Knowledge in the Time of Cholera

by Owen Whooley

  A final direction for future research into epistemic contests is to see whether the concept is useful when applied to cases at different levels of analysis via “analogical theorizing” (Vaughan 2004). While this book explores meso-level practices, there is no logical imperative to restrict epistemic contests to this level of analysis. Indeed, epistemic contests may be just as prevalent, or more so, at a micro-interactive level. Once again, medicine is a good place to find such micro-level epistemic contests. For example, there is research showing fundamental incongruity in understandings of mental illness that play out in the clinical interaction between psychiatrists and patients (Whooley 2010). Or one could examine the conflicts between the standards of scientific evidence and legal evidence in the courtroom through the lens of an epistemic contest (e.g., demanding an expert witness to claim 100 percent certainty when the standards of science cannot possibly allow her to do so). Such analyses might lack the ability to account for large-scale changes over time, but they would likely provide insight into the ways in which actors advocate for epistemological positions that are only visible at the interactive level.

  Regardless of what form this research will assume, sociology stands to gain much insight by reorienting epistemology away from speculative thought experiments toward the everyday practices by which actors adjudicate knowledge claims. Epistemological issues are not just the province of ivory tower philosophers; they are practical problems that must be negotiated in social life.

  Because of this, we can learn from the quacks, dreamers, and medical reformers of the nineteenth century.

  APPENDIX

  A COMMENT ON SOURCES

  In researching this book, I examined a wide variety of historical documents, culling data from book manuscripts, professional journals, meeting minutes, newspapers, magazines, legislative documents, and even memoirs and diaries. I sampled documents from each of the relevant collective actors (i.e., orthodox physicians, homeopaths, Thomsonists, sanitarians) and organizations (i.e., state legislatures, professional societies, boards of health) involved in the epistemic contest. Using these source materials, I was able to index the changes in medical knowledge, reconstructing the history of cholera as an object of intellectual scrutiny so as to gain insight into the more general epistemic contest over medicine in the nineteenth century.

  To provide a baseline for this history, I traced the debates over cholera as they took shape in two medical journals, the Boston Medical and Surgical Journal and the Journal of the American Medical Association. Not only do the pages of these two journals contain debates over cholera; they also include professional polemics as many authors used the journals as a forum to rebut claims of competing medical sects. Moreover, their continuity allowed me to follow the evolution of the debate for the entire time period under concern (roughly 1830 to 1915).

  Having established this foundation, I conducted a more targeted investigation of additional archival materials, which included:

  • Public Documents of the Collective Actors Involved. These documents—journal articles, pamphlets, and editorials—consciously address a public audience, and, thus, reveal actors’ arguments, rhetoric, and frames regarding cholera, as well as the epistemic assumptions underlying these.

  • Meeting Records of the Collective Actors Involved. Transactions of meeting proceedings by the relevant actors balance public documents by providing a window into actors’ strategic deliberations, illuminating internal debates obscured in the more consciously public documents.

  • Institutional Records. Institutional records (i.e., legislative documents, internal sanitary reports, etc.) provide insight into the efficacy of actors’ arguments in particular organizational environments. Because epistemic contests occur within the institutions, institutional documents provide some sense as to the causes of success or failure of particular arguments. These documents include the institutional rationale for taking one side over another in the adoption of particular policies.

  All told I analyzed and coded over one thousand documents in detail and read many, many more. I approached each document as a rhetorical object that reflected a particular position within the epistemic contest, situating it within the longer debate of which the document was a part. My analysis of the documents assumed a dual tack. First, when examining the debates over cholera, I attended to the manner in which actors made truth claims about the disease and understood the nature of medical knowledge, focusing on both the form and content of their arguments. I analyzed not only the specific claims about cholera but also the epistemological assumptions underlying these claims (i.e., the nature of the facts contained therein, the presentation of knowledge claims, the authorities drawn upon, etc.). Second, I drew on internal documents from relevant organizations to reconstruct the strategies that relevant collective actors employed in the epistemic contest. The epistemic contest did not only unfold on the pages of old medical journals; it encompassed a number of strategies, both cultural and organizational, by which actors sought to achieve epistemic recognition. In other words, these internal documents shed light on the professional strategies actors adopted. Furthermore, because institutions have their own epistemologies and cultural norms, I embedded my analyses of these strategies within their institutional context to account for their efficacy in specific institutions.

  Most of these materials were located in seven archives: 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 Academy of Medicine, the New York Historical Society, the Parnassus Library at the University of California–San Francisco, and the Rockefeller Foundation Archive Center. Below is a list of key sources.

