I (Paris: Presses
universitaires
de France, 1968) pp.
Foucault-Psychiatric-Power-1973-74
at Larissa in Thessaly.
His works, written in the Ionian dialect of the learned, constitute the core of what became the Hippocratic corpus.
See, Gossen, "Hippocrates" in A.
F.
Pauly and G.
Wissowa, eds.
, Realencyclopadie der classischen Altertumswissenschaft, vol.
VIII (Stuttgart: Metzler, 1901) col.
1810-1852; M.
Pohlenz, Hippokrates und die Begriindung der wissenschaftlichen Median (Berlin: De Gruyter, 1938); C.
Lichtenthaeler, La Medicine hippocratique (studies in French and German) in 9 volumes (Geneva: Droz, 1948 1963); L.
Edelstein, "Nachtrage: Hippokrates," in Realencyclopadie, supplement VI, 1953, col.
1290-1345; R.
Joly, Le Niveau de la science hippocratique.
Contribution a la psychologic de I'histoire des sciences (Paris: Les Belles Lettres, 1966); J.
Jouanna, Hippocrate. Pour une archeologie de I'ecole de Cnide (Paris: Les Belles Lettres, 1974). The basic edition ol the works oi Hippocrates is the bilingual Littre edition (see above, note 10). The basic, bilingual, English edition is the Loeb Classical Library edition ol Hippocrates, in 8 volumes (Cambridge, Mass. : Harvard University Press, 1923-1995). Thomas Sydenham (1624-1689) was an English practitioner known for the changes he introduced into medical knowledge. As Foucault notes in Histoire de lafolie, pp. 205 207 (omitted from the English translation), he organized knowledge ol pathology according to new norms by making a method ol observation, taking into account the symptoms described by the patient, against the medical systems, like Galenism or iatrochemistry, which relied on a speculative approach--earning him the name "the English
22.
23.
? 24.
Hippocrates"--and by developing a "naturalist" description ol diseases offering the possibility ol reducing clinical cases to morbid "species" delined in a botanical style. He published the results of his observations in his Observationes medicae circa morborum aculorum historiam et curationem. Methodic curandi febres, propiis observalionibus superstructa ( L o n d o n : Kettilby, 1676); English translation, Medical Observations Concerning the History and Cur of Acute Diseases, trans. R. G. Latham, in The Works of Thomas Sydenham, M. D. , vol. 1 (London: The Sydenham Society, 1848). See, K. Faber, Thomas Sydenham, dcr englische Hippocrates, und die Krankheitsbegri/je der Renaissance (Munich: Medizinische Wochenschrift, 1932) pp. 29 33; E. Bergholl, Entwicklungsgeschichte des Krankheitsbegrijjes (Vienna: W. Maudrich, 1947) pp. 68 73; and L. S. King, "Empiricism and rationalism in the works ol Thomas Sydenham," Bulletin of the History of Medicine, vol. 44, no. 1, 1970, pp. 1 11.
As Foucault recalls in Histoire de la folie, pp. 3 0 5 3 0 8 (Madness and Civilisation, pp. 146 150) Sydenham was among those who contributed to a prelerence lor an explanation of hysteria in terms ol physiological disorders of the nerves, attributed to disorders ol the "animal spirits," against the traditional explanation which relerred to the uterus and the humoral model of the "vapors": "it is not any corruption ol either the semen or the menstrual blood, to which, according to many writers, this disease is to be relerred. It is rather the faulty disposition ol the animal spintis" Dissertatio cpistolaris ad G. Cole de obser- valionis nuperis circa curationem variolarum, confuentium, necnon de ajjeclione hysterica ( L o n d o n : Kettilby, 1682); English translation, "Epistolary Dissertation" trans. R. G. Latham, The Works oj Thomas Sydenham, vol. 2,1850, p. 95; French translation in, CEuvres de medecine pra- tique, vol. II, trans. A. F. Jault and J. B. Baumes (Montpellier: J. Tourel, 1816), p. 85. See, I. Veith, "On hysterical and hypochondnacal allections," Bulletin of the History of Medicine, vol. 30, no. 3, 1956, pp. 233 240, and I. Veith, Hysteria: the History of a Disease (Chicago: Chicago University Press, 1965). More generally, see, C. Daremberg, Histoire des sciences medicates, comprcnanl /'anatomic, la physiologic, la medecine, la chirurgie et tes doctrines de patholo-
gic generate, vol. II ( Paris: J. B. Bailliere, 1870), ch. 23, "Sydenham, sa vie, ses doctrines, sa pratique, son influence," pp. 706-7Vv, K. Dewhurst, Dr Thomas Sydenham ( 162/I-16C^9): His Life and Original Writings (London: Wellcome Historical Medical Library, 1966). Foucault bases himself on the work, relerred to in the manuscript, oljohn Barker, Essai sur la conjormite de la medecine des anciens el des modernes, en comparaison entre la pratique d'Hippocrate, Galien, Syndenham et Boerhaave dans les maladies aigue's, trans. R. Schomberg (Paris: Cavalier, 1749) pp- 75 76: "Of necessity, it is indispensable lor the doctor to have a basic knowledge of the doctrine ol crises and critical days ( . . . ) to be able to discover whether or not the heat ol the humors is as it should be, at what moment to expect the cri sis, of what kind it will be, and whether or not it will prevail over the disease. " See also J. B. Aymen, Dissertation fsur] les Jours critiques (Paris: Rault, 1752). The importance ol the notion is indicated by the fact that the article "Crise" in the Encyclopedic ou Dictionnaire raisonne des sciences, des arts et des metiers ol D'Alembert and Diderot was written by a great name in medicine, Theophile Bordeu (1722 1776) and Iills 18 lolio pages (vol. IV, Lausanne: Societe typographique, 1754).
