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 (2008/01/20 17:51)推噓0(0推 0噓 0→)

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Whether contagious or not, an epidemic has a sort of historical individuality, hence the need to employ a complex method of observation when dealing with it. Being a collective phenomenon, it requires a multiple gaze; a unique process, it must be described in terms of its special, accidental, unexpected qualities. The event must be described in detail, but it must also be described in accor- dance with the coherence implied by multi-perception: being an imprecise form of knowledge, insecurely based while ever partial, incapable of acceding of itself to the essential or fundamental, it finds its own range only in the cross-checking of viewpoints, in repeated, corrected information, which final- ly circumscribes, where gazes meet, the individual, unique nucleus of these collective phenomena. At the end of the eighteenth century, this form of ex- perience was being institutionalized. In each subdelegation a physician and several surgeons were appointed by the Intendant (provincial administrator) to study those epidemics that might break out in their canton; they were in constant correspondence with the chief physician of the generalite (treasury subdivision of old France) concerning 'both th reigning disease and the medi- cinal topography of their canton', and when four or five people succumbed to the same disease, the syndic had to notify the subdelegate, who sent the phy- sician to prescribe the treatment to be administered daily by the surgeons; in more serious cases, the physician of the generalite visited the scene of the outbreak himself [11]. But this experience could achieve full significance only if it was supple- mented by constant, constricting intervention. A medicine of epidemics could exist only if supplemented by a police: to supervise the location of mines and cemeteries, to get as many corpses as possible cremated instead of buried, to control the sale of bread, wine, and meat [12], to supervise the running of abattoirs and dye works, and to prohibit unhealthy housing; after a detailed study the whole country, a set of health regulations would have to be drawn up that would be read 'at service or mass, every Sunday and holy day', and which would explain how one should feed and dress oneself, how to avoid illness , and how to prevent or cure prevailing diseases: 'These precepts would become like prayers that even the most ignorant, even children, would learn to recite' [13]. Lastly, a body of health inspectors would have to be set up that could be 'sent out to the provinces, placing each one in charge of a particular department'; there he would collect information about the various domains related to medicine, as well as about physics, chemistry, natural history, topography, and astronomy, would prescribe the measures to be taken, and would supervise the work of the doctor. 'It is to be hoped that the state would pro- vide for these physicians and spare them the expense that an inclination to make useful discoveries entails' [14]. A medicine of eidemics is opposed at every point to a medicine of classes, just as the collective perception of a phenomenon that is widespread but unique and unrepeatable may be opposed to the individual perception of the identity of an essence as constantly revealed in the multiplicity of phenomena. The analysis of a series in the one case, the decipherment of a type in the other; the integration of time in the case of epidemics, the determination of hier- archical place in the case of the species; the attribution of a causality-- the search for an essential coherence, the subtle perception of a complex his- torical and geographical space--the demarcation of a homogeneous surface in which analogies can be read. And yet, in the final analysis, when it is a ques- tion of these tertiary figures that must distribute the disease, medical ex- perience and the doctor's supervision of social structures, the pathology of epidemics and that of the species are confronted by the same requirements: the definition of a political status for medicine and the constitution, at state level, of a medical consciousness whose constant task would be to provide information, supervision, and constraint, all of which 'relate as much to the police as to the field of medicine proper' [15]. This was the origin of the Societe Royale de Medecine and its insuperable conflict with the Faculte (the university authorities). In 1776, the government decided to set up at Versailles a society for the study of the epidemic and epizootic phenomena that had increased considerably in recent years. The pre- cise occasion was a disease affecting livestock that had broken out in south- eastern France, and which had forced the Controleur General des Finances to order the killing off of all suspect animals; this led to a fairly serious disruption of the regional economy. The decree of 29 April 1776 declares in its preamble that epidemics are deadly and destructive at the outset only because their character, being little known, leaves the doctor in uncertainty as to the choice of treatment that should be applied; and this uncertainty arises because so little has been done to study the different treatments used, or to describe the symptoms of the different epidemics and the curative methods that have been most successful. The commission was to have a three-fold role: investigation, by keeping itself informed of the various epidemic movements; elaboration, by comparing facts, recording the treatments used, and organizing experiments; and supervision and prescription, by informing the medical practitioners of the methods that seem to be most suitable to a given situation. It was to be made up of eight doctors : a directeur, entrusted with 'the correspondence concerning epidemic and epi- zootic diseases' (de Lasson), a commissaire general, who would co-ordinate the work of the provincial doctors (Vicq d'Azyr), and six doctors of the Faculte, who would devote themselves to work on these same subjects. The Controleur des Finances could send them out to the provinces to make inquiries and ask them for reports. Lastly, Vicq d'Azyr was to give a course in human and comparative anatomy to the other members of the commission, the doctors of the Faculte, and 'those students who showed themselves to be worthy of it' [16]. Thus a double check was set up: that of the political authorities over the practice of medicine and that of a privileged medical body over the prac- titioners as a whole. The conflict with the Faculte broke out at once. In contemporary eyes, it was a collision of two institutions, one modern and politically supported, the other archaic and inward-looking. A partisan of the Faculte described their opposition thus: The one ancient, respectable for all manner of reasons and principally in the eyes of the members of the society most of whom have been trained by it; the other, a modern institution whose members have preferred to associate with ministers of the Crown rather than with their own institutions, who have de- serted the Assemblies of the Faculte to which the public good and their oaths should kept them attached for a career of intrigue [17]. -- ※ 發信站: 批踢踢實業坊(ptt.cc) ◆ From: 122.120.107.144