  Orthodox Medicine

  • American Medical Times (1860–1864)

  • Boston Medical and Surgical Journal (1828–1928)

  • Journal of the American Medical Association (1883–Present)

  • Medical and Surgical Reporter (1856–1898)

  • New York Journal of Medicine and Collateral Sciences (1843–1856)

  • Transactions of the American Medical Association (1848–1882)

  • Transactions of the Medical Society of the State of New York (1807–1925)

  • Transactions of the New York Academy of Medicine (1851–1903)

  Homeopathy

  • American Journal of Homeopathy (1853–1923)

  • The Homeopathic Examiner (1840–1847)

  • The Physician’s and Surgeon’s Investigator (1880–1889)

  • Transactions of the American Institute of Homeopathy (1844–1908)

  • Transactions of the Homeopathic Medical Society of the State of New York (1863–1896)

  Sanitarians

  • Annual Report of the Metropolitan Board of Health (later titled Annual Report of the Board of Health of the Health Department of the City of New York) (1866–1912)

  • The Plumber and Sanitary Engineer (1877–1880)

  • The Sanitarian (1873–1904)

  • Selections from Public Health Reports and Papers Presented at the Meetings of the American Public Health Association (1873–1907)

  Thomsonism

  • Boston Thomsonian Manual (1840–1845)

  • Botanico-Medical Recorder (1837–1848)

  • The Thomsonian Botanic Watchman (1834–1835)

  • The Thomsonian Messenger (1841–1845)

  Popular Press

  • Harper’s Magazine (1850–present)

  • The New York Times (1851–present)

  NOTES

  INTRODUCTION

  1. I refer to the dominant sect of nineteenth-century America as “regulars,” “allopathic physicians,” or “regular physicians.” In adopting this nomenclature, I intentionally avoid referring to them as “orthodox physicians,” a common practice among many historians. The use of “orthodoxy” tacitly privileges the dominant sect as “real” or “normal” medicine and conveys a degr
ee of cohesion in thought that is historically problematic. This is not to suggest that my nomenclature is neutral. There are problems in using “regulars” and “allopathy” as well, namely the politically charged nature of the labels. Still, my choice of these two terms reflects an attempt at a more neutral nomenclature. The dominant sect referred to themselves as “regulars,” while homeopaths and alternative medical sects (somewhat derisively) called them “allopaths.” Using the two terms interchangeably I hope to, in effect, cancel out their ideological baggage. But there is no escaping the normatively laden nature of name-calling in nineteenth-century medicine. Recognizing this, I use “regulars” and “allopaths” heuristically to maintain the crucial incumbent/challenger distinction by identifying those in the dominant position in opposition to the challengers of alternative medical movements.

  2. The miasmatic theory of disease, popular during the mid 1800s, held that diseases were caused by miasma (pollution), or noxious “bad air” in the atmosphere. Such air contained poisonous vapors and decaying material, that when inhaled, caused disease.

  3. For example, Berlant (1975) examines how advocates of medical science came to monopolize medical work in the United States through the “organizational conduct” of AMA, which captured important organizations (i.e., hospitals) to achieve its goals (Berlant 1975, 48). Similarly, Freidson (1970) highlights the relation of medicine to the state to account for the great autonomy of the U.S. medical profession. Other studies focus on the importance of particular institutions for the consolidation of medical authority, such as hospitals (Rosen and Rosenberg 1983) and the educational system (Ben-David 1960; Ludmerer 1985; Markowitz and Rosner 1973).

  4. This oversight could be avoided if Starr instead conceived of culture as practice—that is, culture as a sphere of practical activity shot through by willful action, power relations, struggle, contradiction, and change (Sewell 2005). By conceiving culture as separate from, and indeed hovering above, human action, Starr fails to interrogate the ways in which cultural forms are produced and reproduced through the practical activities of social actors. Starr therefore tries to understand the transformation of medicine within the broader changes in culture and society, not the role that physicians played in creating these broader cultural changes.

  5. Incidentally, Starr’s temporality is a bit off, as the professionalization of medicine occurred before bacteriology’s true successes. Furthermore, a valuation of scientific expertise under Progressivism, a key factor for Starr, did not dictate which scientific program was to be adopted. Most alternative medical sects saw their own programs as the epitome of science. The Progressive Era’s general embrace of science cannot explain why the particular science of bacteriology was adopted.

  6. This research resonates with the program of “social epistemology” as laid out by Steve Fuller (2002), which recognizes that knowledge is intrinsically social and that forms of knowledge contain an implied social order. However, Fuller situates his program of social epistemology squarely within philosophy; his intent is to achieve a normative assessment of the social organization of knowing. The analysis in this book resides more squarely within sociology; I seek to explain rather than prescribe. For this reason, I refer to what I’m doing as a “sociology of epistemologies” (Abend 2006, 3), not social epistemology. In adopting the plural “epistemologies” I intend to convey that epistemology is not one empirical object, the way philosophers conceive of it, but many different empirical objects.

