by Owen Whooley
OWEN WHOOLEY is assistant professor of sociology at the University of New Mexico.
The University of Chicago Press, Chicago 60637
The University of Chicago Press, Ltd., London
© 2013 by The University of Chicago
All rights reserved. Published 2013.
Printed in the United States of America
22 21 20 19 18 17 16 15 14 13 1 2 3 4 5
ISBN-13: 978-0-226-01746-4 (cloth)
ISBN-13: 978-0-226-01763-1 (paper)
ISBN-13: 978-0-226-01777-8 (e-book)
Parts of chapters 1 and 2 were published in “Organization Formation as Epistemic Practice: The Early Epistemological Function of the American Medical Association,” Qualitative Sociology 33, no. 4 (2011): 491–511. Reprinted with kind permission from Springer Science+Business Media.
Library of Congress Cataloging-in-Publication Data
Whooley, Owen, author.
Knowledge in the time of cholera: the struggle over American medicinein the nineteenth century / Owen Whooley.
pages cm
Includes bibliographical references and index.
ISBN 978-0-226-01746-4 (cloth : alkaline paper) — ISBN 978-0-226-01763-1 (paperback : alkaline paper) — ISBN 978-0-226-01777-8 (e-book)
1. Cholera—United States— History—19th century. 2. Medicine—United States—History—19th century. 3. Knowledge, Sociology of. I. Title.
RC131.A2W46 2013
614.5'14097309034—dc23
2012036982
This paper meets the requirements of ANSI/NISO Z39.48–1992 (Permanence of Paper).
KNOWLEDGE
in the
TIME OF CHOLERA
THE STRUGGLE OVER AMERICAN MEDICINE IN THE NINETEENTH CENTURY
OWEN WHOOLEY
THE UNIVERSITY OF CHICAGO PRESS
Chicago and London
To my mom, Candie
A conflict of ideas is a battle or series of battles, and presents all the meannesses, the cunning, the stratagems, the bitterness and sometimes the violence of actual war.
WILLIAM H. HOLCOMBE
President of the American Institute of Homeopathy, 1874 to 1876
CONTENTS
ACKNOWLEDGMENTS
INTRODUCTION: OF CHOLERA, QUACKS, AND COMPETING MEDICAL VISIONS
1.CHOLERIC CONFUSION
2.THE FORMATION OF THE AMA, THE CREATION OF QUACKS
3.THE INTELLECTUAL POLITICS OF FILTH
4.CHOLERA BECOMES A MICROBE
5.CAPTURING CHOLERA, AND EPISTEMIC AUTHORITY, IN THE LABORATORY
CONCLUSION: MEDICINE AFTER THE TIME OF CHOLERA
APPENDIX: A COMMENT ON SOURCES
NOTES
REFERENCE LIST
INDEX
ACKNOWLEDGMENTS
The great fiction of intellectual life is that books usually bear a single name. All inquiry is communal, and all insight, interactive. This book is the sum of innumerable conversations, real or imagined, that opened my eyes, prodded me forward, and ultimately gave me great pleasure. More so than the final product, it is these conversations that I treasure.
For six years, I called the Department of Sociology at New York University my home. Jeff Goodwin constantly pushed me to keep the big picture in mind. Historical sociologists always run the risk of getting lost in the trees; Jeff helped me see the forest. Craig Calhoun provided me with generous support over my graduate career—so generous that I will never be able to adequately express my appreciation. Always forthcoming in offering me the type of penetrating feedback for which he is well known, he has an uncanny ability to distill key points into a form digestible and understandable to all. Most of the more articulate points in this book can be traced back to him. Ann Morning has a calming presence that is contagious. She is a model of professionalism I can only hope to be able to shamelessly ape one day. To Troy Duster goes the credit of the most useful advice I received during this process—write, write, and then write some more. By reducing this project to the simple exercise of writing, Troy gave me the strategy by which I persevered. Ed Lehman, my reader, has been a constant mentor and friend. Vivek Chibber, David Garland, and Richard Sennett all at some point have read my work and provided invaluable feedback. Finally, I would like to thank the often overlooked administrative staff, who humored my pestering throughout the years, especially Dominick Bagnato, Candyce Golis, and Jamie Lloyd.
