2nd
lecture: “The
Birth of Social Medicine”
Begins with a summary of the “basic
problem”: not opposition of medicine to antimedicine but “take-off” in medicine
and sanitation (134).
Summary of the previous lecture
(134-5):
·
Biohistory
·
Medicalization (MF will focus here,
135)
·
Political economy of Health
Social medicine versus individual
medicine:
·
“With capitalism we did not go from collective
medicine to a private medicine” but rather there were a whole host of social factors
taking a hold of “the body” – “the body is a biopolitical reality” (137).
Three stages of the formation of
social medicine:
·
State Medicine – Germany (pp.137ff.)
·
Urban Medicine – France (pp. 142ff.)
·
Labor Force Medicine – Britain (pp.
151ff.)
State Medicine in Germany
·
Staatswischenschaft:
a field of study and a set of methods
·
Evaluation (or survey) of
populations:
o
Birth and death statistics
o
Census surveys
o
Tables of birth and mortality
§ In France, England, and Austria: all without organized intervention
to raise the level of health
§ In Germany: accompanied by attempt to improve health:
through the Medizinischepolizei (140),
first envisaged in eighteenth century, and then implemented in nineteenth
century, by way of:
·
System of observation (140)
·
Standardization of medicine (140)
[what about corollary standardizations of patients?]
·
Administrative organization for
overseeing doctors (141)
·
Creation of official medical
officers (141)
§ A project not of “labor power” but “strength of the state” in
its “conflicts” both “economic” and “political” (141-2). [Implicit references to unification and
administrativization of Germany. Is this
an explanandum in need of an explanation?
Perhaps not.]
·
Later systems in France, England,
and etc. were “scaled-down variations of this state-dominated administrative
model” (142).
Urban Medicine in France [esp.
Paris]
·
Social
medicine and the expansion of urban structures (142) against the backdrop of
eighteenth-century “heterogeneous cities”
·
Led
to “problem of the unification of urban authority” (143) which was driven by
both economic and political factors. – “a feeling of fear” and “a series of
panics” (144) – a ‘problem’
·
Sets
the stage for: “a new mechanism intervened” – “the model of the quarantine”
(144): cf, D&P and CdF STP lectures.
o
Leprosy:
expulsion
o
Plague:
quarantine
§ Confinement to
stay in dwellings, division of city, detailed reportage (“an exhaustive record”),
daily check on cities, disinfection (145).
§ [What are the role
of different techniques of documentation in the context of different social
dispositifs?]
o
[Smallpox:
security and inoculation – from STP, but not mentioned here]
§ [Were the models a
response to the diseases? Or were they a
response to the problematizations in the background? Or a function of both?]
o
The
mechanisms then become part of the background against which the problems [and ‘social
structures’] are intelligible.
·
Main
objectives of urban medicine:
o
Study
the accumulatiosn of illness-causing refuse (146), “analyzing the zones of
congestion”
o
“Controlling
circulation” (148) but primarily of elements, like water and air
o
Organization
of distributions and sequences (147)
·
This
medicalization is important because:
o
Medicine
comes in contact with sciences (149)
o
Medicine
begins to target what later came to be
called “environment” (15)
o
Medicine
connected to notion of public health
·
The
urban medical model remained decentralized (in part because of “the problem of
private property”) and so was less authoritative than German Staatsmedizin, but was far more effective
in terms of observational and scientificity.
Labor
Force Medicine in England
·
Labor
force or “poor people’s” medicine was not the first but the last objective of
social medicine (151). First, the state,
then the city, and finally poor people.
o
Cf.
HSv1, they first tried it on themselves
·
Poverty
becomes a danger for (at least) three reasons:
o
Political
reasons of social reason
o
Replacing
the services of the underclass
o
Political
and health fears (via cholera epidemic)
·
Establishment
of class segregation (152)
·
Poor
Laws of 1834 (153) – [what is the history of the Poor Laws for Foucault?]
o
“An
important factor” made its “ambiguous appearance”: “the idea of a tax-supported
welfare” (153).
o
This
made an “officially sanctioned sanitary cordon” between rich and poor; the
wealthy freedom themselves of the risk of being victims
o
A
complex system whose components appeared later:
§ Emergence of
Public Health Service:
·
“Control
of vaccination”
·
Organizing
the “record” of epidemics and diseases
·
Localization
of unhealthy places
·
Only the English model persisted
into twentieth-century (so French and German model passed away):
o
Medical assistance of poor
o
Control of health of labor force
o
General survey of public health
·
English model enabled creation of
three superimposed medical systems: welfare medicine, administrative medicine,
and private medicine
Beveridge Plan is the condensing end point: “it
is always a matter of bringing these three sectors of medicine into play”
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