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tion is the development of accident categories, which also in their explanations display a historical cultural specificity. For example, this set of accident categories describes a series of tumbles more common in the industrial world than for a nomadic tribe: |
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| E884 | Other fall from one level to another | | E884.0 | Fall from playground equipment | | | Excludes: recreational machinery (E919.8) | | E884.1 | Fall from cliff | | E884.2 | Fall from chair | | E884.3 | Fall from wheelchair | | E884.4 | Fall from bed | | E884.5 | Fall from other furniture | | E884.6 | Fall from commode | | | | Toilet | | E884.9 | Other fall from one level to another | | | | Fall from: | Fall from: | | | | embankment | stationary vehicle | | | | haystack | tree | | (ICD-9-CM, 289) |
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There is a relatively impoverished vocabulary for talking about natural accidents. The ICD is richest in its description of ways of dying in developed countries at this moment in history; it is not that other accidents and diseases cannot be described, but they cannot be described in as much detail. Differentiating insect bites and snake bites, for example, is very important for those living in the rural tropics. While arthropods, centipedes, and chiggers are singled out under "bites" in the ICD index, however, snakes are only divided into venomous and nonvenomous, as are spiders.
13 Clearly this makes sense to some extent, given that this is a pragmatic classification. There is only a point in making fine distinctions between types of accident if those distinctions might make a difference in practice to some agencymedical or other. At the same time, those agencies have traditionally been more accountable to Western allopathic medicine and to the industrial world than to traditional indigenous or alternative systems. |
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So the ICD bears traces of its historical situation as a tool used by public health officials in developed countries. It also reflects changes in the world at large, either the eradication of diseases or culturally charged changing understandings of certain conditions. Further, it is very much an entrenched scheme. There is a natural reluctance to operate changes, since each change renders a previous set of statistics incomparable and thence less useful. |
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