Porter versus Foucault on the ‘Birth of the Clinic’

Abstract

It is well known that Roy Porter’s oeuvre in the history of psychiatry was partly stimulated by, and in no small measure pitched against, Michel Foucault’s Madness and Civilization (Folie et déraison). But what was Porter’s response to Foucault’s Birth of the Clinic (Naissance de la clinique)?¹ By the ‘birth of the clinic’, let us recall, Foucault referred to the remarkable change in medicine that took place in the Paris École de Santé between 1800, when Xavier Bichat’s Traité des membranes initiated his new doctrine of tissues, which rapidly invigorated pathological anatomy, and 1817, when René-Théophile-Hyacinthe Laennec (1781–1826), one of the most influential pupils of the new school and himself a master of pathological anatomy, invented the stethoscope. Foucault himself, as we shall see, regarded this as the most important transformation in Western medicine’s entire history, and although not all commentators would go this far, none would deny that pathological anatomy made giant strides in the Paris school, or that the stethoscope gave an unprecedented impulse to physical examination, with permanent effects. Thus we are dealing here with a momentous set of events, which means that Porter’s view of Birth of the Clinic is of considerable interest.