What sort of transformations of the clinical gaze are necessary to enable it with the new powers of scientific discovery? How does the clinic transform silent symptoms into speaking signs?

Foucault traces the development of the gaze from the non-interfering, observing gaze to the predictive and directive glance:

The first step in this process is the expansion of the observing gaze, which "refrains from intervening: it is silent and gestureless... Observation leaves things as they are; there is nothing hidden to it in what is given...The correlative of observation is never the invisible, but always the immediately visible, once one has removed the obstacles erected to reason by theories and to the senses by imagination...In the clinician's catalogue, the purity of the gaze is bound up with a certain silence that enables him to listen (p. 107)."

Thus, the observing gaze is one of supreme attentiveness divorced from any pre-established theory of what to look for:

"The clinical gaze has the paradoxical ability to hear a language as soon as it perceives a spectacle...its questions can be well founded only if they are answers to an answer itself without question, an absolute answer that implies no prior language, because, strictly speaking, it is the first word (p. 108)."

As such, "clinical observation involves two necessarily united domains: the hospital domain and the teaching domain (p. 109)." Rather than being the artificial and toxic separation from the true natural environment of the disease as was previously believed, the hospitals are now recognized as "a neutral domain, one that is homogenous in all its parts and in which comparison is possible and open to any form of pahtological event, with no principle of selection or exclusion (p. 109)."

In combining large fields of observation of isolated diseases, the carefully observing gaze gradually learns to logically construct its own method of effective observation and diagnosis:

"By showing itself in a repetitive form, the truth indicates the way by which it may be acquired...It offers itself to knowledge by offering itself to recognition...There is, therefore, no difference in nature between the clinic as science and the clinic as teaching (p. 110)."

Thus, the logical truth of the facts imbues the system with its own direction: a system evolves which can best observe everything which needs most to be observed in order to diagnose and treat. The act of observation becomes self-directing, yet in the practical "'meeting place' of doctor and patient (p. 111)," how does this development in seeing and knowing occur?

Foucault locates the collapse the distinction of seeing and knowing through the following three methods:

The alternation of spoken stages and perceived stages in an observation. This examination/questionnaire format consists of physical examination by the doctor and questions to the patient. Through this "regular alternation of speech and gaze, the disease gradually declares its truth, a truth that it offers to the eye and ear, whose therm, although possessing only one sense, can be restored, in its indubitable totality, only by two senses: that which sees and that which listens (p. 112)." Yet this method of describing and defining disease is limited only to the questions asked and the mode of observation and their is little ability to construct a unified representation of the disease apart from individual answers and observations.

The effort to define a statuatory form of correlation between the gaze and language. Yet once an visual and verbal examination has taken place, how can the doctor represent the disease in a way that is cohesive and meaningful to both realms? How does one construct "the picture" of a disease? Some clinicians such as Fordyce and Pinel attempted to graph the symptoms on an x- and y-axis coordinate grid in order to divine some new truth to the disease, yet such an operation does not reveal any new information, it just restructures it in another form. Graphing is not akin to divination: "But it is obivious that the analytical structure is neither produced nor revealed by the picture itself; the analytical structure preceded the picture, and the correlation between each symptom and its symptomological value was fixed once and for all in an essential a priori; beneath its apparently analytical function, the picture's only role is to divide up the visible within an already given conceptual configuration...It makes nothing known; at most, it makes possible recognition (p. 113)."

The ideal of an exhaustive description. As a result of the inherent failings of the previous two means of representation, a third method of exact and precise description came into practice. Under this method, "[d]escriptive rigour will be the result of precision in the statement of regularity in the designation...Thus language is charged with a dual function: by its value as precision, it establishes a correlation between each sector of the visible and an expressible element that corresponds to it as accurately as possible; but this expressible element operates, within its role as description, a denominating function which, by its articulation upon a constant, fixed vocabulary, authorizes comparison, generalization, and establishment within a totality (p. 114)." The ideal of an exhaustive description not only names but, in doing so, also locates and makes sense of the observed phenomenon in a single, cohesive picture which carries the full import of its designation. It is the revealing process of detailed and calculated naming that "authorizes the transformation of symptom into sign and the passage from patient to disease and from the individual to the conceptual...To describe is to follow the ordering of the manifestations, but it is also to follow the intelligible sequence of their genesis; it is to see and to know at the same time, because by saying what one sees, one integratesit spontaneously into knowledge; it is also to learn to see, because it means giving the key of a language that masters the visible (p. 114)."

