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 09:07)推噓1(1推 0噓 1→)

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The natural locus of disease is the natural locus of life--the family: gentle, spontaneous care, expressive of love and a common desire for a cure, assists nature in its struggle against the illness, and allows the illness itself to attain its own truth. The hospital doctor sees only distorted, altered diseases, a whole teratology of the pathological; the family doctor 'soon acquires true experience based on the natural phenomena of all species of disease' [32]. This family medicine must necessarily be respectful: 'Observe the sick, assist nature without violating it, and wait, admitting in all modesty that much knowledge is still lacking' [33]. Thus, on the subject of the pathology of species, there is a revival of the old dispute between active medicine and expectant medicine [34]. The nosologists of necessity favoured the latter, and one of these, Vitet, in a classification containing over two thousand species, and bearing the title Medecine expectante, invariably prescribes quina to help nature follows its natural course [35]. The medicine of species implies, therefore, a free spatialization for the disease, with no privileged region, no constraint imposed by hos- pital conditions--a sort of spontaneous division in the setting of its birth and development that must function as the paradoxical and natural locus of its own abolition. At the place in which it appears, it is obliged , by the same movement, to disappear. It must not be fixed in a medically prepared domain, but be allowed, in the positive sense of the term, to ' vegetate' in its original soil: the family, a social space conceived in its most natural, most primitive, most morally secure form, both enclosed upon itself and entirely transparent, where the illness is left to itself. Now, this structure coincides exactly with the way in which, in political thought, the problem of assistance is reflected. The criticism levelled at hospital foundations was a commonplace of eighteenth- century economic analysis. The funds on which they are based are, of course, inalienable: they are the perpetual due of the poor. But poverty is not perpetual; needs change, and assistance must be given to those provinces and towns that need it. To do so would not be to contravene the wishes of the donors, but on the contrary to give them back their true form; their 'principal aim was to serve the public, to relieve the State; without departing from the intention of the founders, and even in conformity with their views, one must regard as a common mass all the funds donated to the hospitals' [36]. The single, sacrosanct foundation must be dissolved in favor of a generalized system of assistance, of which society is both the sole admi- nistrator and the undifferentiated beneficiary. Moreover, it is an error in economics to base assistance on an immobilization of caital--that is to say, on an impoverishment of the nation, which, in turn, brings with it the need for new foundations; hence, at worst, a stifling of activity. Assistance should be related neither to productive wealth (capital), nor to the wealth produced (profits, which are always capitalizable), but to the very principle that produces wealth: work. It is by giving the poor work that one will help the poor without impoverishing the nation [37]. The sick man is no doubt incapable of working, but if he is placed in a hospital he becomes a double burden for society: the assistance that he is given relates only to himself, and his family is, in turn, left exposed to poverty and disease. The hospital, which creates disease by means of the enclosed, pestilential domain that it constitutes, creates further disease in the social space in which it is placed. This separation, intended to protect, communicates disease and multiplies it to infinity. Inversely, if it is left in the free field of its birth and development, it will never be more than itself--as it appeared, so will it be extinguished--and the assistance that is given in the home will make up for the poverty that the disease has caused. The care spontaneously given by family and friends will cost nobody anything; and the financial assistance given to the sick man will be to the advantage of the family: 'someone will have to eat the meat from which his broth is made; and in heating his tisane, it costs no more to warm his children as well' [38]. The chain of one disease en- gendering another, and that of the perpetual impoverishment of poverty, is thus broken when one gives up trying to create for the sick a diffren- tiated, distinct space, which results, in an ambiguous but clumsy way, in both the protection and the preservation of disease. Independently of their justifications, the thought structure of the eco- nomists and that of the classificatory doctors coincide in broad terms: the space in which disease is isolated and reaches