Introduction

For as long as realists and instrumentalists have disagreed, partisans of both sides have pointed in argument to the actions and sayings of scientists. Realists in particular have often drawn comfort from the literal understanding given even to very theoretical propositions by many of those who are paid to deploy them. The scientists' realism, according to the realist, is not an idle commitment: a literal understanding of past and present theories and concepts underwrites their employment in the construction of new theories. The theme of this book is philosophy and technology, and here's the connection: new theories point out—and explain—new phenomena. So realism, claim the realists, is at the heart of science's achievement of what Bacon, that early philosopher of technology, identified as science's aim: new knowledge offering new powers.

How does this become an argument for realism? Scientific realism enters the story twice: (tacitly) adopted by scientists, it motivates scientific practice, while the success of the practice might support realism as a philosophical view of science. To fill the story in, we need to know what the realist view is, and an account of how a scientist who accepts it would behave differently from one who does not. But there are many ways to be a realist about science, of which the following is a representative sample: (Aims) Science aims to provide literally true stories about the world, to be a process of discovery and of explanation rather than one of construction and of saving the phenomena.

With a population of nearly half a million people occupying an area of 8 square kilometers, Naples in 1884 was the largest city in Italy. A great Mediterranean seaport famous for evil smells and foul water, it provided perfect conditions for an epidemic of Asiatic cholera. So well known were the pernicious effects of even a visit to the city that in the final decades of the nineteenth century the Neapolitan economy suffered severely as frightened tourists avoided Naples entirely or made fleeting visits to the ancient sights, where they drank only wine and covered their noses. The press, complained Alderman Vincenzo Pizzuti in 1873, ‘writes of us as if we were semi-barbarian Africans’.

The city faced south onto the Bay of Naples, stretching for three miles in an arc along the coast. To the traveller arriving by sea, Naples rose above the harbour in the shape of an amphitheatre. The Lower City, built on land reclaimed from the Mediterranean, formed the stage. It was enclosed to the north and west by a semicircle of hills; to the east by swamps; and to the south by the waters of the Bay. The stage was divided into two unequal crescents by the spur of the Pizzofalcone hill. To the west stood the small and salubrious neighbourhood of Chiaia; to the east, the teeming slums of the Old City. The slopes of the encircling hills were graced by the elegant homes of the Upper City.

The medical histories of Upper and Lower Naples were sharply divergent, and it was common for local doctors to write of the great metropolis as consisting of two separate cities.

Masterful Machinery

Technology, according to Derry and Williams's Short History, ‘comprises all that bewilderingly varied body of knowledge and devices by which man progressively masters his natural environment’. Their casual, and unconscious, sexism is not unrelated to my present topic. Women enter the story as spinners, burden bearers and, at long last, typists. ‘The tying of a bundle on the back or the dragging of it along upon the outspread twigs of a convenient branch are contributions [and by implication the only contributions] to technology which probably had a feminine origin’. Everything else was done by men, and what they did was master, conquer, and control. It is also significant that Derry and Williams take it for granted that ‘the men [sic] of the Old Stone Age, few and scattered, developed little to help them to conquer their environment’: until the advent of agriculture, and settled civilization, there was, they say, neither leisure nor surplus. Later investigation strongly suggests, on the contrary, that hunter-gatherers have time to play with, and keep their ‘surplus’ where it belongs—out in the world. Settled civilization brought us—or most of us—discipline, time-keeping and back-breaking labour. Maybe, as they suggest, Sumerian priests were ‘the first leisured class’, but the emphasis should be on ‘class’. In more egalitarian, less ‘civilized’ days, we were all as leisured as any other primate group, and doubtless as preoccupied with mutual grooming, mutual manipulation and the decorative arts.

