Preface
This book is about space, about language, and about death; it is about theact of seeing, the gaze.
Towards the middle of the eighteenth century, Pomme treated and cured ahysteric by making her take 'baths, ten or twelve hours a day, for ten wholemonths'. At the end of this treatment for the dessication of the nervoussystem and the heat that sustained it, Pomme saw 'membranous tissues likepieces of damp parchment...peel away with some slight discomfort, and thesewere passed daily with the urine; the right ureter also peeled away and cameout whole in the same way'. The same thing occured with the intestines, whichat another stage, 'peeled off their internal tunics, which we saw emerge fromthe rectum. The oesophagus, the arterial trachea, and the tongue also peeledin due course; and the patient had rejected different pieces either by vomit-ing or by expectoration'(1).
Less than a hundred years later, this is how a doctor observed an anatomicallesion of the brain and its enveloping membranes, the so-called 'false mem-branes' frequently found on patients suffering from 'chronic meningitis:'
Their outer surface, which is next to the arachnoidian layer of the dura mater, adheres to this layer, sometimes very lightly, when they can be separatedeasily, sometimes very firmly and tightly, in which case it can be verydifficult to detach them. Their internal surface is only contiguous with thearachnoid, and is in no way joined to it....The false membranes are oftentransparent, especially when they are very thin; but usually they are white,grey, or red in colour, and occasionally, yellow, brown, or black. This matteroften displays different shades in different parts of the same membrane. Thethickness of these accidental productions varies greatly; sometimes they areso tenuous that they might be compared to a spider's web....The organizationof the false membranes also displays a great many differences: the thin onesare buffy, like the albuminous skins of eggs, and have no distinctive struc-ture of their own. Others, on one of their sides, often display traces ofblood vessels crossing over one another in different directions and injected.They can often be reduced to layers placed one upon another, between whichdiscoloured blood clots are frequently interposed (2).
Between Pomme, who carried the old myths of nervous pathology to their ultimateform, and Bayle, who discribed the encephalic lesions of general paralysisfor an era from which we have not yet emerged, the difference is both tinyand total. For us, it is total, because each of Bayle's words, with itsqualitative precision, directs our gaze into a world of constant visibility,while Pomme, lacking any perceptual base, speaks to us in the language offantasy. But by what fundamental experience can we establish such an obviousdifference below the level of our certainties, in that region from which theyemerge? How can we be sure that an eighteenth century doctor did not see whathe saw, but that it needed several decades before the fantastic figures weredissipated to reveal, in the space they vacated, the shapes of things as theyreally are?
What occurred was not a 'psychoanalysis' of medical knowledge, nor any moreor less spontaneous break with imaginary investments; 'positive' medicine isnot a medicine that has made an 'objectal' choice in favor of objectivityitself. Not all the powers of a visionary space through which doctors andpatients, physiologists and practitioners communicated (stretched and twistednerves, burning dryness, hardened or burnt organs, the new birth of the bodyin the beneficent element of cool waters) have disappeared; it is, rather, asif they had been displaced, enclosed within the singularity of the patient,in that region of 'subjective symptoms' that--for the doctor--defines not themode of knowledge, but the world of objects to be known. Far from beingbroken, the fantasy link between knowledge and the pain is reinforced by amore complex means than the mere permeability of the imagination; the pre-sence of disease in the body, with its temsions and its burnings, the silentworld of the entrails, the whole drak underside of the body lined with endlessunseeing dreams, are challenged as to their objectivity by the reductivediscourse of the doctor, as well as established as multiple objects meetinghis positive gaze. The figures of pain are not conjured away by means of abody of neutralized knowledge; they have been redistributed in the space inwhich bodies and eyes meet. What has changed is the silent configuration inwhich language finds support: the relation of situation and attitude to whatis speaking and what is spoken about.
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