To have dear friends who are also your teachers is to be blessed. Jane Jones is the only person to have read every single word of every single piece of my research. She is the consummate editor; without her, my verbosity runs wild. I can never thank her enough for everything. Noah McClain, my fellow chronicler of the absurd, has been a steadfast source of support and much needed merriment. I cultivated my sociological imagination with him, as we subjected the most mundane and ridiculous topics to its wrath, over beers of course. Claudio Benzecry has given me so much advice and enjoyable conversation that I can only hope to someday return even half of it. I would also like to thank (and apologize to) that merry bunch in my writing workshop for enduring my long drafts with smiles of encouragement: Hannah Jones, Sarah Kaufman, Amy LeClair, Tey Meadow, Ashley Mears, Harel Shapira, and Grace Yukich. A special thank-you to Gabi Abend, Rene Almeling, and Andrew Deener, who helped see this book to fruition with prompt and penetrating feedback. Finally, I’d like to thank everyone who participated in NYLON with me, that cauldron of creative sociology, especially Ruthie Braunstein, Ernesto Castaneda, Monika Krause, David Madden, Erin O’Connor, Marion Wrenn, and Mark Treskon, who deserves special mention for constructing the fancy licensing map for the book.
Through the various accidents of my meandering biography, I have been fortunate enough to be a part of not one, but four excellent academic communities. I spent my first two years of graduate school in the Sociology Department at Boston College, and it was there that I figured out who I wanted to be intellectually. Bill Gamson, Char Ryan, and Diane Vaughan are the models of generous scholars. As a NIMH postgraduate fellow in the Institute of Health, Health Care Policy and Aging Research, I was granted the two most important ingredients for successfully writing a book—abundant time and access to interested minds. I’d like to thank Allan Horwitz, David Mechanic, Deborah Carr, Gerry Grob, Eviatar Zerubavel, and my fellow fellows Ken MacLeish, Tyson Smith, and Zöe Wool. My current home is the Sociology Department of the University of New Mexico, where I look forward to years of sharing rarefied conversations with my new colleagues in the rarefied air of Albuquerque.
This book would not have been possible without the archivists and librarians who were more than willing to help me find that elusive document, despite my violations of certain library rules. Toiling away in anonymity, it is they who preserve our past, and for this, they should be celebrated. The staff at the New York Academy of Medicine, particularly Arlene Shaner, deserves much of my gratitude as we spent the better part of two years together. I’d also like to thank the staffs at the Bobst Library at New York University, the Bradford Homeopathic Collection at the Taubman Health Science Library at the University of Michigan, the Butler Library at Columbia University, the New York History Society, the Parnassus Library at the University of California—San Francisco, and the Rockefeller Foundation Archive Center. Historical sociologists depend on the diligent research of historians who keep us honest and make sure we get the details of the story straight. I stood on the shoulders of many historian/giants, whose contributions deserve more recognition than mere references. Of note has been the scholarship of Harris Coulter, John Duffy, John S. Haller Jr., Howard Markel, Charles Rosenberg, and John Harley Warner. Finally, I’m especially grateful to editor—and keen wit—Doug Mitchell, both
for his encouragement and his sharp repartee; I am humbled that my book is now a small part of the indelible mark he has made on the discipline of sociology. Also at the University of Chicago Press, I’d like to thank Tim McGovern, Jennifer Rappaport, and Carol Saller.
