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ICD. "The ability to combine terms in SNOMED provides multiple ways to represent the same concept. We need look no further than the favorite example of the College of American Pathologists: pulmonary tuberculosis can be expressed as either D0188 or as T2800 + M44060 + E2001 + F03003 ('Lung' + 'Granuloma' + 'M. Tuberculosis' + 'Fever')" (Cimino et al. 1989, 515). So standard medical classifications, though they may leak at the edges and become configurationally complex, do not reflect the temporal complexity of the disease itself. They do not represent its composite, amodern nature: culture, nature, discourse, and infrastructure. They posit a single answer to the question of whether this person has tuberculosis or not. As Desrosières (1993, 296) has pointed out with respect to all statistical work, this kind of difficulty leads to a contradiction between field workers and bureaucrats. Those in the WHO supported a formal Linnean classification system; those in the field supported Buffon's practical working system. The latter engage in local classification practices (all the traits that one needs in a given situation, with an overall recognition that no classification is inscribed in nature, see Clarke and Casper 1992). It is one of the purest forms of the deduction versus induction debate (compare here the debate between Susan Grobe and the Nursing Interventions Classification designers described in chapter 7). |
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The classification of the disease of tuberculosis does not stand alone; it is inserted into a shifting terrain of possible classification systems and cultural symbols. For most of the nineteenth centuryand part of the twentiethtuberculosis was believed to be hereditary, and so what was classified was a tuberculoid kind of a person, a temperament: romantic, melancholy, given to emotional extremes, hot cheeked, and so on. Sontag notes, "In 1881, a year before Robert Koch published his paper announcing the discovery of the tubercle bacillus and demonstrating that it was the primary cause of the disease, a standard medical textbook gave the causes of tuberculosis: hereditary disposition, unfavorable climate, sedentary indoor life, defective ventilation, deficiency of light, and 'depressing emotions'" (Sontag 1977, 54). |
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Sontag also writes of the literary and popular cultural images of tuberculosis, noting that many writers have referred to tuberculosis as ethereal or chaste, somehow pure and mental, not physical. "TB is celebrated as the disease of born victims, of sensitive, passive people who are not quite life-loving enough to survive" (Sontag 1977, 25). In some circles in the nineteenth century, this became a romantic image, especially for middle-class women. "The recurrent figure of the |
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