The Birth of the Clinic: An Archaeology of Medical Perception

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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. 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). What you can do: Look to your labor partner and health care team for encouragement and support. Try breathing and relaxation techniques to relieve your discomfort. Use what you learned in childbirth class or ask your health care team for suggestions.

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. Thomas Eakins 1875-1876 Watercolor on cardboard Creative Commons CC0 1.0 Universal Public Domain Dedication This means that the clinical gaze moves from the literally superficial – the doctor can look at your skin or in your mouth and so on – to a gaze in the broadest sense, one where the doctor can listen to your breathing or feel your temperature or pulse, and from this ‘gaze’ interpret what is going on under the surface to tissue there. The shift to a classification system of tissues is essential for this movement and such a shift fundamentally changes how medicine will be carried out. A member of your health care team may massage your abdomen. This may help the uterus contract to decrease bleeding. 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).Foucault sees pathological anatomy as a quantum leap in the modern-day clinic because of the breadth and depth the gaze acquired and the concrete knowledge generated. 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 Company are proud of the high-quality service provided to their patrons and welcome a re-inspection by the CQC. 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. Unless you need to be in a specific position to allow for close monitoring of you and your baby, consider these ways to promote comfort during active 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] 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! Interestingly, I found out more about the contributions of Bichat, Morgagni, Dupuytren and so on, names that nowadays only depict some syndromes, diseases or anatomical parts (Bichat's Bullae, Morgagni tubercles, Dupuytren contracture). This clinical medicine is more open than classificatory medicine and offers a “concrete sensibility.” Doctors no longer decided whether a patient’s condition fit into this or that class; they instead assessed the probabilities of a condition fitting into this or that disease. They no longer had to “simply read the visible; [they had] to discover its secrets” (p. 120). To Foucault, this was the clinic, a place of analysis. 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.You'll continue to have mild, less painful contractions that are close together. The contractions help move the placenta into the birth canal. You'll be asked to push gently one more time to deliver the placenta. You might be given medication before or after the placenta is delivered to encourage uterine contractions and minimize bleeding. 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).

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. Landon MB, et al. Normal labor and delivery. In: Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Elsevier; 2021. http://www.clinicalkey.com. Accessed Oct. 28, 2021.

See also

Learned [and] rewarding... The Birth of the Clinic continues [Focault's] brilliant history, not of ideas as such, but of the structures of perception."-- The New York Times Book Review American College of Obstetricians and Gynecologists. Labor and delivery. In: Your Pregnancy and Childbirth: Month to Month. Kindle edition. 7th ed. American College of Obstetricians and Gynecologists; 2021. Accessed Oct. 28, 2021. There is disease only in the element of the visible and therefore statable” (p. 95). Foucault qualifies, however, that “the purity of the gaze is bound up in a certain silence.” This silence is the need for a gaze unaffected by various theories, preconceptions, and other influences prejudicing interpretations of observations. He locates the space where a pure gaze is corrupted as “anterior to that of the visible” (p. 108).