[RRE]Sorting Things Out: Classification and Its Consequences

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Date: Thu, 04 Nov 1999 17:02:55 -0800
From: "Geoffrey C. Bowker" <bowker@C3BbY3ijx5OimU1-wi84-OT5ZRZg8LFzoYTcLi2q5HZRN-ykROIv4RNEBAHLtP5gHHmxZXmp8VI.yahoo.invalid>

SORTING THINGS OUT: CLASSIFICATION AND ITS CONSEQUENCES

Geoffrey C. Bowker and Susan Leigh Star
Cambridge, MA: MIT Press, 1999.

http://mitpress.mit.edu/book-home.tcl?isbn=0262024616

TABLE OF CONTENTS

Introduction: To Classify is Human
Chapter One: Some Tricks of the Trade in Analyzing Classification

Part One: Classification and Large Scale Infrastructures
Chapter Two: The Kindness of Strangers - Kinds and Politics in
  Classification Systems
Chapter Three: The ICD as Information Infrastructure
Chapter Four: Classification, Coding and Coordination

Part Two: Classification and Biography, or System and Suffering
Chapter Five: Of Tuberculosis and Trajectories
Chapter Six: The Case of Race Classification and Reclassification
  under Apartheid

Part Three: Classification and Work Practice
Chapter Seven: What a Difference a Name Makes - The Classification of
  Nursing Work
Chapter Eight: Organizational Forgetting, Nursing Knowledge, and
  Classification

Part Four: The Theory and Practice of Classifications
Chapter Nine: Categorical Work and Boundary Infrastructures; Enriching
  Theories of Classification
Chapter Ten: Why Classifications Matter

Introduction: To Classify Is Human

Our lives are henged round with systems of classification, limned by
standard formats, prescriptions, and objects.  Enter a modern home and
you are surrounded by standards and categories spanning the color of
paint on the walls and in the fabric of the furniture, the types of
wires strung to appliances, the codes in the building permits allowing
the kitchen sink to be properly plumbed and the walls to be adequately
fireproofed.  Ignore these forms at your peril - as a building owner,
be sued by irate tenants; as an inspector, risk malpractice suits
denying your proper application of the ideal to the case at hand; as a
parent, risk toxic paint threatening your children.

To classify is human.  Not all classifications take formal shape
or are standardized in commercial and bureaucratic products.  We
all spend large parts of our days doing classification work, often
tacitly, and make up and use a range of ad hoc classifications in
order to do so.  We sort dirty dishes from clean, white laundry from
colorfast, important email to be answered from e-junk.  We match the
size and type of our car tires to the amount of pressure they should
accept.  Our desktops are a mute testimony to a kind of muddled folk
classification: papers which must read by yesterday, but which have
been there since last year; old professional journals which really
should be read and even in fact may someday be, and which have been
there since last year; assorted grant applications, tax forms, various
work-related surveys and forms waiting to be filled out for everything
from parking spaces to immunizations.  These surfaces may be piled
with sentimental cards which are already read but which can't yet be
thrown out alongside reminder notes to send similar cards to parents,
sweethearts, or to friends for their birthdays, all piled on top
of last year's calendar (which who knows, may be useful at tax time).
Any part of the home, school or workplace reveals some such system
of classification: medications classed as not for children occupy a
higher shelf than safer ones; books for reference are shelved close to
where we do the Sunday crossword puzzle; door keys are color-coded and
stored according to frequency of use.

What sorts of things order these piles, locations, and implicit
labels?  We have certain knowledge of these intimate spaces,
classifications that seem to live partly in our hands - definitely
not just in the head or in any formal algorithm.  The knowledge about
which thing will be useful at any given moment is embodied in a flow
of mundane tasks and practices and many varied social roles (child,
boss, friend, employee).  When we need to put our hands on something,
it is there.

Our computer desktops are no less cluttered.  Here the electronic
equivalent of "not yet ready to throw out" is also well represented.
A quick scan of one of the author's desktops reveals seven residual
categories represented in the various folders of email and papers:
"fun" "take back to office" "remember to look up" "misc."  "misc.
correspondence" "general web information" "teaching stuff to do"
and "to do." We doubt if this is an unusual degree of disarray or an
overly prolific use of the "none of the above" category so common to
standardized tests and surveys.

These standards and classifications, however imbricated in our lives,
are ordinarily invisible.  The formal, bureaucratic ones trail behind
them the entourage of permits, forms, numerals, and the sometimes-
visible work of people who adjust them to make organizations run
smoothly.  In that sense, they may become more visible, especially
when they break down, or become objects of contention.  But what are
these categories?  Who makes them, and who may change them?  When and
why do they become visible?  How do they spread?  What, for instance,
is the relationship between locally generated categories, tailored
to the particular space of a bathroom cabinet, and the commodified,
elaborate, expensive ones generated by medical diagnoses, government
regulatory bodies, and pharmaceutical firms?  Remarkably for such
a central part of our lives, we stand for the most part in formal
ignorance of the social and moral order created by these invisible,
potent entities.  Their impact is indisputable, and as Foucault
reminds us, inescapable.  Try the simple experiment of ignoring your
gender classification and use instead whichever toilets are the
nearest; try to locate a library book shelved under the wrong Library
of Congress catalogue number; stand in the immigration queue at a
busy foreign airport without the right passport or arrive without
the transformer and the adaptor that translates between electrical
standards.  The material force of categories appears always and
instantly.

At the level of public policy, classifications such as those of
regions, activities, and natural resources play an equally important
role.  Whether or not a region is classified as ecologically
important; whether another is zoned industrial or residential come
to bear significantly on future economic decisions.  The substrate
of decision-making in this area, while often hotly argued across
political camps, is only intermittently visible.  Changing such
categories, once designated, is usually a cumbersome, bureaucratically
fraught process.

For all this importance, classifications and standards occupy a
peculiar place in studies of social order.  Anthropologists have
studied classification as a device for understanding the cultures of
others - categories such as the raw and the cooked have been clues to
the core organizing principles for colonial Western understandings of
"primitive" culture.  Some economists have looked at the effects of
adopting a standard in those markets where networks and compatibility
are crucial.  For example, videotape recorders, refrigerators
and personal computer software embody arguably inferior technical
standards, but standards that benefited from the timing of their
historical entry into the marketplace.  Some historians have examined
the explosion of natural history and medical classifications in
the late nineteenth century, both as a political force and as an
organizing rubric for complex bureaucracies.  A few sociologists have
done detailed studies of individual categories linked with social
movements, such as the diagnosis of homosexuality as an illness and
its demedicalization in the wake of gay and lesbian civil rights.
Information scientists work every day on the design, delegation and
choice of classification systems and standards, yet few see them
as artifacts embodying moral and aesthetic choices that in turn
craft people's identities, aspirations and dignity.  Philosophers
and statisticians have produced highly formal discussions of
classification theory, but few empirical studies of use or impact.

