Tobias BowmanGreen Templeton CollegeProf. Stephen Johnston (Sup.

LO S T I N T RA N S L AT I O N ? A N
INTRODUCTION TO THE BIRTH
OF THE CLINIC, ITS CONTENTS
A N D C O N T E XT S .
TOBIAS BOWMAN

WHAT WAS THE BIRTH OF THE CLINIC?

The focus of this paper will be primarily a single work, The Birth of the Clinic
by Michel Foucault1, however its unique nature as a historical source merits
discussion of its contents and of how to approach it. Whilst its examined by
Historians of Medicine and of Science (though it is still one of Foucaults
lesser-known works 2) it is not necessarily an historical work, nor a medical
one. The Birth of the Clinic is a philosophical text with historical and
historiographic implications, dealing with change in perceptions of medical
knowledge and medical practice surrounding the French Revolution in Paris.
This philosophical nature should be borne in mind, especially when
examining Foucaults use of historical sources. 3
This poses a problem when placing The Birth of the Clinic within a broader
literature review, it does not draw directly (or even, perhaps, indirectly) from
1 M. Foucault, The Birth of the Clinic: An Archaeology of Medical Perception,
translated from the French by A. M. Sheridan Smith, (London, 1973).
2 T. Osborne, On Anti-Medicine and Clinical Reason, in R. Porter and C.
Jones (eds.), Reassessing Foucault : Power Medicine and the Body (Florence,
USA, 1998).
3 J. B. Loudon, The Birth of the Clinic: An Archaeology of Medical Perception. by
Michel Foucault; A. M.Sheridan Smith, Man, New Series, 9, 2 (1974), pp. 319-20.

Tobias BowmanGreen Templeton CollegeProf. Stephen Johnston (Sup.)

the existing literature on the topic, only on a selection of the primary
sources, and it does not directly discuss existing scholarly thought on the
subject of the medical practice in the Paris Hospitals. It sits in the
Historiography like a boulder in a stream, independent and unrelated on an
elemental level. Where can a piece like The Birth of the Clinic fit in with the
growth of more mainstream historical and sociological work throughout the
1960s onwards, with the growing understanding of the nature of the hospital
prior to its perceived medicalization by historians like Horden, Porter, Fissel,
Risse and others?4 In this paper it will be illustrated that in many ways it
cant, nor should historians attempt to do so.

Why then is The Birth of the Clinic, and Foucaults writing more broadly,
influential? Part of this is the time of writing; the 1960s, a period where
progressivist, (seemingly) liberal histories where popular. Foucaults work
upturned many histories of knowledge which saw the present as the pinnacle
of personal and intellectual freedom. 5 One of the recurring themes in
Foucaults writing is the idea that rationalism itself is in fact merely another
system of control.6 By allowing people to evaluate a source of power over
them and validate it, the strength of that power grows exponentially, as it is
4 P. Horden, The Earliest Hospitals in Byzantium, WesternEurope, and Islam,
Journal of Interdisciplinary History, 35, 3
(2005), pp. 361-89; and also L. Granshaw and R. S. Porter (eds.), The Hospital in
History (London, 1989); and also M. Fissell, The disappearance of the patients
narrative and the invention
of hospital medicine in R. French and A. Wear (eds.)
British Medicine in an Age of Reform (London, 1991), pp. 92109; and also G. B. Risse, Mending Bodies, Saving Souls: A History of Hospitals (New
York, 1999).

5 R. Porter and C. Jones, Introduction, in R. Porter and C. Jones (eds.),

Reassessing Foucault: Power, Medicine and the Body (Florence, USA, 1998).

Tobias BowmanGreen Templeton CollegeProf. Stephen Johnston (Sup.)

unopposed.7 Thus The Birth of the Clinic provided something new, a
challenge to traditional philosophies of thought, an anti-progressivism which
was by no means unique to Foucault8, but was nevertheless was fresh and
new, and therefore desirable.9 The Birth of the Clinic therefore could be seen
to represent a Kuhnian paradigm shift in the History of Medicine, inasmuch
as it allowed Historians of Medicine agency to discuss Medicine within a
context of social or institutional control, its validity as a historical text
notwithstanding.10

It may be helpful, therefore, to approach The Birth of the Clinic with the mind
of a Historian of Philosophy; as a philosophical writing concerning the nature
of medical thought, rather than a History of medical thought.

