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The first part of this book is dedicated to understandig the construction of the International Classification of Diseases (ICD): a classification scheme with its origins in the late nineteenth century but still present todayindeed, it is ubiquitous in medical bureaucracy and medical information systems. The ICD constitutes an impressive attempt to coordinate information and resources about mortality and morbidity globally. For the background research for understanding international processes of classification, we went to Geneva and studied the archives of the WHO and its predecessors such as the League of Nations and the Office Internationale d'Hygiène Publique. Roughly every ten years since the 1890s, the ICD has been revised. The UN and the WHO have kept some records of the process of revision; others are to be found in the file cabinets of individuals involved in the revision process. |
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What we found was not a record of gradually increasing consensus, but a panoply of tangled and crisscrossing classification schemes held together by an increasingly harassed and sprawling international public health bureaucracy. Spirit possession and superstition never do reconcile, but for some data to be entered on the western-oriented death certificate, it becomes possible from the WHO point of view for a death to be assigned the category ''nonexistent disease." |
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One of the other major influences on keeping medical records has been insurance companies, as we discuss in chapter 4. As the working lives of individuals became more closely tied up with the state and its occupational health concerns, the classification of work-related diseases (including industrial accidents) became very important. Life expectancy measures were equally important, both for estimating the available labor force and for basic planning measures. Of course, occupational and nonwork related medical classifications did not always line up: companies might have been reluctant to take responsibility for unsafe working conditions, latency in conditions such as asbestosis makes data hard to come by; thus there may have been moral conflicts about the cause of such illnesses. |
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In similar fashion, any classification that touched on religious or ethical questions (and surprisingly many do so) would be disputed. If life begins at the moment of conception, abortion is murder and a fetus dead at three months is a stillbirth, encoded as a live infant death. Contemporary abortion wars in the United States and western Europe attest to the enduring and irreconcilable ontologies involved in these codifications. |
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