Knowledge in the Time of Cholera: The Struggle over American Medicine in the Nineteenth Century by Owen Whooley (review)

Whooley’s book is a well-written, well-researched narrative of the development of American medicine in the nineteenth century. Cholera, so extensively studied in several national contexts, acts here as a narrative center around which the story of American medicine can be loosely but usefully organized. Whooley begins and ends by emphasizing that this is not a triumphal narrative of scientific truth winning out against darkness, but a multiplot account of what he calls competing epistemes—what are at least competing political and social interests, as well as competing knowledge and value systems. One might wonder after Foucault why we need to argue quite so vigorously against a kind of Whig version of medical history as Enlightenment triumph. But as Whooley argues, historians of medicine often still assume that political and religious interests merely interfere with, without being able to permanently overcome, the juggernaut of scientific progress.

Whooley shows that many forces contributed to the negative qualities of American medical exceptionalism in the nineteenth century: the distrust of American democracy for claims derived from expertise and the AMA’s intransigence in the matter of homeopathic practitioners whom it regarded as quacks combined to limit the AMA’s ability to have a significant public voice, as did allopathy’s yielding of the new science of statistics to those same homeopaths. Perversely, it was a private citizen and homeopathic adherent—Rockefeller—who at the end of the period monetized American bacteriology’s successful growth, and allowed allopaths to gain a significant voice in public health by controlling the curriculum of American medical schools that he funded. As Whooley points out, this development was not inevitable, nor was it an unmixed blessing. For example, he cites the World Health Organization, which approached the 1992 outbreak of cholera in Venezuela as a military action against a bacillus, ignoring cultural and economic factors that contributed to the outbreak (p. 240). This shortsighted approach, Whooley credibly argues, is directly traceable to the history of American medicine’s late nineteenth-century choice to turn medicine into a lab science defined in opposition to arts or human sciences—an outcome the great physician and educator William Osler foresaw and deplored (pp. 210–11). Some of our present-day worries about the lack of human values in medical education and practice are results of nineteenth-century choices that were driven as much by politics of exclusion as by beliefs about medicine per se.

The project is not comparative, and many readers familiar with epidemic disease history will be struck chiefly by the distinctness of the American story, given that international exchange of medical knowledge was well established in the period. Occasionally, one could wish for a larger canvas. But a comparative work could not offer so richly textured a tale as that told here. And certainly Whooley’s American medical profession is far from isolated and Adamic; he traces its strong ties at different times to France and Germany, through both young doctors who traveled abroad for training and alliances between specific historical actors. It is very much an account of politics, paradigms, and power; Whooley’s approach doesn’t take him toward questions of history from below, and there is little here on race, gender, or region. As he acknowledges, the consolidation of the profession includes other stories not told here—the decline of female and folk practitioners among them. But he gives us a rich sense of the context of conflict in which American practitioners strove to seize power, and of who succeeded and how.

Several others have covered various questions Whooley treats here, as he details. However, Whooley puts together his various materials effectively in the service of his primary point—that competing views and values drove the development of American medicine rather than scientific innovation—in a compelling story, richly illustrated with a mix...