COMUNICACIÓN Y COLABORACIÓN

Chapter two is part of the first focus of my thesis - a redescription of the medicalising of the female body in late 19th century Melbourne. It presents the historical framework of my analysis of gynaecology and obstetrics by looking at the series of events which constituted the medical understanding of the female body in late 19th century Melbourne. The chapter takes up the methodological concerns of chapter one by looking not at the ’progress’ of gynaecology and obstetrics but at the types of knowledge and practices which constituted the female body as a medical subject. I use a Foucauldian analysies of modem knowledge and practices to look at how the boundaries of gynaecological and obstetrical discourse were constituted in late 19th century Melbourne. I discuss gynaecological and obstetrical discursive practices in two ways. First, I look at the clinical and biopolitical concerns which focused on the female body. This discussion establishes what I mean by ’medical discourse relating to the female body’ - ie which forms of medical knowledge my study takes as important in the conceptualising of woman as a special medical subject. Secondly, I look at the meanings of the gendered body and the social body which operated in the constitution of the female body in these forms of medical knowledge. This discussion shows how the physicality of the female body and the medical management of the population’s health were informed by notions of gender and the social body.

Before moving on to a discussion of the clinical and biopolitical practices of late 19th century Melbourne in this introductory section I first explain my use of the term ’gynaecological and obstetrical’ discourse. I define gynaecological and obstetrical discourse as the set of practices and understandings which in the late 19th century constituted the knowledge of the female body as a different physical entity from the male body needing special medical attention. The key words here are ’different physical entity’. In defining this difference the female body’s reproductive system became the centre around which the medical understanding of woman pivoted. Female difference was situated as residing in the internal reproductive organs and associated with an inherent disorder of the female body. In this medicalising of the female body as a gynaecological and obstetrical subject woman possesses a different biological form which demands special medical attention. This form of medical knowledge was produced in ’the clinical domain’. The clinical domain being the practices developed in what we now call modem scientific medicine which centred on individual examination, diagnosis and therapy established in hospital and private practices. These practices established rules and codes which allowed medicine to claim a ’special truth’ of the body. These practices were not just medical techniques but also the way in which this knowledge was organised - in hospital practices, specialised teaching, rules about who could enter medical practices. All of these professionalising practices produced a set of rules or code for possibilities of knowledge of the particular medical subject - the potential gynaecological and

obstetrical patient.

In the following sections I look at how the -the professionalising of medicine developed in 19th century Melbourne with the institution of hospital teaching and clinical practices. How the doctor could claim ’the truth’ of clinical practice in the development of the body as an object to be examined, surveyed and probed within a prescribed code of ethical and knowledgeable medical behaviour. In developing a special science of the female body in gynaecological and obstetrical clinical practices the possibility of knowledge of the female body was built on to: the notion of woman as a potentially disordered subject; to women’s reproductive organs as the site of disorder; and to woman’s physical existence requiring a different medical knowledge from that needed by the male body. In this process gynaecological and obstetrical knowledge defined the female reproductive existence as a new medical field.

At a second level the development of this new medical field was part of the professionalising of medicine, part of the biopolitical governmental activities. My point here is that the development of a new medical field which defined the medicalised physicality of the female body cannot be isolated from wider medical concerns. The interest in the female body’s reproductive organs was not just at the level of the workings of the individual body but also at the level of the population’s health and reproductive capacity. Gynaecology and obstetrical practices focused on the body from beyond its physicality to its representation of the social health and growth of the population. This understanding of the body as the representation of the social operated in two ways. One theoretical where the term ’body’ signifies ’social meanings’ which in the 19th century were of evolution, national resources, racial and national identity. And the second, which could be described as ’practical’, where the the doctors were the administers and managers of the public’s health and the ’patient’ was the social body. The reproductive female body, in this last context, represented racial and social procreative potential.

In this theorising of medical practices I argue that gynaecological and obstetrical discourses operated in the clinical domain to produce a series of meanings of the female body which constituted the reproductive body at both a physical and social level. The clinic served both as a therapeutic instrument for patients and as the means to more effective promotion of the population’s health as a whole. In this theorization I am concerned not with the ’truth’ of obstetrical and gynaecological discourse, or the particular place of these medical men in the progress and social status of medical science, but rather with the formation, evidence and ways of verification of the concept of the female body as a medical subject. This concept of clinical knowledge can be theorized further by looking at the theories of biopolitics and gender.