Research, especially historical research, can breed insularity and can reward socially deviant behaviors. Fortunately, I am blessed with a rich community of loved ones, who couldn’t care less about the ivory tower and who keep me grounded. My dad, Jim, was a dreaming empiricist and playful rationalist if ever there was one. It was he who taught me to approach the world with humble curiosity. While his death antedates this book, my writing is, and will always be, a conversation with him. My brother and best friend, Michael, is a source of constant laughs. He grounds me in who I am, and I couldn’t imagine experiencing any of life’s vicissitudes without him right next to me. My office mate and walking partner, Jibbs, is a constant source of delight. My closest friends—Sam Fillian, Karyn Miller, Elizabeth Pfifer Payne, and Mary Regan—are the most genuine people I have ever met. Erin Tarica, my wife and my word, is probably the only person to find my bookishness attractive, even generously misrepresenting it as “cool.” Her exuberance draws me out; her intuitive sensitivity is the perfect antidote to my excessive rationality. Words cannot express my feelings; hopefully, a lifetime of laughter will. Finally, this book is dedicated to my mom, Candie, who has been my greatest advocate and sturdiest support throughout my life. To merely thank her is inadequate; I am who I am because of her.
INTRODUCTION
Of Cholera, Quacks, and Competing Medical Visions
When cholera—a disease never seen nor imagined by American physicians—first arrived in the United States in 1832, the horrors it unleashed belied any pretensions doctors may have held to medical mastery. With its dramatic symptoms and rapid mortality, the foreign disease created widespread panic, which intensified as physicians’ interventions did nothing to stem its progress. Worse still, physicians’ heroic therapies, like bloodletting, sped the disease’s course, undermining the ability of cholera patients to stave off death.
Cholera’s ability to “mock the calculations of man” (Short quoted in Chambers 1938, 164) generated a crisis in medicine as doctors scrambled impotently to find a cure for the unfamiliar disease. Their failure to do so seriously compromised the public standing of the medical profession. By the 1830s, allopathic or regular physicians—that is, the dominant sect of physicians later represented by the American Medical Association (AMA)1—had gained a measure of professional control, as thirteen state legislatures had passed medical licensing laws (Numbers 1988). These laws represented early cultural validation, a crucial step in the consolidation of professional authority. Cholera destroyed this momentum. Alternative medical movements pointed to allopathy’s failures during the cholera epidemic to mount a campaign to repeal the licensing laws. And by the mid-1840s, merely a decade after they had been passed, the licensing laws were universally repealed (the one exception being the New Jersey statute). Cholera became a symbolic failure for allopathic medicine that ushered in an era of unregulated medicine and intense competition among medical sects.
Contrast this reaction with a later foreign epidemic. In 1918, the “Spanish” influenza hit the United States for the first time. The “great influenza” epidemic was the worst in the country’s history (Barry 2005), and by all objective measures, an even more stunning failure for the medical profession. The influenza claimed between 500,000 and 670,000 Americans and upward of five million worldwide, 3 percent of the world’s population. By contrast, the 1832 cholera epidemic killed only about 10,000 Americans. Yet, unlike in 1832, no one questioned the authority of the allopathic medical profession. Fortified within institutions like hospitals, laboratories, and research universities, regulars, through the AMA, had achieved such a high level of professional authority that they remained unchallenged by even the most deadly of epidemics. Operating under the banner of science and the bacteriological paradigm, allopathic physicians had wrested control of medicine from competing sects, winning recognition as the experts in treating, controlling, and understanding disease. The medical profession emerged from the influenza epidemic as influential as ever.
Two epidemics, two conspicuous failures, and yet two widely divergent professional outcomes. What happened to the profession in the intervening years, between these two epidemic bookends, that these failures could yield such different results? Cholera destabilized allopathic authority and led to a retraction of professional privileges that gave birth to a period of rancorous medical competition; the Spanish influenza reinforced physicians’ clout as local, state, and federal agencies turned to them—and only them—to combat the flu (Barry 2005). These contrasting outcomes reflected a dramatic shift in the allocation of professional authority between the two epidemics—a shift whose origin clearly was not driven by the profession’s effectiveness in combating infectious diseases. The medical profession failed in both cases, and by all standards, much more spectacularly in 1918. And yet the ramifications of these failures differed greatly. Why was the public unwilling to extend the benefit of the doubt to allopathic doctors during the deadly cholera, but willing to during the deadlier influenza epidemic?
