But hadn't anyone thought of doing anatomical dissections before? Is the new shift in medicine due to religious and/or moral restrictions that were finally banished in the wake of the Enlightenment and the Revolution?
Foucault adamantly argues that this traditional historical interpretation is not what happened: "there was no shortage of corpses in the eighteenth century, no need to rob graves or to perform anatomical black masses...[t]he corpse was part of the medical field, and this was unchallenged by religion and morality" (p. 125-6).
So, if doctors had always been allowed to dissect corpses without too much moral difficulty, then what would account for this new development in the clinical gaze which Foucault asserts?
Foucault argues that the new transformation is not so much a result of new Enlightenment science as it was a new collaboration between two distinctly different occupations: the traditional anatomist and the new clinician.
"[T]he clinic, a neutral gaze directed upon manifestations, frequencies, and chronologies, concerned with linking up symptoms and grasping their language, was, by its structure, foreign to the investigation of mute, intemporal bodies; causes and locales did not interest it; it was interested in history, not geography. Anatomy and the clinic were not of the same mind: strange as it may seem to us now that anatomy and clinic are inseparably linked, and seem to us always to have been, it was clinical thought that for forty years prevented medicine from hearing the lesson of Morgagni (a classic medical anatomist). The conflict was not between a young corpus of knowledge and old beliefs, but between two types of knowledge. Before pathological anatomy could be readmitted into the clinic, a mutual agreement had to be worked out: on the one hand, new geographical lines, and, on the other, a new way of reading time. In accordance with this litigious arrangement, the knowledge of the living, ambiguous disease could be aligned upon the white visibility of the dead" (p. 126).
Foucault traces this new development of the pathological anatomist through the writings of Bichat (one of the few historical figures mentioned in this history of the medical perception). According to Foucault, Bichat is the first clinician to attempt to map the nosological classifications of disease onto/into the various interior surfaces revealed by cadaver dissection:
"Thanks to Bichat, superficiality now becomes embodied in the real surfaces of membranes. Tissual expanses form the perpetual correlative of the surface gaze that defined the clinic. By a realistic shift in which medical positivism was to find its origin, surface, hitherto a structure of the onlooker, had become a figure of the one observed...Hence the appearance that pathological anatomy assumed at the outset: that of an objective, real, and at last unquestionable foundation for the description of diseases: 'A nosography based on the affection of the organs will necessarily be invariable [Foucault is quoting Bichat]'" (p. 129).
Bichat realized the importance of his new method, as is indicated by his lecture to medical students in 1803:
"'For twenty years, from morning to night, you have taken notes at patients' bedsides on affectations of the heart, the lungs, and the gastric viscera, and all is confusion for you in the symptoms which, refusing to yield up their meaning, offer you a succession of incoherent phenomena. Open up a few corpses: you will dissipate at once the darkness that observation alone could not dissipate [51]'" (p. 146).
But what are the details of this transformation (in terms of the Gaze), and how would this new method affect medical science?
Bichat's anatomo-clinical model developed through three main ways:
a transformation of the concept of Disease
a transformation of the Gaze
a transformation of the clinic's relationship to Death
Under the discerning and directing eye of Bichat and his colleagues, the clinic undergoes its most radical transformation. As Foucault sums it up:
"With Bichat, the medical gaze pivots on itself and demands of death an account of life and disease, of its definitive immobility of their time and movements...But Bichat did more than free society of the fear of death. He integrated that death into a technical and conceptual totality in which it assumed its specific characteristics and its fundamental value as experience. So much so that the great break in the history of Western medicine dates precisely from the moment clinical experience became the anatomo-clinical gaze...The living night is dissipated in the brightness of death" (p. 146).
