I should like to attempt here the analysis of a type of discourse--that of medical experience--at a period when, before the great discoveries of the nineteenth century, it had changed its materials more than its systemaic form. The clinic is both a new 'carving up' of things and the principle of their verbalization in a form which we have been accustomed to recognizing as the language of a 'positive science'. To anyone wishing to draw up an inventory of its themes, the idea of the clinic would undoubtedly seem to be imbued with rather vague values; insipid figures would probably take shape, such as the strange effect of disease on the patient, the diversity of individual temperaments, the probability of pathological evolution, the need for sharp perception (the need to be cons- tantly alert to the slightest visible modalities), the empirical form-- cumulative, and endlessly open to medical knowledge--old, threadbare notions that had been medicine's basic tools as far back as the Greeks. Nothing in this ancient arsenal can designate clearly what took place at that turning point in the eighteenth century, when the calling into question of the old clinical theme 'produced'--if we are to believe first appearances--an essen- tial mutation in medical knowledge. Nonetheless, considered on an over-all basis, the clinic appears--in terms of the doctor's experience--as a new outline of the perceptible and statable: a new distribution of the discrete elements of corporal space (for example, the isolation of tissue--a functional, two-dimensional area--in contrast with the functioning mass of the organ, constituting the paradox of an 'internal surface') a reorganization of the elements that make up the pathological phenomenon (a grammar of signs has replaced a botany of symptoms), a definition of the linear series of morbid events (as opposed to the table of nosological species), a welding of the disease onto the organism (the disappearance of the general morbid entities that grouped symptoms together in a single logical figure, and their replace- ment by a local status that situates the being of the disease with its causes and effects in a three-dimensional space). The appearance of the clinic as a historical fact must be identified with the system of these reorganizations. This new structure is indicated--but not, of course, exhausted--by the minute but decisive change, whereby the question: 'What is the matter with you?', with which the eighteenth-century dialogue between doctor and patient began (a dialogue possessing its own grammar and style), was replaced by that other question: 'Where does it hurt?', in which we recognize the operation of the clinic and the principle of its entire discourse. From then on, the whole relatioship of signifier to signified, at every level of medical experience, is redistributed: between the symptoms that signify and the disease that is signified, between the description and what is described, between the event and what it prognosticates, between the lesion and the pain that it indicates, etc. The clinic--constantly praised for its empiricism, the modesty of its attention, and the care with which it silently lets things surface to the observing gaze without disturbing them with discourse--owes its real impor- tance to the fact that it is a reorganization in depth, not only of medical discourse, but of the very possibility of a discourse about disease. The restraint of clinical discourse (its rejection of theory, its abandonment of systems, its lack of a philosophy; all so proudly proclaimed by doctors) reflects the non-verbal conditions on the basis of which it can speak: the common structure that carves up and articulates what is seen and what is said. The research that I am undertaking here therefore involves a project that is deliberately both historical and critical, in that it is concerned--outside all prescriptive intent--with determining the conditions of possibility of medical experience in modern times. I should like to make it plain once and for all that this book has not been written in favor of one kind of medicine as against another kind of medicine, or against medicine and in favor of an absence of medicine. It is a structural study that sets out to disentangle the conditions of its history from the density of discourse, as do others of my works. What counts in the things said by men is not so much what they may have thought or the extent to which these things represent their thoughts, as that which systematizes them from the outset, thus making them thereafter endlessly accessible to new discourses and open to the task of transforming them. [1]Pomme, Traite des affections vaporeuses des deux sexes [2]A. L. J. Bayle, Nouvelle doctrine des maladies mentales [3]F. Lallemand, Recherches anatomo-pathologiques sur l'encephale [4]J. -Ch. Sournia, Logique et morale du diagnostic --

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