Free Knowledge in the Time of Cholera by Owen Whooley Page A

Thomsonians and homeopaths sought to undermine the traditional social order of knowing in medicine, by proffering more democratic visions for medical epistemology, which posited a role for the public in the production of medical knowledge.
    To explain alternative medical sects’ success in transforming cholera into an effective epistemological challenge, I embed these epistemological debates within the institutional contexts in which they unfolded, rather than conceiving them as unfolding in an abstract entity like the “public sphere.” Epistemic contests do not occur in vacuums; they traverse the written page and enter into institutional and organizational contexts that shape their trajectories. Involved in sense-making (Weick 1979), organizations have internal cultures that shape the way information is understood, disseminated, and ultimately assessed (Vaughan 1996). In this way, organizations can be viewed as “epistemic settings” (Vaughan 1999) that delineate acceptable practices and procedures for the production and evaluation of knowledge. They are rhetorical spaces [that] “structure and limit the kinds of utterances that can be voiced within them with a reasonable expectation of uptake and choral support” (Code 1995, ix–x). I draw on the metaphor of an arena to make sense of the influence of organizations on epistemic contests. Arenas are defined by rules, more or less formalized, that shape strategic action—and influence outcomes—within them (Jasper 2006). Different capacities are needed to compete successfully in certain arenas, and therefore strategies must be designed to fit the context in which they are operating. 2 For intellectual disputes, actors must necessarily either forgo rhetorical arguments that are incongruous with that arena or lose.
    The post-cholera medical debates turned on the issue of licensing and, as such, were situated in state legislatures. By the 1830s, regular physicians had begun to gain professional authority, successfully lobbying thirteen state legislatures to pass licensing laws (Numbers 1988). Yet, only a decade after the 1832 epidemic, these laws were universally repealed. Drawing on the insights of “new rhetoric,” which links the success or failure of rhetorical arguments to the particular audiences and contexts that they address (Perelman and Olbrechts-Tyteca 1969), I examine the case of the New York State legislature in detail, to reveal the ways in which alternative medical movements’ arguments—and the manner in which they were rhetorically presented—resonated with antebellum state legislatures. While regulars’ hierarchal notions of medical knowledge clashed with the culture of the state legislature that was increasingly influenced by the ideals of Jacksonian democracy, alternative medical movements, seizing the democratic moment, promoted more egalitarian visions for medicine, which convinced the state legislatures to repeal the licensing laws and deregulate American medicine. In recounting this history, this chapter identifies the genesis of allopaths’ problematic relationship with the state that would frustrate their professional goals and perpetuate the epistemic contest over medicine for nearly a century.
    THE DECAY OF RATIONALISM AND THE CRUTCH OF AUTHORITATIVE TESTIMONY
    In his 1833 presidential address to the Medical Society of the State of New York, Thomas Spencer summed up the regular profession’s anxiety in the wake of cholera. Taking inventory of the ignorance surrounding the disease, Spencer (1833, 217) declared,
    Epidemics have in every age excited the dismay of mankind, and swept from the stage of human action a vast proportion of the inhabitants of the globe. The apprehension they produce is greatly enhanced by the rapidity of their movements, and the mysterious character in which these insidious enemies are enshrouded. It therefore becomes peculiarly important that the nature of