Preface This book is about space, about language, and about death; it is about the act of seeing, the gaze. Towards the middle of the eighteenth century, Pomme treated and cured a hysteric by making her take 'baths, ten or twelve hours a day, for ten whole months'. At the end of this treatment for the dessication of the nervous system and the heat that sustained it, Pomme saw 'membranous tissues like pieces of damp parchment...peel away with some slight discomfort, and these were passed daily with the urine; the right ureter also peeled away and came out whole in the same way'. The same thing occured with the intestines, which at another stage, 'peeled off their internal tunics, which we saw emerge from the rectum. The oesophagus, the arterial trachea, and the tongue also peeled in 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 anatomical lesion 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 separated easily, sometimes very firmly and tightly, in which case it can be very difficult to detach them. Their internal surface is only contiguous with the arachnoid, and is in no way joined to it....The false membranes are often transparent, especially when they are very thin; but usually they are white, grey, or red in colour, and occasionally, yellow, brown, or black. This matter often displays different shades in different parts of the same membrane. The thickness of these accidental productions varies greatly; sometimes they are so tenuous that they might be compared to a spider's web....The organization of the false membranes also displays a great many differences: the thin ones are 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 of blood vessels crossing over one another in different directions and injected. They can often be reduced to layers placed one upon another, between which discoloured blood clots are frequently interposed (2). Between Pomme, who carried the old myths of nervous pathology to their ultimate form, and Bayle, who discribed the encephalic lesions of general paralysis for an era from which we have not yet emerged, the difference is both tiny and total. For us, it is total, because each of Bayle's words, with its qualitative precision, directs our gaze into a world of constant visibility, while Pomme, lacking any perceptual base, speaks to us in the language of fantasy. But by what fundamental experience can we establish such an obvious difference below the level of our certainties, in that region from which they emerge? How can we be sure that an eighteenth century doctor did not see what he saw, but that it needed several decades before the fantastic figures were dissipated to reveal, in the space they vacated, the shapes of things as they really are? What occurred was not a 'psychoanalysis' of medical knowledge, nor any more or less spontaneous break with imaginary investments; 'positive' medicine is not a medicine that has made an 'objectal' choice in favor of objectivity itself. Not all the powers of a visionary space through which doctors and patients, physiologists and practitioners communicated (stretched and twisted nerves, burning dryness, hardened or burnt organs, the new birth of the body in the beneficent element of cool waters) have disappeared; it is, rather, as if they had been displaced, enclosed within the singularity of the patient, in that region of 'subjective symptoms' that--for the doctor--defines not the mode of knowledge, but the world of objects to be known. Far from being broken, the fantasy link between knowledge and the pain is reinforced by a more complex means than the mere permeability of the imagination; the pre- sence of disease in the body, with its temsions and its burnings, the silent world of the entrails, the whole drak underside of the body lined with endless unseeing dreams, are challenged as to their objectivity by the reductive discourse of the doctor, as well as established as multiple objects meeting his positive gaze. The figures of pain are not conjured away by means of a body of neutralized knowledge; they have been redistributed in the space in which bodies and eyes meet. What has changed is the silent configuration in which language finds support: the relation of situation and attitude to what is speaking and what is spoken about. --

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