Spaces and Classes

• The human body traditionally defines disease by anatomical boundaries—lines, volumes, surfaces, and routes.
• However, disease can be spatialized in various ways beyond classical anatomy.
• Questions remain about the specific geometry of processes like allergic reactions and virus diffusion within tissues.
• The historical view where disease directly correlates with anatomical location is a recent development from the 19th century.
• Before this, the spatialization of disease was more abstract, involving ideas of correspondences and homologies rather than strict anatomical mapping.
• Classificatory medicine (e.g., the works of Sauvages and Pinel) defined diseases hierarchically, with a focus on their classification rather than immediate anatomical location.
• This method involved creating a structural configuration of diseases, emphasizing relationships and categories over direct localization.
• Classificatory medicine used a ‘vertical’ space (temporal patterns of symptoms) and a ‘horizontal’ space (homologies between different symptoms or conditions).
• This approach treated anatomical localization as a secondary concern, focusing instead on relational and hierarchical structures of diseases.
• The distinction between ‘historical’ and ‘philosophical’ knowledge in medicine highlights a focus on observable phenomena (symptoms) versus deeper causes.
• Historical knowledge deals with visible symptoms and their sequences, while philosophical knowledge questions the underlying causes and principles.
• Classificatory medicine aimed at a surface-level, simultaneous representation of disease, focusing on visible and immediate aspects rather than deeper causal relationships.
• This approach led to a flat, simultaneous view of disease, emphasizing the observable phenomena and their direct presentation.
• Diseases are spatialized through analogies and resemblances rather than strict anatomical or temporal divisions.
• Analogies define the essence of diseases, where their similarity determines their categorization rather than genealogical or logical distinctions.
• For instance, apoplexy, syncope, and paralysis share common characteristics such as loss of motility or sensory function, but differ in specific manifestations like respiration.
• Classificatory medicine perceives these diseases through surface-level similarities rather than deeper, time-based or functional differences.
• This approach creates a flat, homogeneous space where diseases are unified by their similarities rather than their temporal or causal relationships.
• Similarities in disease forms reveal the rational order of diseases, aligning with the natural order of life.
• The botanical model serves as a framework, suggesting that the production of diseases follows a systematic, natural order similar to plant growth.
• Disease essences are viewed as natural and ideal: natural because they reveal essential truths of diseases, and ideal because they are never experienced in their pure form due to various patient-specific factors.
• Disease knowledge requires abstraction from individual patient variations (such as predispositions, age, and lifestyle) to understand the core pathological facts.
• The patient’s individual characteristics are considered external disturbances that must be set aside to accurately understand the disease’s essence.
• In summary, the focus is on understanding diseases through their ideal forms and similarities rather than through the complexities introduced by individual patients.
• The doctor’s role in treating disease involves adhering strictly to the ideal ordering of nosology to avoid therapeutic indiscretion.
• The doctor’s gaze initially focuses on the ideal, abstract characteristics of disease rather than the concrete, individual patient.
• Therapeutic interventions must align with the ideal classification of the disease to prevent irregularities that could hinder treatment.
• The doctor must wait until the disease’s true nature reveals itself through its progression before intervening.
• In the ideal space of disease, doctors and patients are considered disturbances that must be neutralized to allow the disease’s true form to emerge.
• The aim of medicine is to maintain a clear distinction between the ideal disease configuration and the real patient, effectively neutralizing disturbances.
• Classificatory thought creates an ideal space for disease that is continually effaced by the realities of medical practice.
• The medical gaze is engaged in a reciprocal process: it recognizes disease in the patient while simultaneously using existing knowledge to support that recognition.
• Disease becomes visible in the body, where it interacts with a different spatial configuration, altering solids, functions, and movements.
• The challenge is to map the flat, homogeneous space of disease classification onto the complex, three-dimensional space of the human body.