Both within and outside the academy, single categories or classes
of categories may also become objects of contention and study.  The
above-mentioned demedicalization of the category homosexual in the
American Psychiatric Association's Diagnostic and Statistical Manual
3 (the DSM, a handbook of psychiatric classification) followed direct
and vigorous lobbying of the APA by gay and lesbian advocates (Kirk
and Kutchins, 1992).  During this same era, feminists were split on
the subject of whether the categories of premenstrual syndrome and
post partum depression would be good or bad for women as they became
included in the DSM.  Many feminist psychotherapists were engaged
in a bitter argument about whether to include these categories.
As Ann Figert (1996) relates, they even felt their own identities
and professional judgements to be on the line.  (Allan Young (1995)
makes the complicating observation that psychiatrists increasingly
use the language of the DSM to communicate with each other and their
accounting departments, although they frequently don't believe in the
categories they are using).

More recently, as discussed in Chapter 6, the option to choose
multiple racial categories was introduced as part of the US Government
routine data collection mission, following Statistical Directive
15 in October, 1997.  The Office of Management and Budget issued the
directive, and conservatively, its implementation will cost several
million dollars.  One direct consequence is the addition of this
option to the US Census, an addition that was fraught with political
passion.  A march on Washington concerning the category took the
traditional ultimate avenue of mass protest for American activists.
The march was conducted by people who identified themselves as
multi-racial, and their families and advocates.  At the same time,
it was vigorously opposed by many African-American and Hispanic
civil rights groups (among several others), who saw the option
as a "whitewash" against which important ethnic and policy-related
distinctions would be lost (Robbin, 1998).

However, despite the contentiousness of some categories, none of
the above-named disciplines or social movements has systematically
addressed the pragmatics of the invisible forces of categories and
standards in the modern built world, especially the modern information
technology world.  Foucault's (1970; 1982) work comes the closest to a
thoroughgoing examination in his arguments that an archaeological dig
is necessary in order to find the origins and consequences of a range
of social categories and practices.  He focussed on the concept of
order, and its implementation in categorical discourse.  The ubiquity
described by Foucault appears as an iron cage of bureaucratic
discipline against a broad historical landscape.  But there is
much more to be done, both empirically and theoretically.  No one,
including Foucault, has systematically tackled the question of
how these properties inform social and moral order via the new
technological and electronic infrastructures.  Few have looked at the
creation and maintenance of complex classifications as a kind of work
practice, with its attendant financial, skill and moral dimensions.
These are the tasks of this book.

We take Foucault's practical archaeology as a point of departure for
examining several cases of classification, some of which have become
formal or standardized, and some of which have not.  We have several
concerns in this exploration, growing both from the consideration
of classification work, and its attendant moral dimensions.
First, we seek to understand the role of invisibility in the work
that classification does in ordering human interaction.  We want to
understand how these categories are made and kept invisible, and in
some cases, we want to challenge the silences surrounding them.  In
this sense, our job here is to find tools for seeing the invisible,
much as Emile Durkheim passionately sought to convince his audience
of the material force of the social fact - to see that society was not
just an idea - over one hundred years ago (Durkheim, 1982).

We also explore systems of classification as part of the built
information environment.  Much as a city planner or urban historian
would leaf back through highway permits and zoning decisions to tell
a city's story, we delve the dusty archives of classification design
in order better to understand how wide-scale classification decisions
have been made.

We have a moral and ethical agenda in our querying of these systems.
Each standard and each category valorizes some point of view and
silences another.

This is not inherently a bad thing - indeed it is inescapable.
But it is an ethical choice, and as such it is dangerous - not bad,
but dangerous.  For example, the decision of the US Immigration and
Naturalization Service to classify some races and classes as desirable
for US residents, and others as not, resulted in a quota system which
valued affluent people from Northern and Western Europe over those
(especially the poor) from Africa or South America.

The decision to classify students by their standardized achievement
and aptitude tests valorizes some kinds of knowledge skills and
renders other kinds invisible.  Other types of decisions with serious
material force may not immediately appear as morally problematic.  The
collective standardization in the United States on VHS videotapes over
Betamax, for instance, may seem ethically neutral.  The classification
and standardization of types of seed for farming is not obviously
fraught with moral weight.  But as Busch (1995) and Addelson (1994)
argue, such long-term, collective forms of choice are also morally
fraught.  We are used to viewing moral choices as individual, as
dilemmas, and as rational choices.  We have an impoverished vocabulary
for collective moral passages, to use Addelson's terminology.  For
any individual, group or situation, classifications and standards
give advantage or they give suffering.  Jobs are made and lost; some
regions benefit at the expense of others.  How these choices are made,
and how we may think about that invisible matching process is at the
core of the ethical project of this work.

Working Infrastructures

Sorting Things Out stands at the crossroads of sociology of knowledge
and technology, history and information science.  The categories
represented on our desktops and in our medicine cabinets are fairly
ad hoc and individual, not even legitimate anthropological folk or
ethno classifications.  They are not often investigated by information
scientists (but see Kwasnik, 1988, 1991; Beghtol, 1995; Star,
1998).  But everyone uses and creates them in some form, and they
are (increasingly) important in organizing computer-based work.  They
often have old and deep historical roots.  True, Personal Information
Managers are designed precisely to make this process transparent, but
even with their aid, the problem continues: we still must design or
select categories, still enter data, still struggle with things that
don't fit.  At the same time, we rub these ad hoc classifications
against an increasingly elaborate large-scale system of formal
categories and standards.  Users of the Internet alone navigate, now
fairly seamlessly, more than two hundred formally elected Internet
standards for information transmission each time we send an email
message.  If we are to understand larger-scale classifications, we
also need to understand how desktop classifications link up with those
that are formal, standardized, and widespread.

Every link in hypertext creates a category.  That is, it reflects
some judgment about two or more objects: they are the same, or alike,
or functionally linked, or linked as part of an unfolding series.  The
rummage sale of information on the World Wide Web is overwhelming, and
we all agree that finding information is much less of a problem than
assessing its quality -- the nature of its categorical associations,
and by whom they are made (Bates, in press).  The historical cultural
model of social classification research in this book, from desktop
to wide-scale infrastructure, is a good one through which to view
problems of indexing, tracking, and even compiling bibliographies on
the web.

In its cultural and workplace dimensions, it offers insights into
the problematics of design of classification systems, and a lens
for examining their impact.  It looks at these processes as a sort
of crafting of treaties.  In this, a cross-disciplinary approach is
crucial.  Any information systems design that neglects use and user
semantics is bound for trouble down the line - it will become either
oppressive or irrelevant.  Information systems mix up the conventional
and the formal, the hard technical problems of storage and retrieval
with the hard interactional problems of querying and organizing.

