns of recurrent diseases. The standard death certificate has no room for clusters of diseases to be recorded; and even if two or three are mentioned, they often get reduced to one at the moment of the compilation of statistics. Grmek (1990) discusses at length the evidence for possible former cases of AIDS that remained in the historical record contingently. In some cases, they involved famous figures (for example, Erasmus) whose life was recorded in great detail. In others, they stood out as medical curiosities, such as the unexplained death of a Norwegian family in the 1950s. In that case, the husband had been a sailor who visited East Africa; his wife and subsequent children all died with a set of symptoms akin to those afflicting AIDS patients. Old blood samples have only been kept in aleatory fashion. Even where they have been preserved, they might give false positives to diagnostic tests. It is only through finding a pattern of immune system breakdown that there could be any hope of tracking such diseases through time. That would (would have) require(d) recording all contributing causes, even when it is, at the current state of knowledge, "obvious" what the patients died of. This is infeasible for both practical and epistemological reasons. |
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The reasons for wishing to maintain an "open past" as told from within the history of medicine are clear, however impossible to implement. But if one focuses through the history of medicine in such a fashion, one is likely to miss both the contemporary pragmatics of the period in question and to isolate medicine as a special case among disciplines. |
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In fact, medicine shares many commonalties with other disciplines and professions that have adopted new information infrastructures. To tell this story, we can turn to the history of information technology during this century and to the ways in which technological constraints and information processing developments have shaped the ICD. |
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