Gestation of the clinic.

MICHEL FOUCAULT'S Naissance de la clinique (Paris, Presses Universitaires de France, 1963) makes a brilliant case for the sudden emergence in the late eighteenth century of the hospital clinic as the central concept and institution of Western medicine. Foucault's thesis, briefly stated, sees the birth of the clinic as an "essential mutation in medical knowledge" arising out of a general epistemological transformation and the Revolutionary re-structuring of French society.' There is for Foucault no link between the new medical discourse and the way physicians of the earlier eighteenth century perceived and described disease. A system of medical knowledge based on abstract naming and typing of diseases disappears utterly before one which achieves knowledge by sensory observation, and detailed, graphic reporting and analysis of what has been seen in sick persons. Foucault is well aware that clinical medicine in the literal sense of bedside study of patients and compilation of case histories is at least as old as Hippocrates. In a chapter on 'The Old Age of the Clinic', he notes that hospital clinics modelled after Boerhaave's famous Leyden institution, existed throughout eighteenth-century Europe, though they were peculiarly rare in France. However, these clinics or "protoclinics", Foucault insists (and I think rightly), differed radically from their modern counterpart, and therefore the former did not and indeed could not evolve into the latter.2 The Boerhaavian clinic consisted of human specimens exemplifying categories of the accepted medical taxonomy. It selected these patients from a much larger hospital population in order to provide students with a representative sample of the types of diseases. The sole function of the clinic thus was didactic the transmission of already accepted knowledge from professor to students. In a manner similar to the traditional public anatomy lesson, the eighteenth-century teaching clinic was, in large measure, a