The Kaipo^ designates the moment in the evolution ol the illness when a decisive change occurs: "There is crisis in diseases when they increase, get weaker, are transformed into another disease or end" Hippocrates, Afjeclions, ? 8, in CEuvres completes, vol. VI (1847); English trans lation, Affections, in Hippocrates, vol. V, trans. Paul Potter (Cambridge, Mass: Harvard University Press, Loeb Classical Library, 1988). See, G. Hamelin, "Crtse" in Dictionnaire ency- clopedique des science medicates, T1 series, vol. XXIII (Paris: Masson/Asselin, 1879) pp. 258 319; P. Chantraine "xcupo^" in Dictionnaire etymotogique de la langue grecque, vol. II, p. 584; L. Bourgey, Observation et experience chevies medecins de la Collection Hippocratique(Paris: Vnn, 1953) pp. 236-247. On the Greek medical terms: N. Van Brock, Recherches sur le vocabulaire medical du grec ancien. Soins et guerison (Pans: Klincksieck, 1961). See Foucault, "La maison des fous" Dits et Ecrits, vol. 2, pp. 693 694.
25.
26. This is more or less the definition put torward by Sydenham in his Observationes medicae, Section 1, ch. 1, ? 1; Medical Observations, p. 29: " ( ? . . ) a disease ( . . . ) is nothing more than an effort ol Nature, who strives with might and main to restore the health of the patient by the elimination of the morbilic matter. "
23 January 1974 259
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PSYCHIATRIC POWER
27.
In Hislnire de lafolie, p. 285 and p. 245, Madness and Civilisation, p. 123 and p. 86, Foucault noted the shiit carried out in eighteenth century medicine, when it is "from the body's lie] uid and solid elements that the secret of disease was sought" rather than from the "animal spirits. " Hermann Boerhaave (1668 1738), integrating the contributions of physics, chemistry and the natural sciences, made illness the result ol an alteration of the balance ol solids and liquids: lnstitittiones medicae, in usus annae exercitationis domesticos digestae (Leyden: Van der Linden, 1708) p. 10, French translation by J. O. de La Mettrie, Institutions de medecine, vol. I (Paris: Huart, 1740). See, C. Daremberg, Histoire des sciences medicates, vol. II, ch. xxvi, pp. 897 903; L. S. King, The Background of Hermann Boerhaave's Doctrines (Boerhaave Lecture, September M1'1, 196yi) (Leyden: University of Leyden publications, 1965).
Fnednch Hoffmann (166O 1742), a doctor at Halle, considered diseases to he the result of alterations of the solid and liquid parts of the body and of their functions, and, in accordance with his mechanistic perspective, he gave a major role to modifications of the tomcity of the fibers and of the mechanics ol the blood How: (1) Fundamenta medicinae ex principiis mechanicis el practicis in usum Philiatrorum succincte proposita . . . jam aucla et emendata, et cetera (Halle: Magdeburgicae, 1703), English translation, Fundamenta Medicinae, trans. L. S. King (London/New York: Macdonald/American Elsevier, 1971) p. 10; (2) Medicina rationalis systemica, in 2 volumes (Halle: Renyeriana, 1718-1720), French translation by J. J. Bruhier (Paris: Brlasson, I738). See C. Daremberg, Histoire, vol. II, pp. 905-952; K. E. Rothschuh, "Studien zu Friedrich Hoffmann (1660-1742)" Studhoffs Archiv fur Geschichte der Medizjn, vol. 6 0 , 1976, pp. 163 193 and pp. 235 270. On this eighteenth century med icine, see, L. S. King (1) The Medical World of the Eighteenth Century (Chicago: University ol Chicago Press, 1958), and (2) "Medical theory and practice at the beginning of the eigh teenth century," Bulletin of the History of Medicine, vol. 46, no. 1, 1972, pp. 1 15.