Information systems are undergoing rapid change.  There is an
explosion of information on the World Wide Web and associated
technologies, and fast moving changes in how information may converge
across previously disparate families of technology - for instance,
using one's television to retrieve email and browse the web, using
one's Internet connections to make telephone calls.  Whatever we write
here about the latest electronic developments will be outdated by
the time this book sees print, a medium many would argue is itself
anachronistic.  Conventions of use, and understandings of the impact
of these changes on social organization are slower to come.  The
following example illustrates the intermingling of the conventional
and the local in the types of classificatory links formed by
hypertext.  A few years ago, our university was in the enviable
position of having several job openings in Library and Information
Science.

Both the authors were on the search committee.  During the process of
sifting through applications and finding out more about candidates,
the need arose to query something on the candidate's resume.  We used
the Alta Vista search engine to find the candidate's email address.
(Of course, the first thing one really does with Alta Vista is
egosurfing - checking one's own name to see how many times it appears
on the web - but we had already done that.)  His email address and
formal institutional home page appeared in about 15 seconds on our
desktop -- but so did his contributions to a discussion on world
peace, a feminist bulletin board, and one of the more arcane alt.rec
Usenet groups.  We found ourselves unable to stop our eyes from roving
through the quoted Usenet posts - category boundaries surely never
meant to be crossed by a job search committee.

Fortunately for us as committee members, we interpreted what we found
on the web as evidence that the applicant was a more well rounded
person than his formal CV had conveyed.  He became a more interesting
candidate.  But of course, it might have gone badly for him.  In less
than a minute we had accessed information about him that crossed a
social boundary of de facto privacy, access, and awareness context
(Glaser and Strauss, 1965).  The risk of random readership had been
there in some sense when he posted to a public space -- but who on
a search committee in the old days of a couple of years ago could
possibly be bothered searching ftp archives?  Who would have time?
There are many ethical and etiquette-related questions here, of
course, with the right to privacy not least among them.  The incident
also points to the fact that as a culture we have not yet developed
conventions of classification for the web that bear much moral or
habitual conviction in daily practice.  The label alt.rec does not yet
have the reflex power that the label private does on a desk drawer or
notebook cover.  We would never open someone's desk drawer or diary.
We are not normally known to be a rude people -- but we haven't yet
developed or absorbed routine similar politeness for things such as
powerful web search engines.  We were thus somewhat embarrassed and
confused about the morality of mentioning the alt.rec postings to the
committee.

As we evolve the classifications of habit -- grow common fingertips
with respect to linkages and networks -- we will be faced with some
choices.  How standardized will our indexes become?  What forms of
freedom of association (between people, between texts and people,
between texts) do we want to preserve, and which are no longer useful?
Who will decide these matters?

Investigating Infrastructure

People do many things today that a few hundred years ago would have
looked like magic.  We all know versions of this banal assertion -
we've probably all made it in one form or another or ourselves at some
point.  And if we don't understand a given technology it looks like
magic: for example, we are perpetually surprised by the mellifluous
tones read off our favorite CDs by, we believe, a laser.  Most of us
have no notion of the decades of negotiation that inform agreement
on, inter alia, standard disc size, speed, electronic setting, and
amplification standards.  It is not dissimilar to the experience
of magic one enjoys at a fine restaurant or an absorbing play.
A common description of a good waiter or butler (one thinks of Jeeves
in the Wodehouse stories) is that she clears a table and smoothes the
unfolding of events 'as if by magic.'  In a compelling play, the hours
of rehearsal and missteps are disappeared from center stage, behind a
seamless front stage presentation.  Is the magic of the CD different
from the magic of the waiter or the theater ensemble?  Are these two
kinds of magic or one -- or none?  This book is an attempt to answer
this question, which can be posed more prosaically as:

* What work do classifications and standards do?  Again, we want to
look at what goes into making things work like magic: making them fit
together so that we can buy a radio built by someone we have never
met in Japan, plug it into a wall in Champaign, Illinois and hear the
world news from the BBC.

* Who does that work?  We explore the fact that all this magic
involves much work: there is a lot of hard labor in effortless ease.
Such invisible work is often not only underpaid - it is severely
underrepresented in theoretical literature (Star and Strauss, 1999).
We will discuss where all the 'missing work' that makes things look
magical goes.

* What happens to the cases that don't fit?  We want to draw attention
to cases that don't fit easily into our magical created world of
standards and classifications: the left handers in the world of
right-handed magic, chronic disease sufferers in the acute world of
allopathic medicine, the vegetarian in MacDonald's (Star, 1991b) and
so forth.

These are issues of great import.  It is easy to get lost in
Baudrillard's (1990) cool memories of simulacra.  He argues that
it is impossible to sort out media representations from 'what really
happens.'  We are unable to stand outside representation or separate
simulations from nature.  At the same time, he pays no attention
to the work of constructing the simulations, or the infrastructural
considerations that underwrite the images/events (and we agree that
separating them ontologically is a hopeless task).  The hype of
our postmodern times is that we don't need to think about this sort
of work any more.  The real issues are scientific and technological,
stripped of the conditions of production - in artificial life,
thinking machines, nanotechnology, and genetic manipulation....
Clearly each of these is important.  But there is more at stake -
epistemologically, politically and ethically - in the day to day
work of building classification systems and producing and maintaining
standards than in abstract arguments about representation.  Their
pyrotechnics may hold our fascinated gaze; they cannot provide any
path to answering our moral questions.

What Are You?

I grew up in Rhode Island, a New England state which is largely
Italian-American and French-Canadian, known chiefly for its small
stature.  When I was a kid in our neighborhood, the first thing you
would ask on encountering a newcomer was "what's your name?"  The
second was "what are you?"  "What are you" was an invitation to recite
your ethnic composition in a kind of singsong voice.  90% of the kids
would say "Italian with a little bit of French," or "half-Portuguese,
one-quarter Italian and one-quarter Armenian." When I would chime
in with "half Jewish, one quarter Scottish and one quarter English,"
the range of responses went from very puzzled looks to "does that
mean you're not Catholic?"  Wherein, I guess, began my fascination
with classification, and especially with the problem of residual
categories, or, the Other, or not elsewhere classified.

--Leigh Star

Two Definitions : Classification and Standards

Up to this point, we have been using the terms classification and
standardization without formal definition.  Let us clarify the terms
now.

