|
|
|
|
|
|
|
Any disease classification system should include both spatial and temporal dimensions, but standardized classifications have tended to exist in pure space. As the problems of time emerge in the lives of patients and the work of classifiers, those spatial compartments break down in interesting ways. The formal hierarchy of mutually exclusive categories becomes a set of overlapping contradictory classes. The thesis of this chapter is that when the work of classification abstracts away the flow of historical time, then the goal of standardization can only be achieved at the price of leakage in these classification systems. Under certain conditions, the shifting terrain between standardized classification and the situated temporal biography of the patient is twisted across an axis of negotiation, scientific work and instruments, patience, and time. |
|
|
|
|
|
|
|
|
The Disease Is Constantly in Motion |
|
|
|
|
|
|
|
|
Tuberculosis is a moving target. It is often presented as the great epidemic disease with a cure, heralding the famous optimism (just as AIDS was developing) that epidemic disease could be eradicated from the planet. Disease is in a sense, however, always local and so is its cure, especially when temporal dimensions are taken into account. Consider the following example. In September 1994 the WHO sent out a worldwide press release about the eradication of polio from the planet (New York Times, 2 October 1994). A year earlier sociologist Fred Davis, who suffered polio in his youth, and who was one of the most eloquent analysts of uncertainty in illness (Davis 1963) died of a stroke at the age of 65. Was polio eradicated for him? Was this stroke in part the legacy of his earlier illness? Many of those who had polio in the 1940s and 1950s are now beginning to lose their ability to walk as their overburdened spinal cells, designed for backup purposes, are wearing out after years of tough therapy and rehabilitation. Is the disease thus eradicated or delayed? In the lives of these patients, the answer is not so clear. |
|
|
|
|
|
|
|
|
As Barbara Bates has pointed out (1992, 320321) many observers "now attribute the decline of tuberculosis chiefly to socioeconomic changes" (a position that has been argued for many diseases, as discussed in Sretzer's argument in chapter 4; see Prins 1981). A historically fully contingent rise in standard of living accompanied by less crowded conditions in the cities possibly worked the real miracle. Other epidemiologists, Bates points out, offer a more brutal but still |
|
|
|
|
|