Yet while the power of rigorous description allowed for a vastly improved ability to represent and categorize diseases, the art of "total description" provides little in the way of conceptual framework and predictive, practical diagnosis. Clinicians like Condillac "did not allow a science in which the visible and the describable were caught up in total adequation...Condillac's philosophy gradually shifted from an analysis of the original impression to an operational logic of signs, then from this logic to the constitution of a knowledge that would be both language and calculation (p. 116)." Yet what form would this calculative language take? The genius of Condillac's intention was laden with the belief in the combinatory nature of diseases and passed through several different "epistemological myths" before determining its eventual character:

The alphebetical structure of disease. This myth stemmed from the late 18th century fascination with the ultimate reductionism of knowledge as espoused by the grammarians of the time. "This alphabetical image was transposed essentially unaltered into the definition of the clinical gaze...The alphabetical structure of disease ensures not only that one can always return to the 'unsupersedable' element; it also ensures that the number of these elements will be finite and even small...It is not first impressions [of the disease] that are diverse and apparently infinite, but their combination within a single disease (p. 118)."

The clinical gaze effects a nominalist reduction on the essence of the disease. If the disease is characterized by a certain organization of symptomoligical "letters" then the name of the disease comes to represent a unique, abstract representation with its own significance: "To ask what is the essence of a disease is like 'asking what is the nature of the essence of a word'...It is the concourse of the accidents that constitute it (p. 119)." Thus, the disease itself becomes a sign which is becomes an abstract token of exchange and conceptualization through its nominalist reduction.

The clinical gaze operates on pathological phenomena a reduction of the chemical type. "Until the end of the eighteenth century the gaze of the nosographers was a gardener's gaze; one had to recognize the specific essence in the variety of appearances...At the beginning of the nineteenth century another model emerged: that of the chemical operation, which, by isolating the component elements, mde it possible to define the composition, to establish common points, resemblances, and differences with other totalities, and thus to found a classification that was no longer based on specific types buy on forms of relations (p. 119)." In such a chemical paradigm of the clinic, "the clinician's gaze becomes the funtional equivilant of fire in chemical combustion; it is through it that the essential purity of phenomena can emerge: it is the separating agent of truths...The clinical gaze is a gaze that burns things to their furthest truth (p. 120)." As such, the gaze for the first time takes on a component of seeking to divine the truths beyond the symptoms. This new paradigm introduces the element of predictive investigation of primary causes in smaller, hidden elements: "The reality, whose language it spontaneously reads in order to restore it as it is, is not as adequate to itself as might be supposed: its truth is given in a decomposition that is much more than a reading since it involves the freeing of an implicit structure...One can now see that the clinic no longer has simply to read the visible; it has to discover its secrets (p. 120)."

The clinical experience is identified with a fine sensibility. This new clinical ability to reduce symptoms to their most basic truths of structure requires a "fine sensibility" which takes on the form of "an art" (p. 121) of immediately assessing the symptoms and seeing past them to their deeper, namable truths of existence. This fine sensibility is represented by a shift from the traditional clinical gaze to the glance. Foucault distinguishes the two as: "the gaze implies an open field, and its essential activity is of the successive order of reading; it records and totalizes; it gradually reconstitutes immanent organizations...The glance, on the other hand, does not scan a field: it strikes at one point, which is central or decisive; the gaze is endlessly modulated, the glance goes straight to its object...The glance chooses a line that instantly distinguishes the essential; it therefore goes beyond what it sees; it is not misled by the immediate forms of the sensible, for it knows how to traverse them; it is essentially demystifying...The glance is silent, like a finger pointing, denouncing...The clinical eye develops a kinship with a new sense that prescribes its norm and epistemological structure; this is no longer the ear straining to catch a language, but the index finger palpitating the depths...And by that very fact, clinical experience sees a new space opening up before it: the tangible space of the body, which at the same time is that opaque mass in which secrets, invisible legions, and the very mystery of origins lies hidden (p. 121-2)." Thus the clinical glance opens the way for a new way of understanding medicine: the doctor/instructor can walk through a clinical ward and merely glance at a patient in order to explore the deeper reaches and trajectories of disease within the body itself. And this power to gaze into the very depths of the human body was about to undergo a profound intensification....