ABOUT THE AUTHOR

6 M. Foucault, The Order of Things: An Archaeology of the Human Sciences,

translated from the French by Pantheon Books, (London, 1970); and also M.
Foucault, Madness and Civilisation, translated from the French by R. Howard,
(London, 1971).
7 R. Porter and C. Jones, Introduction, in R. Porter and C. Jones (eds.),
Reassessing Foucault: Power, Medicine and the Body (Florence, USA, 1998).
8 Ibid, pp. 1.
9 J. R. R. Christie, Aurora, Nemesis and Clio, The British Journal for the History of
Science, 26, 4 (1993), pp. 391-405; And also G. Parchomovsky, Publish or Perish,
Michigan Law Review, 98, 4 (2000), pp. 926-52. Ibid, pp 401-2.

10 T. Kuhn, The Structure of Scientific Revolutions, (London, 1970).

Tobias BowmanGreen Templeton CollegeProf. Stephen Johnston (Sup.)

As is crucial when reading any source, an attempt should be made to
understand the authors context, as this can lend to understanding the text
in a less present-centred fashion. Foucault was, at the time of writing The
Birth of the Clinic, a teacher of psychology at the University of ClermontFerrand, (indeed his first book was primarily a psychological history), though
his interests, and already published work Madness and Civilisation, were
philosophical in nature. His area of interest, shaped heavily by Nietzsche, had
a predominantly French focus, as that was the area both of his teaching in
the History of Psychology, and his personal interest philosophically, and thus
the bounds of his knowledge revealed though his process of self-interview
(inspired by Blanchot) remain predominantly French. 11 In addition it should be
noted that Foucault was predominantly left wing, but moved towards the
centre in later life, however, the degree to which his politics affected his
writing is reduced by his more meta-political or hyper-social concerns. 12
Bearing the French Weltanschauung, Nietzscherian influences and preexisting interest in power structures (explored as far back as Mental Illness
and Personality),13 one can begin to examine The Birth of the Clinic within the
context of its author.

THE BIRTH OF THE CLINIC

11 D. Eribon, Michel Foucault, (Cambridge, Mass. 1991).

12 R. Porter and C. Jones, Introduction, in R. Porter and C. Jones (eds.),
Reassessing Foucault: Power, Medicine and the Body (Florence, USA, 1998).
13 D. Eribon, Michel Foucault, (Cambridge, Mass. 1991).

Tobias BowmanGreen Templeton CollegeProf. Stephen Johnston (Sup.)

The Birth of the Clinic is one of Foucaults shorter works, primarily examining
change in the practice of Medicine and of Medical knowledge in the period
surrounding and encompassing the French Revolution (1787-1799). 14 A
phrase often used when discussing The Birth of the Clinic is the Medical
Gaze (le regard). It is used often in The Birth of the Clinic to demonstrate a
shift in medical knowledge and perception, wherein the patient becomes
perceived in terms of the physical, anatomical body, infected with disease,
deviant from the norm, over the more traditional perception of the patient as
a living person with complaints about their state of being. The Medical Gaze,
therefore, is used by Foucault to characterise post-revolutionary French
medical practitioners nascent tendancy to separate the body from the
personality of the patient: the patient as object. 15 It is the period of transition
between these two diagnostic approaches, and all that can be inferred from
them, which The Birth of the Clinic ostensibly examines.

Foucault begins by examining the origins of the medical gaze, whereby the
body is assessed empirically and anatomically. Believing this change to be a
rapid shift (or rupture) in medical practice taking place in the social, political,
ideological and academic contexts of French Revolutionary upheaval,
wherein traditional academic frameworks were abolished and new structures
of teaching and knowledge were championed. Foucault believes that the rise
of centralised institutions of medical research, training and practice, the

14 J. Popkin, A Short History of the French Revolution, (Upper Saddle River,

1998).
15 M. Foucault, The Birth of the Clinic: An Archaeology of Medical Perception,
translated from the French by A. M. Sheridan Smith, (London, 1973), pp. 145.

