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Knowledge in the Time of Cholera: The Struggle over American Medicine in the Nineteenth Century
Author(s): Owen Whooley (Author)
- Publisher: University of Chicago Press
- Publication Date: 10 April 2013
- Edition: Illustrated
- Language: English
- Print length: 320 pages
- ISBN-10: 022601763X
- ISBN-13: 9780226017631
Book Description
Vomiting. Diarrhea. Dehydration. Death. Confusion. In 1832, the arrival of cholera in the United States created widespread panic throughout the country. For the rest of the century, epidemics swept through American cities and towns like wildfire, killing thousands. Physicians of all stripes offered conflicting answers to the cholera puzzle, ineffectively responding with opiates, bleeding, quarantines, and all manner of remedies, before the identity of the dreaded infection was consolidated under the germ theory of disease some sixty years later.
These cholera outbreaks raised fundamental questions about medical knowledge and its legitimacy, giving fuel to alternative medical sects that used the confusion of the epidemic to challenge both medical orthodoxy and the authority of the still-new American Medical Association. In Knowledge in the Time of Cholera, Owen Whooley tells us the story of those dark days, centering his narrative on rivalries between medical and homeopathic practitioners and bringing to life the battle to control public understanding of disease, professional power, and democratic governance in nineteenth-century America.
Editorial Reviews
Review
"Owen Whooley has gone after big game!
Knowledge in the Time of Cholera is bold and assertive, forcing a reconsideration of the historical and sociological relationships between medicine and science, and providing an impressive analysis of the deeply intertwined development of these two professions."--Thomas Gieryn "author of Cultural Boundaries of Science: Credibility on the Line""There are books on the history of cholera, on the laboratory and scientific networks, and on epistemology and science, but none like this one. Owen Whooley has produced a truly original book, an important intervention in science studies, history of medicine, and nineteenth-century American society and culture."--Alexandra Minna Stern "author of Eugenic Nation: Faults and Frontiers of Better Breeding in Modern America"
"This is a valuable and interesting book that will be of interest to scholars from many fields. It makes a contribution to cholera studies but, more importantly, it adds new dimensions to the sociological literature on medical professionalisation. Furthermore, Whooley's conceptualisation of the epistemic contest, elaborated in his concluding chapter, should prove useful in analysing many intellectual debates. I expect we will see it utilised repeatedly by future scholars."-- "Sociology of Health & Illness"
"Whooley provides a sustained attack on traditional narratives of the straight-line upward trajectory of scientific discovery and professionalization of physicians. . . . [This] book is for those who relish academic combat and can delve into notions of epistemology wielded as weapons of control."-- "Health Affairs"
About the Author
Excerpt. © Reprinted by permission. All rights reserved.
KNOWLEDGE in the TIME OF CHOLERA
THE STRUGGLE OVER AMERICAN MEDICINE IN THE NINETEENTH CENTURY
By OWEN WHOOLEY
THE UNIVERSITY OF CHICAGO PRESS
Copyright © 2013 University of Chicago
All rights reserved.
ISBN: 978-0-226-01763-1
Contents
ACKNOWLEDGMENTS............................................................xiINTRODUCTION: OF CHOLERA, QUACKS, AND COMPETING MEDICAL VISIONS............11 CHOLERIC CONFUSION.......................................................312 THE FORMATION OF THE AMA, THE CREATION OF QUACKS.........................733 THE INTELLECTUAL POLITICS OF FILTH.......................................1094 CHOLERA BECOMES A MICROBE................................................1485 CAPTURING CHOLERA, AND EPISTEMIC AUTHORITY, IN THE LABORATORY............183CONCLUSION: MEDICINE AFTER THE TIME OF CHOLERA.............................221APPENDIX: A COMMENT ON SOURCES.............................................254NOTES......................................................................257REFERENCE LIST.............................................................267INDEX......................................................................295
Excerpt
CHAPTER 1
CHOLERIC CONFUSION
When cholera first attacked Europe in 1831, physicianswere caught so unprepared that they struggled to even namethe new malady, much less prevent its spread. Among the names suggestedwere "cholera asphyxia," "spasmodic cholera," "malignant cholera," "biliouscholera," "convulsive nerve cholera," "hyperanthraxis," and the particularlypoetic "blue vomit" (Longmate 1966, 66). Eventually, the disease wasanointed "cholera," a curiously misleading choice, given the amount of baggagethe term bore. Under the centuries-old Hippocratic system, cholera referredto an excess of yellow bile (Hamlin 2009, 19). Over time this humoraldefinition morphed into a more generic stand-in for milder diarrheal diseases.Now, in the panicked days of the first pandemic, cholera underwentanother definitional transformation—from "a transitory state of one's constitution"to "a relentless and deadly invader" (Hamlin 2009, 20). This hastychristening caused much confusion among physicians and officials. The victimizedpoor, on the other hand, suffered no such appellative confusion; tothem the new disease was known simply as "the pestilence."