28. Hippocrates, Epidemies, I, 3 section, ? 12 in CEuvres completes, vol. II (1840), pp. 679 681; English translation, Epidemics, Book 1, (iii), 26, in G. E. R. Lloyd, ed. Hippocratic Writings, trans. J. Chadwick and others (Harmondsworth and New York: Penguin, 1978), p. 101: "Fevers attended by paroxysms at even numbers of days, reach their crisis also in an even number; il the paroxysms are on odd days, so is the crisis. The hrst period of [lever] in those maladies which reach the crisis in an even number ol days is 4, 6, 8, 10, 14, 20, 24, 30, 40, 60, 80 or 120 days. (. . . ). It must be noted that il a crisis occurs on any other day than those mentioned, there will be a relapse and also it may prove a latal sign. One must pay attention to these days which have been specified in the course of a particular fever and realize that on them a crisis may take place leading to recovery or death, to improvement or to deterioration. "
29. On the determination ol lucky or ill lated days (or consulting the oracle, see P. Amandry, La Mantique appollinienne a Delphes. Essaisur lefontionnemenl de Coracle (Paris: E. de Boccard, 1940) ch. vn, "Frequence des consultations" pp. 81 85. On Greek "mantictsm" in general, derived from the verb (xavTeuRcrOou meaning "to prophecy," to conjecture according to ora- cles, to act as a seer ((xavrts"), the basic book, although old, ts still that ol A. Bouche Leclercq, Histoire de la divination dans VAntiquile, in 4 volumes (Paris: Leroux, 1879 1882). Also, W. R. Halliday, Greek Divination: A Study of its Methods and Principles (London: Macmillan, 1913);J. Defradas, "La divination en Grece" in A. Caquot and M. Lcibovici, eds. La Divination, vol.
I (Paris: Presses universitaires de France, 1968) pp. 157 195; R. Flaceliere, Devins et Oracles grecs; and ed.
J. P. Vernant, Divination et Rationalite (Paris: Le Seuil, I974).
30. Hippocrates "considers an important part ol the art of medicine" to be the ability "to
observe the order of the critical days and to extract the elements ol prognosis from it. When we know these things, we know too when and how to give nourishment to the patient" Hippocrates, Epidemies, III, 3ul section, ? 16, in CEuvres completes, vol. Ill; English translation, Hippocrates, Epidemics, 3, trans. W. H. S. Jones, Hippocrates, vol. I, Loeb Classical Library (Cambridge, Mass: Harvard University Press, 1923).
31. Hippocrates, Pronostic, ? 1: "The best doctor seems to me to be one who can know in advance . . . He will treat best those diseases whose future course he can loresee with the help of the present condition" CEuvres completes, vol. II, p. 111; Prognosis ? 1, in Hippocratic Writings: "It seems to be highly desirable that a physician should pay much attention to
? prognosis. . . . he will be better able to effect a cure if he can loretell, trom the present
symptoms, the future course of the disease. " p. 170.
}2. In Hippocrates's own terms, the doctor's task is to "combat (avrayoviaaBai) each of the
accidents through his art. " Or again, "if we know the cause of the disease, we will be in a position to administer what is useful to the body, starting from contraries to counter (SK TOV evavTtov ermao[tEVo<;) the disease" Des Vents, I, in Guvres completes, vol. VI, p. 93 (translation amended by J. L. |; English translation, Airs, I, in Hippocrates, vol. I, Locb Classical Library (1923).
33. Taken from juridical language, the term krisis means "judgment," "decision," before desig nating in medicine the crucial moment at which "the disease judges | KpiveTcu] lor death
or life "Des Affections internes,21 220, 9, in GLuvres completes, vol. VII, p. 217; "Internal Affections," trans. Paul Potter, Hippocrates, vol. VI, Loeb Classical Library (1988). Or again there is this expression in Epidemies, I, 2IK section, ? 4: "In some ( . . . ) the illness is decided by a crisis" in GLuvres completes, vol. II, p. 627; EpiJemies, Book One, (11), ? 8, p. 92. As for the doctor, he is judged on his sense of opportunity and his interventions; see, Des maladies, I, 5. pp. 147 151; Diseases, I, trans. Paul Potter, Hippocrates, vol. V, Loeb Classical Library (1988).
34. See the medical scenes in the plays by Mohere (1622 1673): (1) VAmour medecin (performed
on 14 September, 1665), Act II, scene 2, in which four doctors are involved, and scenes 3-4 of
the consultation, in Guvres completes, ed. M. Rat (Paris: Galhmard, 1947) vol. II, pp. 14 25; (2) Monsieur de Pourceaugnac ( 6 October 1669) in Act I, scenes 7 8, ol which, two doctors and an apothecary are involved, Guvres completes, vol. II, pp. 141-120; and (3) Le Malade imaginaire (10 February 1673), posthumous work ( 1682), Act II, scenes 5 6, and Act III, scene 5, Guvres com- pletes, vol. II , pp. 845-857 and pp. 871 873. See, F. Millepierres, La Vie quotidienne des medecins au temps de Moliere (Paris: Hachette, 1964).
}5. This refers to an episode that took place during Galen's (b. Peigamum 129 A. D. ) first stay in Rome from the autumn of 162 until the summer ol 166, before coming back to settle there from 169 until his death around 200. Sec, De Praecognitione ? 1$ in Opera Omnia, vol. XIV, ed. and Latin trans. C. G. Kiihn (Lipsiae: in officina, C! Cnoblochii, 1827) pp. 666 668; English translation, On Prognosis: Corpus Medicomm Graecorum, V, 8, 1, trans. Vivian Hutton (Berlin: Akademie Verlag, 1979) pp. 135-137. On Galen's relations with the Roman medical world, see J. Walsh, "Galen clashes with the medical sects at Rome (163 A. D. )," Medical Life, vol. 35,1928, pp. 408-444. On his practice, see,J. Ilberg, "Aus Galens Praxis. Ein Kulturbild aus der Kaiserzeit," Neue Jahrbiicher fur das klassische Allerlum (Leipzig: Teubner, vol. 15, 1905, pp. 276 312; and, V. Nutton, "The chronology ol Galen's early career," The Classical Quarterly, vol. 23, 1973, pp. 158 171.