Over the same period, medicine underwent a major change in epistemology, in how medical knowledge was produced and understood. During the 1832 cholera epidemic, Dr. Henry Bronson, a professor at Yale Medical School, offered this account of the disease:
If I am asked the essential, non-contagious cause of cholera, I answer frankly—I do not know. Every agent in nature, real or imaginary, has been accused. Electricity, magnetism, earth, air, water, sun, moon, planets, comets, have each been arraigned in vain. There is a mystery which hangs over the origin and spread of epidemics, which will probably never be removed. The philosophers of the present day are no wiser on this subject than those who lived three thousand years ago. (1832, 86)
Typical of the writings on cholera during the first two cholera epidemics, Bronson’s muddled assessment reveals an unstable definition of the disease. Many possible causes, from comets to magnetism, are interrogated; all are found wanting. Bronson betrays the great confusion of allopathy, not only toward the cause of cholera, but also where to even look for such a cause. There was no paradigmatic account of disease. It is not that Bronson cannot make sense of the evidence; he has little vision of what the evidence should even look like. Absent this, he throws out some ideas and, finally dejected, expresses skepticism that cholera’s mystery will ever be solved. This is the lament of a doctor, who not only lacks a coherent road map to make sense of the disease, but doubts that such a road map even exists. His despondency is palpable. This inchoate account, however, does gesture toward the dominant perception of medical epistemology during the 1832 cholera epidemic. Lamenting that the “philosophers of the present day are no wiser on this subject than those who lived three thousand years ago,” Bronson identifies medicine as a practice of philosophy. This reflects the prevailing view of medicine during the period. Medicine was an exercise in philosophizing rather than scientific researching. Deploying rationalist, speculative systems to understand disease, doctors were less focused on interpreting facts; they were in the business of crafting elaborate philosophical systems.
Sixty years later, William Osler offered a very different account of cholera. In The Principles and Practices of Medicine, the preeminent medical textbook of the period, Osler (1895, 132) concisely defines cholera as “specific, infectious disease, caused by the comma bacillus of Koch, and characterized clinically by violent purging and rapid collapse.” Here we have a much neater definition of cholera. Gone are the uncertainty, the hesitating prose, and the horde of causal candidates. Cholera is now a specific disease caused by a specific microorganism. The authority appealed to is Robert Koch, a German laboratory scientist. In offering a scientific fact, plainly and succinctly stated, Osler displays confidence in the epistemological foundation of his profession.
No longer armchair philosophers, Osler’s doctors derive hard truths from the laboratory. Medicine is a science.
Bronson and Osler would hardly recognize the cholera of which the other speaks. The idea of cholera being caused by a microscopic organism would have seemed just as absurd to Bronson, as searching for cholera’s etiology in comets would have for Osler. This incommensurability speaks to a radical shift in medical epistemology. Typically, epistemological change is viewed as the straightforward product of scientific advancement, the progressive illumination of truth. Such accounts, however, invert temporality; epistemological systems must be accepted prior to recognizing something as truth, as these systems set the standards by which truth is judged. Bronson to Osler was not just a shift from ignorance to insight, from darkness to light. It involved a reformulation of what medical knowledge is and how it is to be obtained. To accept cholera as a germ meant accepting the laboratory as the loci of medical insight and the disease cultures growing in these labs as legitimate medical facts. For Bronson and his peers, this would have been unthinkable. But by 1895, they were well on their way to becoming medical common sense. In sixty years, medical knowledge had made the dramatic leap from an exercise in philosophical inquiry to a science rooted in the experimental methods of the laboratory.
These two changes—a dramatic shift in professional authority on one hand and an epistemological change on the other—coalesced to produce a medical profession unusual in the developed world. These changes were not just concurrent but intimately related, each contributing to the development of a medical profession widely recognized as exceptional among developed countries, in its steadfast—and successful—opposition to government incursions into medical practice (most evident in the AMA’s various campaigns against government-run health insurance), and its fixation on scientific and technological solutions. While physicians of many different countries eventually embraced the laboratory sciences, none did so with as much fervor as the U.S. medical profession.
