by Owen Whooley
epistemic closure: and American Medical Association, 108, 238, 246; and epistemic contests, 20, 27, 181, 213–17, 238, 249, 251; insularity of, 246; and laboratory analysis, 214, 217, 218, 238–39; and meaning of disease, 224; and medical reform, 208–17, 219, 246; process of, 217, 231, 242; shaping of modern medical profession, 22, 28
epistemic contests: and allopathic/regular physicians, 26–27, 39, 67, 70, 85, 94, 96, 98, 106, 107, 108, 113, 153, 156, 158, 161, 243; and alternative medical movements, 21, 22, 26, 37–39, 48, 49, 59, 70, 71–72, 73, 80, 85, 224, 227, 230, 235, 243; and analogical theorizing, 253; and boards of health, 112–14, 115, 135, 146, 147, 189; and cholera epidemics, 22–23, 26, 59, 73, 78, 79–80, 217, 224; and competing actors, 19–20, 28–29; and competing epistemological systems, 18; concept of, 231–32, 248–51; conditions of, 19, 228, 251–53; contexts of, 233, 250; distinctiveness of, 17, 249; diversity of, 249; and embedded strategic action, 233, 249–50; and epistemological change, 16, 21, 229, 233, 249, 258n7; and expert knowledge, 190; and homeopathy, 26, 38, 59, 67, 71, 78, 79, 85, 93, 94, 98, 100, 107, 113, 153, 156, 158, 161, 179, 180, 181, 213–17, 224; and institutional arenas, 38, 59, 113, 249; and interaction between actors, 21, 71, 233; and Koch’s findings, 151, 153, 156, 158, 161, 180; legacy of, 237, 238; and legitimate knowledge, 17, 18, 20, 38, 81, 107, 259n15, 260n16; and medical professionalization, 226–33, 238; and motivations, 28–29; and organizational factors, 18, 20, 27, 38, 80, 81–83, 106–8, 188, 191, 213–14, 225, 232–33, 250; and power disparities, 20, 30; and radical empiricism, 85–87; role of discoveries in, 27–28; and single case study method, 250–51, 259n14; source materials on, 254–56; and Thomsonism, 38, 59, 67, 71, 78, 224
epistemological change: and alternative medical movements, 234–35; and education reform, 203; and epistemic contests, 16, 21, 229, 233, 249, 258n7; and medical professionalization, 4, 5, 9, 10, 11, 13, 221, 227, 229; politics of, 13; and shifting standards, 247
epistemological styles, 248
epistemology: assumptions about standards of truth, 9–10, 11, 12, 232, 247, 258n7; collective agreement on, 10; debates on, 13, 15–21, 247, 258n7; democratic view of, 62, 63, 243; empirical analysis of, 248; and feminist critiques, 259n11; historical epistemology, 247; and justification of knowledge, 15–16, 18, 42; and legitimate knowledge, 18, 38; linear progress of, 9–10; and philosophy, 16, 259n12; and power inequalities, 245–46; social epistemology, 244, 258n6; sociology of, 9, 12–13, 14, 16, 245–53, 258n6; and sociology of scientific knowledge, 15, 259n10; temporal directionality of, 11–12, 155; as universal, 153. See also medical epistemology
ethnicity, 188, 264n1
ethos, and epistemic authority, 18, 114–15, 116, 127, 146–47
Europe: cholera in, 31–33, 148, 183, 260n1; medical sciences in, 160; statistical techniques of, 58
evidence-based medicine (EBM), 252
evolution debates, 253, 266n10
Ewald, Paul, 25
expert knowledge: in democratic cultures, 26–30, 146, 190, 219–20, 242–46; and medical epistemology, 218, 219; and medical professionalization, 191, 227; performance of, 14; and pragmatism, 190; and private philanthropy, 200; and professions, 190, 227, 228, 243; and scientific expertise, 8, 190, 192–94, 198, 200, 203, 219, 226, 234, 258n5
