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Similarly, for ICD-10, we can still find ''Delhi boil" in the index, but the main entry itself is a svelte: |
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| B55 | Leishmaniasis | | B55.0 | Visceral leishmaniasis | | Kala-azar | | Post kala-azar dermal leishmaniasis | | B55.1 | Cutaneous leishmaniasis | | B55.2 | Mucocutaneous leishmaniasis | | B55.9 | Leishmaniasis, unspecified | | (ICD-10, 1: 166) |
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So we go from primacy being given to a place (Baghdad boil) to primacy being given to a kind of place (urban cutaneous) to primacy given to a universal agent. Gradually the narrative of travel inscribed in the disease code and thus on the patient's form, present earlier, is deleted. |
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The loss of eponymy and place markers can of course be read as a story of the advance of science: the replacement of the local and specific with the general; the thing with the kind; the mutable immobile with the immutable mobile, and the concrete instance with the formal abstraction. Another line of argument, however, also deserves attention. As we have already seen, the ICD reflects historical states of the world, and the world has changed. With the huge increase in international travel over the past century and a half, it is more rare for a disease to be tied to any one particular location; rather diseases themselves tend to spread to kinds of location. The malaria map of the world hanging on the wall at the WHO headquarters in Geneva shows the expected tropical venues, and it also shows small red circles around major airports as mosquitoes are transported from the tropics. We are as a world becoming more abstract in this way. |
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Similarly, research now is not attributed to single great figures who can claim sole responsibility for a discovery. Medical work was always done in teams, but they have become larger, involving complex social and institutional relationships of attribution as Gallo and Montaignier would be the first to remind us (Grmek 1990). A typical scientific article has so many authors that the death of the individual scientific author appears certain. In general, the ICD has gone from being the holder of a set of stories about places visited, heroic sufferers, and great doctors to holding another set of stories. |
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