Knowledge in the Time of Cholera

by Owen Whooley

  Rather than conceptualizing discoveries as discrete events with agency of their own, this chapter examines the transformation of Koch’s research into a discovery by embedding it within the epistemic contest over medical knowledge between regulars and homeopaths in the United States. One of the central problems with causal accounts that locate the efficacy of an idea in its content is the misguided assumption that the evaluation of ideas occurs within a universal epistemological system, in which facts are always facts according to some universal criteria. As I discussed in the introduction, this is a dubious assumption, bereft of any historical sensibility. Knowledge claims can only be judged—and only make sense—from within an epistemological system. Because medical epistemology was in flux throughout the nineteenth century, the actual process of reception of Koch in the United States is not a simple story of truth winning out; it is a story of struggle over basic epistemological assumptions. And discoveries can be a resource in an epistemic contest. The status of a discovery confers an importance and uniqueness upon an idea, something to be valued in and of itself. Because a discovery carries within it an implicit acceptance of certain epistemological assumptions, getting an idea accepted as a discovery can go a long way in capturing authority for one’s epistemological system. In a sense, epistemological assumptions can ride the coattails of a widely respected discovery. In this case, Koch’s discovery became a sort of Trojan horse that carried a commitment to the epistemology of the laboratory. Understanding how this idea was folded into a program of epistemological reform along the lines of the laboratory is necessary for explaining how Koch’s research became a discovery in the United States.

  How did Koch’s research get reconfigured as a paradigmatic discovery for a new program of allopathic scientific medicine? Examining a case in which the production of an idea was relatively isolated from the context of reception allows for a targeted investigation of the interpretive work involved in the discovery process. Less concerned with what Koch did, I focus on the subsequent interpretations—and struggles over interpretations—of his research within the U.S. context in the decades after Koch’s announcement. Adopting an attributional model of discovery (Brannigan 1981), this chapter demonstrates how Koch’s research was transformed into an allopathic discovery that heralded a new era of scientific medicine controlled by regulars. Reformers within both medical sects staked claim to Koch, and both faced external and internal challenges in their attempts to align Koch’s ideas with the preexisting systems of thought of their respective sects. In this “mnemonic battle” (Zerubavel 1999, 98), bacteriological advocates constructed discovery narratives that sought to situate Koch’s research in the tradition of their respective sects, while simultaneously downplaying the ambiguity of Koch’s initial findings through the production of promise. The first part of this chapter outlines the different narratives offered by homeopaths and regulars to show how the allopathic narrative of emergent discovery was more effective than the homeopathic narrative of prediscovery in providing a justifiable rationale for acting on Koch’s finding.

  The allopathic narrative provided an interpretive rationale for the embrace of bacteriology, but to solidify their ownership of Koch, allopathic physicians needed to supplement it with the organizational practice of building a network that linked them to Koch. The second section describes how allopathic reformers, building on their narrative justification, forged links with Koch and German laboratory science. In doing so, they claimed ownership of Koch’s research and configured the idea—cholera as a germ—into a discovery that heralded a new era of medicine. For an influential subset of regulars, Koch’s research became a discovery, and as owners of this discovery, allopathic reformers got to define the terms of the future of bacteriological medicine. When Koch became allopathic, homeopaths retreated into an oppositional stance that denied the legitimacy of the germ theory and that would prove professionally fatal.

  An Attribution Model of Discoveries

  Sociological theory on the notion of the discovery traces its roots to Robert Merton (1968), who noted the simultaneous emergence of the same discoveries arrived at independently by multiple scientists. Rather than singular, unique events, the existence of multiple discoveries suggests the influence of broader social and cultural processes on the progression of science. Additional research in the sociology of science further undermines the folk notion of discoveries by showing how scientific practice is inherently social (Shapin 1994; Shapin and Schaffer 1985), how laboratories actively intervene in natural processes, rather than passively observe them (Hacking 1983; Knorr-Cetina 1999), and how extrascientific factors influence scientific practices (Bloor 1991; Haraway 2006; Harding 1986, 1998). Discoveries are made, not unearthed.

