4 of medical discourse
4.4 Scientificality in medical articles from 1730 to 1985
The empirical results which will be referred to in this chapter are based on studies of Swedish medical language carried out at Uppsala University. The medical corpus which will be focused on here consists of 60 scientific articles: 10 from each of the 6 periods: I 1730–1799;
II 1800–1849; III 1850–1880; IV 1895–1905; V 1935–1945; VI 1975–1985.
All these articles come from scientific journals and deal with pulmon-ary diseases (30 articles) or skin diseases (30 articles).5 The analysis has focused on different textlinguistic levels – the cognitive, the prag-matic, and the macrothematic – and also on vocabulary and termin-ology. For a detailed description of the methodology, see Chapter 3.
My discussion below will be organized in the following way: in 4.4.1 I will focus on the content and content structuring of the texts, in 4.4.2. on the formal organization of the text, and in 4.4.3. on the lin-guistic expressions of evaluations.6
4.4.1 Content and content structuring of the texts
First, I will here relate the content and content structuring of med-ical articles to the stage reached by the domain of medmed-ical science,
in terms of degree and type of scientificality, and also to the role of scientists in society.
As described in Chapter 3, the cognitive analysis examined the con-tent of the text in relation to five cognitive worlds: a ‘scientific world’, a ‘practical world’, an ‘object world’, a ‘private world’ and an ‘exter-nal world’. Within each of these, two or three aspects were discerned:
within the scientific world ‘theory’, ‘classification’ and ‘experiment’, within the practical world ‘work’ and ‘interaction’, within the object world ‘phenomenon-focused’, ‘part-focused’ and ‘whole-focused’, within the private world ‘experience’ and ‘conditions’ and within the external world ‘conditions’ and ‘measures’. The cognitive analysis also comprised an analysis of text content in relation to four time dimensions: ‘cause’, ‘phenomenon’, ‘process’ and ‘result’.
Each proposition in the articles was categorized in relation to world, aspect and dimension. We could thus calculate the proportions of the total number of propositions representing each world, each aspect and each dimension in texts from different periods.
The analysis showed a very clear increase in the proportion of each text devoted to the scientific world, i.e. to the presentation of ‘the-ory’, ‘classifications’ and ‘experiment’ over the periods. On the other hand, there was a clear decline in the role of the external world in particular, i.e. in the proportions of texts dealing with ‘conditions’
and ‘measures’ of a political, economic and social nature. There was also an increase in the proportion of ‘experiment/observation’ within the scientific world and a drop in the proportion of ‘measures’ within the external world. The analysis further showed that the proportions of each text devoted to describing ‘causes’ and ‘phenomena’ have decreased over time, while the proportions devoted to ‘processes’ and
‘results’ have increased.
Another part of the analysis, as developed in Chapter 3, focused on the macrothematic structure. The content of the medical articles were then categorized in relation to the four superthemes: ‘intro-duction’, ‘theme development’, ‘discussion’ and ‘conclusions’. This analysis revealed an increase in how much of each text is devoted to the superthemes ‘introduction’ and ‘theme development’ (i.e. to a description of materials, methods, results). The proportion devoted to ‘discussion’ and in particular to ‘conclusions’, on the other hand, had declined.
A third analysis, which aimed at a description of the pragmatic character of the texts, i.e. the types of illocution present, pointed to an increase as regards ‘informative’ and ‘explicative’ illocu-tions and a decrease in ‘expressive’, ‘argumentative’ and ‘directive’
illocutions.
To sum up, the changes in the content and content structuring of Swedish medical articles from 1730 to 1985 show the following tenden-cies: more ‘scientific world’ – less ‘external world’; more ‘experiment’ – less social, political and economic ‘measures’; more ‘process’ and
‘results’ – less ‘cause’ and ‘phenomenon’; a larger proportion of ‘theme development’ – a smaller proportion of ‘discussion’ and ‘conclusions’;
more ‘informative’ and ‘explicative’ illocutions – fewer ‘expressive’ and
‘directive’ illocutions.
These findings relating to changes in the medical article genre point, for one thing, to a development in medical science. The knowledge struc-ture of the texts appears to have changed to include more emphasis on experiment and on process and results. There is also a trend towards a genre of a more purely descriptive character, in which the main part of the text is devoted to developing the theme, i.e. to description of the experiment, observations etc. These are features which could be related to a positivist scientific ideal. All these results can be related to the cog-nitive layer of the construction of academic discourse.
These results reveal the role played by scientists in society. In terms of text content, the proportion devoted to the external world and exter-nal measures has decreased, as has the proportion devoted to con-clusions and directives. Such results can be discussed in the light of the specialization and professionalization of society. Compared with earlier periods, scientists today are acting to a greater extent in a dis-course community of their own. Science in general and medical sci-ence in particular is accepted and highly esteemed in modern society.
