Owen WhooleyCholera and Quacks: The Struggle over Nineteenth Century Medical Knowledge Dissertation Abstract Between the 1840s, when nearly all state medical licensing laws were repealed, and the early 20th century, orthodox medical physicians experienced a dramatic shift in professional authority. Throughout the 1800s, alternative medical movements successfully challenged orthodoxy’s claims to expertise in a number of institutions. However, at the turn of the century, orthodox physicians redefined their expertise under the bacteriological model of disease, and in turn, created one of the most powerful professions in the U.S. This striking reversal cannot be attributed solely to the superior efficacy of scientific medicine under the bacteriological paradigm; bacteriology did not yield significant therapeutic interventions until the 1930s (Spink, 1978). Nor can the prevailing sociological explanations – the functional fulfillment of a societal need (Parsons, 1939), institutional strength (Ben-David, 1960; Berlant, 1975; Caplow, 1954; Kett, 1968), macro-cultural shifts (Starr, 1982), or networks (Latour, 1987) – account for the rise of the unquestioned professional authority of orthodox physicians. How were orthodox physicians able to regain professional authority, lost in the 1840s, under the bacteriological paradigm? Nineteenth century medical debates involved not only the specific facts, but, more fundamentally the standards by which medical knowledge could be attained. Competing medical sects offered vastly different visions of the nature of medical knowledge. Therefore, an explanation of the fluctuations in professional authority experienced by orthodoxy must take into account debates over epistemology, exploring the relationship between professional projects and epistemological debates. To do so, it explores that professionalization of U.S. medicine as an epistemic contest. An epistemic contest is one in which actors, advocating competing understandings of reality and the nature of knowledge, struggle in various realms to achieve validation to their approach to medicine. While they become manifest in controversies over specific knowledge claims, epistemic contests involve fundamental debates over which approach to knowing represents the most promising way to truth, and in turn, demands societal investment. I examine this epistemic contest over medicine through the case study of cholera - “the classic epidemic disease of the nineteenth century” (Rosenberg, 1987:1) - tracing the evolution of the conflicting definitions of the disease to analyze the strategies used by competing medical sects in the struggle to define disease and, in turn, advocate for their epistemological visions. Drawing on archival research of primary source documents from relevant institutions and actors, I reconstruct the history of cholera as a contested object of intellectual scrutiny. In the process, I identify a diverse array of practices– organizational and cultural – employed by collective actors in this contest. I argue that after being successfully challenged in a number of public institutions, orthodox physicians only achieved control over the definition of cholera when they insulated the debate from public scrutiny. They did this by convincing a small group of elites – namely the Rockefeller and Carnegie Foundations - to back their epistemological project outside of government institutions. This analysis stresses 1) the institutional embeddedness of epistemological debates, 2) the dynamic, give-and-take strategic action between actors that shapes the trajectories and outcomes of epistemic contests; and 3) the effects of epistemic contests on the allocation of expertise, professional authority, and organizational resources. Empirically, this project offers an alternative interpretation of the exceptional nature of the modern U.S. medical system by locating its origin in the particular trajectory of this epistemic contest. Additionally, in analyzing the specific case of cholera, it represents the first comprehensive analysis of all five U.S. cholera epidemics. Theoretically, by introducing the concept of the epistemic contest, I seek to bring sociology to bear on epistemology, long the province of philosophers, through an empirical focus on practices of epistemology. Curriculum Vitae |
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