In utilising biopolitics as a conceptual tool, I argue that the professionalising practices of 19th century medicine cannot be divorced from the organisation of the ’politics of health’, the consideration of disease as a political and economic problem. According to Foucault’s analysis (Foucault, 1984a) the importance of the health and physical well being of the population from the 18th century onwards, became an essential objective of political power. In the modem regime of

power a different power apparatus was produced to take charge of bodies, ’to contain them’, to ’ensure their own good health’(Foucault 1984a). This ’technology of the population’ constituted the body of individuals and the body of populations as the bearer of a utilisable biology which was amenable to profitable investment. In this development the biological traits of a population became relevant facts for economic management. This process gave medicine, as the priviledged intervener in private and public health, an increasingly important place in the administrative system and machinery of power. The clinical domain was an important site of social power - the point of support and point of departure for the great medical inquiries into the health of the population of the 19th century which served to govern and manage modem social bodies. In these enquiries a ’medico-administrative’ knowledge developed concerning society, its health and sickness, its conditions of life, housing, habits, a knowledge which served as the basic core for the ’social economy’. (Foucault, 1984a:283 ) This ’politico-medical’ knowledge related not only to disease but to general forms of behaviour. Evidence of the extent of this ’biopolitical’ power in late 19th century Melbourne was the increasing presence of doctors in the academic and learned societies, the substantial medical participation in government inquiries, and the organisation of medical societies officially charged with administrative responsibilities.

Adopting the concept of biopolitics allows us to see how medical discourse, has wider power effects than just those produced in clinical practice. In my study of the special medical knowledge of the female body I look at gynaecological and obstetrical concerns not only in relation to the ’pursuit of knowledge’ but also in relation to the questions and issues raised by the medico-political management of the population’s health and growth. The needs of hygiene and the growth of the race made the female body a particular subject of medical concern. Gynaecology and obstetrics, then, were part of biopolitical concerns in the government of the social body and part of 19th century knowledge of the female body. This latter concern raises a second area ©# relating to medicine and gender, an area which has so far been under theorised in this discussion. In raising the issue of 19th century knowledge of the female body as opposed to the ’social’ body, or the ’male’ or the ’gender neutral’ body I wish to raise the question of gender. That is, how can we theorise the notion of gender in relation to 19th century social and medical knowledge of the reproductive body. In part answer to this question, one which my whole thesis addresses, I utilise another theoretical approach - that of literary ’readings’. In this theory the subject has meaning which is informed by more than one discourse, in fact though our understanding of the female body, appears to offer a simple meaning of ’body with uterus’ immediately we start to try and define its physicality the simplicity slips away and we instead see a range of meanings which do not remain fixed but shift according to different emphases of time, political and intellectual understanding. My task here is to explain what I see as the major meanings of the female body in the historically specific juncture of late 19th century Melbourne obstetrical and gynaecological discourse. These discourses, attempt to produce the meaning of the female body as predominantly that of ’body with uterus’. For the moment I remain with that

meaning, equating the gendered female body as the reproductive body as it was constituted in gynaecological and obstetrical practice in order to establish what form of medical practices operated in late 19th century Melbourne. My argument is that the reproductive body, on both an individual and social level in the 19th century had resonances of meaning which can be identified in other social discourses, specifically evolutionary and eugenic discourses and feminist debates concerned with women’s racial and political role. These discourses were important in the understanding of medicine’s role in the effective political and social management of the population. In this sense, the notion of the individual female body and its functioning in the social body was invested with knowledge/power as an agent of the transformation of human life. Gynaecology and obstetrics could isolate certain anomalies of femaleness, of reproductive potential and correct them through its technologies which were seen as having an important effect in the evolutionary and racial role of woman in social progress. The concept of gender, in this process allows for assumptions about woman as mother, as nurturer of the race to become naturalised in medical explanations of women’s biology and women’s function in the management of public health. The social evolutionary and feminist debates on woman as representative of the health and growth of the race invested the reproductive medical subject with an importance which at once subjugated the female patient in modem power relations and identified the modem female subject as the reproductive body.1 Gender, in this interplay of power/knowledge links the biological and social perception of woman to the naturalising of the medical scientific ’truth’ of female physicality.

These theoretical concerns are explored in the following five sections which look at gynaecological and obstetrical discourse in the historical context of late 19th century Melbourne.

Section two sets out the specific historical situation by looking at the general development of scientific medical practices in late 19th century Melbourne. Section three looks at how gynaecology and obstetrics developed as special fields of medical knowledge during this period. The fourth section looks at how the female body was defined as an object of knowledge in gynaecology and obstetrics and at the changing descriptions of the female body in the medical gaze. The fifth and sixth sections take up the issue of how social concerns were medicalised by looking, in section four, at the areas where doctors played a crucial role in the administration and management of social life, and, in section six, at debates which focused on women’s health and reproductivity as social issues.