Classification

A classification is a spatial, temporal or spatio-temporal
segmentation of the world.  A 'classification system' is a set of
boxes (metaphorical or literal) into which things can be put in order
to then do some kind of work - bureaucratic or knowledge production.
In an abstract, ideal sense, a classification system exhibits the
following properties:

1. There are consistent, unique classificatory principles in
operation.  One common sort of system here is the genetic principle of
ordering.  This refers not to DNA analysis, but an older and simpler
sense of the word: classifying things by their origin and descent
(Tort, 1989).  A genealogical map of a family's history of marriage,
birth and death is genetic in this sense (even for adopted children
and in-laws).  So is a flow chart showing a hierarchy of tasks
deriving from one another over time.  There are many other types of
classificatory principles - sorting correspondence by date received
(temporal order), for example, or recipes by those most frequently
used (functional order).

2. The categories are mutually exclusive.  In an ideal world,
categories are clearly demarcated bins, into which any object
addressed by the system will neatly and uniquely fit.  So in the
family genealogy, one mother and one father give birth to a child,
forever and uniquely attributed to them as parents - there are no
surrogate mothers, or issues of shared custody or of retrospective
DNA testing.  A rose is a rose, not a rose sometimes and a daisy other
times.

3. The system is complete.  With respect to the items, actions
or areas under its consideration, the ideal classification system
provides total coverage of the world it describes.  So, for example, a
botanical classifier would not simply ignore a newly discovered plant,
but would always strive to name it.  A physician using a diagnostic
classification must enter something in the patient's record where
a category is called for; where unknown, the possibility exists
of a medical discovery, to be absorbed into the complete system of
classifying.

No real-world working classification system that we have looked at
meets these 'simple' requirements and we doubt that any ever could.
In the case of unique classificatory systems, people disagree about
their nature; they ignore or misunderstand them; or they routinely
mix together different and contradictory principles.  A library,
for example, may have a consistent Library of Congress system in
place, but supplement it in an ad hoc way.  Best sellers to be
rented out to patrons may find themselves on a separate shelf; very
rare, pornographic or expensive books may be locked away from general
viewing at the discretion of the local librarian.  Thus, the books are
moved, without being formally reclassified, yet carry an additional
functional system in their physical placement.

For the second point, mutual exclusivity may be impossible in
practice, as when there is disagreement or ambivalence about the
membership of an object in a category.  Medicine is replete with
such examples, especially when the disease entity is controversial
or socially stigmatized.  In terms of the third point, completeness,
there may be good reasons to ignore data that would make a
system more comprehensive.  The discovery of a new species on an
economically important development site may be silenced for monetary
considerations.  An anomaly may be acknowledged, but be too expensive
- politically or bureaucratically -- to introduce into a system
of record keeping.  In Chapter 2, we demonstrate ways of reading
classification systems so as to be simultaneously sensitive to these
conceptual, organizational and political dimensions.

Consider the International Classification of Diseases (ICD), which
will be one of our major examples throughout this book.  The full
title of the current (10th) edition of the ICD, is: "ICD-10 -
International Statistical Classification of Diseases and Related
Health Problems; Tenth Revision." Note that it is designated a
'statistical' classification.  By this is meant that only diseases
which are statistically significant are to be entered in (it is not
an attempt to classify all disease).

The ICD calls itself a 'classification,' even though many have said
that it is a 'nomenclature' since it has no single classificatory
principle (it has at least four; which are not mutually exclusive
(this point is developed in Chapter 4)).  A nomenclature simply means
an agreed-upon naming scheme, and need not follow any classificatory
principles.  The nomenclature of streets in Paris, for example,
includes those named after intellectual figures, plants and trees,
battles, and politicians, as well as those inherited from former
governments, such as Rue de Lutèce (Lutèce was the ancient Roman
name for Paris).  There is no classificatory system.  Nomenclature
and classification are frequently confused, however, since often
attempts are made to model nomenclature on a single, stable system
of classification principles - as for example with botany (Bowker,
in press) or anatomy.  In the case of the ICD, diagnostic nomenclature
and the terms in the ICD itself were conflated in the American
system of diagnosis-related groups (DRGs), much to the dismay of some
medical researchers.  In many cases the ICD represents a compromise
between conflicting schemes: The terms used in categories C82-C85 for
non-Hodgkin's lymphomas are those of the Working Formulation, which
attempted to find common ground among several major classification
systems.  The terms used in these schemes are not given in the Tabular
List but appear in the Alphabetical Index; exact equivalence with the
terms appearing in the Tabular List is not always possible.  (ICD-10,
1: 215).

However, the ICD presents itself clearly as a classification scheme
and not a nomenclature.  Since 1970, there has been an effort underway
by the World Health Organization to build a distinct International
Nomenclature of Diseases (IND), whose main purpose will be to provide:
"a single recommended name for every disease entity" (ICD-10, 1: 25).

For the purposes of this book, we take a broad enough definition so
that anything that is consistently called a classification system
and treated as such can be included in the term.  This is a classic
Pragmatist turn - things perceived as real are real in their
consequences (Thomas and Thomas, 1917).  If we took a purist or
formalist view, the ICD would be a (somewhat confused) nomenclature
and who knows what the IND would represent.  With a broad, Pragmatic
definition we can look at the work that is involved in building and
maintaining a family of entities that people call classification
systems - rather than attempt the Herculean, Sisyphian task of
purifying the (un)stable systems in place.  Howard Becker makes a
cognate point here: Epistemology has been a ... negative discipline,
mostly devoted to saying what you shouldn't do if you want your
activity to merit the title of science, and to keeping unworthy
pretenders from successfully appropriating it.  The sociology of
science, the empirical descendant of epistemology, gives up trying
to decide what should and shouldn't count as science, and tells what
people who claim to be doing science do.  (Becker, 1996: 54-55).

The work of making, maintaining, and analyzing classification systems
is richly textured.  It is one of the central kinds of work of
modernity, including science and medicine.  It is, we argue, central
to social life.

Standards

Classifications and standards are closely related, but not identical.
While this book focuses on classification, standards are crucial
components of the larger argument.  The systems we discuss often
do become standardized; in addition, a standard is in part a way of
classifying the world.  What then are standards?  The term as we use
it in the book has several dimensions:

1. A 'standard' is any set of agreed-upon rules for the production of
(textual or material) objects.

2. A standard spans more than one community of practice (or site of
activity).  It has temporal reach as well, in that it persists over
time.

3. Standards are deployed in making things work together over distance
and heterogeneous metrics.  For example, computer protocols for
Internet communication involve a cascade of standards (cf. Abbate and
Kahin, 1995) which need to work together well in order for the average
user to gain seamless access to the web of information.  There are
standards for the components to link from your computer to the phone
network, for coding and decoding binary streams as sound, for sending
messages from one network to another, for attaching documents to
messages, and so forth.