  7. Because of the ubiquity of the concept of paradigms in analysis of intellectual change, a word on the relationship between my analysis and Kuhn’s is in order. Clearly, there are similarities between Kuhn’s paradigm shifts and my exploration of epistemological change. They both challenge the progressive view of knowledge by showing how standards of good research change from era to era. The difference is one of emphasis. Kuhn focuses on scientific paradigms and models of good science that share more or less similar epistemological commitments (i.e., hypothesis testing, empiricism, etc.). I am interested in cases where these assumptions are contentious, arguing that the dynamics of epistemic contest vary in important respects from paradigm shifts.

  8. In terms of knowledge debates, Abbott focuses primarily on the issue of abstraction and the various cognitive strategies professionals used to achieve “optimum abstraction” (Abbott 1988, 105). The case discussed in this book reveals a great diversity in types of strategies—cultural and organizational—deployed in epistemic contests.

  9. Because of their ubiquity and authority, it is easy to forget that professions are a relatively new way to organize knowledge in society. It was not until the early twentieth century that they were institutionalized and became uncontroversial. Prior to this, the history of claims to professional standing were highly suspect. This history of professions is often obscured by sociologists, who tend to take professions for granted and, in the process, unintentionally naturalize them. The case under discussion in this book shows how, in the democratic fervor of the nineteenth-century United States, the legitimacy of professions was widely challenged.

  10. Much of the explicit discussion of epistemology within SSK is relegated to reflexive moments, when SSK contrasts its research agenda with the dominant positivistic accounts of science or when defending itself against accusations of relativism (Kurzman 1994).

  11. The great exceptions to this rule are feminist critiques of science that offer a more conscious exploration of epistemology. Donna Haraway’s Primate Visions (2006) is an exemplar of this research, as she reveals how gendered thinking insinuates itself in the thinking and practices of primatologists.

  12. While critical philosophical approaches (e.g., American pragmatism and naturalized epistemology) have tried to steer philosophy toward empirical analyses, it remains largely a speculative exercise, focused on elucidating logical arguments rather than studying how people negotiate these problems in real-life encounters.

  13. The basic conceit of this book is that concept formation and elaboration are essential exercises in sociological research as good concepts “capture essences, identify dominant forces, determine our focus, and suggest future direction” (Light and Levine 1988,11).

  14. Here I should acknowledge the limitations of a single case study. The strength of a single case study is that it allows for fine-grain process-tracing that can accommodate complex causality and a more detailed examination of context (George and Bennett 2005). My attention to historical detail allows for theory-building regarding epistemic contests by identifying important strategies, processes, and factors at play. But in adopting a single case study method, I trade depth for breadth. When extending the concept of epistemic contests to other cases, there is a limit to what I can say generally. I can say that if an epistemic contest is at play, then there are certain qualities it will assume, but whether or not these conditions hold, is, at the end of the day, an empirical question. What I offer future researchers is not a general theory of epistemic contests, but an elaboration of the various strategies, factors, and processes involved in epistemic contests.

  15. This is not to suggest that Gieryn’s work ignores epistemological issues altogether. To the contrary, he is concerned with “epistemic authority,” which he defines as “the legitimate power to define, describe, and explain bounded domains of reality” (Gieryn 1999, 1), and some of his case studies—most notably, his analysis of John Tyndall’s promotional work for science through London’s Royal Institute—involved fundamental debates over the nature of knowledge. Nevertheless, these epistemological dimensions are not explicitly theorized by Gieryn. He is focused on investigating “science-in-culture,” specifically how the adjudication of competing truths is accomplished through settlements of the boundaries of science. He wants to explore how and why science becomes so widely trusted. My analysis orbits around the more fundamental epistemological question of what constitutes legitimate knowledge, of which the answer “science” is only one of many possible answers.


  16. While credibility contests originate in conditions in which science possesses an exalted status, historically the epistemological valuation of science fluctuates over time. During the Jacksonian era, science was looked upon with great suspicion (Hofstadter 1963), and this suspicion fueled the epistemic contest over medicine.

  17. The model of historical change animating my analysis is taken from Sewell (1992), who, while acknowledging the influence of structural factors on human action, retains a principal commitment to the role of the agency—the choices and understandings of historical actors—in bringing about transformations.

  18. The counting of cholera epidemics is not as straightforward as one would think. For most of the epidemics discussed here, cholera stayed in the United States for a discrete period of time. This was not the case for the epidemic beginning in 1848. The intensity of the epidemic waned after 1849, but pockets of cholera remained throughout a six-year period, with an uptick in 1854, after which cholera disappeared for over a decade. Following the precedent set by Charles Rosenberg (1987b), I treat 1848, and its subsequent milder incarnations up to 1854, as a single epidemic.