Knowledge in the Time of Cholera (28 page)

Even critical histories succumb to the dubious causality of the diffusion model. In his study of the social transformation of U.S. medicine, Starr (1982, 135) writes,

The key scientific breakthroughs in bacteriology came in the 1860s and 1870s in the work of Pasteur and Koch. The 1880s saw the extension and diffusion of these discoveries, and by 1890 their impact began to be felt. The isolation of the organisms responsible for the major infectious diseases led public health officials to shift from the older, relatively inefficient measures against disease in general to more focused measures against specific diseases.

Here Starr falls prey to the crude causal explanations of the diffusion model. Uncritically accepting the bacteriological findings as “scientific breakthroughs,” Starr describes their diffusion using the passive voice (e.g., the 1880s “saw the extension and diffusion of these discoveries”). The “isolation of organisms”—an idea—is given its own agency, as it “led” public health officials to certain measures. Letting ideas speak for themselves, these analyses offer limited insight into
how
these ideas came to be seen as paradigmatic discoveries. For even if we take for granted that a discovery is true (in whatever sense of the word), we still need to account for its acceptance. To avoid the tendency of ascribing to an idea “an ontological life of its own” outside of its historical emergence (Tomes and Warner 1997, 9), we need to historicize knowledge claims, embedding them in the context of their reception to unearth the processes by which actors advocate for ideas so as to get them institutionalized as discoveries.

Discoveries are not born. They are not unearthed in single moments of time but materialize over a long period
following
that moment. The sociology of scientific knowledge (SSK) has long criticized the folk understand
ing
of a discovery “as a unitary event, one, which, like seeing something, happens to an individual at a specifiable time and place” (Kuhn 1962, 760). In practice, discovery is a social process involving two components—the production of a fact and the subsequent conferral of the status of discovery upon that fact. In relation to the first phase—the production of a fact—SSK, through laboratory studies, has produced a comprehensive body of research that illuminates the way in which scientists produce or construct scientific knowledge in practice (e.g., Knorr-Cetina 1999; Latour and Wool-gar 1986; Pickering 1984;). It is the second phase—how the special status of “discovery” is conferred upon an idea—that remains underexamined. Discoveries do not spring up fully formed in the research process. Rather, they are defined as such through public struggles over the meaning of a given idea between actors with various agendas. In other words, discoveries are produced via work performed on an idea subsequent to its creation. The transformation of an idea into a discovery is a process that occurs literally after the fact.

Rather than conceptualizing discoveries as discrete events with agency of their own, this chapter examines the transformation of Koch's research into a discovery by embedding it within the epistemic contest over medical knowledge between regulars and homeopaths in the United States. One of the central problems with causal accounts that locate the efficacy of an idea in its content is the misguided assumption that the evaluation of ideas occurs within a universal epistemological system, in which facts are always facts according to some universal criteria. As I discussed in the introduction, this is a dubious assumption, bereft of any historical sensibility. Knowledge claims can only be judged—and only make sense—from within an epistemological system. Because medical epistemology was in flux throughout the nineteenth century, the actual process of reception of Koch in the United States is not a simple story of truth winning out; it is a story of struggle over basic epistemological assumptions. And discoveries can be a resource in an epistemic contest. The status of a discovery confers an importance and uniqueness upon an idea, something to be valued in and of itself. Because a discovery carries within it an implicit acceptance of certain epistemological assumptions, getting an idea accepted as a discovery can go a long way in capturing authority for one's epistemological system. In a sense, epistemological assumptions can ride the coattails of a widely respected discovery. In this case, Koch's discovery became a sort of Trojan horse that carried a commitment to the epistemology of the laboratory. Understanding how this
idea
was folded into a program of epistemological reform along the lines of the laboratory is necessary for explaining how Koch's research became a discovery in the United States.

How did Koch's research get reconfigured as a paradigmatic discovery for a new program of allopathic scientific medicine? Examining a case in which the production of an idea was relatively isolated from the context of reception allows for a targeted investigation of the interpretive work involved in the discovery process. Less concerned with what Koch did, I focus on the subsequent interpretations—and struggles over interpretations—of his research within the U.S. context in the decades after Koch's announcement. Adopting an attributional model of discovery (Brannigan 1981), this chapter demonstrates how Koch's research was transformed into an allopathic discovery that heralded a new era of scientific medicine controlled by regulars. Reformers within both medical sects staked claim to Koch, and both faced external and internal challenges in their attempts to align Koch's ideas with the preexisting systems of thought of their respective sects. In this “mnemonic battle” (Zerubavel 1999, 98), bacteriological advocates constructed discovery narratives that sought to situate Koch's research in the tradition of their respective sects, while simultaneously downplaying the ambiguity of Koch's initial findings through the production of promise. The first part of this chapter outlines the different narratives offered by homeopaths and regulars to show how the allopathic narrative of emergent discovery was more effective than the homeopathic narrative of prediscovery in providing a justifiable rationale for acting on Koch's finding.

The allopathic narrative provided an interpretive rationale for the embrace of bacteriology, but to solidify their ownership of Koch, allopathic physicians needed to supplement it with the organizational practice of building a network that linked them to Koch. The second section describes how allopathic reformers, building on their narrative justification, forged links with Koch and German laboratory science. In doing so, they claimed ownership of Koch's research and configured the idea—cholera as a germ—into a discovery that heralded a new era of medicine. For an influential subset of regulars, Koch's research became a discovery, and as owners of this discovery, allopathic reformers got to define the terms of the future of bacteriological medicine. When Koch became allopathic, homeopaths retreated into an oppositional stance that denied the legitimacy of the germ theory and that would prove professionally fatal.