  However, the production of an idea is only the first step in the discovery process. To fully grasp how an idea becomes a discovery requires an analysis that moves “downstream” from the laboratory (Gieryn 1999). An attribution model of discoveries examines how discoveries are constituted over time via interpretive and organizational work done to ideas postproduction and, in turn, how the newly minted discovery is subsequently disseminated (Brannigan 1981). The emphasis is placed on the socially defined status conferred upon an idea—a status characterized by originality, singularity, and decisiveness. The “discovery-ness” of an idea is not inherent to the idea itself but is obtained through socially mediated interpretive practices. And the power of the status of a discovery is derived from its perceived significance. Contrasted to other possible statuses—replication or normal science—it transforms an idea into a watershed event that alters the future of knowledge.

  There is a key temporal dimension to this status, as the event of the discovery demarcates the ignorant past from the promising future. To deem something a discovery is an exercise in marking time. The extraordinary present of the discovery reinterprets the past and anticipates a new future. The past becomes a period of ignorance and a repository of error, resolved and redeemed by the discovery. The future, on the other hand, becomes a rich new vista of possibility, emanating from the discovery. Because the attribution is a marking of a singular event heralding a new future, it confers upon its owner a certain degree of authority over this future. With this authority come professional, intellectual, and material payoffs to claiming a discovery for one’s intellectual community. And as a vessel for particular epistemological assumptions, discoveries can be an important resource in epistemic contests. If one’s idea is accepted as a self-evident discovery, it can naturalize the epistemological assumptions underlying it and, in a sense, smuggle them into legitimacy. With the future course of intellectual activity at stake, actors often jockey to claim discoveries to promote their epistemological vision.

  As this chapter demonstrates, the configuration of a discovery involves both organizational and cultural practices. Actor Network Theory (ANT) has long recognized the importance of networks in the configuration and dissemination of discoveries, showing that the success of an idea depends on the creation of networks by which multiple actors are enrolled into the project of promoting it (Callon 1986; Latour 1987, 1988, 2005; Law 1992). In his exemplary study of the spread of Louis Pasteur’s germ theory in France, Bruno Latour (1988) argues that Pasteur’s ideas regarding microbes were successful because he was able to enroll allies, especially hygienists, in his project. This newly constructed network brought the laboratory into the field, disseminated Pasteur’s germ theory, and promoted his research as a singular discovery. Network formation, as related to the ownership of a discovery, is particularly important in situations like the case discussed here when the production of the idea is severed from the context of its reception. For actors removed from the context of production, forming networks linked to those who produced it is essential in claiming ownership of an idea and using it to serve one’s ends. In order for homeopathic or allopathic physicians to use Koch’s idea in their epistemic contest, they had to form connections to Koch’s laboratories, connections that were not p
redetermined, as both sects were similarly isolated from German science.

  There is a crucial interpretative dimension required to establish the intellectual rationale for building networks. In other words, networks are necessary, but not sufficient, to configure a discovery. The transformation of Koch’s research into a discovery first required significant interpretative work to be performed on the idea in order to make it acceptable—and accessible—to the very actors who would subsequently carry it along the network. Here is where Latour’s account of Pasteurization stumbles. In a sense, he skips this intermediate interpretive step between the production of the idea and the construction of a network. Focusing primarily on practices of network-building, Latour largely ignores the practices of interpretation and sense-making necessary for building networks. In deploying military metaphors, he overemphasizes the building of alliances (Paul 1990), reducing actors’ sense-making practices to the alignment of interests.3 But ideas are adopted not only because they serve certain interests; they must also make sense to the actors adopting them. A discovery must be recognized, incorporated into, and reconciled with preexisting schemas. It also must find or prepare an audience willing to change its commonsense perceptions to accommodate it (Zerubavel 2003).