Considerable funding is given to medical research. The role of large-scale experiments has increased.
The discourse changes can be related to this endeavour among med-ical scientists to become specialists with a profession of their own and their own exclusive domain to deal with. A high degree of scientifi-cality in spoken and written discourse imparts prestige.
A more purely scientific genre has emerged. Scientist-writers have turned towards their own group, and the medical article genre has become a within-science genre. The popularization of medical find-ings is undertaken by others – by trained journalists. Scientists can write for their own group without having to bother about a growing gap between the lay public and the experts. The article genre has become more exclusively internal and less concerned with reaching out to other sectors of society.
These results can also be interpreted in the light of the interplay between the cognitive and societal layers. The role played by the med-ical profession in society interrelates with the presentation of scien-tific content.
4.4.2 Formal organization of the text
Secondly, I will relate the formal organization of the texts and their rhetorical patterns to the stage reached in the development of the medical scientific community. A robust scientific community reveals itself in firm genre conventions: in more homogeneous texts and also in explicit indications of group affiliation.
The number and types of headings in the Swedish modern articles vary over time. The use of section headings has increased dramat-ically. The type of heading has also changed. In the early periods, headings relate to the content of the article, while in modern articles they relate to its structure: Material, Methods, Results, Discussion, Conclusions. The modern headings thus structure the presentation in a general scientific way, which also reflects a more homogeneous organization of the texts.
An increasing homogeneity is also found in relation to the thematic article structure.7 The articles from the period around 1980 (1975–1985) were clearly more homogeneous in terms of their linear text structure than earlier articles (cf. Chapter 3). Similarly, the introductions in art-icles from different periods revealed a gradually greater homogeneity.
This homogeneity can also be seen in a contrastive perspective, i.e. the Swedish pattern has come to resemble that of the English scientific article, as this is described in Swales (1990).
Another finding relates to the information flow of the text. An analysis of the connection between content structure and graphical disposition in articles from different periods showed that each sen-tence has become more independent with regard to the surround-ing text. It introduces a new angle, which means that it becomes less integrated with its neighbouring sentences (Melander, 1993). We thus find a change towards a fact-listing or ‘catalogue’ style in the modern article.
This tendency towards a catalogue style can be seen as another fea-ture reflecting firmer genre conventions. When texts are organized in a homogeneous and predictable way, there is less need to elaborate on the details. Readers know where in the text they will find different types of content. The tendency towards a more catalogue-like article could also be seen as indicating a strengthening of the scientific com-munity. The knowledge of this community is well established among the specialist readers, and need not be elaborated on.
Other analyses reveal that the number of references per article has increased over time, and that their presentation has become more homogeneous. Another tendency relates to the changed use of personal pronouns. In the articles from the eighteenth century, the pronoun
‘I’ was used quite frequently although it has more or less totally dis-appeared in the articles from the latter part of the twentieth century.
The pronoun ‘we’, on the other hand, which was quite unusual dur-ing the first two periods, had a similar low rank in the medical texts until the last period (1975–1985). The author’s explicit marking of art-icle relevance has also changed over time. We here find a shift from a societal orientation in earlier periods to a more internal orientation in the last period.8
To sum up, the changes in formal text organization and the rhet-orical patterns show the following diachronic tendencies: more headings; more homogeneous text organization; more homogeneous article introductions; more fact-listing; more references; less use of the personal pronoun ‘I’; more relevance marking relating to the group.
The medical article has developed towards greater homogeneity – relating to the use of headings, the superthematic text structure, the rhetorical structure of introductions etc. –, a homogeneity that indi-cates a strengthening of genre conventions. The medical article has become more established as a genre, and its genre conventions have become firmer and thus more homogeneous. This strengthening of the academic article genre, however, is also a sign of a growing and stronger medical discourse community. For the medical discourse community, as for most scientific discourse communities, writing plays an essential role as a group marker, and the establishment of firmer conventions for written text genres is part of the growth and strengthening of this community. The trend towards a more fact- listing and catalogue type of article can also be seen as a sign of a stronger discourse commu-nity, in the sense of a more homogeneous and closed community. It is a well-known fact within sociolinguistics that communication within a dense group or network needs to be less explicit and elaborated than communication within an open and less dense one (cf. discussion in Chapter 9).
The modern habit of giving references to the works of colleagues is another sign of a strong discourse community, a discourse community with a clear group feeling. When the group is essential to its mem-bers, it becomes important to indicate one’s sense of belonging and one’s relationship to other group members. Problems relating to the group also become more important than those relating to the world outside the group. The modern tendency to list references, to use ‘we’
instead of ‘I’, and to mark relevance in relation to one’s own group can be viewed from this social perspective. I would suggest that these text features are part of the construction of an increasingly close-knit (dense) medical discourse community.
