Knowledge in the Time of Cholera

by Owen Whooley

  Waldor, Matthew K, Eric J. Rubin, Gregory D. N. Pearson, Harvey Kimsey, and John J. Mekalanos. 2003. “Regulation, Replication, and Integration Functions of the Vibrio Cholerae CTX Are Encoded by Region RS2.” Molecular Microbiology, 24, no. 5: 917–926.

  Warner, John Harley. 1991. “Ideals of Science and Their Discontents in Late 19th-Century American Medicine.” Isis 82, no. 313: 454–478.

  . 1997. The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820–1885. Princeton, NJ: Princeton University Press.

  . 1998. Against the Spirit of System: The French Impulse in Nineteenth-Century American Medicine. Princeton, NJ: Princeton University Press.

  2002. “The Fall and Rise of Professional Mystery: Epistemology, Authority, and the Emergence of Laboratory Medicine in Nineteenth-Century America.” In The Laboratory Revolution in Medicine, edited by Andrew Cunningham and Perry Williams, 110–141. New York: Cambridge University Press.

  Weber, Max. 2002. The Protestant Ethic and the “Spirit” of Capitalism and Other Writings. New York: Penguin Books.

  Weick, Karl E. 1979. The Social Psychology of Organizing. Reading, MA: Addison-Wesley.

  Weisz, George. 1978. “The Politics of Medical Professionalization in France 1845–1848.” Journal of Social History 12, no. 1: 3–30.

  Wheatley, Steven C. 1988. The Politics of Philanthropy: Abraham Flexner and Medical Education. Madison: University of Wisconsin Press.

  White, Hayden. 1980. “The Value of Narrativity in the Representation of Reality.” Critical Inquiry 7, no. 1: 5–27.

  Whooley, Owen. 2008. “Objectivity and Its Discontents: Knowledge Advocacy in the Sally Hemings Controversy.” Social Forces 86, no. 4: 1367–1389.

  . 2010. “Diagnostic Ambivalence: Psychiatric Workarounds and the Diagnostic and Statistical Manual of Mental Disorders.” Sociology of Health and Illness 32, no. 3: 452–469.

  Whorton, James C. 1982. Crusaders for Fitness: The History of American Health Reformers. Princeton, NJ: Princeton University Press.

  . 2002. Nature Cures: The History of Alternative Medicine in America. New York: Oxford University Press.

  Wilson, Major L. 1974. Space, Time, and Freedom: The Quest for Nationality and the Irrepressible Conflict, 1815–1861. Westport, CT: Greenwood Press.

  Worboys, Michael. 2000. Spreading Germs: Diseases, Theories, and Medical Practice in Britain, 1865–1900. New York: Cambridge University Press.

  Young, James Harvey. 1967. The Medical Messiahs: A Social History of Health Quackery in Twentieth-Century America. Princeton, NJ: Princeton University Press.

  Zerubavel, Eviatar. 1999. Social Mindscapes: An Invitation to Cognitive Sociology. Cambridge, MA: Harvard University Press, 1999.

  . 2003. Terra Cognita: The Mental Discovery of America. New Brunswick, NJ: Transaction Publishers.

  . 2011. Ancestors and Relatives: Genealogy, Identity, and Community. New York: Oxford University Press.

  Ziporyn, Terra. 1988. Disease in the Popular American Press: The Case of Diphtheria, Typhoid Fever, and Syphilis, 1870–1920. New York: Greenwood Press.

  INDEX

  Note: Bold page numbers refer to figures and tables.