  Because the attribution of a discovery marks a certain idea as a crucial event in time, the construction of narratives becomes a key interpretive practice for actors seeking to obtain the attribution of a discovery for an idea and to subsequently build a network around it. As analytical constructs, narratives make sense of disparate events by organizing them into a coherent relational whole through emplotment and attention to sequencing (Bruner 1991; Davis 2002; Polletta 2006; Riessman 1993; Tilly 2006; White 1980). They form a crucial component of the collective actors’ repertoires in their struggles over meaning (Davis 2002; Patterson 2002). In narratives of discoveries, the “event” of the discovery is configured as the pivotal moment in the plot that demarcates the ignorant past from the promising future.

  To transform Koch’s research into a discovery, bacteriological advocates within allopathy and homeopathy constructed competing discovery narratives that sought to situate Koch’s research in a manner that spoke simultaneously to the past and the future of their respective sects. Aimed internally at converting reluctant peers and externally at capturing ownership of Koch, these narratives emphasized certain elements of Koch’s research that resonated with the particular traditions of allopathy and homeopathy and excluded those aspects that did not.

  In constructing these narratives, allopaths and homeopaths had to walk a precariously fine line between embedding Koch within their respective traditions and arguing that the singularity of his idea demanded a departure from these very traditions. They had to balance a tension between continuity and discontinuity, framing the discovery as simultaneously emanating from the preexisting knowledge of their sect but moving toward a new knowledge base. To reconcile Koch with the past and anticipate a brighter future, the narratives deployed the logic of cognitive awakening (DeGloma 2010), in which the event of the “discovery” provided a flash of insight that demanded reformulation of the past and plotted a new course for the future. Through the construction of a new future, bacteriological advocates engaged in a type of promissory practice through which they glossed over the uncertainties and ambiguities in Koch’s actual research to make bold claims (i.e., further discoveries, revolutions in medical therapies, and even the elimination of disease altogether) for its future implications. Ultimately, the allopathic discovery narrative proved more effective in resolving the continuity/discontinuity dilemma to successfully supply the rationale for an allopathic network linked to the German laboratory. Through the concatenation of the interpretive, narrative work of its advocates and the building of alliances with German science—this effective combination of cultural and organizational strategies—allopathic bacteriologists transformed Koch’s cholera research into a discovery that promoted allopathy’s interests in the epistemic contest.

  NARRATING KOCH IN AMERICA

  Early medical writings on the germ theory, Koch’s research included, were plagued by inconsistencies in terminology, overzealous “discoveries” that later proved to be false, and technical difficulties in replicating findings (Hamlin 2009; Richmond 1954; Tomes 1997; Tomes and Warner 1997). In many ways, bacteriology raised more questions than it answered (Rothstein 1992, 267), as early bacteriological research contained a high degree of ambiguity. Ideas, and especially muddled ideas, cannot speak for themselves. Koch’s identification of the cholera microbe was no exception to this rule of uncertainty, as it failed to meet his own rigorous standards. Koch established four postulates a microbe must meet in order to prove a causal link to disease:4

  1. The microorganism must be found in abundance in all organisms suffering from the disease, but not in healthy organisms.

  2. The microorganism must be isolated from a diseased organism and grown in a pure culture.

  3. The cultured microorganism should cause disease when introduced into a healthy (animal) host.

  4. The microorganism must be isolated again from the diseased experimental host and identified as being identical to the original specific causative agent.

  Koch’s cholera research did not meet the third postulate as he could not reproduce cholera in a healthy organism (Gradmann 2009). This failure was fodder for critics who argued that Koch’s causal claims were exaggerated and overstepped the bounds of his evidence. Subsequent attempts to inoculate animals were plagued by technical issues and were viewed with wide skepticism (Coleman 1987; Ogawa 2000; Rothstein 1992).

