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missing from the other figures in their approach to truth" (Commission Internationale Nomenclature Internationale des Maladies 1910, 138). The need to distribute was urgentJacques Bertillon estimated that over half the causes of death would be "other" in Paris in 1900 if all the residual categories were gathered together (Commission Internationale Nomenclature Internationale des Maladies 1910, 5). |
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These garbage or residual categories, then, tend to fix the maximum level of granularity that is possible. Their advantage is that they can signal uncertainty at the level of data collection or interpretation under conditions where forcing a more precise designation could give a false impression of positive data. The major disadvantage is that the lazy or rushed death certifier will be tempted to overuse "other." By their nature, forms of this kind are only manageable if there is a zone of ambiguity written into them. In this case, precise definitions would drive a wedge among doctor, statistician and epidemiologist. |
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Throughout the history of the ICD, there has been continual, endemic debate about whether it constituted a nomenclature or a classification. The difference is that a nomenclature is merely a list of names that does not give any indication of cause. Nomenclatures are not thus necessarily tied to models of disease. A classification, on the other hand, gives causes and arranges them in relation to one another. The advantage of a nomenclature is that it can remain more stable over time. For example, a nomenclature based on the "seat" of the disease can list a series of indications that can then be used at a second degree of analysis to rediagnose in line with current theory. Systemic diseases like AIDS or systemic lupus erythematosis can be tracked this way, even though the category might not have existed at the time the original diagnosis was made. Classification systems are more immediately convenient in that they carry more complex information, but as we have seen, they change every few years with the development of new medical techniques or knowledge. |
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Intuitively it might appear desirable to have a single, well-defined classificatory governing principle for the ICD. Just as for garbage categories, however, and for the same reasonsthe array of actors and opinions involvedthe solution that has emerged over time has not been monolithic. Instead, it has incorporated a workable (practically and politically) level of ambiguity (the same issue arises in nursing classifications in chapter 7). The ICD has been as heterogeneous as |
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