36. This passage echoes a number of treatments by Foucault of "the inquiry": (1) The 1971- 1972 lectures at the College de France, the first part of which deals with the inquiry and its development in the Middle Ages; see the course summary, "Theories et Institutions penales" Dits et Ecrits, vol. 2, pp. 390 391; "Penal Theories and Institutions," trans. Robert Hurley, Essential Works of Foucault, 1, pp. 17 19; (2) The College de France lectures ol 1972 1973, "The Punitive Society," in which, in the lecture of 28 March 1973, Foucault returns to the constitution of an "inquiry knowledge"; (3) The third lecture (23 May 1973) on "La Verite et les formes jundiques" pp. 581 588; "Truth and Juridical Forms" pp. 44 52. Foucault returns to the process of the colonization of a "truth test" in the form of the event by a "truth-findings" in the lorm ol a body of knowledge in 1975 in "La Maison des lous" Dits et Ecrits, vol. 2, pp. 6 9 6 697.
37. In the second half ol the eighteenth century, since Fnedrich Hoffmann, who still believed in the theory of crises, albeit with reservations about the notion of critical days, died in 1742. See, C. Daremberg, Histoire des sciences medicates, vol. II, p. 929.
38. This grid, which dates from the organization of administrative health correspondence by the Intendants in order to collect lnlormation on epidemics and endemic diseases, found institutional expression with the creation on 29 April 1776, on Turgot's initiative, of the "Societe Royale de Medecine" responsible for studying epidemics and epizootic diseases, before disappearing in 1794. See, C. Hannaway, "The Societe Royale de Medecine and epi demies in the Ancient Regime," Bulletin of the History of Medicine, vol. 46, no. 3, 1972, pp.
23> January 1974 261
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PSYCHIATRIC POWER
257273. Concerning these inquiries, see, J. Meyer, "Une enquete de 1'Academie de medecine sur les epidemics (1774 1794)" Annales ESC, 21st year, no. 4, August 1966, pp. 729 749; H. Dupin and L. Masse, uUne enquete epidemiologique a peripeties multiple: I'etude de la pellagre," Revue d'epidemiologie, medecine sociale el sanle publique, vol. XIX, no. 8, 1971, pp. 743 76();J. P. Peter, (1) "Une enquete de la Societe Royale de Medecine. Malades et maladies a la fin du xvmc siecle," Annales ESC, 22,ul year, no. 4, July August 1967, pp. 711 751; ( 2 ) "Les mots et les objets de la maladie. Remarques sur les epidemies et la medecine dans la societe Iran^aise de la lin du xvni' siecle," Revue hisloriijue, no. 499, 1971,pp. 13 38;J. P. Desaive, P. Goubert, E. Le Roy Ladurie, Medecins, climals et epidemies a fin du xviii . siecle (Paris: Mouton, 1972). See also the pages devoted to this in M. Foucault, Naissance de la clinicjue, ch. 2, "Une conscience politique," pp. 21 36; Birl/i of the Clinic, ch. 2, "A Political Consciousness," pp. 22 37.
39. On the development of hospital lacilities and the advent ol a medical police, see, G. Rosen, (1) "Hospitals, medical care and social policy in the French Revolution," Bulletin of the Histoty of Medicine, vol. 30, no. I, 1956, pp. 124 I49, reprinted in G. Rosen, From Medical Police to Social Medicine: Essays on the History of Health Care ( N e w York: Science History Publications, 1974) pp. 220 245; (2) A History of Public Health (New York: MD Publications, 1958); ( 3 ) "Mercantilism and health policy in eighteenth century French thought," Medical History, vol. Ill, October 1959, pp. 259 277, reprinted in From Medical Police, pp. 201 219; M. Joeger, (1) "Les enquetes hospitalieres au xviii' siecle," Bulletin de la Societe francaise d'histoire des hopitaux, no. 31,1975, pp. 51 6(); ( 2 ) "La structure hospital lere de la France sous I'Ancien Regime," Annales ESC, 32m year, no. 5, September October 1977, pp. 1025 1051; M. J. Imbault Huart, "L'hopital, centre d'une nouvelle medecine (1780 1820)," in Zusammentrang Festschrift fur Marilene Pulscher, vol. II (Cologne: Wienand, 1984) pp. 581 603. Foucault takes up this question in a number ol places: ( 1) Naissance de la clinique, ch. v, "La lecon des hopitaux," pp. 63 86; Birth oj the Clinic, ch. 5, "The lesson of the Hospitals" pp. 64 87; "La politique de la sante au XVIII1' siecle," in Michel Foucault, Blandine Barret Kriegel, Anne Thalamy, Francois Beguin, and Bruno Fortier, Les Machines a guerir. Aux origines de l'hopital moderne. Dossiers et documents (Paris: Institut de I'Environnement, 1976) pp. 11 21, reprinted in Dits et Ecrits, vol. 3, pp. 13 27; English translation, "The politics ol health in the eighteenth century," trans. Colin Gordon, Essential Works oj Foucault, 3, pp. 9 0 105; (3) he relers to it in his hrst lecture on the his tory ol medicine in Rio de Janeiro in October 1974: "Crise de la medecine 011 crise de 1'an- timedecine? " Dits et Ecrits, vol. 3, pp. 50 54, and in the third "L'incorporation de l'hopital dans la technologic moderne," Dits et Ecrits, vol. 3, pp. 5 0 8 521.
