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. . . There have . . . been adjustments to meet the variety of statistical applications for which the ICD is designed, such as mortality, morbidity, social security and other types of health statistics and surveys" (ICD-10, 2: 12). The preamble to the classification defines a classification of diseases as: 'a system of categories to which morbid entities are assigned according to established criteria' (ICD-10, 2, vol. 1). A statistical classification, such as the ICD "must encompass the entire range of morbid conditions within a manageable number of categories" (ICD-10, 2: 1). It is not meant to be a net to capture all knowledge, but rather a workable epidemiological tool. This practical goal does not make it less scientific. All classification systems are developed within a context of organizational practice. The goal of the ICD's designers is to create what Latour (1988) has called immutable mobiles, inscriptions that may travel unchanged and be combinable and comparable. Indeed the term immutable mobile might almost have been in the designers' minds when they wrote, "The purpose of the ICD is to permit the systematic recording, analysis, interpretation, and comparison of mortality and morbidity data collected in different countries or areas and at different times. The ICD is used to translate diagnoses of diseases and other health problems from words into an alphanumeric code, which permits easy storage, retrieval and analysis of the data'' (ICD-10, 2: 2). The ICD has become the international tool for "standard diagnostic classification for all general epidemiological and many health management purposes" (ICD-10, 2: 2). |
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The world has changed since the ICD was first introduced, and the classification scheme has evolved to try to encompass these changes. The ICD is thus both highly responsive and tightly constrained. A large-scale change in the way that people die (Israel et al. 1986, 161) has led to the addition of one line in the internationally recommended death certificate (see figure 2.3). One of the main bureaucratic uses of the ICD is the recording and compiling of causes of death from bureaus of vital statistics via coroners, hospitals, doctors, or priests: |
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In considering the international form of medical certificate of cause of death, the Expert Committee had recognized that the situation of an aging population with a greater proportion of deaths involving multiple disease processes, and the effects of associated therapeutic interventions, tended to increase the number of possible statements between the underlying cause and the direct cause of death: this meant that an increasing number of conditions were being entered on death certificates in many countries. This led the committee to recommend the inclusion of an additional line (d) in Part 1 of the certificate. (ICD-10, 1: 18) |
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