  Abbott, Andrew, 13–14, 258n8

  Actor Network Theory (ANT), 156

  Agnew, C. R., 135

  Alabama, repeal of medical licensing laws, 68

  allopathic/regular physicians: and authoritative testimony, 46–47, 48, 49, 53, 58, 64, 67, 244; authority of, 6, 7, 21, 45–46, 47, 58, 70, 72, 91–92, 137, 154, 162, 165, 168, 178, 179, 180, 189, 195–96, 212, 219, 238, 242; and biomedical model, 7; and boards of health, 113, 115–16, 128–29, 133, 135, 136, 137, 138–47; and class differences, 136–37; debates with alternative medical movements, 12, 17, 19, 23–24, 48, 51–54, 57, 67, 80, 227, 261n3, 261n6; defeat of epistemic challengers, 21–22; and democratic ideals, 5, 29, 107, 108; and discovery narratives, 28, 157–58; as dominant sect of physicians, 1, 4–5, 257n1; and education reforms, 210; effect of cholera epidemics on, 1, 2, 19, 21, 23, 26, 36–37, 39, 45, 47, 49, 71; and empiricism, 40, 42, 43, 47, 84, 85, 170–71, 190; and epistemic contests, 26–27, 39, 67, 70, 85, 94, 96, 98, 106, 107, 113, 153, 156, 158, 179, 180, 181, 189, 224, 227, 233, 238, 242; homeopaths’ relationship with, 21, 26, 27, 28, 55, 57, 67, 77, 79, 80, 81, 87, 93, 96, 97–100, 101, 102, 106, 113, 135, 164, 179, 213, 215, 225, 245, 262n6; internal tensions of, 37, 40, 42–48, 83, 167, 210, 211; and Koch’s findings, 151, 154, 165–67, 171, 179, 181; and laboratory analysis, 210, 239, 243–44, 246; and legitimate knowledge, 45, 46; and medical epistemology, 42, 45–48, 80, 83–84, 88, 90–93, 100, 106, 191–96, 224–25, 243; and medical licensing laws, 59–60; narrative of emergent discovery, 165–67, 171, 177, 178, 179, 181, 225–26; and Paris School, 83–85, 101, 171, 172; professional identity of, 194, 221, 223, 229; and proto-empiricism, 44–45, 47, 83; and public health, 115, 116, 128, 129, 136–37, 140, 145, 211, 212; and quantification, 89; and radical empiricism, 27, 80, 85–90, 92–94, 98, 100–102, 106–7, 125, 165–67, 181, 189, 191–92, 225, 233, 244, 262n3; and rationalism, 37, 40, 42–47, 83, 85, 87, 88, 89, 90, 93, 191, 224–25, 233, 244, 262n6; reaction to cholera epidemics, 32–35, 40–42, 48, 49, 53–54, 74, 76, 77–78, 79, 90; and sanitary interventions, 27, 124, 128, 135–36; and sense of status, 45; and state legislatures, 1, 26, 38–39, 59–60, 70–71, 96, 145–46, 189, 208, 213, 218, 226, 233, 236, 243; styles of reasoning, 59

  alternative medical movements: on allopathic physicians, 4–5, 257n1; contributions of, 5, 49; debates with allopathic/regular physicians, 12, 17, 19, 23–24, 48, 51–54, 57, 67, 80, 227, 261n3, 261n6; dismissing of, 6; and education reform, 216, 217; emergence of, 26; endurance of, 238; and epistemic closure, 238; and epistemic contests, 21, 22, 26, 37–39, 48, 49, 59, 70, 71–72, 73, 80, 85, 224, 227, 230, 233, 235, 243; and epistemological change, 234–35; epistemologies of, 63, 64–67, 218, 234; government inclusion of, 4, 93, 102–5, 213, 234, 262–63n7; identification with science, 258n5; and repeal of licensing laws, 1, 68–69; and state legislatures, 1, 68–69, 70, 71, 213, 218, 224, 233. See also homeopaths and homeopathy; Thomsonism

  American Institute of Homeopathy (AIH), 95, 125, 163, 164–65

  American Medical Association (AMA): and boards of health, 212; Code of Ethics, 96–97, 98, 99, 101, 214; and education reform, 80, 95, 103–4, 205, 207, 216; and epistemic closure, 108, 238, 246; and epistemological problem of adjudication, 80, 81, 94, 95, 98, 100, 106, 225, 233; as exclusive, 27, 95–98, 100, 102–7, 145, 213, 244; goals of, 80–81; and no consultation clause, 96, 98, 101, 103–4, 105, 106, 143, 144, 214, 225, 233; opposition to government oversight of medical practice, 4, 26, 29, 102, 189, 212, 236–38, 243, 265n5; and organizational infrastructure, 8, 80, 81–83, 95, 100, 102, 106–8, 225, 226, 233, 243, 257n3; and professional power, 2, 13, 22, 26, 95, 108, 135, 137, 226–27, 236; and quackery, 95–97, 98, 99–102, 105, 106, 214, 225; regional character of, 262n5; and Rockefeller Foundation, 227, 236; Statement of Principles, 214; strategy of non-dialogue, 29, 102, 217; and thought collective, 107; and truth-wins-out narratives, 8. See also allopathic/regular physicians