Tobias BowmanGreen Templeton CollegeProf. Stephen Johnston (Sup.)

teaching hospital (le clinique), allowed the growth of anatomical
understandings of disease and standardised, empirical knowledge of the
body, the medical gaze to form. 16 This view, if viewed historiographically, is
strongly anti-progressivist, assessing historical events such as the
Revolution, and its perceived impact on the practice of medicine as a
rupture, or sudden shift in the status quo, independent from pre-existing
trends (assuming such trends existed). Earlier works by Science Historians
such as Kuhn or, to a lesser extent, Merton, 17 had taken a broadly similar
approach, abandoning progressivist, Whiggish histories in favour of
aprogressional ones,18 whereby historical events may be contingent or
processual, but dont constitute singular progress. In this context, any kind of
major change in the status quo of a discipline, be that Medicine, Physics or
Alchemy, can be seen as a rapid shift necessarily caused by external factors.

In some ways, therefore, The Birth of the Clinic could be seen alongside the
rise of the sociology of science in the broader History of Science that took
hold in the 1960s as a challenge to traditional historical practice with the fall
of Synthetic, philosophical and political histories. 19 However, a challenge to
16 Ibid, pp. 64-5, 79.
17 A. Cunningham and P. Williams, De-Centring the 'Big Picture': "The
Origins of Modern Science" and the Modern Origins of Science, The British
Journal for the History of Science, 26, 4 (1993), pp. 407-32.
18 A. Wilson and T. G. Ashplant, Whig History and Present-Centred History,
The Historical Journal, 31, 1 (1988), pp. 1-16.
19 A. Barry, The History of Measurement and the Engineers of Space, The
British Journal for the History of Science, 26, 4 (1993), pp. 459-68; and also
C. Hakfoort, The Missing Syntheses in the Historiography of Science,
History of Science, 29, 2 (1991), pp. 207-16.

Tobias BowmanGreen Templeton CollegeProf. Stephen Johnston (Sup.)

placing The Birth of the Clinic within the History of Medicine is its breadth.
For example The Birth of the Clinic explores what Foucault would come to call
Bio-Power20, in this case, that the vast, post-revolution teaching hospitals
of Paris were instruments of control over the public. Foucault saw the medical
and anatomical knowledge of the body as a source of power, exercised by
doctors over patients, and the trust in the knowledge of the doctor that
power engenders. Foucault furthermore believes that empirical medical
knowledge within the medical profession (a profession the French Revolution
sought to disband), was also incorporated within the power structures of the
state, especially with the rise of state control or influence within hospitals
that can be seen in France with the establishment of the main Paris hospitals
during and after the French Revolution.21 Again however there are precedents
for examining medical knowledge as power, and of the professionalization of
disciplines as a source of power, Foucault was not unique in this. 22

Perhaps then Foucaults uniqueness stems from his treatment of this rapid
change in the perception of the patients body and of the body of disease
within the context of social, political and institutional change, during the
revolution, as opposed to a predominantly internal, progressivist, disciplinary
change. The medical gaze could therefore be seen as an indicator of a
20 M. Foucault, The History of Sexuality: Volume 1, The Will to Knowledge,
translated from the French by Robert Hurley, (London, 1990).
21 M. Foucault, The Birth of the Clinic: An Archaeology of Medical Perception,
translated from the French by A. M. Sheridan Smith, (London, 1973), pp. 356.
22 J. Pickstone, Ways of Knowing: Towards a Historical Sociology of Science,
Technology and Medicine, The British Journal for the History of Science, 26,
4 (1993), pp. 433-58.

