SOC 7108 Chapter 18: SOC 7108 - Chapter 18
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THE RISE OF SURVEILLANCE MEDICINE
Perhaps the greatest contribution for understanding the advancement of modern
medicine has been the work of Ackerknecht who was the first to describe a number of different
medical perspectives during the 18th century. He was the first to identify the early phase of
what is known as “Library Medicine” where classical learning of the doctor appeared to be
more important than having any specific knowledge of an illness giving way to bedside
medicine when they began to address the issues of practical management, classifying patient
symptoms. Following this, it was replaced by “Hospital Medicine”. A vast revolution within
medical thinking, further known as clinical, pathological, western, and biomedicine it has
survived and extended itself over the last two centuries to become the dominant model of
medicine within the modern world.
This medical framework first emerged at the beginning of the 18th century with the rise
of familiar procedures of examination, post-mortem and hospitalization. Foucault described
these changes in terms of “specializations” of illness.
1. He referred to the cognitive mapping of the different elements of illness. Under bedside
medicine, illness had the same boundaries with the symptoms that the patients had and
reported. It was a two-dimensional model where symptoms were classified within a
chart. Here, the symptom itself was the illness
Later on, it was replaced by hospital medicine where the relationship of symptom and illness
was reconfigured into a three-dimensional framework involving: symptom, sign and pathology.
In this case, the symptom was a marker of an illness by the patient following being perceived as
an indicator, an added sign of the disease found by the physician through a clinical examination.
The picture here is drawn by both the symptom and the sign discovered during pathology
creating what is known as a clinic-pathological correlation creating a new relationship between
surface and depth – AKA discovering the presence of a hidden pathological lesion
2. Secondary specialization referred to the location of the lesion in relation to the body of
the patient. Under bedside medicine the task was to identify/classify illness through the
distinctiveness of the possible cluster of symptoms. In other words, the mobility of the
illness through the body could be captured by monitoring the sequence of the
symptoms. In contrast, hospital medicine, the physician had to infer from symptoms and
signs within the underlying pathological legion within the patient body. The body
became the focus of medical attention leading to the intervention of classical
techniques – inspection, percussion, palpitation and auscultation allowing the individual
human body to mapped and identify the precise nature of the hidden lesion.
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