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 (2008/01/26 09:24)推噓0(0推 0噓 0→)

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For three months, the Faculte 'went on strike' in protest: it refused to exercise its functions, and its members refused to consult with the members of the society. But the outcome was determined in advance be- cause the Conseil supported the new committee. By 1778, the letters pa- tent confirming its transformation into the Societe Royale de Medecine had been registered, and the Faculte had been forbidden 'to employ any kind of defence in this affair'. The Societe received an income of 40,000 francs raised from mineral waters, while the Faculte received hardly 2,000 francs [18]. But, above all, its role was constantly being enlarged : as a control body for epidemics, it gradually became a point for the centralization of knowledge, an authority for the registration and judgement of all medical activity. At the beginning of the Revolution, the Finance Committee of the National Assembly was to justify its status thus: 'The object of this society is to link French medicine with foreign medicine by means of a useful correspondence; to gather together isolated observa- tions, to perserve them and to compare them; and, above all, to research into the causes of common diseases, to forecast their occurrence, and to discover the most effective remedies for them' [19]. The Societe no longer consisted solely of doctors who devoted themselves to the study of collec- tive pathological phenomena; it had become the official organ of a collective consciousness of pathological phenomena, a consciousness that operated at both the level of experience and the level of knowledge, in the international as well as the national space. Political events had a certain novelty value here, as far as basic structures were concerned. A new type of experience was created whose general lines, formed around the years 1775-1780, were to extend far in time and bring with them, during the Revolution and right up to the Consulate, many projects of reform. No doubt very few of these plans were ever implemented. And yet the form of medical perception that they involve is one of the constituent ele- ments of clinical experience. There was a new type of totalization. The treatises of the eighteenth century, Institutions, Aphorisms, Nosologies, enclosed medical knowledge within a defined space: the table drawn up may not have been complete in every detail, and may have contained gaps here and there owing to ignorance, but in its general form it was exhaustive and closed. It was now replaced by open, in- finitely extendable tables. Hautesierck had already provided an example of such a table, when, at Choiseul's request, he proposed a plan of collective work for military physicians and surgeons, comprising four parallel, unlimited series: the study of topographies (location, terrain, water, air, society, the temperaments of the inhabitants), meteorological observations (pressure , temperature, winds), an analysis of epidemics and common diseases, and a description of extraordinary cases [20]. The theme of the encyclopaedia is replaced by that of constant, constantly revised information, where it is a question, rather, of totalizing events and their determination than of en- closing knowledge in a systematic form: 'It is so true that there exists a chain linking, throughout the universe, on earth and in man, all beings, all bodies, all affections; a chain whose subtlety eludes the superficial gaze of the meticulous experimenter and the writer of cold dissertations, but is re- vealed to the truly observant genius' [21]. At the beginning of the Revolution , Cantin proposed that this work of information should be undertaken in each department by a commission elected from among the doctors [22]; Mathieu Geraud demanded the creation in every large town of a 'government health centre' and in Paris of a 'health court', sitting beside the National Assembly, centrali- zing information, conveying it from one part of the country to another, dis- cussing questions that still remain obscure, and indicating what research needs to be carried out [23]. What now constituted the unity of the medical gaze was not the circle of know- ledge in which it was achieved but that open, infinite, moving totality, cease- lessly displaced and enriched by time, whose course it began but would never be able to stop--by this time a clinical recording of the infinite, variable series of events. But its support was not the perception of the patient in his singularity, but a collective consciousness, with all the information that intersects in it, growing in a complex, ever-proliferating way until it finally achieves the dimensions of a history, a geography, a state. In the eighteenth century, the fundamental act of medical knowledge was the drawing up of a 'map' (reperage): a symptom was situated within a disease, a disease in a specific ensemble, and this ensemble in a general plan of the pathological world. In the experience that was being constituted towards the end of the century, it was a question of 'carving up' the field by means of the interplay of series, which, in intersecting one another, made it possible to reconstitute the chain referred to by Menuret. Each day Razoux made meteo- rological and climatic observations, which he then compared with a nosological analysis of patients under observation and with the evolution, crises, and outcome of the diseases [24]. A system of coincidences then appeared that in- dicated a causal connexion and also suggested kinships or new links between diseases. 