2) From Surfaces to the Depth of the Body

Policing the State

In the period surrounding the French Revolution, charitable organisations were reorganised and the ways of caring for the sick were changed. For example, the Poor Laws were re-organised in 1834. The almshouse transformed into the workhouse where the poor would repay the shelter and food they received through manual labour. Although, workhouses also served as a punishment.

Parish funds largely paid for medicines and hospitals. But, 'noblesse oblige' refers to the duty privileged and wealthy people held for society and their social responsibilities, like giving charitable donations to hospitals. But, hospitals were seen as unproductive and the ailing and dying could be seen as repaying for their care by caring for worse sick patients.

Philanthropy and the Poor Laws supported hospitals of all kinds which included:

  • Foundling hospitals where children were left to be cared for. They were often orphans.
  • Infirmaries.
  • Asylums, which were mostly run privately.
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The Officer of Public Health

The conjunction of medicine and institutions emerging in France was embodied in the Officer of Public Health. Epidemics were a big problem in centralised states like Paris as disease in one community could quickly spread to others and undermine the functioning of the entire state, making them hugely feared. Quarantines were used that prohibited movement in or out of the city for 40 days in an attempt to stop the spread of disease. Cordon sanitaire were used for this purpose, a guarded line preventing movement.

Officers of Public Health, organised by the Royal College of Medicine, policed local communities to seek the possible sources of contagion and deal with it. They used statistics to trace the spread of disease over time and space to identify the point of origin of the epidemic. They also recorded who died of what and who is alive but infected with what. This required a lot of time and effort. They are also an example of bio-politics as officers were introduced to deal with matters of biology.

But, it's important to note that these officers' understandings of disease would have been different to those of physicians'. They created a causal understanding of the relationship between the constituitive parts of a body politic and its distinctive diseases. One of the Officers' major problems was that of the hospital as these were often the points of origin of diseases. But, this brought them into conflict with physicians in the Faculties of Medicine as hospitals were key to accessing networks of patronage for physicians.

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Revolutionary Medicine

Officers of Public Health believed the causes of disease could be removed. So, they shared the revolutionary ambitions of a radical transformation of society that would bring equality (of treatment) and freedom (of disease). Thus, in the 1790s, Officers of Public Health pressed for the elimination of hospitals, to be replaced with care in the home, and the reform of the Faculties of Medicine as they were mainly seats of privilege.

But, this revolutionary programme for medicine failed. Care in the home would have been expensive and difficult to regulate; it would be better delivered centrally by an institution like the hospital. Officers of Public Health also couldn't provide an alternative to the medical philosophy that informed teaching in the Faculties of Medicine. The reformed hospital had to become centrally important to medical practice.

Development in the political realm called for a new theory of medicine, but the Officers struggled to do this too.

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Transformation of Medicine

In the 1800s, hopsitals transformed and became a site of new knowledge. In the medicine of species, disease was a complex phenomenon with diagnoses riddled in uncertainty because the true essence of disease was hidden by the accidental features of the body. Introducing statistics in the hospital to control the patients increasingly changed the understanding of disease's complexity. It became increasingly understood as the combined effect of multiple, determinate factors, which the statistician could discover by comparing patients.

This changing perspective meant the critical distinction medicine of species had drawn between essential and accidental features of disease became meaningless. Visible manifestations of disease were symptoms of it as it spread through the body, leading positivism to emerge (which said physical manifestations of disease were the symptoms). Mapping the course of disease on anatomical organs became very important in the development of medical knowledge.

But this new medicine couldn't build on the old one as animals' organs had been used which were different to our own. The old medicine also only measured what happened in life but the new medicine wanted to establish what happened in the organs through dissection, a process only possible after death. But, due to the changes after death, could much be told about life? Dissection had to occur quickly to understand what caused death. It was also disreputable. In England, the increasing legitimation of surgery led to the separation of surgeons and barbers and the establishment of the Royal College of Surgeons in 1800.

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The Rise of the Surgeon

Due to the new understanding of medicine and disease, surgeons began to rise in prestige, but this wasn't immediate or obvious. The nosological categories of the medicine of species didn't neatly map onto the anatomical organs because there were too many overlapping lesions, creating questions about the relationship between disease and organs. The nosological categories were also about life. Disease has a life of its own and also unfolds in the living. This meant that dissection of the dead could tell very little about disease which added to the public criticism held towards dissection, especially after the Murder Act 1752.

Disease became a spatially and temporally ordered reaction of the body to some anatomical lesions. The physician's first question changed from 'what is wrong?' to 'where does it hurt?'.

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The Politics of the Stethoscope

The stethoscope, created in France in 1819, was tied to the question of 'where does it hurt?'. It allowed an anatomical study of the heart, and was the first invention of many of this type. It allowed the measurement of signs rather than symptoms whilst also allowing a visualisation of what was happening inside the body.

The emergence of an anatomo-pathological understanding of disease had been taking shape in many places besides Paris, but Paris had increasingly become the place where ambitious physicians wished to study. However, the links between this new form of medicine and the revolution made it a quite suspect innovation, especially when young physicians returned from Paris with new ideas about the nature of disease, and ideas concerning the organisation of the entire medical profession.

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