4. Legal bodies often enforce standards - be these professional
organizations, manufacturers' organizations or the State.  We might
say tomorrow that volapük (a universal language that boasted some
23 journals in 1889 (Proust, 1989: 580)) or its successor Esperanto
shall henceforth be the standard language for international diplomacy.
Without a mechanism of enforcement, or a grassroots movement, we shall
fail.

5. There is no natural law that the best standard shall win - QWERTY,
Lotus 123, DOS and VHS are often cited in this context.  The standards
that do win may do so for a variety of other reasons: they build on an
installed base, they had better marketing at the outset, and they were
used by a community of gatekeepers who favored their use.  Sometimes
standards win due to an outright conspiracy, as in the case of the gas
refrigerator documented by Cowan (1985).

6. Standards have significant inertia, and can be very difficult
and expensive to change.  It was possible to build a cathedral like
Chartres without standard representations (blueprints) and standard
building materials (regular sizes for stones, tools etc.)  (Turnbull,
1993).  People invented an amazing array of analog measuring devices
(such as string lengths).  Each cathedral town posted the local analog
metric (a length of metal) at its gates, so that peripatetic master
builders could calibrate their work to it when they arrived in the
town.

They did not have a wide-scale measurement system such as our modern
metric or decimal systems.  (Whether as a result of this local
improvisation or not, Turnbull notes, many cathedrals did fall down!)
It is no longer possible to build a complex collective project without
standardized measurements.  Consider a modern housing development;
too much needs to come together from distant and proximate sources
- electricity, gas, sewer, timber sizes, screws, nails and so on.
The control of standards is a central, often underanalyzed feature of
economic life (but see the work of Paul David - for example David and
Rothwell, 1994 - for a rich treatment).  They are key to knowledge
production as well - Latour (1987) speculates that far more
economic resources are spent creating and maintaining standards than
in producing 'pure' science.  There are a number of histories of
standards which point to the development and maintenance of standards
as being critical to industrial production.

At the same time, just as with classifications, these dimensions
of standards are in some sense idealized.  They embody goals of
practice and production that are never perfectly realized - like
Plato's triangles.  The process of building to a standardized code,
for example, usually includes a face-to-face negotiation between
builder(s) and inspector(s), which itself includes a history of
relations between those people.  Small deviations are routinely
overlooked, unless the inspector is making a political point.
The idiom "good enough for government use" embodies the common
sense accommodations of the slip between the ideal standard and the
contingencies of practice.

In this and in many other ways, then, classifications and standards
are two sides of the same coin.  Classifications may or may not
become standardized.  If they do not, they are ad hoc, limited to an
individual or a local community, and/or of limited duration.  At the
same time, every successful standard imposes a classification system,
at the very least between good and bad ways of organizing actions
or things.  And the workarounds involved in the practical use of
standards frequently entail the use of ad hoc non-standard categories.
For example, a patient may respond to a standardized protocol for
the management of chronic back pain by approximating the directions
and supplementing them with an idiosyncratic or alternative medical
classification scheme.  If the protocol requires a number of exercises
done three times a day, the patient may distinguish good days from bad
days, vacation days from working days, and only do the exercises when
they deem them necessary.

Classifications and standards are related in another sense, which
concerns the use of a classification by more than one social world
or community of practice, and the impact that use has on questions
of membership and the taken-for-grantedness of objects.  Throughout
this book, we speak of classifications as objects for cooperation
across social worlds, or as boundary objects (Star and Griesemer,
1989).  Drawing from earlier studies of interdisciplinary scientific
cooperation, we define boundary objects as those objects that both
inhabit several communities of practice and satisfy the informational
requirements of each of them.  In working practice, they are objects
that are able both to travel across borders and maintain some sort
of constant identity.  They can be tailored to meet the needs of
any one community (they are plastic in this sense, or customizable).
At the same time, they have common identities across settings.  This
is achieved by allowing the objects to be weakly structured in common
use, imposing stronger structures in the individual-site tailored
use.  They are thus both ambiguous and constant; they may be abstract
or concrete.  In Chapter 9, we explore in detail the abstract
ramifications of the use of classifications by more than one community
and the connection with the emergence of standards.

The Structure of this Book

In order to explore these questions, we have written a first chapter
detailing some key themes of the work to follow.  We have then
divided the middle of the book into three parts, which look at several
classification systems.  We have structured these studies around three
issues in turn: classification and large-scale infrastructures (Part
1); classification and biography (Part 2) and classification and work
practice (Part 3).  Weaving these three themes in combination, we can
explore the texture of the space within which infrastructures work and
classification systems from different worlds meet, adjust, fracture
or merge.  In two concluding chapters, we elaborate some theoretical
conclusions from these studies.

Part 1: Classification and Large-Scale Infrastructures

Classification systems are integral to any working infrastructure.
In Part 1 (Chapters 2-4) we examine how a global medical classification
system was developed to serve the conflicting needs of multiple local,
national and international information systems.  Our investigation
here begins in the late nineteenth century, with another kind
of information explosion - the development of myriad systems of
classification and standardization of modern industrial and scientific
institutions.  In the nineteenth century people learned to look at
themselves as surrounded by tiny, invisible things which have the
power of life or death: microbes and bacteria.  They learned to teach
their children to wash their hands of germs before eating, and later,
to apply antiseptic salve to a cat scratch or an inflamed fingernail.
Company washrooms sprouted signs admonishing employees to wash hands
before returning to work, especially if they worked with food served
to others.  In this period, people also learned how to perform surgery
that would not usually be fatal and how to link gum disease with
bacteria between the teeth.

At the same time as they learned these practices with respect to
germs, another ubiquitous set of tiny, invisible things were being
negotiated and sewn into the social fabric.  These were formal,
commodified classifications and standards, both scientific and
commercial.  People classified, measured and standardized just about
everything -- animals, human races, books, pharmaceutical products,
taxes, jobs, and diseases.  The categories so produced lived in
industry, medicine, science, education and government.  They ranged
from the measurement of machine tools to the measurement of people's
forearms and foreheads.  The standards were sometimes physically
tiny measures -- how big should be a standard size second of time,
or an eyeglass screw or an electrical pulse rate?  At other times,
they were larger: what size should a railroad car be, or a city street
- or a corporation?  Government agencies, industrial consortia, and
scientific committees created the standards and category systems.  So
did mail order firms, machine tool manufacturers, and animal breeders,
and thousands of other actors.  Most of these activities became
silently embodied in the built environment and in notions of good
practice.  The decisions taken in the course of their construction
are forever lost to the historical record.  In fact, their history
is considered by most to be boring, trivial, and unworthy of
investigation.