Tobias BowmanGreen Templeton CollegeProf. Stephen Johnston (Sup.)

substantial shift in medical practice, the heart of which is the birth of the
clinic, or teaching hospital. The teaching hospital, according to Foucault, is
vital in reshaping the nature of medical knowledge, as it allowed, for the first
time (certainly in Western Europe) medical teaching, medical research and
medical practice to take place in the same space, with the same professional
body, on an unprecedented scale.23 This, Foucault believes, provided the
environment for large scale study of the dead (the mortality rate in the postrevolution Paris hospitals was around 20%24) and resultantly a greater
awareness on the part of trainee medical practitioners and practicing doctors
of the anatomical body, and that this would contribute towards a
disassociation of the body and patient (viz. the patient as an individual).
These teaching hospitals came to be following the dissolution of the old
perceived power structures over the course of the French Revolution, one of
the principle aims of which was to eradicate professionalism and its
perceived monopolisation of knowledge. This was pursued through a variety
of methods, including the closure of hospitals, medical academies and
universities, and the abolition of the medical licence (a practice which, like
the closure of universities, did not hold out long 25), in an attempt to open up
the medical profession, and others, to the broader public, reducing their lite
power. Thus Foucault can be seen to be examining a period of marked
change in almost all areas of life through a case study, specifically the status
23 M. Foucault, The Birth of the Clinic: An Archaeology of Medical Perception,
translated from the French by A. M. Sheridan Smith, (London, 1973), pp. 64.
24 T. Jones and L. Jones, A tour of old Parisian hospitals, American College
of Physicians Hospitalist, March 2012, Accessed 16 November 2013.
http://www.acphospitalist.org/archives/2012/03/student.htm.
25 M. Foucault, The Birth of the Clinic: An Archaeology of Medical Perception,
translated from the French by A. M. Sheridan Smith, (London, 1973), pp. 535.

Tobias BowmanGreen Templeton CollegeProf. Stephen Johnston (Sup.)

quo of medical practice. Again if we regard The Birth of the Clinic through a
historical lens, it may be possible to understand it along with the so-called
micro-sociologies and micro-histories abundant both in the History of
Medicine and in the broader histories of science in the period from the early
1960s26 to, in many ways, the present day, as a means of both avoiding, or
appearing to avoid, positivist philosophies and Whiggishness 27, whilst
simultaneously allowing the examination of the social, cultural and political
mores of a historical period through an inductive, reductionist posture 28.
However, unlike Butterfields Zoom-Lens history29, Foucault cannot be said
to examine every available source relating to the rise of the teaching
hospital, or broader Parisian medical practice at the time of, and in the years
following, the French Revolution.

Rising from the new teaching hospitals, and the centralisation and
standardisation of medical and anatomical knowledge arose a stronger, more
powerful profession than before, possessed of a greater perceived body of
knowledge and a resulting trust that reflected this new perception, Foucault
asserts that the doctors, empowered by their re-categorised knowledge,
26 A. Barry, The History of Measurement and the Engineers of Space, The
British Journal for the History of Science, 26, 4 (1993), pp. 459-68; and also J.
R. R. Christie, Aurora, Nemesis and Clio, The British Journal for the History
of Science, 26, 4 (1993), pp. 391-405.
27 A. R. Hall, On Whiggism, History of Science, 21, 1 (1983), pp. 45-60; and
also A. Wilson and T. G. Ashplant, Whig History and Present-Centred
History, The Historical Journal, 31, 1 (1988), pp. 1-16.
28 G. R. Elton, The Practice of History, (London, 1967).
29 A. Wilson and T. G. Ashplant, Whig History and Present-Centred History,
The Historical Journal, 31, 1 (1988), pp. 1-16.

Tobias BowmanGreen Templeton CollegeProf. Stephen Johnston (Sup.)

replaced the clergy of the ancien-rgime, with the treatment of the
anatomical body becoming more important, and more powerful, than the
treatment of the spiritual body. Foucault sees the Enlightenment, therefore,
as cementing the scientific professions power base, enabled by the rise of
rationalism and the apparent rationalisation of Medical practice. Moreover,
Foucault sees the institutionalisation of medicine, and thus of medical
knowledge, as representing not merely a greater understanding of the
anatomical body and the pathology of disease, but a completely new
structure to knowledge, coming back to the aforementioned concept of
historical rupture, rather than progression, a fairly new approach considering
the broader historiography of medicine, but still very much of its time.
However, as implied above, the degree to which The Birth of the Clinic might
be considered to be an history is questionable, in part due to the sources
used.

CRITIQUE OF THE CLINIC.

