democratic decision-making.
Each chapter is organized around a pivotal moment in the history of cholera, exploring issues pertaining to epistemological politics so as to develop the concept of the epistemic contest. The first two chapters describe the initial confusion surrounding cholera, the decline in authority for allopathic medicine that resulted, and the limited allopathic response to this professional/epistemic crisis. Chapter 1 focuses on the effective campaigns of alternative medical sects to transform the perceived allopathic failure during the first cholera epidemic into an epistemic contest that eventually led to the wholesale repeal of licensing laws. Thomsonism, an egalitarian, anti-intellectual grassroots medical movement, and homeopathy, an elite urbane sect that sought to claim the mantle of science, offered more democratic epistemological visions for medicine that contrasted with the elitist, obfuscating epistemology of rationalism. They compelled regulars to provide an epistemological justification for their professional privileges in state legislatures. Drawing on theories of rhetoric, I show how the democratized epistemologies of alternative medical sects resonated, rhetorically and epistemologically, with the state legislatures influenced by Jacksonian ideals. Licensing laws were universally repealed in the 1840s; the medical market was deregulated; and an epistemic contest was born.
Chapter 2 describes the allopathic response to the democratic challenges of alternative medical sects, particularly homeopathy. After the 1848 epidemic, allopathic reformers redefined the identity of regulars, embracing a radical empiricism inspired by the Paris School of medicine. While this shift ostensibly allowed allopaths to claim some democratic bona fides, the selective manner in which they adopted the Paris School led to intellectual fragmentation. Eschewing the search for general laws in medicine (Warner 1998), allopathic reformers lacked standards to adjudicate competing knowledge claims. To solve this âproblem of adjudicationâ they adopted an organizational strategy, establishing the AMA and substituting the criterion of membership for epistemological standards in order to deem homeopathy as quackery. Still, the exclusionary politics of the AMA failed to sway legislatures, which remained committed to the idea that open debate would lead to the best medical knowledge. This chapter reveals that epistemic contests are not waged by cultural/epistemological means only; organizational strategies can be usefully analyzed as epistemic practices as well.
Chapter 3 discusses a key event in the history of choleraâthe establishment of the Metropolitan Board of Health of New York City and the rise of public health more generally prior to the 1866 epidemic. United around a common understanding of cholera as a miasma, an eclectic group of actors, which included sanitary-minded allopathic physicians, homeopaths, social reformers, and sanitarians, came together to prevent cholera by cleaning up the environment. This was accomplished to great result, and the board of health was widely credited with having prevented another cholera epidemic in New York City. As public health grew in popularity, allopathic physicians sought to transform sanitary success into justification for their professional recognition. Once again, the legislatures refused to recognize these claims, as sanitarians framed them as contrary to the apolitical nature of the public health enterprise. Public health remained an eclectic movement rather than an allopathic-dominated one. This chapter explores the multiple ways in which claims to epistemic authority can be made, noting that
how
actors choose to make these claims has ramifications for their professional goals.
The final two empirical chapters explore the consolidation of allopathic professional authority through epistemic closure. Chapter 4 describes the ways in which American physicians
Each chapter is organized around a pivotal moment in the history of cholera, exploring issues pertaining to epistemological politics so as to develop the concept of the epistemic contest. The first two chapters describe the initial confusion surrounding cholera, the decline in authority for allopathic medicine that resulted, and the limited allopathic response to this professional/epistemic crisis. Chapter 1 focuses on the effective campaigns of alternative medical sects to transform the perceived allopathic failure during the first cholera epidemic into an epistemic contest that eventually led to the wholesale repeal of licensing laws. Thomsonism, an egalitarian, anti-intellectual grassroots medical movement, and homeopathy, an elite urbane sect that sought to claim the mantle of science, offered more democratic epistemological visions for medicine that contrasted with the elitist, obfuscating epistemology of rationalism. They compelled regulars to provide an epistemological justification for their professional privileges in state legislatures. Drawing on theories of rhetoric, I show how the democratized epistemologies of alternative medical sects resonated, rhetorically and epistemologically, with the state legislatures influenced by Jacksonian ideals. Licensing laws were universally repealed in the 1840s; the medical market was deregulated; and an epistemic contest was born.
Chapter 2 describes the allopathic response to the democratic challenges of alternative medical sects, particularly homeopathy. After the 1848 epidemic, allopathic reformers redefined the identity of regulars, embracing a radical empiricism inspired by the Paris School of medicine. While this shift ostensibly allowed allopaths to claim some democratic bona fides, the selective manner in which they adopted the Paris School led to intellectual fragmentation. Eschewing the search for general laws in medicine (Warner 1998), allopathic reformers lacked standards to adjudicate competing knowledge claims. To solve this âproblem of adjudicationâ they adopted an organizational strategy, establishing the AMA and substituting the criterion of membership for epistemological standards in order to deem homeopathy as quackery. Still, the exclusionary politics of the AMA failed to sway legislatures, which remained committed to the idea that open debate would lead to the best medical knowledge. This chapter reveals that epistemic contests are not waged by cultural/epistemological means only; organizational strategies can be usefully analyzed as epistemic practices as well.
Chapter 3 discusses a key event in the history of choleraâthe establishment of the Metropolitan Board of Health of New York City and the rise of public health more generally prior to the 1866 epidemic. United around a common understanding of cholera as a miasma, an eclectic group of actors, which included sanitary-minded allopathic physicians, homeopaths, social reformers, and sanitarians, came together to prevent cholera by cleaning up the environment. This was accomplished to great result, and the board of health was widely credited with having prevented another cholera epidemic in New York City. As public health grew in popularity, allopathic physicians sought to transform sanitary success into justification for their professional recognition. Once again, the legislatures refused to recognize these claims, as sanitarians framed them as contrary to the apolitical nature of the public health enterprise. Public health remained an eclectic movement rather than an allopathic-dominated one. This chapter explores the multiple ways in which claims to epistemic authority can be made, noting that
how
actors choose to make these claims has ramifications for their professional goals.
The final two empirical chapters explore the consolidation of allopathic professional authority through epistemic closure. Chapter 4 describes the ways in which American physicians
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