Fenton, Reuben, 111, 133
fermentation theories, 92, 159
Ferran, Jaime, 183, 184, 265n6
fibromyalgia, 252
Flexner, Abraham, 200, 206–10, 211, 214, 216, 219–20, 223
Flexner, Simon, 202, 206
Flexner Report, 205–7, 208, 209, 223, 234, 245, 264n6
Flint, Austin, 89
Flower, Roswell, 187–88
Foucault, Michel, 11
Fourcade, Marion, 265n4
France, 32, 148, 150, 151, 156, 230–31. See also Paris School of medicine
Frasch, Herman, 199
Freidson, Eliot, 14, 219, 257n3
Fuller, Steve, 218–19, 258n6
Galileo, 252–53
Gates, Frederick T., 200–203, 207–8, 214
Georgia, repeal of medical licensing laws, 68–69
Germany: allopathic/regular physicians’ networks with, 154, 156, 158, 171–73, 176–77, 179; educational standards of, 204; government health care insurance in, 265n5; and homeopathy, 162; and Koch’s India expedition, 149; and laboratory analysis, 28; and medical professionalization, 231; university system of, 151
germ theory: acceptance of, 7, 148, 150, 151, 159–60, 161, 179, 180, 226, 229, 230–31, 260n21, 266n8; and authority of allopathic/regular physicians, 6, 28, 91–92, 154, 162, 165, 166, 167, 168, 178, 179, 180, 189; de Kruif on, 264–65n1; and diagnosis, 184; and discovery, 156, 158; and homeopathy, 163, 164–65, 168, 180, 226; limitations of, 240–41; and medical epistemology, 179, 193; and miasmatic theory of disease, 25; and promissory practice, 168–71; and public health, 160, 211–12; skepticism toward, 160–61, 178, 183; and sterile surgery, 239; variations of, 260n22
Giddens, Anthony, 261n2
Gieryn, Thomas, 14, 17, 259n15
Gilman, Daniel Coit, 204
Godkin, E. L., 187
Gold Rush of 1849, 76
government oversight of medical practice: American Medical Association’s opposition to, 4, 26, 29, 102, 189, 212, 236–38, 243, 265n5; and epistemic contests, 188, 190, 191, 217, 218, 243; and health insurance, 228–29, 237, 265n5; and laboratory analysis, 196, 202, 218–19, 230, 236; and quarantine measures, 186–88. See also boards of health; state legislatures
Grimes, James Wilson, 104
Griscom, John, 130
Hacking, Ian, 11–12, 16
Haffkine, Waldemar, 265n6
Hahnemann, Samuel, 55, 56, 97, 162–64, 180, 202, 261n6, 262n6
Halley, William, 138
Hamilton, F. W., 207
Hamlin, Christopher, 241
Hammond, William Alexander, 262–63n7
Haraway, Donna, 259n11
Harper’s Magazine, 160–61
Harper’s Weekly: cartoon showing political board appointees, 132, 133; and quarantine measures, 187
Harris, Elisha, 125, 130
Harrison, William, 186
health insurance, 228–29, 237, 265n5
healthy carriers, 178–79
Herter, Christian, 201, 202
Hiller, Frederick, 57
Hippocrates, 263n2
Hippocratic system, 31, 87
Holmes, Oliver Wendell, 101
Holt, Emmett, 201
Homeopathic Medical Society of Massachusetts, 104
Homeopathic Medical Society of the State of New York, 141
Homeopathic Physician, 164
homeopaths and homeopathy: on allopathic physicians, 257n1; and boards of health, 113, 115, 140–45, 147, 225; democratic rhetoric of, 54–59, 63–65, 79, 87, 107, 213, 215, 218, 261–62n10; and epistemic contests, 26, 38, 59, 67, 71, 78, 79, 85, 93, 94, 98, 100, 107, 113, 153, 156, 158, 161, 179, 180, 181, 213–17, 224; and germ theory, 163, 164–65, 168, 180, 226; government inclusion of, 93, 102–5, 213, 234, 262–63n7; internal divisions, 164–65, 215; and knowledge advocacy, 235; and Koch’s findings, 28, 151, 154, 161, 162–65, 178, 179, 180, 181; and lay public, 58, 61, 64, 79; and medical