40. See M. Foucault, Naissance de la clinique, ch. vui, "Ouvrez quelques cadavres," pp. 125 149; Birth of the Clinic, ch. 8, "Open Up a Few Corpses," pp. 124 148. E.
Jouanna, Hippocrate. Pour une archeologie de I'ecole de Cnide (Paris: Les Belles Lettres, 1974). The basic edition ol the works oi Hippocrates is the bilingual Littre edition (see above, note 10). The basic, bilingual, English edition is the Loeb Classical Library edition ol Hippocrates, in 8 volumes (Cambridge, Mass. : Harvard University Press, 1923-1995). Thomas Sydenham (1624-1689) was an English practitioner known for the changes he introduced into medical knowledge. As Foucault notes in Histoire de lafolie, pp. 205 207 (omitted from the English translation), he organized knowledge ol pathology according to new norms by making a method ol observation, taking into account the symptoms described by the patient, against the medical systems, like Galenism or iatrochemistry, which relied on a speculative approach--earning him the name "the English
22.
23.
? 24.
Hippocrates"--and by developing a "naturalist" description ol diseases offering the possibility ol reducing clinical cases to morbid "species" delined in a botanical style. He published the results of his observations in his Observationes medicae circa morborum aculorum historiam et curationem. Methodic curandi febres, propiis observalionibus superstructa ( L o n d o n : Kettilby, 1676); English translation, Medical Observations Concerning the History and Cur of Acute Diseases, trans. R. G. Latham, in The Works of Thomas Sydenham, M. D. , vol. 1 (London: The Sydenham Society, 1848). See, K. Faber, Thomas Sydenham, dcr englische Hippocrates, und die Krankheitsbegri/je der Renaissance (Munich: Medizinische Wochenschrift, 1932) pp. 29 33; E. Bergholl, Entwicklungsgeschichte des Krankheitsbegrijjes (Vienna: W. Maudrich, 1947) pp. 68 73; and L. S. King, "Empiricism and rationalism in the works ol Thomas Sydenham," Bulletin of the History of Medicine, vol. 44, no. 1, 1970, pp. 1 11.
As Foucault recalls in Histoire de la folie, pp. 3 0 5 3 0 8 (Madness and Civilisation, pp. 146 150) Sydenham was among those who contributed to a prelerence lor an explanation of hysteria in terms ol physiological disorders of the nerves, attributed to disorders ol the "animal spirits," against the traditional explanation which relerred to the uterus and the humoral model of the "vapors": "it is not any corruption ol either the semen or the menstrual blood, to which, according to many writers, this disease is to be relerred. It is rather the faulty disposition ol the animal spintis" Dissertatio cpistolaris ad G. Cole de obser- valionis nuperis circa curationem variolarum, confuentium, necnon de ajjeclione hysterica ( L o n d o n : Kettilby, 1682); English translation, "Epistolary Dissertation" trans. R. G. Latham, The Works oj Thomas Sydenham, vol. 2,1850, p. 95; French translation in, CEuvres de medecine pra- tique, vol. II, trans. A. F. Jault and J. B. Baumes (Montpellier: J. Tourel, 1816), p. 85. See, I. Veith, "On hysterical and hypochondnacal allections," Bulletin of the History of Medicine, vol. 30, no. 3, 1956, pp. 233 240, and I. Veith, Hysteria: the History of a Disease (Chicago: Chicago University Press, 1965). More generally, see, C. Daremberg, Histoire des sciences medicates, comprcnanl /'anatomic, la physiologic, la medecine, la chirurgie et tes doctrines de patholo-
gic generate, vol. II ( Paris: J. B. Bailliere, 1870), ch. 23, "Sydenham, sa vie, ses doctrines, sa pratique, son influence," pp. 706-7Vv, K. Dewhurst, Dr Thomas Sydenham ( 162/I-16C^9): His Life and Original Writings (London: Wellcome Historical Medical Library, 1966). Foucault bases himself on the work, relerred to in the manuscript, oljohn Barker, Essai sur la conjormite de la medecine des anciens el des modernes, en comparaison entre la pratique d'Hippocrate, Galien, Syndenham et Boerhaave dans les maladies aigue's, trans. R. Schomberg (Paris: Cavalier, 1749) pp- 75 76: "Of necessity, it is indispensable lor the doctor to have a basic knowledge of the doctrine ol crises and critical days ( . . . ) to be able to discover whether or not the heat ol the humors is as it should be, at what moment to expect the cri sis, of what kind it will be, and whether or not it will prevail over the disease. " See also J. B. Aymen, Dissertation fsur] les Jours critiques (Paris: Rault, 1752). The importance ol the notion is indicated by the fact that the article "Crise" in the Encyclopedic ou Dictionnaire raisonne des sciences, des arts et des metiers ol D'Alembert and Diderot was written by a great name in medicine, Theophile Bordeu (1722 1776) and Iills 18 lolio pages (vol. IV, Lausanne: Societe typographique, 1754).