There are some striking similarities to our own late 20th century
historical moment in that faced by Europeans at the end of the 19th
century.  A new international information-sharing and gathering
movement was starting, thanks to the advent of wide-scale
international travel, international quasi-governmental governance
structures, and a growing awareness that many phenomena (like
epidemics and markets) would not be confined to one country.  In the
19th century, people faced for the first time large numbers of bodies
and their microbes moving rapidly across national borders and between
large bureaucracies -- and at an unprecedented rate.  Especially in
the case of epidemics, international public health became an urgent
necessity.  Attempts to control these passengers represent one of the
first large-scale Western medical classification schemes: ships who
had called at ports on the way back from Mecca had to follow a period
of quarantine during which anyone infected would become symptomatic --
thus emulating the slower timeline of horse or camel travel.

Figure 1. Map of Cholera Epidemics.  Source: A. Proust, 1892.

After quarantine, one was given a 'clean bill of health' and allowed
freedom of transport.  This was a costly delay for the ships.  And so,
of course, a black market in clean bills of health appeared shortly
thereafter ... .  The problem of tracking who was dying of what, where
on earth became a permanent feature of international bureaucracy.

Figure 2. French Bill of Health.  Source: A. Proust, 1892.

Constructing such a list may seem to us like a comparatively
straightforward task, once the mechanisms for reporting were in place.
However, for over one hundred years there has never been consensus
about disease categories or about the process of collecting data.  So
one culture sees spirit possession as a valid cause of death, another
ridicules this as superstition; one medical specialty sees cancer
as a localized phenomenon to be cut out and stopped from spreading,
another sees it as a disorder of the whole immune system which merely
manifests in one location or another.  The implications for both
treatment and classification differ.  Trying to encode both causes
results in serious information retrieval problems.

In addition, classifications shift historically.  In Britain in 1650
we find that 696 people died of being 'aged'; 31 succumbed to wolves
9 to grief and 19 to 'King's Evil'.  "Mother" claimed 2 in 1647
but none in 1650, but in that year 2 were 'smothered and stifled.'
Seven starved in 1650 (Graunt, 1662), but by 1930 the World Health
Organization would make a distinction: if an adult starved to death it
was a misfortune; if a child starved, it was homicide.  Death by wolf
alone becomes impossible by 1948, where death from animals is divided
between venomous and non-venomous, and only dogs and rats are singled
out for categories of their own (ICD 5, 1948, p. 267).

Insert Figure 3. Mortality Table, England in Seventeenth Century.
Source: J.  Graunt, 1662.

The first part of this book is dedicated to understanding the
construction of the International Classification of Diseases (ICD):
a classification scheme with its origins in the late 19th century but
still present today - indeed 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 World Health Organization and
its predecessors such as the League of Nations and the Office
Internationale d'Hygiene 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.

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 in order that some data 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 'non-existent
disease'.

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 in terms of
estimating the available labor force and for basic planning measures.
Of course, occupational and non-work 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; there may have been
moral conflicts about the cause of such illnesses.

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 3 months is a stillbirth, encoded as a live infant
death.  Contemporary abortion wars in the U.S. and Western Europe
attest to the enduring and irreconcilable ontologies involved in these
codifications.

For a bureaucracy to establish a smooth data collection effort,
a means must be found to detour around such higher-order issues.
The statistical committee discussed in Chapter 4, assigned with
determining the exact moment of the beginning of life by number of
attempted breaths and weight of fetus or infant, cuts a Solomon-like
figure against such a disputed landscape.  At the same time, there
is an element of reductionist absurdity here - how many breaths
equals 'life'?  If not specified, another source of quality control
for data is lost; if specified, it seems to make common sense ironic.
This is an issue we will revisit as well in the discussion of nursing
interventions, Chapter 7.  Algorithms for codification do not resolve
the moral questions involved, although they may obscure them.  For
decades, priests, feminists and medical ethicists on both sides have
debated the question of when a human life begins.  The moral questions
involved in encoding such information - and the politics of certainty
and of voice involved - are much more obscure.

Forms like the death certificate, when aggregated, form a case of what
Kirk and Kutchins call "the substitution of precision for validity"
(1992; see also Star, 1989b).  That is, when a seemingly neutral
data collection mechanism is substituted for ethical conflict about
the contents of the forms, the moral debate is partially erased.  One
may get ever more precise knowledge, without having resolved deeper
questions, and indeed, by burying them.

There is no simple pluralistic answer to how such questions may be
resolved democratically or with due process.  Making all knowledge
retrievable, and thus re-debatable, is an appealing solution in a
sense from a purely information scientific point of view.  However,
from a practical organizational viewpoint this fails.  For example,
in 1927, a manual describing simultaneous causes of death listed
some 8,300 terms, which represented 34 million possible combinations
that might appear on the face of a death certificate.  A complete
user manual for filling out the certificate would involve 61 volumes
of 1,000 pages each.  This is clearly not a pragmatic choice for
conducting a task which most physicians also find boring, low-status,
and clinically unimportant.  As we know from studies of work of all
sorts, people do not do the ideal job, but the doable job.  When faced
with too many alternatives and too much information, they satisfice
(March and Simon, 1958).  As an indicator of this, studies of the
validity of codes on death certificates repeatedly show that doctors
have favorite categories; these are regionally biased; and autopsies
(which are rarely done anyway) have a low rate of agreement with the
code on the form (Fagot-Largeault, 1989).

Even when there is relatively simple consensus about the cause of
death, the act of assigning a classification can be socially or
ethically charged.  Thus, in some countries the death certificate
has two faces: a public certificate which is handed to the funeral
director in order that arrangements be made quickly and discreetly,
and a statistical cause which is filed anonymously with the public
health department.  In this case, the doctor is not faced with telling
the family of a socially unacceptable form of death: syphilis can
become heart failure, or suicide can become a stroke.  For example,
as we discuss in Chapter 4, the process of moving to an anonymous
statistical record may reveal hidden biases in the reporting of death.
Where the death certificate is public, stigma and the desire to
protect the feelings of the family may reign over scientific accuracy.

Over the years, those designing the list of causes of death and
disease have struggled with all of these problems.  One of the simple
but important rules of thumb to try to control for this degree of
uncertainty is to distribute the residual categories.  "Not elsewhere
classified" appears throughout the entire ICD, but nowhere as a
top-level category.  So since uncertainty is inevitable, and its scope
and scale essentially unknowable, at least its impact will not hit
a single disease or location disproportionately.  Its effects will
remain as local as possible; the quest for certainty is not lost, but
postponed, diluted, and abridged.

