The Birth of the Clinic: An Archaeology of Medical Perception

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We must place ourselves, and remain once and for all, at the level of the fundamental spatialization and verbalization of the pathological, where the loquacious gaze with which the doctor observes the poisonous heart of things is born and communes with itself” (xii-xiii).

Modern medicine has fixed its own date of birth as being in the last years of the eighteenth century. Reflecting on its situation, it identifies the origin of its positivity with a return—over and above all theory—to the modest but effecting level of the perceived. In fact, this supposed empiricism is not based on a rediscovery of the absolute values of the visible, nor on the predetermined rejection of systems and all their chimeras, but on a reorganization of that manifest and secret space that opened up when a millennial gaze paused over men’s sufferings. Nonetheless the rejuvenation of medical perception, the way colours and things came to life under the illuminating gaze of the first clinicians is no mere myth. How long it lasts: Early labor is unpredictable. For first-time moms, the average length varies from hours to days. It's often shorter for subsequent deliveries. Bahasa yang sederhana dan adunan ilmu perubatan dengan politik, sejarah dan falsafah yang diolah baik oleh penulis Perancis ini. Membaca karya Edward Said dan Michel Foucault pasti menimbulkan bibit-bibit akan pentingnya menguasai bahasa Perancis. By what right can one transform into an object of clinical observation a pacient whose poverty has compelled him to seek assistance at the hospital?The first stage is the longest of the three stages. It's actually divided into two phases — early labor and active labor. Early labor In that light, the empiricism of the 18th and 19th centuries was not a dispassionate act of looking, noting, and reporting the disease presented before the doctor's eyes. The relationship between doctor and patient (subject and object) is not about the one who knows and the one who tells, because doctor–patient interactions are not "mindless phenomenologies" that existed before their consultation (medical discourse) as patient and doctor. [6] Clinical medicine came to exist as part of the intellectual structure that defines and organises medicine as "the domain of its experience and the structure of its rationality" as a field of knowledge. [7] Thus, the medical—classificatory—gaze during this period was confined to signs and symptoms such that “paradoxically, in relation to that which he is suffering from, the patient is only an external fact; the medical reading must take him into account only to place him in parentheses” (p. 8). As a result, judgments about a patient’s condition could draw only from similarities and differences among sets of signs and symptoms laid out in pre-determined patterns—this sign goes here, that symptom goes there. Time and space have no role; never first this, then that, or here this, there that. The Shifting Gaze If you're having an uncomplicated pregnancy, you may spend most of your early labor at home until your contractions start to increase in frequency and intensity. Your health care provider will instruct you on when to leave for the hospital or birthing center. If your water breaks or you experience significant vaginal bleeding, call your health care provider right away. Active labor

At some point, you might be asked to push more gently — or not at all. Slowing down gives your vaginal tissues time to stretch rather than tear. To stay motivated, you might ask if you could feel the baby's head between your legs or see it in a mirror. Prior to this time, diseases were viewed in a rather Aristotelean sense: they were viewed as beings (substances) themselves, to be classified according to their accidental properties. The physician’s task was to discover the disease, to classify it and to let it develop along a natural course. There is an almost exact analogy to be drawn with the botanist, who studies, classifies and cultivates plants. Within this structure of knowledge, the patient is a negative factor – his body distorts the way the disease manifests himself. The physician has to negate the patient, and himself as well (as observer), and view the disease in its pure manifestation. Modern medicine begins for Foucault around the time of the French Revolution, at a time when the gaze newly encompasses other factors. Time and space now mattered. Nevertheless, there are also very interesting parts, which, as a doctor for human medicine, i appreciated a lot.T]he solidity, the obscurity, the density of things closed in upon themselves, have powers of truth that they owe not to light, but to the slowness of the gaze that passes over them, around them, and gradually into them, bringing them nothing more than its own light. The residence of truth in the dark centre of things is linked, paradoxically, to this sovereign power of the empirical gaze that turns their darkness into light” (xiii-xiv). The Birth Company are proud of the high-quality service provided to their patrons and welcome a re-inspection by the CQC. Foucault does not make it easy to understand his ideas. Perhaps the translation obscures his ideas to a degree, but some scholars have suggested that Foucault is purposely abstruse and prolix (to use one of his own favorite words). The major thrust of this book is also obscured by some French history and Franco-centrism that while interesting does not clarify. To appreciate The Birth of the Clinic requires more than one careful reading and the aid of Foucaultian scholars who have worked through his ideas. Done this way, however, Foucault rewards the reader interested in how medical knowledge and the clinic came to be. Source: The Birth of the Clinic: An Archaeology of Medical Perception ( Naissance de la clinique: une archéologie du regard médical, 1963), by Michel Foucault, presents the development of la clinique, the teaching hospital, as a medical institution, identifies and describes the concept of Le regard médical ("the medical gaze"), and the epistemic re-organisation of the research structures of medicine in the production of medical knowledge, at the end of the eighteenth century. Although originally limited to the academic discourses of post-modernism and post-structuralism, the medical gaze term is used in graduate medicine and social work. [1] The medical gaze [ edit ]

I understand what he is trying to say, but I just think its bullshit. With the introduction of the anatomical method in the clinical practice, doctors now had to move from symptoms (as they manifest themselves in the total body of the patient through his behaviour) to the tissues of organs (wherefrom allegedly these symptoms originate). Now, symptoms as well as tissues were viewed by doctors in two dimensions – i.e. plane surfaces on bodies. Anatomy now adds a third dimension to this, depth, in trying to relate symptoms to diseased tissues in specific organs. And this constitutes the new anatomo-clinical method.

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But this experience [of the epidemic –ZJB] could achieve full significance only if it was supplemented 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, to supervise the running of abattoirs and dye works, and to prohibit unhealthy housing; after a detailed study of 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.’ 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 provide for these physicians and spare them the expense that an inclination to make useful discoveries entails’” (25-6). But we are concerned here not simply with medicine and the way in which, in a few years, the particular knowledge of the individual patient was structured. For clinical experience to become possible as a form of knowledge, a reorganization of the hospital field, a new definition of the status of the patient in society, and the establishment of a certain relationship between public assistance and medical experience, between help and knowledge, became necessary; the patient has to be enveloped in a collective, homogeneous space. It was also necessary to open up language to a whole new domain: that of a perpetual and objectively based correlation of the visible and the expressible. An absolutely new use of scientific discourse was then defined: a use involving fidelity and unconditional subservience to the coloured content of experience—to say what one sees; but also a use involving the foundation and constitution of experience—showing by saying what one sees.” (p.196) Gutting, Gary (1989). Michel Foucault's Archaeology of Scientific Reason. Cambridge: CUP. ISBN 9780521366984. There's some very sharp reminders in here of why Foucault is considered a descendent of Nietzsche. The one most important for me is that, unlike most philosophers, he's a damn good writer. His love of language shines almost as brightly. During this period, hospitals were deemed to be economic and medicinal hindrances. They would distort the natural flow of capital through a society as well as distort the natural flow of a disease. The hospitals confounded disease. Reforms were introduced which closed the hospitals, limited the freedom of doctors, and send patients to their families. Medicine would now become family medicine.