The Birth of the Clinic: An Archaeology of Medical Perception

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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 because those whole "ancient" theories about tissues and diseases are nowadays outdated, you can read them and think of them as medical dystopies (HAHAHA).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) Bangsa yang hidup tanpa peperangan dan keganasan tidak akan mengalami perkara-perkara di atas. Begitu juga bangsa yang kaya. Sebaliknya, rakyat marhaen pula akan menjadi mangsa despotik kuasawan. Mereka dihimpit dengan cukai yang menyebabkan mereka mengemis, kemiskinan yang hanya menguntungkan golongan atasan dan penginapan yang tidak kondusif (malahan gelandangan) yang hanya memaksa mereka untuk tidak mendirikan keluarga atau hidup dalam rupa bentuk yang sangat mengerikan!

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 GazePathological anatomy took the medical gaze deeper through “a path that had not so far been opened to it: vertically from the symptomatic surface to the tissual surface” (p. 135). The gaze could now account for more than just surface observations and signs and symptoms, and became three dimensional as a result. Even the term “gaze” took on added meaning. Where it once referred to what was seen, pathological anatomy added touch and hearing as sensorial elements. Altered anatomy and various lesions, such as “deformations, figures, and accidents and of displaced, destroyed, or modified elements” could be linked to observations” (p. 136). Access-restricted-item true Addeddate 2011-11-22 23:00:37 Boxid IA156124 Camera Canon EOS 5D Mark II City New York Donor The history of illness to which he is reduced is necessary to his fellow men because it teaches them by what ills they are threatened. The gaze determined the scope of analysis possible in the clinic, which amounted to what could be seen and what could be stated, and the interdependency between these two dimensions, i.e., what could be stated was made possible by what could be seen, and what could be seen was made possible by what could be stated. Antara penekanan lain yang cukup memukau ialah mengenai jalinan teori dan praktikal ilmu perubatan. Teaching Hospital (atau klinik yang disebut oleh penulis) bertindak sebagai tempat membumikan analisis-analisis dan teori-teori perubatan. Ia ibarat menghidupkan semula kefalsafahan perubatan klasik. Seni sebenar untuk mengubati pesakit adalah melalui amali dan kunci kepada ilmu perubatan sendiri ialah apabila seseorang individu itu menguasai selok-belok ilmu ini serta sentuhan teknologi perubatan yang wujud padanya. Bukan sekadar mengetahui keabstrakan teori-teorinya semata-mata.

In the 18th century, the professional authority of the doctor was based upon his command of the organised medical knowledge of his time; in the 19th century, a doctor's authority derived from his command of the new, verifiable clinical medicine. An 18th-century doctor would examine a diseased organ as would a 19th-century doctor, yet, because of their different medical cultures, these doctors would reach different conclusions about the cause and treatment of the disease. Despite their perceptual differences of diagnosis, each medical report would be "true", because each doctor diagnosed according to a generally accepted way of thinking (an episteme) in which their respective forms of organised medical knowledge were considered factual. Hence, despite their medical researches having occurred thirty years apart, the father of anatomical pathology, Giovanni Battista Morgagni (1682–1771), and the father of histology, Xavier Bichat (1771–1802), did not practise the same human anatomy. [8] See also [ edit ] 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 conclusion, wherein he writes about how death rose to be one of the defining points of knowledge, is worth the read alone.

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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 ]

The clinic—constantly praised for its empiricism, the modesty of its attention, and the care with which it silently lets things surface to the observing [medical] gaze without disturbing them with discourse—owes its real importance to the fact that it is a reorganization-in-depth, not only of medical discourse, but of the very possibility of a discourse about disease. [5] The Doctor by Sir Luke Fildes (1891) Naissance de la clinique" est sans doute la moins lue et la moins commentée de toutes les monographies foucaldiennes. Publiée pour la première fois en 1963, cette "archéologie du regard médical" n'a jamais suscité le même intérêt que des ouvrages désormais classiques comme "Les Mots et les choses" (1966) ou "Surveiller et punir" (1975). 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. St. Godard, E. E. (2005). "A better Reading". Canadian Medical Association Journal. 173 (9): 1072–1073. doi: 10.1503/cmaj.051067. PMC 1266341.

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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 locus in which knowledge is formed is no longer the pathological 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… “(p. 31) Foucault's thesis about the birth of the clinic (teaching hospital) contradicts the histories of medicine that present the late 18th century as the beginning of a new empirical system "based on the rediscovery of the absolute values of the visible" material reality. [4] The birth of modern medicine was not a common-sense move towards seeing what already existed, but actually was a paradigm shift in the intellectual structures for the production of knowledge, which made clinical medicine a new way of thinking about the body and illness, disease and medicine:

The Birth Company in Alderley Edge, Cheshire was last inspected by the Care Quality Commission in April 2021. The CQC rated The Birth Company as Good for being a caring and responsive service. 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. 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. 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) . 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.Over the ensuing two centuries, new technologies have taken the gaze deeper into bodies. Imaging technologies such as x-rays, CT scans, and PET scans see deeper into tissues and cells. Biological technologies see deeper into molecular structures including the human genome. Visualization technologies like miniature cameras and virtual reality see the once-hidden. Sensor technologies can see the invisible such as pulmonary artery pressures and blood glucose concentrations. Artificial intelligence and other analytical processes bring more precision to interpretations of what the gaze sees. 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. 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] 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 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]