Re: Michel Foucault--The Birth of the Clinic

看板EngTalk (全英文聊天)作者fizeau (Gratias ad Opus)時間18年前 (2008/01/11 04:08)推噓0(0推 0噓 0→)

留言0則, 0人參與討論串9/17 (看更多)

In this pathology, time plays a limited role. It is admitted that a disease may last, and that its various episodes may appear in turn; ever since Hippocrates doctors have calculated the critical days of a disease, and known the significant values of the arterial pulsations: 'When the rebounding pulse appears at each thirtieth pulsation, or thereabouts, the haemorrhage occurs four days later, more or less; when it occurs at every sixteenth pulsation, the haemorrhage will occur in three days' time....Lastly, when it recurs every fourth, third, second pulsation, or when it is continual, one must expect the haemorrhage within twenty-four hours' [17]. But this numerically fixed duration is part of the essential structure of disease, just as chronic catarrh becomes, after a period of time, phthisic fever. There is no process of evolution in which duration introduces new events of itself and at its own insistence; time is integrated as a nosological constant, not as an organic variable. The time of the body does not affect, and still less determines, the time of the disease. What communicates the essential 'body' of the disease to the real body of the patient are not, therefore, the points of localization, nor the effects of duration, but, rather, the quality. In one of the experiments described before the Prussian Royal Academy in 1764, Meckel explains how he observed the alteration in the brain during different diseases. When he carried out an autopsy, he removed from the brain small cubes of equal volume ('6 lines in each direction') in different places in the cerebral mass: he compared these extractions with each other, and with similar cubes taken from other corses. The instrument used for this comparison were weighing scales; in phthisis, a disease involving exhaustion, the specific weight of the brain was found to be relatively lower than in the case of apoplexy, a disease involving discharge (1 dr 3 3/4 gr as against 1 dr 6 or 7 gr); whereas in the case of a normal subject who had died naturally the average weight was 1 dr 5 gr. These weights may vary according to the part of the brain from which th samples have been extracted: in phthisis it is, above all, the cerebellum that is light; in apoplexy the central areas are heavy [18]. Between the disease and the organism, then, there are connexion points that are situated according to a regional principle; but these are only sectors in which the disease secretes or transposes its specific qualities: the brains of maniacs are light, dry, and friable because mania is a lively, hot, explosive disease; those of phthisics are exhausted and languishing, inert, anaemic, because phthisis belongs to the general class of the hae- morrhages. The set of qualities characterizing a disease is laid down in an organ, which then serves as a support for the symptoms. The disease and the body communicate only through the non-spatial element of quality. It is understandable, then, that medicine should turn away from what Sauvages called a 'mathematical' form of knowledge: 'Knowing quantities and being able to measure them, being able, for example, to determine the force and speed of the pulse, the degree of heat, the intensity of pain, the violence of the cough, and other such symptoms' [19]. Meckel measured, not to obtain knowledge of mathematical form, but to gauge the intensity of the pathological quality that constituted the disease. No measurable mechanics of the body can, in its physical or mathematical particularities, account for a pathological phenomenon; convulsions may be due to a dehydration and contraction of the nervous system--and this is certainly a phenomenon of a mechanical order; but it is a mechanics of interlinked qualities, articulated movements, up- heavals that are triggered off in series, not a mechanics of quantifiable segments. It may involve a mechanism, but it cannot belong to the order of Mechanics as such. 'Physicians must confine themselves to knowing the forces of medicines and diseases by means of their operations; they must observe them with care and strive to know their laws, and be tireless in the search for physical causes' [20]. A true mathematization of disease would imply a common, homogeneous space, with organic figures and a nosological ordering. On the contrary, their shift implies a qualitative gaze; in order to grasp the disease, one must look at those parts where there is dryness, ardour, excitation, and where there is humidity, discharge, debility. How can one distinguish, beneath the same fever, the same coughing, the same tiredness, pleurisy of the phthisis, if one does not recognize here a dry inflammation of the lungs, and there a serous discharge? How can one distinguish, if not by their quality, the convulsions of an epileptic suffering from cerebral inflammation, and those of a hypochondriac suffering from congestion of the viscera? A subtle perception of qualities, a percetion of the differences between one case and another, a delicate perception of variants--a whole hermeneutics of the pathological fact, based on modulated, coloured experience , is required; one should measure variations, balances, excesses, and defects. The human body is made up of vessels and fluids;...when the vessels and fibres have neither too much nor too little tone, when the fluids have just the right consistency, when they have neither too much nor too little movement, man is in a state of health; if the movement...is too strong, the solids harden and the fluids thicken; if it is too weak, the fibre slackens and the blood becomes thinner [21]. And the medical gaze, open to these fine qualities, necessarily becomes at- tentive to all their modulations; the decipherment of disease in its specific characteristics is based on a subtle form of ercetion that must take account of each particular equilibrium. But in what does this particularity consist? It is not that of an organism in which pathological process and reactions are linked together in a unique way to form a 'case'. We are dealing, rather, with qualitative varieties in the second stage. What classificatory medicine calls 'particular histories' are the effects of multiplication caused by the qualitative variations (owing to the temperaments) of the essential qualities that characterize illnesses. The individual patient finds himself at the point at which the result of this multiplication appears. Hence his paradoxical position. If one wishes to know the illness from which he is suffering, one must subtract the individual, with his particular qua- lities: 'The author of nature,' said Zimmermann, 'has fixed the course of most diseases through immutable laws that one soon discovers if the course of the disease is not interrupted or disturbed by the patient' [22]; at this level the individual was merely a negative element, the accident of the disease, which, for it and in it, is most alien to its essence. But the individual now reappears as the positive, ineffaceable support of all these qualitative phenomena, which articulate upon the organism the fundamental oedering of the disease; it is the local, sensible presence of this order--a segment of enigmatic space that unites the nosological plane of inships to the anatomic volume of vicinities. The patient is a geometrically impossible spatial syn- thesis, but for that very reason unique, central, and irreplaceable: an order that has become density in a set of qualifying modulations. And the same Zimmermann, who recognized in the patient only the negative of the disease, is 'sometimes tempted', contrary to Sydenham's general descritions, 'to admit only of particular histories. However simple nature may be as a whole, it is nevertheless varied in its arts' [23]. The medicine of species becomes engaged in a renewed attention to the individual--an ever-more impatient attention, ever less able to tolerate the general forms of perception and the hasty in- spection of essences. -- ※ 發信站: 批踢踢實業坊(ptt.cc) ◆ From: 122.120.96.100