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Stories of Carving Up the Body: The Vermilion Border of the Lip |
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In Regions of the Mind (1989a), Star examined the ways in which researchers seeking to localize cerebral functions cut up the brain into meaningful units. The process is a messy one, since brains themselves come in many shapes and sizes. During the early days of brain research, a diagram of a "typical" monkey brain, with minutely localized and labeled regions, was transposed onto a representation of a human brain in an attempt to produce a standardized diagram. (Human brains are of a much different size than monkey brains.) Nevertheless, the need for standardized representations was so urgent that the physiologists overlooked this source of uncertainty, among others (Star 1985). Much the same problem occurs with the cutting-up of bodies for medical purposes. Stefan Hirschauer (1991) has noted this for the practice of the surgeon's trade; Berg and Bowker (1997) have discussed the same phenomenon in the development of medical records. |
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The ICD bears traces of this sort of uncertainty most notably at liminal sites (those whose borders are unclear, or used in several different categories) and with respect to roving categories like neoplasms (a cancer may overlap ICD categories). We can use the vermilion border of the lip, also known as the 'lipstick area' as a tracer for this. An early appearance in ICD-9 reads as follows: |
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4. Malignant neoplasms overlapping site boundaries |
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Categories 140195 are for the classification of primary malignant neoplasms according to their point of origin. A malignant neoplasm that overlaps two or more subcategories within a three-digit rubric and whose point of origin cannot be determined should be classified to the subcategory .8 "Other." For example, 'carcinoma involving tip and ventral surface of tongue' should be assigned to 141.8. On the other hand, "carcinoma of tip of tongue, extending to involve the ventral surface" should be coded to 141.2, as the point of origin, the tip, is known. Three subcategories (149.8, 159.8, 165.8) have been provided for malignant neoplasms that overlap the boundaries of three-digit rubrics within certain systems. Overlapping malignant neoplasms that cannot be classified as indicated above should be assigned to the appropriate subdivision of category 195 (malignant neoplasm of other and ill-defined sites): |
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| 140.0 | Upper lip, vermilion border | | | Upper lip: | | | | NOS | | | | external | | | | lipstick area | | (ICD-9CM, 26) |
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