fulfilment is an ab- solutely open space, without either division or a privileged, fixed figure, reduced solely to the plane of visible manifestations; a homogeneous space in which no intervention is authorized except that of a gaze which is effaced as it alights, and of assistance whose sole value is its transitory com- pensation--a space with no other morphology than that of the resemblances perceived from one individual to another, and of the treatment administered by private medicine to a private patient. But, by being carried to its conclusion in this way, the structure is inverted . Is a medical experience, diluted in the free space of a society reduced to the single, nodal, and necessary figure of the family, not bound up with the very structure of society? Does it not involve, because of the special attention that it pays to the individual, a generalized vigilance that by extension applies to the group as a whole? It would be necessary to conceive of a medicine sufficiently bound up with the state for it to be able, with the cooperation of the state, to carry out a constant, general, but differen- tiated policy of assistance; medicine becomes a task for the nation. (Menuret in the early days of the French Revolution dreamt of a system of free medical care administered by doctors who would be paid by the government out of the income from former church property [39].) In this way a certain supervision would be exercised over the doctors themselves; abuses would be prevented and quacks forbidden to practice, and, by means of an organized, healthy, rational medicine, home care would prevent the patient's becoming a victim of medicine and avoid exposure to contagion of the patient's family. Good medicine would be given status and legal protection by the state; and it would be the task of the state 'to make sure that a true art of curing does exist' [40]. The medicine of individual perception, of family assistance, of home care can be based only on a collectively controlled structure, or on one that is inte- grated into the social space in its entirety. At this point, a quite new form, virtually unknown in the eighteenth century, of institutional spatialization of disease, makes its appearance. The medicine of spaces disappears. [1] Gilibert, L'anarchie medicinale (Neuchatel, 1772, vol. 1, p.198). [2] F. Boissier de Sauvages, Nosologie methodique (Lyons, 1772, vol. 2). [3] Ibid., vol. 3 [4] W. Cullen, Institutions de medecine pratique (Fr. trans., Paris 1785, vol. 2, pp. 39-60). [5] W. Cullen, Institutions de medecine pratique (Fr. trans., Paris, 1785, 2 vols.). [6] Th. Sydenham, Medecine pratique (Fr. trans. Jault, Paris, 1784, p.390). [7] Ibid. [8] Th. Sydenham, quoted by Sauvages, op. cit., vol. 1, p. 88. [9] W. Cullen, op. cit., vol. 2, p. 86. [10] Sydenham, quoted by Sauvages, op. cit., vol. 1, pp. 124-5. [11] Ibid. [12] Clifton, Etat de la medecine ancienne et moderne (Fr. trans., Paris, 1742, p. 213) [13] Frier, Guide pour la conservation de l'homme (Grenoble, 1789, p.113). [14] T. Guindant, La nature opprimee par la medecine moderne (Paris, 1768, pp. 10-11). [15] L'Encyclopedie, article 'Spasme'. [16] J. Haslam, Observations on Madness (London, 1798, p. 259). [17] Fr. Solano de Luques, Observations nouvelles et extraordinaires sur la prediction des crises, enlarged by several new cases by Nihell (Fr. trans., Paris, 1748, p. 2). [18] Account in Gazette salutaire, vol. XXI, 2 August 1764. [19] Sauvages, op. cit., vol. 1, pp. 91-2. [20] Tissot, Avis aux gens de lettres sur leur sante (Lausanne, 1767, p. 28). [21] Ibid., p. 28. [22] Zimmermann, Traite de l'experience (Fr. trans., Paris, 1800, vol. 1, p. 122). [23] Ibid., p. 184. [24] Ibid., p. 187. [25] Ibid., p. 127. [26] Ibid., p. 178. [27] Tissot, Traite des nerfs et de leurs maladies (Paris, 1778-1780, vol. 2, pp. 432-44). [28] Tissot, Essai sur la sante des gens du monde (Lausanne, 1770, pp. 8-12). [29] Tenon, Memoires sur les hopitaux (Paris, 1788, p. 451). [30] Percival, 'Lettre a M. Aikin', in J. Aikin, Observations sur les hopitaux (Fr. trans., Paris, 1777, p. 113). [31] Dupont de Nemours, Idees sur les secours a donner (Paris, 1786, pp. 24-5). [32] Ibid. [33] Moscati, De l'emploi des systemes dans la medecine pratique (Fr. trans., Strasbourg, Year VII, pp. 26-7). [34] Cf. Vicq d'Azyr, Remarques sur la medecine agissante (Paris, 1786). [35] Vitet, La medecine expectante (Paris, 1806, 6 vols.). [36] Chamousset (C.H.P.), 'Plan general pour l'administration des hopitaux', Vues d'un citoyen (Paris, 1757, vol. II). [37] Turgot, article 'Fondation', in L'Encyclopedie. [38] Dupont de Nemours, op. cit., pp. 14-30. [39] J. -J. Menuret, Essai sur les moyens de former de bons medecins (Paris, 1791). [40] Jadelot, Adresse a Nos Seigneurs de l'Assemblee Nationale sur la necessite et le moyen de perfectionner l'enseignement de la medecine (Nancy , 1790, p. 7). -- ※ 發信站: 批踢踢實業坊(ptt.cc) ◆ From: 122.120.109.37 ※ 編輯: fizeau 來自: 122.120.109.37 (01/11 15:34)