3rd
lecture: “The
Incorporation of the Hospital into Modern Technology”
The medicalized hospital dates from the end of the eighteenth
century
·
Exemplar of the investigations of/into
hospitals in 1760s, which had three characteristics:
o
Reform and reconstruction
o
Transformation from monumental to
functional description of hospitals, as well as a description of “the state of
cleanliness”
o
Inquiries conducted by doctors, not
architects
§ Hospital
as a mechanism of cure is the effect/result of these inquiries
·
MF poses a hypothetical objection: the perennial
hypothesis that hospitals have always been dedicated to curing (cf. to the
perennial hypothesis about the prison in D&P)
·
MF will “express a series of objections to
that hypothesis”
o
MF argues for a crucial distinction between
medicine and hospital (cf. to the punishment and prison distinction in D&P)
Prior to the 18th c.:
·
Hospital was a place to gather and assist to
the poor, and was an institution of exclusion
·
Medicine was an individualistic enterprise:
individuals (rather than diseases) were cured
·
Medical intervention revolved around a
concept of crisis
·
There was nothing in the medical practice
that organized knowledge
How did the hospital become medicalized in the 18th
c.? (The causal question of why.) (144)
·
The “principal factor” was “annulment of
the negative effects of the hospital” [??? this is perhaps an odd category of
analysis for MF to be using]
o
An effect of purifying the hospital of its
harmful effects and disorder
·
Reform began in maritime and military hospitals
in the 17th century (145)
o
Economic vector
o
Quarantine vector
o
Maritime and military hospitals became a
model
How did this reorganization come to be carried about? (The technical question of how.) (146)
·
Short answer: discipline (as a “political technology”)
o
Not invented but elaborated [not origin
but emergence]
o
Not isolated but “perfected” [by which he
must mean not isolated but diffuse]
What is it that arises in this period? [I.e., what is discipline? An archaeological description] (146)
·
Characteristics:
o
A fourfold list of characteristics:
§ “An
art of spatial distributions” – above all, an analysis of space
§ Control
over not “the results of an action but on its development”
§ A
constant and perpetual surveillance
§ Continuous
registration
o
Contrast the fourfold list of discipline
in D&P (which is maybe not a problem b/c it’s a different field of inquiry):
§ Art
of distributions
§ Control
of activity
§ Organization
of time
§ Composition
of forces
·
Basic instrument:
o
The examination [MF doesn’t say much about
it here]
MF’s central claim: introduction of disciplinary
mechanisms + displacing of medical intervention allowed its medicalization
(148)
·
Displacement of intervention:
o
From crisis in health to intervention in
environment
·
Introduction of disciplinary mechanisms
o
As described above.
Now we can understand several characteristics of the
hospital (149)
·
Localization of hospital and internal distribution
of space
·
Transformation of system of power in the
heart of the hospital
·
Permanent and complete records that
register whatever occurs; “a collection of documents”
o
[But how diffuse is this?]
All of this leads to the formation of the clinic as a
site for the organization and transmission of medical knowledge (151)
