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Michel Foucault “The Politics of Health in the 18th Century”

Foucault, Michel 2000. The Politics of Health in the Eighteenth Century. – Foucault, Michel. Power. Essential Works of Foucault, Volume 3. New York: The New Press: 90-105.

An analysis of idleness—and its conditions and effects—tends to replace the somewhat global charitable sacralization of “the poor.” This anal-ysis has as its practical objective at best to make poverty useful by fixing it to the apparatus of production, at worst to lighten as much as possible the burden it imposes on the rest of society. The prob-lem is to set the “able-bodied” poor to work and transform them into a useful labor force; but it is also to assure the self-financing by the poor themselves of the cost of their sickness and temporary or permanent incapacitation, and further to make profitable in the short or long term the education of orphans and foundlings. Thus, a complete utilitarian decomposition of poverty is marked out, and the specific problem of the sickness of the poor begins to figure in the relationship of the imperatives of labor to the needs of produc-tion. (93)

Down to the end of the ancien regime, the term “police” does not signify (at least not exclusively) the institution of police in the modern sense; “police” is the ensemble of mechanisms serving to ensure order, the properly channeled growth of wealth, and the conditions of preservation of health “in general.” (94)

The medical politics outlined in the eighteenth century in all Eu-ropean countries has as its first effect the organization of the family or, rather, the family-children complex, as the first and most im-portant instance for the medicalization of individuals. The family is assigned a linking role between general objectives regarding the good health of the social body and individuals’ desire or need for care. This enables a “private” ethic of good health as the reciprocal duty of parents and children to be articulated onto a collective sys-tem of hygiene and scientific technics of cure made available to individual and family demand by a professional corps of doctors qualified and, as it were , recommended by the state. (98)

The city with its principal spatial var-iables appears as a medicalizable object. Whereas the medical to-pographies of regions analyze climatic and geological conditions outside human control, and can only recommend measures of cor-rection and compensation, the urban topographies outline, in neg-ative at least, the general principles of a concerted urban policy. During the eighteenth century the idea of the pathogenic city in-spires a whole mythology and very real states of popular panic (the Charnel House of the Innocents in Paris was one of these high places of fear); it also gave rise to a medical discourse on urban morbidity and the placing under surveillance of a whole range of urban developments, constructions, and institutions. (99)

A “medico-administrative” knowledge begins to develop concerning society, its health and sickness, its conditions of life, housing and habits; this serves as the basic core for the “social economy” and sociology of the nineteenth century. And there is likewise constituted a politico-medical hold on a population hedged in by a whole series of prescriptions relating not only to disease but to general forms of existence and behavior (food and drink, sexuality and fecundity, clothing and the layout of living space). (100)

The point is that, in relation to these new problems, the hospital appears as an obsolete structure in many respects. A fragment of space closed in on itself, a place of internment of men and diseases, its ceremonious but inept architecture multiplying the ills in its in-terior without preventing their outward diffusion, the hospital is more the seat of death for the cities where it is sited than a thera-peutic agent for the population as a whole. (101)

However, the disappearance of the hospital was never more than the vanish-ing point of a Utopian perspective. The real work lay in the effort to elaborate a complex system of functions in which the hospital comes to have a specialized role relative to the family (now con-sidered as the primary instance of health), to the extensive and continuous network of medical personnel, and to the administrative control of the population. It is within this complex framework of policies that the reform of the hospitals is attempted. (103)

It is also necessary to organize the internal space of the hospital so as to make it medically efficacious, a place no longer of assis-tance but of therapeutic action. The hospital must function as a “curing machine.” First, in a negative way: all the factors that make the hospital dangerous for its occupants must be suppressed, solv-ing the problem of the circulation of air (which must be constantly renewed without its miasmas or mephitic qualities being carried from one patient to another), and solving as well the problem of the changing, transport, and laundering of bed linen. Second, in a positive way, the space of the hospital must be organized according to a concerted therapeutic strategy, through the uninterrupted pres-ence and hierarchical prerogatives of doctors, through systems of observation, notation, and record-taking. […]The hospital tends toward becoming an essen-tial element in medical technology, not simply as a place for curing, but as an instrument which, for a certain number of serious cases, makes curing possible. (103-104)

Consequently, it becomes necessary in the hospital to articulate medical knowledge with therapeutic efficiency. In the eighteenth century, specialized hospitals emerge. (104)

Finally, the hospital must serve as the supporting structure for the permanent staffing of the population by medical personnel. Both for economic and medical reasons, it must be possible to make the passage from treatment at home to a hospital regime. (104)

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