An
Attribution Model of Discoveries

Sociological theory on the notion of the discovery traces its roots to Robert Merton (1968), who noted the simultaneous emergence of the same discoveries arrived at independently by multiple scientists. Rather than singular, unique events, the existence of multiple discoveries suggests the influence of broader social and cultural processes on the progression of science. Additional research in the sociology of science further undermines the folk notion of discoveries by showing how scientific practice is inherently social (Shapin 1994; Shapin and Schaffer 1985), how laboratories actively intervene in natural processes, rather than passively observe them (Hacking 1983; Knorr-Cetina 1999), and how extrascientific factors influence scientific practices (Bloor 1991; Haraway 2006; Harding 1986, 1998). Discoveries are made, not unearthed.

However, the production of an idea is only the first step in the discovery process. To fully grasp how an idea becomes a discovery requires an analysis that moves “downstream” from the laboratory (Gieryn 1999). An attribution model of discoveries examines how discoveries are constituted over time via interpretive and organizational work done to ideas postproduction and, in turn, how the newly minted discovery is subsequently disseminated (Brannigan 1981). The emphasis is placed on the socially defined status conferred upon an idea—a status characterized by originality, singularity, and decisiveness. The “discovery-ness” of an idea is not inherent to the idea itself but is obtained through socially mediated interpretive practices. And the power of the status of a discovery is derived from its perceived significance. Contrasted to other possible statuses—replication or normal science—it transforms an idea into a watershed event that alters the future of knowledge.

There is a key temporal dimension to this status, as the event of the discovery demarcates the ignorant past from the promising future. To deem something a discovery is an exercise in marking time. The extraordinary present of the discovery reinterprets the past and anticipates a new future. The past becomes a period of ignorance and a repository of error, resolved and redeemed by the discovery. The future, on the other hand, becomes a rich new vista of possibility, emanating from the discovery. Because the attribution is a marking of a singular event heralding a new future, it confers upon its owner a certain degree of authority over this future. With this au
thority
come professional, intellectual, and material payoffs to claiming a discovery for one's intellectual community. And as a vessel for particular epistemological assumptions, discoveries can be an important resource in epistemic contests. If one's idea is accepted as a self-evident discovery, it can naturalize the epistemological assumptions underlying it and, in a sense, smuggle them into legitimacy. With the future course of intellectual activity at stake, actors often jockey to claim discoveries to promote their epistemological vision.

As this chapter demonstrates, the configuration of a discovery involves both organizational and cultural practices. Actor Network Theory (ANT) has long recognized the importance of networks in the configuration and dissemination of discoveries, showing that the success of an idea depends on the creation of networks by which multiple actors are enrolled into the project of promoting it (Callon 1986; Latour 1987, 1988, 2005; Law 1992). In his exemplary study of the spread of Louis Pasteur's germ theory in France, Bruno Latour (1988) argues that Pasteur's ideas regarding microbes were successful because he was able to enroll allies, especially hygienists, in his project. This newly constructed network brought the laboratory into the field, disseminated Pasteur's germ theory, and promoted his research as a singular discovery. Network formation, as related to the ownership of a discovery, is particularly important in situations like the case discussed here when the production of the idea is severed from the context of its reception. For actors removed from the context of production, forming networks linked to those who produced it is essential in claiming ownership of an idea and using it to serve one's ends. In order for homeopathic or allopathic physicians to use Koch's idea in their epistemic contest, they had to form connections to Koch's laboratories, connections that were not predetermined, as both sects were similarly isolated from German science.

There is a crucial interpretative dimension required to establish the intellectual rationale for building networks. In other words, networks are necessary, but not sufficient, to configure a discovery. The transformation of Koch's research into a discovery first required significant interpretative work to be performed on the idea in order to make it acceptable—and accessible—to the very actors who would subsequently carry it along the network. Here is where Latour's account of Pasteurization stumbles. In a sense, he skips this intermediate interpretive step between the production of the idea and the construction of a network. Focusing primarily on practices
of
network-building, Latour largely ignores the practices of interpretation and sense-making necessary for building networks. In deploying military metaphors, he overemphasizes the building of alliances (Paul 1990), reducing actors' sense-making practices to the alignment of interests.
³
But ideas are adopted not only because they serve certain interests; they must also make sense to the actors adopting them. A discovery must be recognized, incorporated into, and reconciled with preexisting schemas. It also must find or prepare an audience willing to change its commonsense perceptions to accommodate it (Zerubavel 2003).

Because the attribution of a discovery marks a certain idea as a crucial event in time, the construction of narratives becomes a key interpretive practice for actors seeking to obtain the attribution of a discovery for an idea and to subsequently build a network around it. As analytical constructs, narratives make sense of disparate events by organizing them into a coherent relational whole through emplotment and attention to sequencing (Bruner 1991; Davis 2002; Polletta 2006; Riessman 1993; Tilly 2006; White 1980). They form a crucial component of the collective actors' repertoires in their struggles over meaning (Davis 2002; Patterson 2002). In narratives of discoveries, the “event” of the discovery is configured as the pivotal moment in the plot that demarcates the ignorant past from the promising future.

To transform Koch's research into a discovery, bacteriological advocates within allopathy and homeopathy constructed competing discovery narratives that sought to situate Koch's research in a manner that spoke simultaneously to the past and the future of their respective sects. Aimed internally at converting reluctant peers and externally at capturing ownership of Koch, these narratives emphasized certain elements of Koch's research that resonated with the particular traditions of allopathy and homeopathy and excluded those aspects that did not.