The birth of clinical medicine

Author: Michel Foucault
Translator: Liu Beicheng
France/France
Publisher:
Publish Date: 2001-08-01
Features: The "Edict of the Gauze" issued in March 1707 imposed restrictions on the practice and training of physicians in the 18th century. The task at the time was to combat quacks, incompetent doctors, and "unqualified and incapable practitioners"; at the same time, there was an urgent need to reform the "loosely organized" medical schools. Therefore, the edict stipulated that all universities in the kingdom that had or had once had medical schools must teach medicine; teaching positions could not remain vacant indefinitely; once a vacancy occurred, it must be filled; students were required to register every four months and could only obtain a degree after three years of study; they must pass annual exams in sequence to earn the degrees of baccalaureate, licentiate, and doctor; they must complete mandatory courses such as anatomy, chemistry, Galenic pharmacology, and herb demonstration. In addition, Article 26 of the edict announced the following principle: "Those who have not obtained a licentiate degree shall not practice medicine or prescribe medicine, even if unpaid"; this clause was supplemented (this was a significant achievement and goal for medical schools in exchange for reform): "All religious personnel, whether mendicant or non-mendicant, are subject to this prohibition." By the end of the century, criticism was consistent in at least four aspects: quacks were still rampant; the formal education provided by medical schools could neither meet the needs of medical practice nor keep pace with new discoveries (it only taught theory; it completely ignored mathematics and physics); there were too many and too many medical schools; corruption was severe (teaching positions could be bought like other official posts; teachers charged for classes; students could pass exams by paying money and could hire cheap doctors to write their theses), making the cost of studying medicine extremely high—in worse cases, even after obtaining a medical qualification, new doctors had to follow famous doctors on house calls to gain practical experience, for which they had to pay money. Thus, the French Revolution faced two demands: one was to impose stricter restrictions on medical practice qualifications, and the other was to impose stricter management on university curricula. However, both of these were at odds with the overall trend of reform, as the goal of reform was to abolish guilds and apprenticeships and close universities. As a result, a certain tension arose among the following three demands: one was to reorganize knowledge, two was to abolish privileges, and three was to effectively monitor the health of the nation. Medicine, and the government through medicine, should be able to monitor citizens without restriction, but how could this freedom of visual surveillance be both well-equipped and fully effective without falling into the mystique of knowledge and the grip of strict social privileges? The question is: can a doctor become a free profession without the protection of guild laws, practice restrictions, qualification restrictions, and so on? Is the nation's medical consciousness as spontaneous as its civic or moral consciousness? Doctors defend their guild rights on the grounds that these rights are not privileges but rights to cooperation. Medical associations should differ from political associations because they have no intention of limiting others' freedom or imposing laws and obligations on citizens; their regulations only apply to themselves; their "jurisdiction is limited to their own internal affairs"; however, they also differ from other trade associations because they are not aimed at maintaining certain rights and vague traditions but at verifying