Chapters 4 and 5 - Chapters 4 and five The Formation of...

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Chapters 4 and five: The Formation of Enunciative Modalities; and The Formation of Concepts. Summary Chapter 4: The Formation of Enunciative Modalities. Many different kinds of statements constitute the discourse of medicine in the nineteenth century (the field that remains our central example). What laws 'operate behind' this set of statements, linking them together? What 'place' do they all come from? Once again, there are three levels of approach to this particular set of questions. First: 'who is speaking?' What is the position from which the doctor speaks? A long list of factors is involved here, ranging from 'criteria of competence and knowledge' to relational systems such as professional and pedagogical hierarchies to the shifting role of the doctor as a guardian within society as a whole. Second: from what site is he or she speaking? A hospital, a laboratory, or a library? What were the changing functions of these sites in the nineteenth century? Third: What is the position of the subject with regard to 'various domains or groups of objects [physical things, not objects of discourse]?' This is a question about perceptual positioning, modes of and ideas about 'seeing,' observation, about instruments that act as perceptual intermediaries, and about the level of thing observed (body, organ, cell, and so on). It also addresses the position of the doctor as an 'emmitter and receiver' of observations, case histories, data, theoretical propositions, clinical decisions, etc. Again, this set of possible positions changed radically in the nineteenth century. Thus, the question of where a given statement comes from implicates another complex set of relations. The advent of clinical medicine in the nineteenth century cannot be understood solely as a result of the advent of the autopsy or the teaching hospital (which had, in any case, significant precursors), but only as 'the establishment of a relation.' In an important sense, this relation between diverse elements is 'effected' by the clinical discourse itself; the relation only exists as a relation by virtue of the set of local enunciations that comprise the discourse. This set of enunciations, however,
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