With the rise of very-large scale information systems, the Internet,
the World Wide Web, and digital libraries, we find that the sorts
of uncertainties faced by the WHO are themselves endemic in our own
lives.  When we use email filters, for example, we risk losing the
information that doesn't fit the sender's category: junk email is very
hard to sort out automatically in a reliable way.  If we have too many
detailed filters, we lose the efficiency sought from the filter in
the first place.  As we move into desktop use of hyperlinked digital
libraries, we fracture the traditional bibliographic categories across
media, versions, genres, and author.  The freedom entailed is that we
can customize our own library spaces; but as Jo Freeman (1972) pointed
out in her classic article, 'The Tyranny of Structurelessness,'
this is also so much more work that we may fall into a lowest-level
convenience classification rather than a high-level semantic one.  In
one of our digital library projects at Illinois, for example, several
undergraduates we interviewed in focus groups stated that they would
just get five references for a term paper -- any five -- since that's
what the professor wanted, and they'd better be ones that are listed
electronically and available without walking across campus.

The ICD classification is in many ways an ideal mirror of how people
designing global information schemes struggle with uncertainty,
ambiguity, standardization, and the practicalities of data quality.
Digging into the archives, and reading the ICD closely through its
changes, reveals some of the upstream, design-oriented decisions
informing the negotiated order achieved by the vast system of forms,
boxes, software, and death certificates.  At the same time, we have
been constantly aware of the human suffering often occasioned by the
apparently bloodless apparatus of paperwork through which these data
are collected.

Part 2: Classification and Biography

Our second section of this book looks at two cases where the lives of
individuals are broken, twisted, and torqued by their encounters with
classification systems.  This often-invisible anguish informs another
level of ethical inquiry.  Once having been made, the classification
systems are applied to individual cases - sometimes resulting in a
kind of surreal bureaucratic landscape.  Sociologist Max Weber spoke
of the "iron cage of bureaucracy" hemming in the lives of modern
workers and families.  The cage formed by classification systems
can be constraining in just this way - although cage might be too
impoverished a metaphor to describe its variations and occasional
stretches.  In Chapters 5 and 6, we look at biography and
classification.  We chose two examples where classification has become
a direct tool mediating human suffering.  Our first case concerns
tuberculosis patients, and the impact of disease classification on
their lives.  We use historical data to discuss the experience of the
disease within the tuberculosis asylum.

Tuberculosis patients, like many with chronic illness, live under
a confusing regime of categories and metrics (see also Ziporyn,
1992).  Many people were incarcerated for years - some for decades -
waiting for the disease to run its course, to achieve a cure at high
altitudes, or to die there.  They were subjected to a constant battery
of measurements: lung capacity, auscultation, body temperature and
pulse rate, X-rays, and, as they were developed, laboratory tests of
blood and other bodily fluids.  The results of the tests determined
the degree of freedom from the sanatorium regime, as well as,
ultimately, the date of release.

As will be no surprise to medical sociologists, the interpretation and
negotiations of the tests between doctor and patient were fraught with
questions of the social value of the patient (middle class patients
being thought more compliant and reliable when on furlough from the
asylumthan those from lower classes); with gender stereotypes; and
with the gradual adaptation of the patient's biographical expectations
to the period of incarceration.  Thomas Mann's The Magic Mountain and
Julius Roth's Timetables are full of stories of classification and
metrication.  We examine how different timelines, and expectations
about those timelines, unfold in the two remarkable volumes.
Biography, career, the state of the medical art with respect to the
disease, and the public health adjudication of tuberculosis are all
intertwined against the landscape of the sanatorium.

Life in the sanatorium has a surreal, almost nightmarish quality, as
detailed by Mann, Roth and many other writers throughout the twentieth
century.  This sense comes precisely from the misalignment between
a patient's life expectations, the uncertainties of the disease
and of the treatment, and the negotiations laden with other sorts of
interactional burdens.  It is one thing to be ill and in the hospital,
with an indefinite release date.  It is another when the date of
release includes one's ability to negotiate well with the physicians,
their interpretation of the latest research, and the exigencies of
public health forms and red tape.  We call this agglomeration torque,
a twisting of timelines that pull at each other, and bend or twist
both patient biography and the process of metrication.  When all are
aligned, there is no sense of torque or stress; when they pull against
each other over a long period, a nightmare texture emerges.

A similar torque is found in our second case in this section, that
of race classification and reclassification under apartheid in South
Africa.  Between 1950 and the fall of apartheid forty years later,
South Africans were ruled under an extremely rigid, comprehensive
system of race classification.  Divided into four main 'racial' groups
(White/European, Bantu (Black), Asian and Colored (Mixed Race)),
people's lives were rigidly segregated.  The segregation extended
from so-called petty apartheid (separate bus stops, water fountains
and toilets) to rights of work, residency, education and freedom of
movement.  This system became the target of worldwide protest, and
eventually came to a formal end.  These facts are common knowledge.
What has been less well documented or publicized are the actual
techniques used to classify people by race.  In Chapter 6, we
examine in detail some cases of mixed-race people who applied to be
re-classified after their initial racial designation by the state.
These borderline cases serve to illuminate the underlying architecture
of apartheid.  This was a mixture of brute power, confused eugenics
and appropriations of anthropological theories of race.  The
scientific reason given for apartheid by the white supremacist
Nationalist Party was 'separate development' - the idea that in order
to develop naturally, the races must develop separately.

In pursuing this ideology, of course, people and families that
crossed the color barrier were problematic.  If a natural scientific
explanation was given for apartheid, systematic means should be
available to winnow white from black, colored from black and so
on.  As the chapter delineates, this attempt was fraught with
inconsistencies and local work-arounds, as people never easily fit any
categories.  Over 100,000 people made formal appeals concerning their
race classification; most were denied.

Although it lies at a political extreme, these cases form a continuum
with the classification of people at different stages of tuberculosis.
In both cases, biographies and categories fall along often-conflicting
trajectories.  Lives are twisted, even torn, in the attempt to force
the one into the other.  These torques may be petty or grand, but
they are a way of understanding the co-construction of lives and their
categories.

Part 3: Classification and Work Practice

In Part 3, Chapters 7 and 8, we will look at how classification
systems organize and are organized by work practice.  We will look at
the effort of a group of nursing scientists based at the University
of Iowa and led by Joanne McCloskey and Gloria Bulechek to produce a
classification of nursing interventions.  Their Nursing Intervention
Classification (NIC) aims to depict the range of activities that
nurses carry out in their daily routines.  Their original system
consisted of a list of some 336 interventions; each comprised
of a label, a definition, a set of activities, and a short list
of background readings.  Each of those interventions is in turn
classified within a taxonomy of six domains and 26 classes.  For
example, one of the tasks nurses commonly perform is preparing and
monitoring intravenous medication.  The nursing intervention "Epidural
Analgesia Administration" is defined as: "preparation and delivery
of narcotic analgesics into the epidural space" another common one,
"Cough Enhancement", groups activities designed to help respiration.