Foucault uses, in The Birth of the Clinic, a variety of overwhelmingly primary
sources, relevant to, and overwhelmingly provenanced within, the area the
work studies. The majority of these sources are theses and minor journal
publications from within Paris, examining the nature of the medical
profession within France, or examining specific epistemological or practical
developments or trends within the medical discipline. 30 The majority of these
sources date from the French Revolution and the antecedent and subsequent
30 M. Foucault, The Birth of the Clinic: An Archaeology of Medical Perception,
translated from the French by A. M. Sheridan Smith, (London, 1973), pp. 247
266.

Tobias BowmanGreen Templeton CollegeProf. Stephen Johnston (Sup.)

decades, and there are only two sources dating from the 1900s, the
emphasis clearly being on sources contemporary to the period being studied.

One of the primary criticisms of Foucaults work, particularly by historians,

and especially of his earlier books including The Birth of the Clinic, is the
sporadic quality of the sources used.31 It is certainly the case that Foucault
paid little attention to recent or contemporary historical writing when
working on The Birth of the Clinic32, which in the views of many historians
greatly damages its standing, as historical practice (certainly when one
attempts to place the work within the historiography of medicine or of
science) places great emphasis on historical truth (in as much as there can
ever be such a thing). However, this criticism is in many ways unjust; whilst
it is true that Foucault ignores a great many secondary sources pertinent to
his work, his attention to primary sources, within the extremely limited
sample universe of his study (the medical profession in Paris from c. 1770 to
c. 1820) is in fact fairly deep, and had been under-examined prior to his use
of them.33 It can be argued fairly however that Foucaults study lacks
historical breadth, and that the temporal and spatial scope is highly
restrictive when applying the findings of The Birth of the Clinic to broader
historical and historiographical enquiry, this is part of why it is so often set
apart when discussing revolutionary French medicine.
31 J. B. Loudon, The Birth of the Clinic: An Archaeology of Medical Perception. by
Michel Foucault; A. M. Sheridan Smith, Man, New Series, 9, 2 (1974), pp. 319-20.

32 L. King, Michel Foucault. The Birth of the Clinic: An Archaeology of

Medical Perception, Translated from the French by A. M. Sheridan Smith,
Bulletin of the History of Medicine, 49, 4 (1975), 591-93.
33 Ibid, pp. 592-3.

Tobias BowmanGreen Templeton CollegeProf. Stephen Johnston (Sup.)

Regardless, this criticism should not be allowed to diminish the value of The
Birth of the Clinic to study, primarily on account of a fact mentioned at the
top of this paper; Foucault is a philosopher, not a historian. 34 Foucault writes
discursively, not didactically, The Birth of the Clinic being understood, should
one wish it, as an explanation of social, political, and epistemological change
within a specific historical period, is often misconstrued as a historical work
which it neither is, nor intends to be. Thus there must be a divide over the
apportionment of doubt: Did Foucault ignore secondary sources because he
was unaware of them, or because they highlighted errors in his work, or
perhaps because he sought a clean break from the pre-existent history and
historiographical framework of Medicine? It could be argued, upon reading
the text with the nature and context of the author borne in mind, that it is a
mixture of the latter two suggestions. Many of Foucaults examples and
perceived processes examined in The Birth of the Clinic are based on
questionable or apocryphal records, and the degree to which they are
historically true is open for considerable debate. However, what Foucault
sought to do it seems, is highlight changing trends which he perceived within
the power-structures, knowledge-structures and socio-cultural developments
within the context of the French Revolution. In this way therefore these
questionable or even outright inaccurate accounts of specific historical
events or individual thoughts are merely examples, tools for explanation,
they become anecdotes. In this way one can begin to see why Foucault may
lean toward primary sources, the secondary sources have their own
philosophies, their own historical aims and their own perceptions, in addition
34 R. Porter and C. Jones, Introduction, in R. Porter and C. Jones (eds.),
Reassessing Foucault: Power, Medicine and the Body (Florence, USA, 1998).

