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lungs are affected, but it could produce lesions in other organs and tissues. Star (1989) notes that the disease's tendency to spread through the body implicated it in all investigations of nervous and brain disease in the nineteenth century. Whether a patient had a brain or spinal tumor or tuberculosis was often unclear; the disease, in addition to the cough, may cause seizures, paralysis, lameness, or dementia. Thomas Mann poses of one of his characters "the question whether the disease would be arrested by a chalky petrifaction and heal by means of fibrosis, or whether it would extend the area, create still larger cavities, and destroy the organ." (Mann 1929, 447) |
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And indeed even pulmonary tuberculosisits most common form and one of the greatest killers in the history of humanitycannot be simply classified: |
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The lesions of tuberculosis are highly diverse in appearance, and their manifestations are numerous. No single system of classification can give information that completely describes the lesions. Certain classifications and descriptions are needed, however, for records and for statistical purposes. These essential categories may be termed basic, and they should include subdivisions which describe the status of a patient's disease at the time of diagnosis, and at any time in the months and years thereafter. These basic classifications should be used for all cases. (Diagnosis 1961, 39) |
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And this basic classification should, it is recommended, tell a story, detailing the extent of disease, status of clinical activity, bacteriologic status, therapeutic status, exercise status and other lifestyle variables as they are called nowadays. |
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Medical classification work as based on the ICD does not, however, give a context, it records a fact (one died of the disease or not). There is, as Fagot-Largeault (1989) has pointed out, a complex narrative written into the death certificate that is the primary product of the ICD. Doctors and other health workers must sift through multiple causes of death to determine proximate, contributing, and underlying causes. There can be only one true underlying cause and only a small range of contributing causes. The ICD cannot contain this protean disease.
24 It is oriented toward a cause-and-effect that resembles a set of slots, bins, or blanks on a form, even where it is multivalanced and multislotted; it is not, like disease and diagnosis, messy, leaky, liquid, and textured with time. Indeed, the problem of tuberculosis has been a long-standing problem for the ICD, leading to the convening of several special committees to produce a standard. It remains a problem for the System for Medical Nomenclature (SNOMED), a rival to the |
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