Free Knowledge in the Time of Cholera by Owen Whooley

Public confidence in regular medicine waned (Berman and Flannery 2001; Whorton 1982), as doctors were blamed for their inability to combat cholera and accused of fleeing in cowardice during their patients’ time of greatest need. American doctors’ opportunity to observe the workings of cholera in their own country did little to demystify the disease or assuage panic. To the contrary, it raised fundamental questions about the adequacy of medical knowledge. An anonymous letter to the
BMSJ
(1833b, 314) voiced the dismay of many physicians:
    Numerous are the pamphlets and compilations already before the public, detailing the extensive ravages of this destroyer of mankind; and yet how li ttle, in view of all that has been written, worthy of retention! What has hitherto been laid down in regard to the proper mode of treating epidemic cholera? To what source shall we direct the inquiring student for the gratification of his laudable curiosity, and the establishment of his views upon the best method of combating this disease? Upon this branch of the subject, previous accounts are irregular and contradictory. The little that is valuable lies buried in confusion, and covered with an almost impenetrable mass of worthless matter.
    The 1832 cholera epidemic forever altered the medical landscape, creating problems for the medical profession that would be transformed by enterprising alternative medical sects into a professional crisis of epistemological proportions.
    THE MAKING OF AN EPISTEMIC CONTEST
    This chapter recounts how an epistemic contest developed out of the 1832 cholera epidemic. The epidemic disrupted the normal functioning of regular medicine. But in itself it did not cause allopathic medicine to reevaluate its intellectual foundations or question its professional future. Rather, alternative medical movements transformed the opportunities afforded by the epidemic into a crisis that forced allopaths to give an epistemological account of their knowledge. In the politics of knowledge that ensued, regulars’ budding professional program was derailed, as state licensing laws, passed prior to the epidemic, were universally repealed. The intensification of competition in the newly unregulated medical market was joined with fierce debates over the nature of knowledge to produce an epistemic contest that would take nearly a century to resolve. Cholera may have entered the United States through a poor, unfortunate Irish immigrant, but alternative medical movements ensured that its humble origins belied its eventual impact.
    When cholera arrived, the intellectual foundation of allopathic medicine was already in a fragile state. Rationalism—the intellectual foundation of allopathy—was coming under increasing scrutiny by some within allopathy who advocated for a more empirical approach to medical knowledge. Cholera exacerbated these internal tensions. Unable to provide a coherent picture of the disease, regular practitioners attempted to justify their professional authority, not on intellectual grounds, but on their standing as learned men. With deaths mounting, however, these epistemological debates, for merly latent and circumscribed within the profession, became public issues with life or death ramifications. Alternative medical practitioners, particularly Thomsonians and homeopaths, drew on the uncertainty introduced by cholera to force public medical debates onto the terrain of epistemology. What they offered were more democratic medical epistemologies. Epistemologies imply a social order (Shapin and Schaffer 1985). At the most basic level, they discriminate between those who are legitimate knowers and those who are not. From this basic distinction follows cultural (i.e., whose testimony is to be trusted) and organizational effects (i.e., who controls the institutional production of knowledge). Epistemic contests open possibilities for the reformulation of hierarchies in knowing. As this chapter shows,