  American Medical Times, 136

  American Public Health Association (APHA), 135

  animacular theory, 91–92

  anticommunist ideology, and health insurance, 237

  antiseptics, 239

  Aristotle, 252

  Army Medical Board, 104, 105

  atmospheric theories, 92, 160

  auscultation, 84

  authority: of allopathic/regular physicians, 6, 7, 21, 45–46, 47, 58, 70, 72, 91–92, 137, 154, 162, 165, 168, 178, 179, 180, 189, 195–96, 212, 219, 238, 242; challenges to, 48–49, 62; and medical professionalization, 1, 2, 4, 5, 6, 7, 8, 12–13, 28, 37–39, 45, 185, 213–14, 219, 226, 236. See also epistemic authority

  autopsy, 84

  Bacon, Francis, 58

  bacteriological paradigm: and allopathic/regular physicians, 2, 21, 22, 151, 154, 157, 158, 161, 162, 165, 166–67, 171, 177–78, 179, 180, 182, 18
3, 189; and cholera epidemics, 7, 24–26, 148, 149, 150, 151, 183, 187–88, 189, 224, 240, 260n20; and definition of disease, 13, 193, 240; and diagnostic testing, 189; and epistemic closure, 217; and Gates, 200–201; and German-American network, 154, 156, 158, 171–73, 176–77, 179; and homeopathy, 157, 161, 162, 163, 164, 180, 181, 215; and Koch’s findings, 152, 154, 157, 158, 166–71, 172, 178, 179, 180, 183, 192; and medical authority, 21, 24, 191; and medical education, 28, 194, 203; and medical professionalization, 191, 195, 208, 258n5; and Progressive Era, 258n5; and promissory practice, 158, 168–71; and public health, 152, 169–70, 195, 240–41; and quarantine measures, 184, 185, 186; and truth-wins-out narrative, 6, 7, 9, 24, 239; and vaccines, 24; and Welch, 167, 172, 176, 186. See also laboratory analysis

  Baker, Jean H., 62

  Barker, Fordyce, 128–29

  Bartlett, Elisha, 86–87, 88, 89

  Bartley, Horatio, Illustrations of Cholera Asphyxia, 35, 35

  Bates, Joseph, 68

  Behring, Emil von, 239

  Bell, John, 96

  Bellevue Hospital, New York, 172

  Berlant, Jeffrey Lionel, 257n3

  Biggar, Henry, 197, 202, 203

  Biggs, Hermann, 176, 184, 186, 202

  Billings, F. S., 165–66, 168

  biomedical research, and clinical practice, 210, 251–52

  Bismarck, Otto von, 149

  bloodletting, 1, 23, 41, 43, 50, 53, 234

  boards of health: alerting public to cholera, 34; and allopathic/regular physicians, 113, 115–16, 128–29, 133, 135, 136, 137, 138–47; and bacteriological paradigm, 183, 185, 188; debates on cholera, 26; debates on composition of, 4, 77, 212, 225; and epistemic contests, 112–14, 115, 135, 146, 147, 189; and laboratory analysis, 183, 184, 185, 188, 208, 211–12; organizational infrastructure of, 179; permanent boards of health, 132–35; and plumbers, 115, 137–40, 147, 225; and political issues, 16, 115, 126–29, 130, 131–32, 147, 188; and sanitary movement, 110–11, 225; and sanitary surveys, 122

  Bossey, P., 48

  Boston Medical and Surgical Journal: on cholera’s symptoms, 31–32; on cholera’s transmission, 73; debates over cholera in, 254; on quacks, 67; and therapeutic treatment of cholera, 33, 36–37, 48

  Boston Thomsonian and Lady’s Companion, 51

  Boston Thomsonian Manual, 54, 63

  Bosworth, Joseph S., 143

  boundary work: and credibility contests, 17, 259n15; as cultural practice, 82, 232; and legitimacy for ideas, 14; organizations’ role in, 94, 96–97, 101, 106, 214, 262n2

  Briggs, Charles, 240

  Britain: cholera in, 32; government health care insurance in, 265n5; and Koch’s findings, 159, 183; and laboratory analysis, 231; and medical professionalization, 230; and quarantines, 150; universities as model for American medical education, 204