The Iowa NIC researchers built up their system of nursing
interventions inductively.  They created a preliminary list that
distinguished between nursing interventions and activities, then
nurtured a large grassroots network of nursing researchers.  This
group narrowed the preliminary list of interventions to the original
336 published in Nursing Interventions Classification, and further
validated them via surveys and focus groups.  Different interventions
were reviewed for clinical relevance, and a coding scheme was
developed.  The classification system grew through a cooperative
process, with nurses in field sites trying out categories, and
suggesting new ones in a series of regional and specialist meetings.
Since 1992, the nurses have added over 50 interventions to their
original list.  We attended a number of these meetings, and
interviewed many of the nurses involved.  Caring work such as calming
and educating patients, usually done by nurses, often cuts across
specific medical diagnostic categories.  The NIC investigators use
their list of interventions in order to make visible and legitimate
the work that nurses do.  The idea is that it will be used to compare
work across hospitals, specialties and geographical areas, and to
build objective research measures for the outcomes.  NIC, although
still relatively young, promises to be a major rallying point for
nurses in the decades to come.  Before NIC, much nursing work was
invisible to the medical record.  As one nurse poignantly said,
"we were just thrown in with the cost of the room." Another said,
"I am not a bed!"  The traditional, quintessential nurse would be
ever present, caregiving, and helpful -- but not a part of the formal
patient-doctor information structure.  Of course, this invisibility
is bound up with traditional gender roles, as with librarians, social
workers and primary school teachers.  But as with the ICD, classifying
events is difficult.  In the case of NIC, the politics move from a
politics of certainty to a politics of ambiguity.  The essence of
this politics is walking a tightrope between increased visibility and
increased surveillance; between over-specifying what a nurse should do
and taking away discretion from the individual practitioner.

When discretion and the tacit knowledge that is part of every
occupation meet the medical bureaucracy which would account for every
pill and every moment of health care workers' time, contradictions
ensue.  This is especially true in the "softer" areas of care.
Social-psychological caregiving is also one of the areas where this
dilemma is prominent.  For example, NIC lists as nursing interventions
"anticipatory guidance" and "mood management" -- preparation for
grief, or surgery.  Difficult though these are to capture in a
classification scheme, one much more difficult is "humor." How can
one capture humor as a deliberate nursing intervention?  Does sarcasm,
irony, or laughter count as a nursing intervention?  When do you
stop?  How to reimburse humor, how to measure this kind of care?  No
one would dispute its importance, but it is by its nature a situated
and subjective action.  A grey area of common sense remains for
the individual staff nurse to define whether some of the nursing
interventions are worth classifying.

There are continuing tensions within NIC between just this kind
of common sense, and abstracting away from the local in order to
standardize and compare, while at the same time rendering invisible
work visible.  Nurses' work is often invisible for a combination of
good and bad reasons.  Nurses have to ask mundane questions, rearrange
bedcovers, move a patient's hand so that it is closer to a button,
and sympathize about the suffering involved in illness.  Bringing this
work out into the open and differentiating its components can mean
belaboring the obvious or risking being too vague.

One of the battlefields where comparability and control appear as
opposing factors is in linking NIC to costing.  NIC researchers
assert that the classification of nursing interventions will allow a
determination of the costs of services provided by nurses and planning
for resources needed in nursing practice.  As the nurse above says,
nursing treatments are usually bundled in with the room price.  NIC is
used in the development of nursing health care systems and may provide
a planning vehicle for previously untracked costs.  As we shall see,
NIC can also be problematic for nurses.  Like any other classification
scheme which renders work visible, it can also render surveillance
easier - and could in the end lead to a Tayloristic dissection of the
tasks of nursing (as the NIC designers are well aware).  So-called
unskilled tasks may be taken out of their hands and the profession as
a whole may suffer a loss of autonomy and the substitution of rigid
procedure for common sense.  As in the case of the ICD, there are
many layers of meaning involved in developing and implementing nursing
classification.  NIC might look like a straightforward organizational
tool: it is in fact much more than that.  It merges science, practice,
bureaucracy and information systems.  NIC coordinates bodies,
impairments, charts, reimbursement systems, vocabularies, patients,
and health care professionals.  Ultimately, it provides a manifesto
for nursing as an organized occupation, a basis for a scientific
domain and a tool for organizing work practices.

Why it is important to study classification systems

The sheer density of the collisions of classification schemes in our
lives calls for a new kind of science, a new set of metaphors, linking
traditional social science and computer and information science.
We need a topography of things such as the distribution of ambiguity;
the fluid dynamics of how classification systems meet up - a plate
tectonics rather than static geology.  This new science will draw
on the best empirical studies of workarounds, information use, and
mundane tools such as desktop folders and file cabinets (perhaps
peering backwards out from the web and into the practices).  It will
also use the best of object-oriented programming and other areas of
computer science to describe this territory.  It will build on years
of valuable research on classification in library and information
science.

Let us finish this introduction with a future scenario that symbolizes
this abstract endeavor.  Imagine that you're walking through a forest
of inter-articulated branches.  Some are covered with ice or snow,
and the sun melts their touching tips to reveal space between.  Some
are so thickly brambled they seem solid.  Others are oddly angular in
nature, like esplanaded trees.  Some of the trees are wild, some have
been cultivated.  Some are old and gnarled, and some are tiny shoots;
some of the old ones are nearly dead, others show green leaves.  The
forest is still wild, but there are some parks, and some protocols
for finding one's way along, at least on the known paths.  Helicopters
flying overhead can quickly tell you how many types of each tree,
even each leaf, there are in the world, but they cannot yet give you
a guidebook for birdwatching or forestry management.  There is a lot
of underbrush and a complex ecology of soil bacteria, flora and fauna.

Now imagine that the forest is a huge information space, and each
of the trees and bushes are classification systems.  Those who make
them up and use them are the animals and plants, and the soil is
a mix of the Internet, the paper world, and other communication
infrastructures.

Your job is to describe this forest.  You may write a basic manual of
forestry, or paint a landscape, compose an opera, or improve the maps
throughout.  What will your product look like?  Who will use it?

In this book, we show from our studies of medical, scientific and
race classification that, like a good forest, some areas will be
left wild, or in darkness, or even unmapped (that is, some ambiguity
will remain).  We will show that abstract schema that do not take use
into account -- say, maps that leave out landmarks or altitude or how
readers use maps -- will simply fail.  (That is, common sense will be
seen as the precious resource that it is.)  We intuit that a mixture
of scientific, poetic, and artistic talents, such as that represented
in the hypertextual world, will be crucial to this task.  We will
demonstrate the value of a mixture of formal and folk classifications,
used sensibly in the context of people's lives.

end