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

every disease prevailing under this form, should be carefully investigated, and that the symptoms and mode of treatment found most successful, should be faithfully recorded.
    This reasonable call for more research on cholera was sullied by the fact that, symptomatic of his peers, Spencer offered no clue as to
how
to answer these questions or what a “careful investigation” would actually entail. Instead, he goes on to dismiss cholera, not as something new, but as “a disease long known by the name of diarrhea serosa” (Spencer 1833, 218). In one quick stroke, Spencer explained away cholera’s mysteriousness, claiming it was merely a variation of a familiar disease. A simple name change divested it “of mysticism” (Spencer 1833, 220).
    Spencer’s startling conclusion contradicted allopathic common sense. Upon what did he justify his unusual claim? On the one hand, Spencer suggests that it is built upon empirical observations, the “detail of the symptoms and the practical results to which my observations and investigations have conducted me” (Spencer 1833, 218). Yet such observations are never presented, nor is the nature of his investigations. This appears to be little more than a rote appeal to experience. On the other hand, he seems to situate cholera within a traditional rational system of disease (e.g., “Is it
rational
to believe, that diarrhea has its essential character changed, by becoming epidemic, and is thus rapidly disseminated by contagion?” [Spencer 1833, 288 emphasis added]). As to the components of this rational system, Spencer likewise remains silent. Without evidence to assess or a rational system through which to make sense of his claims, Spencer’s declaration ultimately stands or falls on his own authority.
    As founder of the Medical College of Geneva (New York), Spencer was considered one of “the most eminent physician of central New York,” (“Death of Doctor Thomas Spencer” 1857, 6) and an important figure in allopathy. And while his conclusion may have been atypical, the fact that such a preeminent doctor succumbed to such muddled reasoning when encountering cholera underscores the epistemological problems facing regular medicine. When cholera arrived in the United States, the epistemological foundation of allopathy was languishing in ambiguity—torn between understated commitments to rationalism and jejune calls for empiricism. By 1832, the traditional foundation for allopathic knowledge—rationalism, or an approach to medicine by which particular cases were interpreted through universal, speculative systems of disease—was coming under criticism by regular reformers calling for knowledge rooted in bedside observation. Cholera intensified these calls, and the tensions between rationalism and empiricism, evident in Spencer’s attempt to walk a fine line between the two, grew.
    Given the uncertain foundation of medical knowledge, it is not surprising that during this period cholera was a truly heterogeneous thing, lacking a fixed identity and prone to multiple, often contradictory, interpretations. Regulars could not reach consensus on the most basic questions of the epidemic. Debate focused on three major issues, none of which would be resolved until decades later. These questions included:
    â€¢
Was cholera a new disease?
Despite its unusual symptoms and morbidity, many U.S. doctors doubted that cholera was something altogether new. The debate over cholera’s identity focused on “whether this be a
new
species of
morbid action
, one
peculiar to itself
, or whether it be
similar
to the medical actions that obtain in other cases, in the same structures, and
differing
from them
only in degree
” (Hott 1832, 60). Complicating matters was the fact that the very
idea
of specific disease entities—that diseases had discrete causes and characteristic courses—was contested (Rosenberg 1987b,