Whatever its name, the new disease killed in a dramatic fashion. Doctorsmarveled at the speed at which cholera claimed those in their prime(Rosenberg 1987b). According to Dr. M. Magendie (1832, 6), of Sunderland,cholera "cadaverizes in an instant the person whom it attacks." Victims purgedan abundant amount of "rice water" diarrhea. A "loose and relaxed state ofthe bowels" was attended "by frequent loose or watery discharges" (Atkins1832, 65) with up to 10 percent of a person's weight lost within hours. Butcholera's most macabre symptoms were the "cholera voice" and the surrealcolor of its victims. Patients took on an eerie bluish pallor just before dying,a ghastly visage of impending death. And the blue victims emitted strangesounds. One haunted doctor reported in the Boston Medical and SurgicalJournal (BMSJ), "In the most deadly form of cholera there is a tone of voice,a wail, which once heard, can never be mistaken; by him, upon whose earit has fallen in the accents of anguish, it can never be forgotten" ("CholeraVoice," 1832, 148). More than the number dead, it was the nature of cholerathat caused it to loom large in the popular imagination (Humphreys 2002).
Cholera plunged Europe into turmoil. Hungary and France each lostover one hundred thousand people to the disease. Cholera claimed anotherfifty-five thousand in England. These raw mortality counts only hinted atthe horrors on the ground. Europe's inadequate infrastructure of charitableorganizations and government institutions was overwhelmed. Churcheswere converted into makeshift hospitals, while their cemeteries swelled.A report from Paris described the deteriorating scene: "The deaths are sonumerous every day that hearses have become altogether inadequate tothe purposes for which they are ordinarily used, and the dead are carriedto their burial places in large wagons" (BMSJ 1832b, 254). Cholera killed itsvictims quicker than communities could bury them (Grob 2002, 108). Whereverit touched, cholera produced a type of "epidemic psychology" (Strong1990) of suspicion, fear, and stigmatization. The feeble actions adopted byEuropean governments heightened tensions, often resulting in riots fueledby rumors of physician-led conspiracies against the poor (Briggs 1961; Burrelland Gill 2005; Durey 1979; Morris 1976). Faced with the breakdown ofthe social fabric, many looked to the heavens, conjuring up supernaturalexplanations for cholera. Seizing this opportunity, shrewd religious leadersused the scourge to admonish their flocks for their moral laxity.
Anticipating cholera jumping the Atlantic, American physicians scouredreports from Europe for any useful information on the disease. The editorsat the Boston Medical and Surgical Journal (1831a, 5) instructed every Americanphysician "to watch with eagle eye the progress of this dreadful malady,and to treasure up in his mind every incident in its history which may aid informing philosophical views with regard to its treatment." But the profusereporting offered scant medical intelligence (Hamlin 2009, 110). Measuredanalyses were difficult given the circumstances. Helpless in the face of "KingCholera," European doctors could not agree on the most basic details of thedisease. Was it a new disease or a more virulent form of an old one? Whatwas its cause? Did it prey on the weak and immoral or kill indiscriminately?Which treatments were most effective? As doctors impotently mulled thesequestions, deaths accumulated. Hope dwindled. Having tried "every meanssanctioned by recorded experience," a London physician voiced the futilityfelt by many European doctors: "To our patient, laboring under a violentand advanced attack of Spasmodic Cholera, no solid expectation of recoverycould be extended" (BMSJ 1831a, 8). Eventually, American physicians gaveup on gaining any insight from abroad. An anonymous letter to the BMSJ(1832a, 189–190) summed up the situation:
We have nothing, therefore, to learn from the practice of the most distinguishedphysicians in Europe, except to notice their errors, and to avoidthe rocks and shoals upon which they have made shipwreck. Let us turnthese scenes of horror to the writers of our own country.... Seeing theutter failure of the European physicians, in their treatment of the presentepidemic, it behooves our practitioners to make themselves masters of allprincipal writers of their own country, who have been familiar with cold,sinking febrile disease.
While few doctors clung to the hope that cholera would not reach the UnitedStates or that the country's salubrious environment would limit its spread,most resigned themselves to the fact that they would get the chance to seethe disease for themselves, as the Atlantic Ocean was no longer an insurmountablebarrier for Europe's problems given advances in sea travel.
On June 26, 1832, the inevitable occurred. Cholera arrived in New YorkCity, by way of Canada. An Irish...
