The politics of health in the eighteenth century

Abstract

A private, " liberal " medicine, sought out by individual initiative and subject to the mecha‐ nisms of supply and demand—and to its side, or perhaps facing it, a medical management determined by the authorities, supported by an administrative apparatus, framed by strict legislative structures, and addressing itself to the entire collectivity. Is it productive to demar‐ cate a clear opposition and to determine which of these two types of medicine was the first, from which the other was derived? Is it necessary to suppose, at the origin of Western medi‐ cine, a collective practice from which the forms of individual relationships would have slowly disassociated? Or must we imagine that modern medicine first developed in singular relations (relationships with clients and clinical relations) before a series of corrections and adjustments would have integrated it into a politics and a management of the group? Posing the problem in this way supposes a somewhat fictional separation. In every so‐ ciety, illness—the manner in which the sick person demonstrates and expresses it, that which for the sick person and for others distinguishes it from health, the signs by which it is recog‐ nized, the behaviors that it induces—makes reference to collective systems. Better: the doc‐ torʹs intervention—the form of his action, right down to the secret of his remedies and their 1 Translator: This essay was first published in Les Machines à guérir. Aux origines de lʹhôpital moderne (Brussels: Pierre Mardaga, 1979), 7‐18, and is translated from Dits et Ecrits, © Gallimard 1994 (no. 257, vol. III, pp. 725‐ 742). It appears in English for the first time here, with the permission of Éditions Gallimard. The article is translated for Foucault Studies by Richard A. Lynch (DePauw University, USA). The translation of this text was supported by a grant from the University of San Francisco; my thanks also to Jeffrey Paris and Eduardo Mendieta. This is the second of two texts that Michel Foucault published under the title " The politics of health in the eighteenth century; " the first (DE168) was published in 1976. Making matters more complicated, the two texts appeared in volumes also bearing the same title, Les Machines à guérir [Curing Machines]. (The 1976 volume was published in Paris by the Institut de lʹenvironnement.) Nevertheless, these two texts are not identical. They are approximately the same length, and the second halves of the two essays are virtually identical (one paragraph from the 1976 version is omitted in 1979); the essaysʹ first halves, however, differ in significant ways. The (current) second essay also includes a long list of " bibliographical suggestions, " which were not included in 1976. The earlier 1976 essay was translated into English by Colin Gordon. It first appeared in 1980 in Pow‐ er/Knowledge, and has since been anthologized in The Foucault Reader, Power, and The Essential Foucault. I benefited from consulting that translation as I completed this one.