• Classificatory medicine allows for diseases to manifest in various organs without altering their fundamental nature.
• Diseases can move across different bodily sites while maintaining their essential characteristics, indicating a flexible relationship between disease and organ localization.
• This movement and variation in symptoms across different body areas demonstrate that the spatial relationship between disease and body is not fixed or absolute.
• Disease undergoes metastases and metamorphoses within the body, moving freely without a fixed course.
• For instance, a nosebleed may evolve into haemoptysis or cerebral haemorrhage, but the specific type of blood discharge remains consistent.
• The doctrine of sympathies historically connected medical practices with the idea of sympathetic communication within the body.
• Sympathetic communication can occur through:
  • Local relays (e.g., diaphragm for spasms)
  • Systems of diffusion (e.g., nervous system for pains)
  • Functional correspondences (e.g., suppression of excretions from intestines to kidneys)
  • Nervous system adjustments (e.g., lumbar pains in hydrocele)
• Despite these forms of sympathetic transfer, the essential structure of the disease remains unchanged; sympathy maintains the disease’s fundamental form across space and time.
• Beyond sympathetic transfer, causality can create relationships between diseases that are not based on kinship but on causal links.
• Causality can lead to complications and mixed forms, such as the relationship between mania and paralysis.
• Symptoms overlapping or appearing simultaneously are insufficient to define a single disease; causality accounts for the connections between different forms of disease.
• Time plays a limited role in disease evolution; it is integrated as a constant within the essential structure of disease rather than introducing new events.
• Duration of disease episodes is part of the disease’s inherent structure, not an organic variable affecting disease progression.
• The essential nature of disease is communicated to the patient’s body not through localization or duration but through quality.
• Historical experiments, such as those by Meckel in 1764, revealed that the weight and qualities of brain matter can vary according to the disease.
• In diseases like phthisis, brain matter is lighter and more exhausted, whereas in apoplexy, it is heavier and more filled.
• The qualities characterizing a disease are reflected in specific regions of the body, which serve as support for symptoms.
• The connection between disease and the body is mediated through qualities rather than spatial localization.
• Medicine historically turned away from a purely quantitative or “mathematical” form of knowledge, focusing instead on qualitative aspects of disease.
• Sauvages critiqued measuring quantities like pulse force, heat degree, pain intensity, and cough violence, which did not provide insights into the qualitative nature of disease.
• Meckel’s measurements aimed to gauge the intensity of pathological qualities rather than mathematical forms.
• Mechanical or mathematical descriptions of the body are insufficient for explaining pathological phenomena; diseases involve qualities and movements, not just quantifiable mechanics.
• Physicians should focus on understanding the effects of medicines and diseases based on their operational laws and physical causes, rather than seeking purely mathematical models.
• Qualitative perception is crucial for distinguishing between diseases with similar symptoms but different underlying qualities, such as differentiating pleurisy and phthisis or epileptic convulsions versus hypochondriac symptoms.
• The body’s health is defined by the right balance of vessel and fluid tones; deviations from this balance result in illness.
• Medical perception must account for fine variations and imbalances in the qualities of disease, requiring a detailed and nuanced understanding of each case.
• Classificatory medicine views particular histories as the result of qualitative variations and temperamental factors, leading to a multiplicative effect on the essential qualities of illness.
• The patient’s individuality appears paradoxically in medical analysis: initially seen as an accidental element disrupting disease, but ultimately as the concrete embodiment of qualitative phenomena.
• Zimmermann’s perspective highlights the patient’s dual role: both a negative element in the abstraction of disease and a positive, irreplaceable representation of its qualitative order.
• The individual patient represents a complex spatial synthesis of disease qualities, blending the nosological and anatomical aspects of illness.
• Medicine’s renewed focus on the individual challenges the general and abstract forms of classification, demanding a more attentive and detailed examination of each patient’s unique presentation.

