Foucault's "The Birth of Social Medicine" (Summary)

 

The Birth of Social Medicine focuses on the development of the medical system and model that followed the "take-off" in medicine and sanitation in the West from the eighteenth century onward. It highlights three important points: biohistory, medicalization, and the economy of health. Biohistory examines the biological impact of medical intervention on human history, such as the disappearance of infectious diseases like the plague and tuberculosis. Medicalization refers to the establishment in the eighteenth century that brought an existence, behavior, and the human body into an increasingly dense network of medicalization that allowed fewer things to escape.

The economy of health is the integration and improvement of health, health services, and health consumption in the economic development of privileged societies. The author discusses the history of medicalization, focusing on the birth of social medicine in the late 19th century. They argue that ancient Greek and Egyptian medicine were social, collective medicines that were not centered on the individual. Modern medicine, born between Giambattista Morgagni and Xavier Bichat, is not individualistic because it has worked its way into market relations.

The author cites Varn L. Bullough's work, The Development of Medicine as a Profession: 7The Contribution of the Medieval University to Modern Medicine, where the individualistic character of medieval medicine becomes evident while the collective dimension of medical activity is extremely inconspicuous and limited. The author explains that the human body was politically recognized as a labor force, but medical power did not concern itself at the start with the human body as labor power until the second half of the nineteenth century when the problem of the body, health, and the level of productive force of individuals was raised.

State medicine emerged in Germany during the early eighteenth century due to the slow development of the German economy and the Great War. The concept of StaatswissenschoJt, which combines the terms "science of the state" and "state knowledge," emerged in Germany during this time.

In the 18th century, Europe began to focus on the health of their populations due to mercantilism, a political practice aimed at regulating international monetary currents, goods, and population productivity. France, England, and Austria began to evaluate the active strength of their populations, leading to the development of birth and death rate statistics in these countries. However, these countries only showed health interest through drawing up tables of birthrate and mortality without organized intervention to raise the level of health.

In Germany, a medical practice developed that was currently devoted to improving public health. Frank and Daniel proposed a program called the "medical police" between 1750 and 1770, which consisted of observing sickness, recording epidemiological and endemic phenomena, and standardizing medical practice and knowledge. This movement spread to other parts of Europe, with Germany affecting doctors, while France focused on standardizing activities at the state level, such as the production of cannons and rifles. The first standardized individual in Germany was the doctor, who was the first standardized individual in the country.

The birth of social medicine in the 18th century saw the standardization of medical knowledge, the standardization of the medical profession, the subordination of doctors to a general administration, and the incorporation of different doctors into a state-controlled medical organization. This led to the creation of a "state medicine" that did not aim to form a labor force adapted to the needs of developing industries. This concern for state strength was influenced by economic and political factors, and medicine was obliged to perfect and develop that state strength.

The second form of social medicine emerged in France at the end of the 18th century, focusing on urbanization rather than state structure. A large French city between 1750 and 1780 was made up of seignorial authorities held by the laity, Church, religious communities, guilds, and representatives of the state. Political factors also played a part in this development, as the development of cities and the appearance of a poor, laboring population transformed into a proletariat during the nineteenth century.

During this period, a feeling of fear and anxiety about cities emerged and grew, leading to urban panics and the quarantine model, which was applied in all European countries, including France, as a response to the plague or other serious epidemic diseases.

In the 18th century, urban medicine emerged as an improvement on the politico-medical schema of quarantine, which emerged at the end of the Middle Ages. It focused on studying the accumulation and piling-up of refuse that might cause illnesses in urban spaces, the places that generated and propagated epidemic or endemic phenomena. Graveyards were the main concern, and protests against cemeteries began between 1740 and 1750. The first great removals to the city's periphery began around 1750, leading to the establishment of individualized cemeteries, which were the individual coffin and tomb reserved for family members.

Antoine-Frangois de Fourcroy, one of the greatest chemists of the end of the eighteenth century, was consulted about combating the influence of cemeteries and took charge of the first medical and urban policing sanctioned by the banishment of cemeteries. Urban medicine aimed to organize distributions and sequences of essential elements for the city's shared life, such as fountains, sewers, pumps, and river washhouses. The first hydrographic plan of Paris in 1742 was the first survey of places where water that was not contaminated by sewers could be drawn and the first attempt at defining a policy for river life.

During the French Revolution in 1789, an urban medical police in Paris established directives for a sanitary organization of the city. However, there was no conflict between medicine and other forms of authority, such as private property. Official policy relating to private dwellings was not sketched out before the 18th century, except for the subsurface. In the middle of the 18th century, binding legislation relating to the subsoil was formulated, ensuring that the state and the king were the sole owners of the subsoil, not disposers of the ground.

The medicalization of cities in the 18th century was significant for several reasons. Firstly, urban social medicine brought the medical profession into direct contact with related sciences, mainly chemistry, due to the analysis of water, air currents, and conditions of life and respiration. Second, urban medicine is not a medicine of man, the body, and the organism but a medicine of things—air, water, decompositions, and fungi. The organization of urban medicine was important for the formation of scientific medicine.

The notion of salubrity appeared shortly before the French Revolution, and one of the major journals of this period, the Annales d’hygiene publique et de medecine legale, would become the organ of French social medicine.

The third direction of social medicine, labor force medicine, focuses on the health and well-being of the poor. In the English example, the state, city, and poor people and workers were the objects of medicalization. French urban medicine respected the private sphere and did not regard the poor, underclass, or people as an element that threatened public health.

The problem of poverty as a source of medical danger did not arise in the eighteenth century due to several reasons. One reason is that the number of poor people in cities was not large enough for poverty to represent a real danger. Another reason is that urban activity depended on the poor, who performed basic functions such as water hauling or refuse disposal. However, starting in the second third of the nineteenth century, the problem of poverty was raised in terms of menace or danger. Political reasons include the transformation of the destitute population during the French Revolution and the great social unrest of the beginning of the nineteenth century.

In the nineteenth century, the Poor Law made English medicine a social medicine by imposing medical control on the disadvantaged. This law allowed the wealthy classes to maintain control over the health of the needy and protect the privileged population. The Health Service emerged from the same thinking that produced the Poor Law, providing for a medical service specifically intended for the poor.

In the second half of the nineteenth century, English medical control administered by the Health Offices provoked violent popular reactions and resistances, small-scale antimedical insurrections. In contrast to German state medicine of the eighteenth century, there appeared in the nineteenth century, especially in England, a medicine that consisted only in controlling the health and bodies of the needy classes, making them more fit for labor and less dangerous to the wealthy classes.