'If anything is able to improve our art,' Sauvages himself wrote to Razoux, 'it is work of this kind carried out over a period of fifty years, by a team of thirty doctors as meticulous and industrious as yourself....I will do all in my power to have one of our doctors carry out the same observations in our Hotel-Dieu' [25]. What defines the act of medical knowledge in its con- crete form is not, therefore, the encounter between doctor and patient, nor is it the confrontation of a body of knowledge and a perception; it is the systematic intersection of two series of information, each homogeneous but alien to each other--two series that embrace an infinite set of separate events , but whose intersection reveals, in its isolable dependence, the individual fact. A sagittal figure of knowledge. In this movement, medical consciousness is duplicated: it lives at an immediate level, in the order of 'savage' observations; but it is taken up again at a higher level, where it recognizes the constitutions, confronts them, and, turning back upon the spontaneous forms, dogmatically pronounces its judgement and its knowledge. It becomes centralized in structure. At the institutional level this is apparent in the Societe Royale de Medecine. And at the beginning of the Revolution there were innumerable projects that schematized this dual and necessary authority (instance) of medical knowledge, with its ceaseless movement between these two levels, at the same time maintaining and traversing the distance between them. Mathieu Geraud proposed the setting up of a Health Court (Tribunal de Salubrite) where a prosecutor would denounce 'any person who, without having given proof of his ability, exercises upon another, or upon an animal that does not belong to him, anything pertaining to the direct or indirect application of the art of health' [26]; the decisions of this court concerning professional abuses, inadequacies, and imperfections should consti- tute the jurisprudence of the medical state. In addition to a Judiciary, there should be an Executive that would exercise a policing function over all aspects of health (la haute et grande police sur toutes les branches de la salubrite). It would prescribe what books were to be read and what new works were to be written; it would indicate, on the basis of the information received, what treatment was to be administered for prevalent diseases; it would publish what- ever was required by an enlightened medical practice, whether the results of inquiries carried out under its own supervision or foreign works. Following an autonomous movement, the medical gaze circulates within an enclosed space in which it is controlled only by itself; in sovereign fashion, it distributes to daily experience the knowledge that it has borrowed from afar and of which it has made itself both the point of concentration and the centre of diffusion. In that experience, medical space can coincide with social space, or, rather, traverse it and wholly penetrate it. One began to conceive of a generalized presence of doctors whose intersecting gazes form a network and exercise at every point in space, and at every moment in time, a constant, mobile, diffe- rentiated supervision. The problem of the settling of doctors in the country- side was raised [27]; there were requests for a statistical supervision of health based on the registration of births and deaths (which would have to mention the disease from which the individual suffered, his mode of life, and the cause of his death, thus constituting a pathological record); there were demands that the reasons for exemption from military service on medical grounds should be given in detail by the recruiting board; in fact, that a medical topography of each department should be drawn up, 'with detailed ob- servations concerning the region, housing, people, principal interests, dress, atmospheric constitution, produce of the ground, time of their perfect maturity and their harvesting, and physical and moral education of the inhabitants of the area' [28]. And since the question of the settling of doctors was not enough, the consciousness of each individual must be alerted; every citizen must be informed of what medical knowledge is necessary and possible. And each practitioner must supplement his supervisory activity with teaching, for the best way of avoiding the propagation of disease is to spread medical knowledge [29]. The locus in which knowledge is formed is no longer the patho- logical garden where God distributed the species, but a generalized medical consciousness, diffused in space and time, open and mobile, linked to each individual existence, as well as to the collective life of the nation, ever alert to the endless domain in which illness betrays, in its various aspects, its great, solid form. -- ※ 發信站: 批踢踢實業坊(ptt.cc) ◆ From: 118.168.188.22