• The practice of treating patients based on a standard set of prescriptions (e.g., bleeding, purging, clyster, change of air) is criticized as superficial and inadequate. This routine approach stifles observation and undermines the doctor’s ability to understand individual cases.

• Effective medical perception requires a detailed, individualized approach, akin to using a magnifying glass to reveal hidden aspects of a condition. The doctor must capture the full complexity of the patient’s condition, including their personal symptoms, gestures, and experiences.

• The patient becomes a detailed representation of the disease, embodying its nuances and variations. Describing a disease involves rendering the patient’s unique experiences and manifestations of the illness.

• Primary spatialization focuses on classifying diseases into general categories without regard for individual variation. Secondary spatialization involves acute perception of the individual, moving beyond collective structures to understand unique presentations of disease. Tertiary spatialization refers to how disease is organized and managed within society, including medical practices, institutions, and responses to illness.

• Tertiary spatialization encompasses the social and political dimensions of medicine, including economic constraints and social confrontations. It reveals how medical practices and institutions interact with societal structures and norms.

• Disease initially appears in its purest form in a pre-civilized or simple social context, revealing its basic essence. As societies become more complex, diseases become more varied and intertwined with social conditions, leading to more diversified and complex health issues.

• Health deteriorates with increasing social complexity, leading to a rise in diverse and complex diseases. Simpler conditions of life, such as those experienced by peasants and workers, are associated with more straightforward diseases. As one’s social status increases, so does the complexity of diseases, reflecting the tighter grip of societal structures on individual health.

• The hospital, like civilization, can alter the essential nature of a disease. It introduces complications such as hospital fever, characterized by muscular weakness, a coated tongue, livid face, sticky skin, diarrhea, and difficulty in breathing, often leading to death within a specific timeframe.

• In the hospital setting, diseases interact with one another, potentially distorting their natural characteristics and complicating diagnosis. The hospital environment, with its exposure to various infections and its often grim atmosphere, may negatively affect the sick, leading to a disruption in the natural course of their illnesses.

• The ideal care setting for disease is the family home, where natural and loving care helps the body combat illness and allows diseases to reveal their true nature. Family medicine emphasizes respect for the natural course of illness and avoiding unnecessary interference.

• Hospital diseases are often viewed as distorted versions of illnesses due to the unnatural conditions of hospital environments. The family doctor, working in a more natural setting, is better positioned to understand and manage diseases based on natural phenomena.

• The debate between active and expectant medicine reflects differing approaches to treatment. Expectant medicine, as practiced by nosologists, supports natural processes and avoids unnecessary interventions, often using remedies like quina to assist nature.

• Medicine of species benefits from a free spatialization of disease, where illness develops and resolves in its natural context without the constraints imposed by medical institutions. The disease should not be confined to a medically controlled environment but allowed to progress naturally in its original setting, such as the family home.

• The critique of hospitals reflects a broader economic and political analysis. Hospitals, funded by fixed donations, may become outdated as needs change. Assistance should not be tied to fixed capital but rather to providing work and support that adapt to changing needs.

• Hospitals can inadvertently contribute to social and health problems by isolating the sick and creating a breeding ground for disease. This separation may lead to further disease and social strain.

• Allowing diseases to remain within their original context—such as the family home—prevents them from becoming more complex or destructive. Providing support in the home rather than in hospitals helps mitigate the financial and social burdens on families and society.

• The approach of integrating sick individuals into their familial and social environments breaks the cycle of disease proliferation and poverty, promoting a more sustainable and humane form of assistance.

• The thought structures of economists and classificatory doctors share similarities in their approach to disease: both view the space where disease manifests as open, homogeneous, and free from fixed divisions or privileged figures. This space is reduced to visible symptoms and individual treatment, with minimal intervention.

• In this framework, medical experience is characterized by a gaze that is transient and a form of assistance that is only temporarily compensatory. The focus is on individual cases without a broader, systemic approach.

• However, this approach can be seen as inherently linked to the structure of society. A medicine that prioritizes individual care within the family context implies a generalized vigilance that extends to the entire community.

• To achieve a more integrated approach, medicine would need to be closely tied to the state. The state could oversee a consistent, general policy of assistance, combining public health efforts with private care to address both individual and collective needs.

• Early ideas, such as those proposed by Menuret during the French Revolution, envisioned a system of free medical care funded by the state. This model aimed to prevent quackery, regulate medical practice, and ensure high-quality care for patients, with government oversight and support.

• Such a system would involve a collective control over medical practice and integrate health care into the broader social framework, ensuring that home care and medical assistance are coordinated and effective.

• This shift represents a new form of institutional spatialization of disease, moving away from isolated or fragmented approaches to a more unified, state-supported model of health care.

• As a result, the traditional model of medicine that relies on individual perception and family assistance becomes less relevant, giving way to a more organized and state-integrated approach.