The Kaipo^ designates the moment in the evolution ol the illness when a decisive change occurs: "There is crisis in diseases when they increase, get weaker, are transformed into another disease or end" Hippocrates, Afjeclions, ? 8, in CEuvres completes, vol. VI (1847); English trans lation, Affections, in Hippocrates, vol. V, trans. Paul Potter (Cambridge, Mass: Harvard University Press, Loeb Classical Library, 1988). See, G. Hamelin, "Crtse" in Dictionnaire ency- clopedique des science medicates, T1 series, vol. XXIII (Paris: Masson/Asselin, 1879) pp. 258 319; P. Chantraine "xcupo^" in Dictionnaire etymotogique de la langue grecque, vol. II, p. 584; L. Bourgey, Observation et experience chevies medecins de la Collection Hippocratique(Paris: Vnn, 1953) pp. 236-247. On the Greek medical terms: N. Van Brock, Recherches sur le vocabulaire medical du grec ancien. Soins et guerison (Pans: Klincksieck, 1961). See Foucault, "La maison des fous" Dits et Ecrits, vol. 2, pp. 693 694.
25.
26. This is more or less the definition put torward by Sydenham in his Observationes medicae, Section 1, ch. 1, ? 1; Medical Observations, p. 29: " ( ? . . ) a disease ( . . . ) is nothing more than an effort ol Nature, who strives with might and main to restore the health of the patient by the elimination of the morbilic matter. "
23 January 1974 259
? 260
PSYCHIATRIC POWER
27.
In Hislnire de lafolie, p. 285 and p. 245, Madness and Civilisation, p. 123 and p. 86, Foucault noted the shiit carried out in eighteenth century medicine, when it is "from the body's lie] uid and solid elements that the secret of disease was sought" rather than from the "animal spirits. " Hermann Boerhaave (1668 1738), integrating the contributions of physics, chemistry and the natural sciences, made illness the result ol an alteration of the balance ol solids and liquids: lnstitittiones medicae, in usus annae exercitationis domesticos digestae (Leyden: Van der Linden, 1708) p. 10, French translation by J. O. de La Mettrie, Institutions de medecine, vol. I (Paris: Huart, 1740). See, C. Daremberg, Histoire des sciences medicates, vol. II, ch. xxvi, pp. 897 903; L. S. King, The Background of Hermann Boerhaave's Doctrines (Boerhaave Lecture, September M1'1, 196yi) (Leyden: University of Leyden publications, 1965).
Fnednch Hoffmann (166O 1742), a doctor at Halle, considered diseases to he the result of alterations of the solid and liquid parts of the body and of their functions, and, in accordance with his mechanistic perspective, he gave a major role to modifications of the tomcity of the fibers and of the mechanics ol the blood How: (1) Fundamenta medicinae ex principiis mechanicis el practicis in usum Philiatrorum succincte proposita . . . jam aucla et emendata, et cetera (Halle: Magdeburgicae, 1703), English translation, Fundamenta Medicinae, trans. L. S. King (London/New York: Macdonald/American Elsevier, 1971) p. 10; (2) Medicina rationalis systemica, in 2 volumes (Halle: Renyeriana, 1718-1720), French translation by J. J. Bruhier (Paris: Brlasson, I738). See C. Daremberg, Histoire, vol. II, pp. 905-952; K. E. Rothschuh, "Studien zu Friedrich Hoffmann (1660-1742)" Studhoffs Archiv fur Geschichte der Medizjn, vol. 6 0 , 1976, pp. 163 193 and pp. 235 270. On this eighteenth century med icine, see, L. S. King (1) The Medical World of the Eighteenth Century (Chicago: University ol Chicago Press, 1958), and (2) "Medical theory and practice at the beginning of the eigh teenth century," Bulletin of the History of Medicine, vol. 46, no. 1, 1972, pp. 1 15.
28. Hippocrates, Epidemies, I, 3 section, ? 12 in CEuvres completes, vol. II (1840), pp. 679 681; English translation, Epidemics, Book 1, (iii), 26, in G. E. R. Lloyd, ed. Hippocratic Writings, trans. J. Chadwick and others (Harmondsworth and New York: Penguin, 1978), p. 101: "Fevers attended by paroxysms at even numbers of days, reach their crisis also in an even number; il the paroxysms are on odd days, so is the crisis. The hrst period of [lever] in those maladies which reach the crisis in an even number ol days is 4, 6, 8, 10, 14, 20, 24, 30, 40, 60, 80 or 120 days. (. . . ). It must be noted that il a crisis occurs on any other day than those mentioned, there will be a relapse and also it may prove a latal sign. One must pay attention to these days which have been specified in the course of a particular fever and realize that on them a crisis may take place leading to recovery or death, to improvement or to deterioration. "
29. On the determination ol lucky or ill lated days (or consulting the oracle, see P. Amandry, La Mantique appollinienne a Delphes. Essaisur lefontionnemenl de Coracle (Paris: E. de Boccard, 1940) ch. vn, "Frequence des consultations" pp. 81 85. On Greek "mantictsm" in general, derived from the verb (xavTeuRcrOou meaning "to prophecy," to conjecture according to ora- cles, to act as a seer ((xavrts"), the basic book, although old, ts still that ol A. Bouche Leclercq, Histoire de la divination dans VAntiquile, in 4 volumes (Paris: Leroux, 1879 1882). Also, W. R. Halliday, Greek Divination: A Study of its Methods and Principles (London: Macmillan, 1913);J. Defradas, "La divination en Grece" in A. Caquot and M. Lcibovici, eds. La Divination, vol.
