The Birth of the Clinic: An Archaeology of Medical Perception

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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. 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 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.

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. 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 because those whole "ancient" theories about tissues and diseases are nowadays outdated, you can read them and think of them as medical dystopies (HAHAHA).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) Disease is perceived fundamentally in a space of projection without depth, of coincidence without development. There is only one plane and one moment. The form in which truth is originally shown is the surface in which relief is both manifested and abolished—the portrait: ‘He who writes the history of diseases must… observe attentively the clear and natural phenomena of diseases, however uninteresting they may seem. In this he must imitate the painters who when they paint a portrait are careful to mark the smallest signs and natural things that are to be found on the face of the person they are painting.'

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I'd recommend to read this book to anyone who wants to use the word „science“. Yes. The book describes in painful detail everything related to illness, its diagnosis and treatment, but all that information is needed only to understand how those people understood the illness (and human body). It's about creating, constructing & painfully transforming the structure of knowledge. (Interesting point is seeing my own (popular, common-sensical) understanding of the topic and seeing various layers of (often deprecated) professional knowledge in it.)

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. Gutting, Gary (1989). Michel Foucault's Archaeology of Scientific Reason. Cambridge: CUP. ISBN 9780521366984. Pathological 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).

CHESHIRE CLINIC

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) 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.

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 The Birth of the Clinic (1963) is Michel Foucault’s second major work, after Madness and Civilization (1961), but perhaps it’s his more important work of the two. This is because madness, perceived as a disease, is just one aspect of a more wider transition in the eighteenth century, i.e. the emerge of clinical medicine. In this sense, Madness and Civilization (which I read prior to Birth of the Clinic) started making sense only whilst I was reading through the second work. 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! He further notes that there is no significance to whether these signs and symptoms progress over time within a single person, suggesting some sort of pathological relationship, or whether one or more occur separately across several individuals, suggesting differentiating pathologies; they still get placed in the same class: “single spasmodic malady.”Now, Foucault argues that these changes in epistemes, and thus all changes in how mankind looks at the world, are rooted in social, political and economic developments. Different times and places imply different systems of knowledge. This is, by definition, not a historical process – there is no temporality involved in all this, thus no causality, chronology, etc. For Foucault, there is just a long list of episteme after episteme and thus a long list of systems of knowledge. There is no deep reason (either ontological or epistemological) for us to prefer one over the other. We just invent new grids that we lay over reality, and which uncover new things and cover up other things – and that’s that. MRI scan; brain cancer (glioma). Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0) 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.

Don't be surprised if your initial excitement wanes as labor progresses and your discomfort intensifies. Ask for pain medication or anesthesia if you want it. Your health care team will partner with you to make the best choice for you and your baby. Remember, you're the only one who can judge your need for pain relief. 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] What you can do: Relax! By now your focus has likely shifted to your baby. You might be oblivious to what's going on around you. If you'd like, try breastfeeding your baby.spasms of lower abdomen, where it may cause dyspepsia, visceral congestion, interruption of the menstrual or hemorrhoidal flow, towards the chest, which breathlessness, palpitations, the feeling of a lump in the throat, coughing, and finally reach the head, causing epileptic convulsions, syncope, or sleepiness.” (p. 10) What you can do: For many women, early labor isn't particularly uncomfortable, but contractions may be more intense for some. Try to stay relaxed. 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). Thomas Eakins 1875-1876 Watercolor on cardboard Creative Commons CC0 1.0 Universal Public Domain Dedication