Tobias BowmanGreen Templeton CollegeProf. Stephen Johnston (Sup.)

to those of the primary sources they themselves examine. Foucault can
therefore be seen to take some primary sources and use them to construct
new interpretations of the socio-politico-epistemological change which
undeniably occurred in one way or another during the French Revolution, not
from within the Historical discipline, but the Philosophical one.

Whilst historiographically The Birth of the Clinic can be seen in some ways to
be at the forefront of historical research (for its time, its attention to the
social effects on historical effects, and the examination of primary sources to
elucidate not only names and dates, but moods and ways of perceiving, was
highly advanced, not to mention that many of his concepts, if not practices,
were prevalent with the French historiography in particular 35), it can also be
seen as, paradoxically, quite Whiggish. The Birth of the Clinic and Foucaults
other work in general has been criticised by many historians for having too
limited a scope36, focussing on French studies with the exclusion of almost
anywhere else. Whilst historically this can be damaging to a piece of work, as
it limits the awareness of the historian to ones context, it need not be
restated by now that The Birth of the Clinic is not a work of history, but one
of philosophy, it is at most a history of thought-processes, and even then it is
examining changes in thought specifically in France, if not in Paris which
goes some way to justifying that Francocentrism. This French focus can also
be understood in the context of the Author, Foucault was French himself, and
his sphere of knowledge was principally French, having received a typically
35 Ibid, pp. 8.
36 D. Freundlieb, Foucaults Theory of Discourse and Human Agency, in R.
Porter and C. Jones (eds.), Reassessing Foucault: Power, Medicine and the
Body (Florence, USA, 1998). pp. 152-80.

Tobias BowmanGreen Templeton CollegeProf. Stephen Johnston (Sup.)

French education.37 In addition to this, France, and specifically Paris, was a
great centre of Medicine in the 18th, 19th and 20th centuries, indeed Paris
could be seen as the capital of Western medicine during the period The Birth
of the Clinic covers, in this way one could excuse Foucaults francocentrism
by way of scholastic necessity. The majority of the criticisms of Foucaults
work can be seen therefore to stem from its meaning, or intended purpose,
being misunderstood.

CONCLUSIONS
The main problem with The Birth of the Clinic, and with the majority of
Foucaults work, is that it is misinterpreted as History, when it is not
attempting to be so. Foucault is a philosopher and a wordsmith. One of the
main obstacles to us as historians in perceiving this, and perhaps the reason
it is not more widely perceived, is that of translation. The translation of The
Birth of the Clinic is cumbersome at best, misleading at worst, leading the
flowing and elegant French prose, which is clearly an examination of
epistemological change, and the philosophies which drove such change in
revolutionary France to appear a confused and disconnected work, some
passages of which are almost opaque to the Anglophonic reader 38. At several
37 D. Eribon, Michel Foucault, (Cambridge, Mass. 1991), pp. 24-25.
38 L. King, Michel Foucault. The Birth of the Clinic: An Archaeology of
Medical Perception, Translated from the French by A. M. Sheridan Smith,
Bulletin of the History of Medicine, 49, 4 (1975), 591-93.

Tobias BowmanGreen Templeton CollegeProf. Stephen Johnston (Sup.)

stages in the paper, the notion of examining The Birth of the Clinic within the
historiographical context has been mentioned, though always as an attempt
to insert it, this is because it seems inadvisable, if not impossible, to place
such a work, having come to understand its purpose, within a framework of
historical texts. The Birth of the Clinic should instead be placed within a
philosophical framework, as it appears to make a rather poor history in-andof itself, though that is not what it is intended to be. Foucaults work sits with
other histories of science and medicine fairly neatly, at face value, within the
historiographical sequence, it deals with concepts of power, social
constructivism and social history, making it tempting to try and incorporate it
within the historiographical corpus, but it does not belong there. Treating The
Birth of the Clinic as a work of history would be like doing the same for Julius
Caesar: whilst the play may be set in ancient Rome, it is a tragedy, a drama,
its characters and settings drawn from history to communicate the authors
thoughts, a history it is not, and neither is The Birth of the Clinic.

BIBLIOGRAPHY

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of Science, 26, 4 (1993), pp. 391-405.
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Tobias BowmanGreen Templeton CollegeProf. Stephen Johnston (Sup.)

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