The Birth of the Clinic: An Archaeology of Medical Perception

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Pathological anatomy, the science generating knowledge about the visible alterations on organs and tissues diseases cause, marked an important advance for the clinic upon “the day it was admitted that lesions explained symptoms” (p. 127). From then on, and accelerated by investigations using exhumed corpses, pathological anatomy became “an objective, real, and at last unquestionable foundation for the description of diseases” (p. 129). In the genealogy of medicine—knowledge about the human body—the term Le regard médical (The medical gaze) identifies the doctor’s practice of objectifying the body of the patient, as separate and apart from his or her personal identity. In the treatment of illness, the intellectual and material structures of la clinique, the teaching hospital, made possible the inspection, examination, and analysis of the human body, yet the clinic was part of the socio-economic interests of power. Therefore, when the patient’s body entered the field of medicine, it also entered the field of power where the patient can be manipulated by the professional authority of the medical gaze. [2]

the development of clinical medicine, of pathology (this part is quite tenuous to read especially if you are a doctor and know the actual state of the arts. because those whole "ancient" theories about tissues and diseases are nowadays outdated, you can read them and think of them as medical dystopies (HAHAHA). Nevertheless, the reasons for inventing the stethoscope are quite funny (as the doctor was not allowed to put his ear on the woman's chest) The CQC found that The Birth Company needed to make some improvements in areas of safety and being well-led and therefore the service was rated ‘Requires Improvement’ overall. Less than a hundred years later, this is how a doctor observed an anatomical lesion of the brain and its enveloping membranes, die so-called ‘false membranes’ frequently found on patients suffering from ‘chronic meningitis:’ This is one of those books in which it feels like the author is intentionally obscure -- almost in a self-aggrandizing way. To use one of Foucault's favorite (or at least most frequent) criticisms against others (in this text), this book is needlessly prolix; he throws that word around like it's going out of style. Oh, wait. Yet it concerns one of those periods that mark an ineradicable chronological threshold: the period in which illness, counter-nature, death, in short, the whole dark underside of disease came to light, at the same time illuminating and eliminating itself like night, in the deep, visible, solid, enclosed, but accessible space of the human body. What was fundamentally invisible is suddenly offered to the brightness of the gaze, in a movement of appearance so simple, so immediate that it seems to be the natural consequence of a more highly developed experience. It is as if for the first time for thousands of years, doctors, free at last of theories and chimeras, agreed to approach the object of their experience with the purity of an unprejudiced gaze. But the analysis must be turned around: it is the forms of visibility that have changed; the new medical spirit to which Bichat is no doubt the first to bear witness in an absolutely coherent way cannot be ascribed to an act of psychological and epistemological purification; it is nothing more than a syntactical reorganization of disease in which the limits of the visible and invisible follow a new pattern; the abyss beneath illness, which was the illness itself, has emerged into the light of language” (p.195).In "Reading Capital" Althusser defines philosophical work as an intervention in science, an exposing of what the object of a science is. "The Birth of the Clinic" is a philosophical work in this sense. the development of hospitals, the whole philosophy around hospital and disease (before that step, people were treated at home, and after that step, the rich were still treated at home and the hospital was just a mean of treating / isolating the poor) 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 ] 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.