  British Medical Journal, 150

  Bronson, Henry, 2–4

  Brown, E. Richard, 197, 235

  Cameron (New York physician), 33

  Carnegie, Andrew, 200

  Carnegie Foundation, 173, 205–6

  Carnegie Report, 205–6

  Catholic Church, 252–53

  Chapin, Charles, 211–12

  Chapman, Nathaniel, 95

  Chinese medicine, 251

  chiropractors, 213

  cholera: anticholera inoculations, 183, 184; Bronson on, 2–4; debates over, 11, 17, 26, 40–42, 45, 47, 48, 74, 125, 188, 189, 254–56; definition of, 3, 28, 31, 39–40, 116, 136, 146, 183, 189, 195, 217, 223–24, 225, 241–42; diagnosis of, 31, 32, 41, 90, 168, 169; discoveries in history of, 7, 148–51; epistemological crisis of, 19, 39–40, 73–74; etiology of, 7, 25, 26, 57, 91–93, 116, 124; in Europe, 31–33, 148, 183, 260n1; faces of, from Horatio Bartley, 35, 35; as filth, 113, 116–26, 136, 137, 146, 185, 195, 225; incubation period of, 186; in India, 149, 166, 167, 181, 260n1; Koch’s finding of cholera microbe, 3, 6, 7, 27–28, 149–52, 171, 176, 178–79, 189, 221, 225–26, 239, 263n1; myths of, 77, 262n1; in New York City, 33–35, 36, 74, 110–12; Osler on, 3–4; physical reality of, 24; study of, 23, 240–41; symptoms of, 1, 24–25, 31–32, 33, 35; therapeutic interventions for, 1, 32, 33, 36–37, 41–42, 45, 48, 49, 51, 52, 54, 74, 77–78, 79, 90–91, 102, 224, 261n4; translocal character of, 47; transmission of, 41, 73, 224; and transportation, 33, 47, 74, 76

  cholera epidemics: allopathic/regular physicians’ reactions to, 32–35, 40–42, 48, 49, 53–54, 74, 76, 77–78, 79, 90; and bacteriological paradigm, 7, 24–26, 148, 149, 150, 151, 183, 187–88, 189, 224, 240, 260n20; broadside of New York City Medical Council, 74, 75; counting of, 26, 260n18; effect on allopathic/regular physicians, 1, 2, 19, 21, 23, 26, 36–37, 39, 45, 47, 49, 71; and epistemic contests, 22–23, 26, 59, 73, 78, 79–80, 217, 224; mortality rate of, 1, 2, 24, 31, 32, 35, 49, 57, 73, 74, 76–77, 112, 115, 117, 121–22, 188; New York City Medical Council’s actions against, 74–76; and sanitary interventions, 23, 25, 74–75, 90, 109, 112, 185, 187–88, 240–41; spread of, 35–36

  cholera nests, 123–24, 131, 134

  Christian Advocate Journal, 77

  chronic fatigue syndrome, 252

  Citizens’ Association of New York, 130, 131

  Civil War, 104–5, 106, 109, 190, 262–63n7

  Cleveland, Grover, 183

  clinical practice: and biomedical research, 210, 251–52; and laboratory analysis, 219

  cognitive awakening, 157–58

  Coleman, William, 263n1

  Collins, Lottie, 187

  comma bacillus: Biggs’s and Prudden’s isolation of, 176; and definition of cholera, 3, 149, 160, 186, 189; and Koch’s findings, 177, 192, 221, 239, 263n2; and laboratory analysis, 185, 192; Pettenkofer’s swallowing of, 159, 178

  common sense: and germ theory, 159; and homeopathy, 99; and Jacksonian democracy, 62, 63, 64, 65; and Koch’s findings, 179; and medical epistemology, 194; and Thomsonism, 51, 52–53, 61, 63, 65

  Complementary and Alternative Medicine (CAM), 238, 251

  concept formation, in sociological research, 259n13

  Connecticut, 262n5

  contagion theories, 7, 77, 91–92, 118, 121, 124, 161

  contested illnesses, 252

  contingent contagionism, 91, 124

  Cooper, Peter, 130

  corporations, 196, 199–200, 235–36

  Council of Hygiene and Public Health, 130–32

  Council on Medical Education (CME), 205–6, 207

  credibility contests, 17, 232, 249, 259n15, 259–60n16

  CTX phage, 25

  cultural factors: culture as practice, 257–58n4; and discovery, 156; and epistemic contests, 18, 20, 71, 82, 106, 107, 232, 250; and institutional production of knowledge, 38; in medical professionalization, 8–9, 234; norms of trust, 14; and role of discoveries, 28. See also democratic cultures

