Knowledge in the Time of Cholera by Owen Whooley Page B

of government involvement and democratic oversight. In the end, the key emergent theme in the history of U.S. medical politics is the tension between professionalization and democracy, which I discuss in the conclusion. The former stresses the recognition of a protected, privileged group of experts, in which the production of knowledge is mystified and insulated from public oversight. The latter stresses transparency and participation. The animating issue underlying the epistemic contest over medicine was the question of the place of expert knowledge in a democratic society. Indeed, without doing too much injustice to the nuance of the analysis, the entire epistemic contest could be read as an account of the persistent tensions between democratized epistemologies and the exclusive epistemological system proffered by allopathy. Skirting the public institutions of the state, allopathic physicians overcame democratic debate by avoiding it, persuading a small group of elite philanthropists to bankroll their professional project. The success of this “strategy of nondialogue” (Biagioli 1994, 216) was not lost on the AMA; it became its default strategy in subsequent debates over health care and public health in the first half of the twentieth century, and an ingrained part of its professional culture.
    Focusing on the epistemic contest over medicine as determinative in the professionalization of U.S. medicine opens an analytical space for understanding the nature of the ascendancy of the bacteriological model and the triumph of allopathic medicine over other alternative medical sects. The history of this epistemic contest yields a surprising, and disconcerting, finding, namely that the genesis of the U.S. medical system involved a repudiation of democratic principles. It also serves as an example of what the sociol ogy of epistemologies (Abend 2006, 3) can achieve, what an empirical focus on epistemology can tell us about the power/knowledge nexus (Foucault 1980). By taking a quixotic journey into the history of American cholera, we gain insight not only into the strange world of professionalization of U.S. medicine but also into the general politics of knowledge and the everyday practices of epistemology in democratic cultures.

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    CHOLERIC CONFUSION
    When cholera first attacked Europe in 1831, physicians were caught so unprepared that they struggled to even name the new malady, much less prevent its spread. 1 Among the names suggested were “cholera asphyxia,” “spasmodic cholera,” “malignant cholera,” “bilious cholera,” “convulsive nerve cholera,” “hyperanthraxis,” and the particularly poetic “blue vomit” (Longmate 1966, 66). Eventually, the disease was anointed “cholera,” a curiously misleading choice, given the amount of baggage the term bore. Under the centuries-old Hippocratic system, cholera referred to an excess of yellow bile (Hamlin 2009, 19). Over time this humoral definition morphed into a more generic stand-in for milder diarrheal diseases. Now, in the panicked days of the first pandemic, cholera underwent another definitional transformation—from “a transitory state of one’s constitution” to “a relentless and deadly invader” (Hamlin 2009, 20). This hasty christening caused much confusion among physicians and officials. The victimized poor, on the other hand, suffered no such appellative confusion; to them the new disease was known simply as “the pestilence.”
    Whatever its name, the new disease killed in a dramatic fashion. Doctors marveled 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 purged an abundant amount of “rice water” diarrhea. A “loose and relaxed state of the bowels” was attended “by frequent