epistemology, 234; medications of, 216; method of, 55–56; narrative of prediscovery, 162–65, 170, 225–26; as quackery, 27, 96, 97, 98, 99–100, 105, 106, 142; rebirth of, 264n8; relationship with allopathic/regular physicians, 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; and repeal of medical licensing laws, 64, 69, 93, 142; resistance to laboratory analysis, 213–17; and John D. Rockefeller, 197, 199, 202, 203; and sanitary interventions, 27, 124; and self-experimentation, 56, 261n7; and statistics, 56–58, 63, 64, 79, 90, 91, 101, 107, 118, 124–25; styles of reasoning, 59
Hooker, Worthington, 67, 99
Hopkins, Johns, 204
hospitals: and education reform, 204, 209; and full-time controversy, 209–11; history of, 209; and laboratory analysis
, 194–95, 208, 209–11, 219; and medical authority, 257n3; and Paris School of medicine, 84
humoral system of disease, 31, 42, 50
Hungary, 32
immigrants, 188, 264n1, 264n2
immunology, 159, 178–79
India, cholera in, 149, 166, 167, 181, 260n1
inductive reasoning, 44, 56
industrial production, 196, 198, 201, 235–36
infectious diseases: and allopathic/regular physicians, 2; and bacteriological paradigm, 170, 195, 239; cholera defined as, 3, 170, 189; and diffusion model, 152; and germ theory, 168; and Koch’s research, 167, 177, 178, 183
Intelligent Design (ID), 266n10
International Hahnemannian Association (IHA), 165
invisible college, 171, 179
isomorphism, 20
Jackson, Andrew, 34–35, 63, 261n9
Jacksonian era: and allopathic/regular physicians, 83; and anti-intellectualism, 49, 62, 63; cultural changes of, 234; democratic ideals of, 61–62, 63, 64, 65, 200; and democratized epistemologies of alternative medical movements, 26, 39, 49, 50–59, 61, 71; egalitarianism of, 8, 50, 51, 53, 61, 63, 94, 190, 220; hostility to science in, 12, 260n16; politics of, 238; and statistics, 58
James, William, 246, 262n3
Jasper, James, 261n2
Jenkins, William T., 186–87
Jenner, Edward, 266n7
Johns Hopkins Medical School, 201, 202, 204–5, 206, 207–8, 210, 226
Johns Hopkins University, 172–73, 204–5, 264n5
Journal of the American Medical Association, 170, 254
Kellogg, Edwin Miller, 58
King, Dan, 68
Knorr-Cetina, Karin, 192
knowledge advocacy, 19, 235
knowledge claims: and epistemic contests, 16, 17, 18, 227, 231–32, 253; historicizing of, 152; methods-based claims, 18; rhetorical forms of, 248; within epistemological system, 153
knowledge production: conflict model of, 21; and epistemic closure, 246; organizations for, 248
Koch, Robert: and bacteriological paradigm, 152, 154, 157, 158, 166–71, 172, 178, 179, 180, 183, 192; causal link of microbe to disease, 158–59, 160, 169, 171, 178, 241, 263–64n4, 264n5; finding of cholera microbe, 3, 6, 7, 27–28, 149–52, 171, 176, 178–79, 189, 221, 225–26, 239, 263n1; transformation of research into discovery, 153–58, 166, 171, 178, 179, 182; uncertainty and ambiguity in findings, 24, 149, 158, 160, 168, 178, 179, 180, 183
Koch Imperial Health Office, 201
Kuhn, Thomas S., 12, 258n7