  To overcome this, Koch supported his microscopic research with epidemiological evidence, while drawing analogies to other diseases (e.g., leprosy and typhoid fever) widely believed to have a microbial cause that also failed to meet the third postulate (Porter 1998). Cobbling this evidence together, he radically simplified cholera, equating “all questions of cholera’s cause with the doings of the bacillus” (Hamlin 2009, 215). His causal argument rested on a presence/absence reasoning, which argued that the bacillus was a necessary cause because in its absence, there was an absence of cholera, other things being equal (Coleman 1987). However, even this presence/absence argument was undermined by the presence of cholera bacilli in “healthy carriers,” violating the first postulate.5 The healthy-carrier problem would not be solved until the early 1900s with developments in immunology.

  Koch’s critics picked up on these problems. These critics were not marginal figures in the world of nineteenth-century medical science. Pettenkofer, perhaps the world’s most famous German scientist (Richmond 1954), accepted Koch’s bacillus as one important factor in the development of cholera, but he believed that the germ itself was harmless unless it underwent a process of fermentation caused by environmental factors in a type of poisonous metamorphosis. In 1892, to prove his fermentation theory, Pettenkofer publicly swallowed the comma bacillus to demonstrate its harmlessness, taking his failure to develop cholera as conclusive evidence of the microbe’s inherent innocuousness. His fermentation theory gained widespread support in the United States (Richmond 1954). Louis Pasteur himself, a major proponent of the germ theory, remained skeptical of Koch’s research (Brock 1988). And most British physicians, from whom American doctors had taken their cues for decades, opposed Koch’s findings out of nationalistic pride and commercial concerns about trade.

  There were good intellectual reasons to question the germ theory beyond the specifics of Koch’s research, as it flew in the face of much medical common sense. For one, it was inconsistent with medicine’s focus on predisposition; since medicine lacked any notion of the immune system, it seemed arbitrary to attribute the cause of disease to a small microorganism irrespective of the traits of the individual (Rosenberg 1987a, 138). It seemed to contradict a basic, widely accepted empirical observation—cholera affected some types of people (e.g., the poor, the malnourished, etc.) more than others. The germ theory seemed to also deny the
relevance of the atmosphere and filth, the focus of public health for decades and the organizing principles behind most sanitary measures. And finally, skeptics had difficulty accepting the seeming randomness and meaninglessness of attributing the cause to a small microorganism (Rosenberg 1987a, 138). The skepticism toward the germ theory “was neither irrational nor reactionary; it was a reasonable position, taken by many leaders of the profession” (Rothstein 1992, 267).

  In the United States, most of the opposition to Koch arose from a hesitancy to confer privileged epistemic status to laboratory analysis. During this period, Americans lagged far behind Europe in the medical sciences (Richmond 1954). The microscope and the laboratory were foreign to the overwhelming majority of American physicians, as most schools did not teach microscopy until the 1890s (Rothstein 1992). In fact, before 1884, there was no English-language medical text that discussed bacteriology in a comprehensive way (Bonner 1963). Given their unfamiliarity with the laboratory, American doctors were reluctant to grant primacy to it over other forms of evidence (Tomes and Warner 1997). Why, critics asked, should the bacteriological cause of cholera trump other known causes (e.g., poor sanitary conditions) gleaned from different types of data (e.g., sanitary surveys)? Drawing on clinical experience—in which doctors treated cholera patients at close proximity without succumbing to the disease—and epidemiological data—which pointed to environmental factors as causes of the disease— these critics argued that, while the bacillus might be correlated with cholera, there was no evidence to warrant Koch’s causal claims: “There is no doubt, then, some relation between these bacilli and the cholera process. Nevertheless, the coincidence of the process with the bacilli does not prove the bacilli are the cause of cholera. The inverse may be true” (Kinsman 1886, 528). The comma bacilli might be thought of as “a concomitant effect rather than as the cause of cholera” (Blake 1894, 881). This “innocent bystander” argument, formerly used to reject bacteriological accounts of tuberculosis (Maulitz 1979), was common among Koch’s critics.