Knowledge in the Time of Cholera Read Free Page A

of these discoveries are subsequently accorded requisite acclaim and authority, often in the form of professional privileges.
    In the case of the professionalization of U.S. medicine, the truth-wins-out narrative has two variations. In its most basic form, professional authority was awarded to those who subscribed to true ideas, who made the key “discoveries” in the new science of bacteriology. “True” ideas won out over lesser, partial truths. Professionalization followed the imperatives of scientific progress, with the consolidation of professional power achieved through the gradual, rational incorporation of scientific principles into medical practice (see, for example, Bulloch 1979; de Kruif 1996; Duffy 1993; Rutkow 2010). The second variation of the truth-wins-out narrative shares the logic of scientific progress but adds the element of efficacy. Here professional authority is achieved, not only through the power of ideas, but in the results they obtain, as developments in medical knowledge led to more effective therapeutic or sanitary interventions, which legitimated professional authority of physicians. The germ theory rapidly led to new cures that justified its assumptions and solidified the authority of doctors.
    The seductive common sense of the truth-wins-out narrative muddies how we understand the history of the U.S. medical profession, the progress in medicine generally, and the origins of the tremendous authority afforded doctors in the United States. It ignores the heterogeneity of nineteenth-century medical thought, reducing professionalization to a single linear process. Rather than exploring the ascendancy of one
way
of thinking about medicine, it tells of a single march toward progress in medical knowledge. It obscures significant ideas once entertained but ultimately discarded and dismisses alternative medical movements as aberrations or mere repositories of ignorance, that is, if they are even considered at all. Intellectual developments are decontextualized, depoliticized, and presented as evolving according to the dictates of disinterested research rather than as part of a specific professional project. And the dissemination of bacteriological ideas is given no explanation other than a vague appeal to the propulsion of their self-evident truth: “By this time [1880] the news of Koch’s discoveries had
spread
to all of the laboratories of Europe and
had crossed the ocean
and inflamed the doctors of America” (de Kruif 1996 [1926], 119). Exercising what E. P. Thompson (1968, 12) terms the “condescension of posterity,” the truth-wins-out narrative naturalizes professional authority, transforming the flux of the nineteenth century into something of a predetermined outcome.
    While the truth-wins-out narrative is rarely laid out as explicitly as this, its underlying logic persists in our understandings of professionalization, as it squares with commonsense notions of the development of science, notions which the sociology of science has spent decades combating. But the history of knowledge does not conform to the strictures of common sense, and the truth-wins-out narrative cannot bear the weight of historical scrutiny. Take the two key discoveries in the history of cholera lauded in the truth-wins-out narrative—John Snow’s discovery of the waterborne nature of the disease in 1855 and Robert Koch’s identification of the cholera microbe in 1884. These true ideas, rapidly accepted, gave birth to bacteriology and scientific medicine, which led to the disease’s demise. A tidy story, yes, but it’s wrong. Snow’s famous cholera map can only be considered a tipping point in the debate over the etiology of cholera by reading history backward. The map, almost an afterthought in Snow’s work, had little effect in convincing skeptics of the validity of the contagion theory (Koch 2005; Vinten-Johansen et al. 2003). There is almost no mention of it in