Wat een prachtig boek, zoveel wijsheid! Het vergt echt een boel inspanning om het te begrijpen maar het is het meer dan waard. Foucault gebruikt het halve boek om de tegenstelling te schetsen tussen hoe de geneeskunde was en hoe de geneeskunde nu is. Dat is nog best een lastig onderscheid, maar dat het zo moeilijk te begrijpen is, toont ook hoe normaal de huidige manier van denken is. Stap voor stap ontleedt en reconstrueert Foucault de klinische blik, de vanzelfsprekendheid waarmee je als arts je patiënt tegemoet treedt. Dat is ontzettend waardevol, want de blinde vlekken worden zo ook duidelijk. En kritische reflectie op het hoe en waarom kan ook nooit kwaad. Dit boek is een absolute aanrader voor iedereen die zich wel eens afvraagt waarom we de dingen in de kliniek op een bepaalde manier doen. Foucault jumps in during the mid-eighteenth-century period of “classificatory medicine,” when “…disease is given an organization, hierarchized into families, genera, and species,” (p. 4) akin to botanical classifications, offering doctors “a gardener’s gaze” (p. 119). Diseases were accorded their own existence independent of the individual body, and so knowledge of particular bodies only interfered with discerning true diseases. Botanical classification; 227 figures of plant anatomical segments with descriptive text. Colour process print. Wellcome Collection. Public Domain Mark Patient attributes and environmental factors became relevant considerations in discerning diseases. Furthermore, political changes stemming from the French Revolution ceded power over health matters to the new government, which it promptly transferred to the doctors. Society would now have a point of view on what constitutes health, a view the gaze could not escape. This gaze focused on health as it concerned a “benefit to the state.” Not until later yet in the nineteenth-century would the gaze shift towards deviations from established norms of health, when, in other words, the gaze was redirected from what Foucault calls the social space to the pathological space. This particular shift for him marked a transformation of classificatory medicine to clinical medicine.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]

the becoming of the clinical medicine, the whole narrative around "the gaze" made me realize again how important this step was in the development of modern medicine. This was a very challenging book to read. Foucault's narrative is very meandering and tortuous, sometimes I had the feeling that the phrases made no sense at all, but they looked well altogether through the type of used words.Nevertheless, there are also very interesting parts, which, as a doctor for human medicine, i appreciated a lot. This book is about space, about language, and about death; it is about the act of seeing, the gaze. urn:oclc:record:1391290941 Foldoutcount 0 Identifier birthofclinicarc0000fouc Identifier-ark ark:/13960/s2mwv35p140 Invoice 1652 Isbn 0679753346 Lccn 94193796 Ocr tesseract 5.3.0-1-gd3a4 Ocr_detected_lang en Ocr_detected_lang_conf 1.0000 Ocr_detected_script Latin Ocr_detected_script_conf 0.9100 Ocr_module_version 0.0.18 Ocr_parameters -l eng Old_pallet IA16393 Openlibrary_edition Tip voor de lezer die net als ik geen filosofische achtergrond heeft: na de inleiding wordt het boek een stuk beter te begrijpen! (De inleiding is volstrekt logisch nadat je het boek uit hebt) .

If this is a structuralist account we can expect some talk about signs, signifiers and the signified. And, being medicine, some talk of symptoms also seems inevitable. But what is the difference between a sign and a symptom? The problem is that we have a fairly limited vocabulary of signs – ‘my stomach hurts, I’ve a sore head, it’s a kind of stabbing pain here” – and putting these signs together so as they add up to symptoms defining a disease can be anything but obvious. Particularly given a disease is generally temporal in nature and therefore changes over time. Yet, Foucault moves on a philosophical plane with his books, and there are certain rules you have to abide by if you want to play this game. For starters, there is the justification of claims. Foucault makes radical claims but he does not argue for them. He describes how different ways of seeing the world and speaking about it follow up one another; he describes how doctors viewed disease, life, death, etc. at each particular time. But describing is not explaining. And this is, of course, on purpose: Foucault is heavily inspired by phenomenology. Originally developed by Edmund Husserl it is a method of doing philosophy through describing how phenomena appear in themselves and leaving it at that. Supposedly, this circumvents the (age old) problem of explain the relationship between these phenomena and the consciousness observing them. But it handicaps the philosopher significantly, since it is impossible to argue for any position since it is simply description. This book is a philosophical compendium of the progression of medical history and ethical discourses, language development, aesthetical theories and medical system of thoughts that led to the development of the clinical gaze, a non-language beyond languages that physicians have been deploying to read the human body, instead of the former Aristotelean way of simply classifying symptoms and illnesses. According to Foucault, during the eighteenth century this way of viewing diseases was transformed on a structural level. This development heralded the birth of the clinic, which itself is the birth of modern medicine.

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St. Godard, E. E. (2005). "A better Reading". Canadian Medical Association Journal. 173 (9): 1072–1073. doi: 10.1503/cmaj.051067. PMC 1266341.