There is also a connection between these features and the role of medical scientists in society, i.e. the strengthening of the professional group is paralleled by a process of gradual specialization of the pro-fessions. These features are thus also part of the construction of a role for the medical community within society. We can thus see how the social and societal layers interact. Strengthening of the internal group structure is interrelated with the underlining of a role for the group in society.
4.4.3 Linguistic expressions of evaluations
Thirdly, I will relate the linguistic expressions of evaluation and its variation over time to the positioning of the scientist/author on the developmental axes for the three contextual dimensions.
The study referred to was based on an analysis of 30 Swedish scien-tific medical articles from six periods. All articles dealt with pulmon-ary diseases. The study, which comprised an analysis of evaluations linked to descriptions of the subjects studied, the diseases and treat-ments, the introduction of the author’s own initiatives, and descrip-tions of the research and findings of others, focused on three main aspects: (1) what is being evaluated, (2) through whom the evaluation is taking place and (3) how the evaluation is being made.9
In articles from all periods, the object of the study and the initia-tives of other researchers are evaluated. The author also refers to his own initiatives in most articles.
From a diachronic perspective, however, it is more interesting to consider the second aspect, through whom the evaluation is taking place (author’s own voice, author through others, author through facts).
A comparison of the medical texts from the eighteenth, nineteenth and twentieth centuries shows that in the earliest texts the evaluation is made by the author himself, using his own voice, whereas in later articles it is allowed to emerge indirectly via facts from others, e.g. in references to articles by others.
A change over time is also found in relation to the third aspect, how the evaluation is being made. When articles from the eighteenth century are compared to articles from the twentieth century, we find increasing temperance with the evaluations in articles from 1730 being expressed more severely. A more obvious change, however, relates to the degree of certainty. Here we find a discernible increase in the use of hedges and other expressions of caution over time.10
We thus find a progressive moderation of the author’s own voice in the medical articles and increasingly the focus is placed on facts.
There is another clear change in the author’s relationship to facts,
which is revealed in an increase in the frequency of markers of epi-stemic modality.
These tendencies were also found in analysis of word frequencies.
As mentioned earlier, there is a change in the use of the personal pronouns ‘jag’ [I] and ‘vi’ [we] in the articles over time. The occur-rences of the pronoun ‘I’ decline by half between period I (eighteenth century) and period IV (1895–1905) and disappear completely during period VI (1975–1985). To some extent the pronoun ‘I’ is replaced by the pronoun ‘we’ in the last period. In this case, however, the increased use of ‘we’ is not mainly explained either by the use of reader- inclusive
‘we’ or by co-authorship. It could rather be linked to the progressive phasing out of authorial identity in scientific prose.
A comparison of the frequencies of a number of markers of modal-ity in the Swedish medical corpus, revealed an increase over time. All nine markers – ‘torde’ [is probably], ‘tyder’ [suggests], ‘tycks’ [seems],
‘tänkbar’ [conceivable], ‘tveksam’ [doubtful], ‘sannolik’ [likely], ‘sannolikhet’ [likelihood], ‘möjlig’ [possible], ‘möjlighet’ [possibility] – revealed a linear increase in the frequency over the six periods.
This increasing tendency to be cautious can of course be seen as a sign of the progressive extension of medical knowledge, i.e. it can be related to the author’s placement on the knowledge axis. The greater the body of collective knowledge, the more aware authors are of its relativity. But it could also be linked to circumstances within the social group, in this case the medical community. In order to survive in a competitive society, which is what the world of medical research undeniably is, one must be careful not to lose face and take care not to threaten the face of others. Ideas of this kind are proposed in Myers (1989). Myers claims that in order to survive in the competitive aca-demic world modern scientists adopt pragmatic politeness strategies and that Brown and Levinson’s concepts of ‘face saving’ and ‘face threatening’ are relevant also in the analysis of scientific texts (Brown and Levinson, 1987). Scientists tread a narrow path between the need to emphasize their own achievements, on the one hand, and to criti-cize those of their peers, on the other.
It may well be that the difference in the wording results from the increased knowledge scientists now possess about illnesses and their treatment, i.e. that the difference can be linked to the cognitive dimen-sion. Or it may result from greater awareness of the importance of politeness in a large and well-developed scientific community, i.e. the difference can be linked to the social dimension; doctors/researchers admittedly make evaluations, but they avoid expressing them subject-ively and straightforwardly and choose greater objectiveness, thus showing more caution.