I (Paris: Presses universitaires de France, 1968) pp. 157 195; R. Flaceliere, Devins et Oracles grecs; and ed.
J. P. Vernant, Divination et Rationalite (Paris: Le Seuil, I974).
30. Hippocrates "considers an important part ol the art of medicine" to be the ability "to
observe the order of the critical days and to extract the elements ol prognosis from it. When we know these things, we know too when and how to give nourishment to the patient" Hippocrates, Epidemies, III, 3ul section, ? 16, in CEuvres completes, vol. Ill; English translation, Hippocrates, Epidemics, 3, trans. W. H. S. Jones, Hippocrates, vol. I, Loeb Classical Library (Cambridge, Mass: Harvard University Press, 1923).
31. Hippocrates, Pronostic, ? 1: "The best doctor seems to me to be one who can know in advance . . . He will treat best those diseases whose future course he can loresee with the help of the present condition" CEuvres completes, vol. II, p. 111; Prognosis ? 1, in Hippocratic Writings: "It seems to be highly desirable that a physician should pay much attention to
? prognosis. . . . he will be better able to effect a cure if he can loretell, trom the present
symptoms, the future course of the disease. " p. 170.
}2. In Hippocrates's own terms, the doctor's task is to "combat (avrayoviaaBai) each of the
accidents through his art. " Or again, "if we know the cause of the disease, we will be in a position to administer what is useful to the body, starting from contraries to counter (SK TOV evavTtov ermao[tEVo<;) the disease" Des Vents, I, in Guvres completes, vol. VI, p. 93 (translation amended by J. L. |; English translation, Airs, I, in Hippocrates, vol. I, Locb Classical Library (1923).
33. Taken from juridical language, the term krisis means "judgment," "decision," before desig nating in medicine the crucial moment at which "the disease judges | KpiveTcu] lor death
or life "Des Affections internes,21 220, 9, in GLuvres completes, vol. VII, p. 217; "Internal Affections," trans. Paul Potter, Hippocrates, vol. VI, Loeb Classical Library (1988). Or again there is this expression in Epidemies, I, 2IK section, ? 4: "In some ( . . . ) the illness is decided by a crisis" in GLuvres completes, vol. II, p. 627; EpiJemies, Book One, (11), ? 8, p. 92. As for the doctor, he is judged on his sense of opportunity and his interventions; see, Des maladies, I, 5. pp. 147 151; Diseases, I, trans. Paul Potter, Hippocrates, vol. V, Loeb Classical Library (1988).
34. See the medical scenes in the plays by Mohere (1622 1673): (1) VAmour medecin (performed
on 14 September, 1665), Act II, scene 2, in which four doctors are involved, and scenes 3-4 of
the consultation, in Guvres completes, ed. M. Rat (Paris: Galhmard, 1947) vol. II, pp. 14 25; (2) Monsieur de Pourceaugnac ( 6 October 1669) in Act I, scenes 7 8, ol which, two doctors and an apothecary are involved, Guvres completes, vol. II, pp. 141-120; and (3) Le Malade imaginaire (10 February 1673), posthumous work ( 1682), Act II, scenes 5 6, and Act III, scene 5, Guvres com- pletes, vol. II , pp. 845-857 and pp. 871 873. See, F. Millepierres, La Vie quotidienne des medecins au temps de Moliere (Paris: Hachette, 1964).
}5. This refers to an episode that took place during Galen's (b. Peigamum 129 A. D. ) first stay in Rome from the autumn of 162 until the summer ol 166, before coming back to settle there from 169 until his death around 200. Sec, De Praecognitione ? 1$ in Opera Omnia, vol. XIV, ed. and Latin trans. C. G. Kiihn (Lipsiae: in officina, C! Cnoblochii, 1827) pp. 666 668; English translation, On Prognosis: Corpus Medicomm Graecorum, V, 8, 1, trans. Vivian Hutton (Berlin: Akademie Verlag, 1979) pp. 135-137. On Galen's relations with the Roman medical world, see J. Walsh, "Galen clashes with the medical sects at Rome (163 A. D. )," Medical Life, vol. 35,1928, pp. 408-444. On his practice, see,J. Ilberg, "Aus Galens Praxis. Ein Kulturbild aus der Kaiserzeit," Neue Jahrbiicher fur das klassische Allerlum (Leipzig: Teubner, vol. 15, 1905, pp. 276 312; and, V. Nutton, "The chronology ol Galen's early career," The Classical Quarterly, vol. 23, 1973, pp. 158 171.