laboratory analysis: and boards of health, 183, 184, 185, 188, 208, 211–12; and cholera epidemics, 184; and diagnosis, 184, 189, 194, 195, 209, 239; and education reform, 194, 203–8, 210, 211, 216, 223, 245; and epistemic authority, 183–84, 190, 191, 194, 196, 219, 220; and epistemic closure, 214, 217, 218, 238–39; exclusionary nature of, 244, 245; expense of, 196, 209, 264n7; experimental methods of, 4; and German-American network, 154, 156, 158, 171–73, 176–77; homeopathy’s resistance to, 213–17; and hospitals, 194–95, 208, 209–11, 219; interventionist nature of, 192–93, 194, 205; and knowledge production, 248; and medical epistemology, 10, 22, 28, 153–54, 158, 160, 165, 167, 176–78, 181–82, 191–96, 205, 209, 211, 218–19, 220, 222–23, 224, 226, 229, 230, 235, 241–42, 244, 245, 246, 265n2; and medical facts, 3, 4, 191, 192, 193; and patient/doctor relationship, 195, 219, 264n8; and public health, 176, 183, 184–85, 210, 211–12; and quarantine measures, 184–87; and John D. Rockefeller, 198, 199, 235–36, 244, 264n3; and Welch, 172–73. See also bacteriological paradigm
Lakoff, Andrew, 251
Larson, Magali, 238
Latin, allopathic/regular physicians’ use of, 46, 52, 67
Latour, Bruno, 156–57, 263n3
law of similars (similia similibus curantur), 56, 93, 163, 216
lay public: and allopathic/regular physicians, 67, 72, 80, 95, 102; and homeopathy, 58, 61, 64, 79; and New York State legislature, 64–65; and patient/doctor relationship, 195; role in democracy, 220, 242, 243; and sanitary interventions, 211; and Thomsonism, 65
Lee, Robert E., 109
Lewins, Robert, 48, 261n4
Lewis, Sinclair, 221–23
Lincoln, Abraham, 104
Lippe, Arthur, 58–59
Lister, Joseph, 266n8
Little, Arthur D., 198
Loeb, Jacques, 265n3
Löffler, Friedrich, 263n4
Loomis, Albert L., 166, 210
Louis, Pierre Charles Alexandre, 89
Magendie, M., 31
Maine State Board of Health, 203
Mannheim, Karl, 243
Mantini-Briggs, Clara, 240
Maryland, repeal of medical licensing laws, 69
Massachusetts, 135, 262n5
Mather, Cotton, 266n7
McPherson, John, 187
measles, 239
Medical and Surgical Reporter, 169
Medical College of Geneva (New York), 40
medical epistemology: and allopathic/regular physicians, 42, 45–48, 80, 83–84, 90–93, 191–96, 217; and alternative medical movements, 26, 39, 49, 50–59, 61, 71, 218, 234; debates on, 12, 13, 15, 19, 38, 42–43, 153, 196, 218, 226, 232, 242; democratic visions for, 38, 50–59, 61, 66–68, 69, 70, 71, 79, 195, 196, 218–19, 230, 242; during cholera epidemic of 1832, 2–3, 5, 11; hierarchies of, 59, 59, 63, 67, 70, 102; and Koch’s findings, 151, 153; and laboratory analysis, 10, 22, 28, 153–54, 158, 160, 165, 167, 176–78, 181–82, 191–96, 205, 209, 211, 218–19, 220, 222–23, 224, 226, 229, 230, 235, 241–42, 244, 245, 246, 265n2; and Lewis’s novel, 221–23; and medical facts, 3, 4, 11; and medical professionalization, 4, 10, 11, 15, 21, 234–38; of Paris School, 84; reformulation of, 2, 4, 5–6, 9, 10, 11, 12, 15, 179, 181, 193, 203, 227; and truth-wins-out narratives, 5–6
medical facts: and epistemic contests, 17, 191; and laboratory analysis, 3, 4, 191, 192, 193; and medical epistemology, 3, 4, 11; and radical empiricism, 85–89, 191; and truth-wins-out narratives, 9
medical licensing laws: conflicts over, 4; and epistemic contests, 38, 59–61; and laboratory analysis, 208, 216; repeal of, 26, 37, 39, 60–61, 60, 64–70, 69, 71, 78, 83, 93, 142, 213, 224; states’ passage of, 1, 39, 59–60; and Thomsonism, 53, 54, 64