  dehydration, and cholera, 24, 25, 261n4

  de Kruif, Paul, 221, 264–65n1, 265n3

  Deloney, Edward, 49

  democratic ideals: and American Medical Association, 107; and challenges to authority, 48–49; and epistemic closure, 218, 224, 242, 246; and epistemology, 62, 63, 243; and expert knowledge, 26–30, 146, 190, 219–20, 242–46; and homeopaths’ rhetoric, 54–59, 63–65, 79, 87, 107, 213, 215, 218, 261–62n10; and values, 5, 29, 61–62, 107, 108, 200; and mapping of cholera, 119; and medical epistemologies, 38, 50–59, 61, 66–68, 69, 70, 71, 79, 195, 196, 218–19, 230, 242; and medical professionalization, 26, 242–46; and private philanthropy, 200, 219; and radical empiricism, 87, 102, 107; and religion, 49; and role of professions, 5, 26, 29, 242, 243, 244–45, 258n9; and science, 244, 266n9; and Thomsonism’s democratization of medical knowledge, 50–54, 59, 63, 64–65, 69, 87, 261–62n10. See also lay public

  Democratic Party, 61, 62, 63, 129, 130

  democratization: and American culture, 48, 49, 190, 258n9; and medical knowledge, 38, 39, 54, 55, 59, 61, 63, 64, 68, 71, 80, 86,87, 119, 217–20, 243; and state legislatures, 61–63, 224

  Descartes, René, 16

  de Tocqueville, Alexis, 58, 62

>   diagnosis: of cholera, 31, 32, 41, 90, 168, 169; and laboratory analysis, 184, 189, 194, 195, 209, 239; and patient/doctor relationship, 195, 219

  Dickens, Charles, 33, 75

  diffusion model, of epistemology, 5–6, 152

  diphtheria, 7, 24, 176, 180, 239

  discovery: allopathic/regular physicians’ narrative of emergent discovery, 165–67, 171, 177, 178, 179, 181, 225–26; attribution model of, 154, 155–58, 178; and construction of narratives, 157; and epistemic authority, 153, 155–56; and germ theory, 156, 158; homeopaths’ narrative of prediscovery, 162–65, 170, 225–26; and network formation, 156–57, 171, 263n3; process of, 151–58; transformation of Koch’s research into, 153–58, 166, 171, 178, 179, 182

  dot maps, 115, 118–19, 119, 121–23, 225, 263n4

  economic development, cholera linked with, 76

  education reform: and alternative medical movements, 216, 217; and American Medical Association, 80, 95, 103–4, 205, 207, 216; and consolidation of medical authority, 28, 52, 179, 219, 257n3; and epistemological change, 203; and German-American network, 172–73; and homeopathy, 55, 98, 101, 103–4, 214, 216; and hospitals, 204, 209; and laboratory analysis, 194, 203–8, 210, 211, 216, 223, 245; and medical epistemology, 203; and Paris School, 83–85, 88; and public health, 212; standards of, 203–4, 205, 206–7, 208, 219, 223, 245, 264n5; and Thomsonism, 54, 55, 79; and Welch, 204–5

  Egypt, 148, 149, 166, 167

  Ehrlich, Paul, 170, 239

  elective affinity, 63–65, 261–62n10

  Eliot, Charles, 203

  empiricism: and allopathic/regular physicians, 40, 42, 43, 47, 84, 85, 88, 170–71, 190; and bacteriological paradigm, 192, 193; bedside empiricism, 44, 80, 84, 86, 87, 165, 181, 189, 192, 193, 209, 218, 223; and cholera epidemic, 77; and diagnosis, 184; and germ theory, 160; and homeopathy, 56, 79, 87; proto-empiricism, 44–45, 47, 83. See also radical empiricism

  Enlightenment, 85

  environmental illness, 252

  epidemiological data, 160

  episteme, 11, 252

  epistemic authority: claims of, 27, 191; as cultural product, 81–82; and discovery, 153, 155–56; and epistemic contests, 18, 19, 21, 113, 136, 146, 177, 183, 191, 249, 259n15; and ethos, 18, 114–15, 116, 127, 146–47; framing of, 112–16, 194; as grounded in content, 114–15; as grounded in methodology, 114–15; and laboratory analysis, 183–84, 190, 191, 194, 196, 219, 220; and professionalization, 146, 185; and sanitary movement, 113, 114, 126, 128, 146, 183