36. This passage echoes a number of treatments by Foucault of "the inquiry": (1) The 1971- 1972 lectures at the College de France, the first part of which deals with the inquiry and its development in the Middle Ages; see the course summary, "Theories et Institutions penales" Dits et Ecrits, vol. 2, pp. 390 391; "Penal Theories and Institutions," trans. Robert Hurley, Essential Works of Foucault, 1, pp. 17 19; (2) The College de France lectures ol 1972 1973, "The Punitive Society," in which, in the lecture of 28 March 1973, Foucault returns to the constitution of an "inquiry knowledge"; (3) The third lecture (23 May 1973) on "La Verite et les formes jundiques" pp. 581 588; "Truth and Juridical Forms" pp. 44 52. Foucault returns to the process of the colonization of a "truth test" in the form of the event by a "truth-findings" in the lorm ol a body of knowledge in 1975 in "La Maison des lous" Dits et Ecrits, vol. 2, pp. 6 9 6 697.
37. In the second half ol the eighteenth century, since Fnedrich Hoffmann, who still believed in the theory of crises, albeit with reservations about the notion of critical days, died in 1742. See, C. Daremberg, Histoire des sciences medicates, vol. II, p. 929.
38. This grid, which dates from the organization of administrative health correspondence by the Intendants in order to collect lnlormation on epidemics and endemic diseases, found institutional expression with the creation on 29 April 1776, on Turgot's initiative, of the "Societe Royale de Medecine" responsible for studying epidemics and epizootic diseases, before disappearing in 1794. See, C. Hannaway, "The Societe Royale de Medecine and epi demies in the Ancient Regime," Bulletin of the History of Medicine, vol. 46, no. 3, 1972, pp.
23> January 1974 261
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PSYCHIATRIC POWER
257273. Concerning these inquiries, see, J. Meyer, "Une enquete de 1'Academie de medecine sur les epidemics (1774 1794)" Annales ESC, 21st year, no. 4, August 1966, pp. 729 749; H. Dupin and L. Masse, uUne enquete epidemiologique a peripeties multiple: I'etude de la pellagre," Revue d'epidemiologie, medecine sociale el sanle publique, vol. XIX, no. 8, 1971, pp. 743 76();J. P. Peter, (1) "Une enquete de la Societe Royale de Medecine. Malades et maladies a la fin du xvmc siecle," Annales ESC, 22,ul year, no. 4, July August 1967, pp. 711 751; ( 2 ) "Les mots et les objets de la maladie. Remarques sur les epidemies et la medecine dans la societe Iran^aise de la lin du xvni' siecle," Revue hisloriijue, no. 499, 1971,pp. 13 38;J. P. Desaive, P. Goubert, E. Le Roy Ladurie, Medecins, climals et epidemies a fin du xviii . siecle (Paris: Mouton, 1972). See also the pages devoted to this in M. Foucault, Naissance de la clinicjue, ch. 2, "Une conscience politique," pp. 21 36; Birl/i of the Clinic, ch. 2, "A Political Consciousness," pp. 22 37.
39. On the development of hospital lacilities and the advent ol a medical police, see, G. Rosen, (1) "Hospitals, medical care and social policy in the French Revolution," Bulletin of the Histoty of Medicine, vol. 30, no. I, 1956, pp. 124 I49, reprinted in G. Rosen, From Medical Police to Social Medicine: Essays on the History of Health Care ( N e w York: Science History Publications, 1974) pp. 220 245; (2) A History of Public Health (New York: MD Publications, 1958); ( 3 ) "Mercantilism and health policy in eighteenth century French thought," Medical History, vol. Ill, October 1959, pp. 259 277, reprinted in From Medical Police, pp. 201 219; M. Joeger, (1) "Les enquetes hospitalieres au xviii' siecle," Bulletin de la Societe francaise d'histoire des hopitaux, no. 31,1975, pp. 51 6(); ( 2 ) "La structure hospital lere de la France sous I'Ancien Regime," Annales ESC, 32m year, no. 5, September October 1977, pp. 1025 1051; M. J. Imbault Huart, "L'hopital, centre d'une nouvelle medecine (1780 1820)," in Zusammentrang Festschrift fur Marilene Pulscher, vol. II (Cologne: Wienand, 1984) pp. 581 603. Foucault takes up this question in a number ol places: ( 1) Naissance de la clinique, ch. v, "La lecon des hopitaux," pp. 63 86; Birth oj the Clinic, ch. 5, "The lesson of the Hospitals" pp. 64 87; "La politique de la sante au XVIII1' siecle," in Michel Foucault, Blandine Barret Kriegel, Anne Thalamy, Francois Beguin, and Bruno Fortier, Les Machines a guerir. Aux origines de l'hopital moderne. Dossiers et documents (Paris: Institut de I'Environnement, 1976) pp. 11 21, reprinted in Dits et Ecrits, vol. 3, pp. 13 27; English translation, "The politics ol health in the eighteenth century," trans. Colin Gordon, Essential Works oj Foucault, 3, pp. 9 0 105; (3) he relers to it in his hrst lecture on the his tory ol medicine in Rio de Janeiro in October 1974: "Crise de la medecine 011 crise de 1'an- timedecine? " Dits et Ecrits, vol. 3, pp. 50 54, and in the third "L'incorporation de l'hopital dans la technologic moderne," Dits et Ecrits, vol. 3, pp. 5 0 8 521.
40. See M. Foucault, Naissance de la clinique, ch. vui, "Ouvrez quelques cadavres," pp. 125 149; Birth of the Clinic, ch. 8, "Open Up a Few Corpses," pp. 124 148. E.