medical professionalization: and autonomy, 70, 136, 140, 212, 219, 257n3, 263n7; and bacteriological paradigm, 191, 195, 208, 258n5; and class differences, 230; and competition, 2; concepts of, 81; consolidation of authority, 1, 2, 4, 5, 6, 7, 8, 12–13, 28, 37–39, 45, 185, 213–14, 219, 226, 236; debates on, 4–5, 12; and democratic ideals, 29, 242–46; effect of cholera epidemics on, 1, 2, 23, 26, 49; and epistemic closure, 238; and epistemic contests, 226–33, 238; and exceptionalism in U.S. medical system, 228–30; and expert knowledge, 191, 227; functionalist accounts of, 8; and laboratory analysis, 230, 242; and medical epistemology, 4, 10, 11, 15, 21, 234–38; and medical licensing laws, 59–60, 70; organizational factors in, 8–9, 81–82, 191, 213–14, 226, 243, 257n3; political explanations of, 8, 12, 15, 21, 29, 30; and private philanthropies, 5, 28, 29, 190, 226, 236, 242, 243–44; rethinking of, 234–38; and sanitary success, 27; sociological analyses of, 8–9, 13; and truth-wins-out narrative, 6, 7, 8, 10
Medical Record, 202
medical reform: and education reform, 208; and epistemic closure, 208–17, 219, 246; and epistemic contests, 19, 26, 189, 190; and German-American network, 154, 171–73, 176–77, 179; and germ theory, 178, 179, 189; and industrial philanthropists, 28; and laboratory analysis, 182, 188, 190–96, 203, 213, 226, 233; and Rockefeller Foundation, 213, 214, 215, 217, 218, 219, 226. See also bacteriological paradigm; sanitary movement
Medical Society of the County of New York, 97
Medical Society of the State of New York, 128, 135, 143
medicine: effect of cholera epidemics on, 22–24; egalitarian visions for, 39; heterogeneity of nineteenth-century medical thought, 6, 15, 106; politics of, 22, 26, 29, 30; as practice of philosophy, 3, 4, 42, 43, 45; as science, 2, 3, 4
Mellon, Andrew, 200
Metropolitan Board of Health of New York City, 27, 111–12, 113, 115, 123–24, 132–35, 225
Metropolitan Health Bill, 110, 111, 141
miasmatic theory of disease, 7, 25, 27, 92, 116, 257n2, 260n21
Michigan State Medical Society, 103–4
microscopy, 160
Miller, T. Clarke, 139
M’Naughton, James, 110
monopolies: and American Medical Association, 81; and homeopathy, 107; and medical epistemology, 242; and medical licensing laws, 68; Thomsonism on, 53–54, 63, 107
Murphy, Starr, 201
Nagel, Thomas, 15–16
Nation, 110, 132
National Board of Health, 135
nativism, 23, 188, 264n2
network formation: and discovery, 156–57, 171, 263n3; German-American network, 154, 156, 158, 171–73, 176–77, 178, 179, 226; and legitimacy for ideas, 14
New Jersey, 262n5
New Light Thomsonians, 79
New York Academy of Medicine (NYAM): and boards of health, 133, 143–44; on contagious nature of cholera, 92, 125–26; and exclusion, 97–98, 102, 107; and Koch’s findings, 165, 166; and sanitary interventions, 128, 129
New York Assembly Select Committee on Petitions, 65, 66, 69–70
New York City: cholera in, 33–35, 36, 74, 110–12; Five Points neighborhood, 33; public health efforts in, 184–85; and sanitary movement, 110–12
New York City Medical Council, 74–76, 75
New York Department of Health, 184, 185
New York Evangelist, 78
New York Journal of Medicine, 68, 89
New York Sanitary Association, 130
New York Senate Select Committee on Medical Colleges and Societies, 66
New York Senate Select Committee on Petitions, 64–65
New York State legislature: and allopathic/regular physicians’ defeat, 107, 108; and alternative medical movements’ arguments, 39; and board of health, 114, 132, 141; democratic reform in, 61–64, 261–62n10; and free and open debate, 65–68; and medical licensing law deregulation, 61, 64; and Metropolitan Health Bill, 111; and statistical data, 64