FROM SCATTERED CASES TO A NEW EPIDEMIC: THE SPRING OF 1911

Almost unnoticed, Asiatic cholera persisted throughout the winter of 1910–11 – despite resolute denials by Italian and Neapolitan officials. As we have seen, occasional ‘stragglers’ attracted the attention of anxious American officials for months after Italian authorities had declared the autumn outbreak finished. In January 1911 Henry Geddings informed Washington that the continuing existence of foci of infection and ‘the inertness of the authorities’ warranted a ‘gloomy prognosis’ for the spring and summer. On the basis of this information, Surgeon- General Walter Wyman published in the sanitary bulletin Public Health Reports an official warning to Americans contemplating ‘the usual tour of southern Italy in the spring and summer’. The abiding presence of the disease in the city, he argued, suggested that there was a grave danger that the return of warm weather would unleash a new and possibly even larger epidemic. American citizens would be wise, he cautioned, to consider alternative destinations.

Between February and May, a sharp divergence developed between the public pronouncements of Italian authorities and the confidential files of the Department of Public Health. Stunned by the Neapolitan revolt, state officials categorically repudiated all suggestions that there was any danger to public health. The outbreak that caused such alarm first in Apulia and then in Naples, they claimed, had been totally vanquished. Signor Cusani, the Italian Ambassador to Washington, specifically protested to the American Government about the offensive, unjustified and – above all – public musings of the Surgeon-General and his subordinates. ‘Italy’, Cusani informed the Secretary of State, ‘is entirely free from cholera and public health is excellent.’

This is not the first time the title ‘Art and Technology’ has been used, but to distinguish what I have to say from Walter Gropius's Bauhaus exhibition of 1923, I am subtitling my paper ‘an old tension’, where the architect spoke of ‘a new unity’. In a way, Gropius has been proved right; the structures of the future avoiding all romantic embellishment and whimsy, the cathedrals of socialism, the corporate planning of comprehensive Utopian designs have all gone up and some come down. We have a mass media culture also largely made possible by technology. Corporatist architecture, whether statist ‘social housing’ or freemarket inspired, films, videos, modern recording and musical techniques are all due to technological advances made mostly this century. Only in a very puritanical sense could what has happened be thought of as inevitably bringing with it enslavement. All kinds of possibilities are now open to artists and architects, which would have been imaginable a few decades ago. No one is forced to use these possibilities in any specific way.

If I have a complaint about what has happened in the arts this century, it is not that technology is constraining imagination, or making slaves of us. It is rather that it isn't constraining it enough, that technology is removing those very constraints which made art a matter of craft, rather than an unfettered display of expression and imagination.

In recent years there has been an increasing focus on the role of instruments in the study of nature, both by historians and by philosophers of science, and even by a few art historians who are interested by the images produced by these devices.

My own approach is that of the historian of science with an interest in the philosophical implications. To the instrument historian, science is applied technology, put to the task of understanding nature by revealing the kinds of beings of which she is ultimately composed.

Scientific instruments have become indispensable in collecting and ‘dissecting’ natural phenomena from the seventeenth century when the techniques were developed that are at the roots of modern western technology-orientated science. At the most general level, these instruments made visible that which could not be seen by the unaided senses: Galileo Galilei's surface of the moon as seen through his primitive telescope, or Robert Hooke's compound eye of the fly as seen through his microscope, and in more recent times, C. T. R. Wilson's particle tracks in the cloud chamber.

None of the images produced by these devices was, of course, strictly neutral, in the sense that in their making a complex relationship existed between the observer and the observed.

Introduction: The Medical and Legal Background

There are many conflicting attitudes to technological progress: some people are fearful that robots will soon take over, even perhaps making ethical decisions for us, whilst others enthusiastically embrace a future largely run for us by them. Still others insist that we cannot predict the long term outcome of present technological developments. In this paper I shall be concerned with the impact of the new technology on medicine, and with one particularly agonizing ethical dilemma to which it has already given rise.

A patient lies in a hospital bed. He is not in a coma. He sleeps, wakes, sleeps again. His limbs remain crooked and taut but are capable of primitive reflex movements. The touch of bedclothes can elicit a grasp reflex. He sometimes chews, scratches, swallows, grinds his teeth. He may even grunt and groan. The patient's family, in hope, interprets these movements as signifying the stirrings of renewed mental activity. But the neurological experts shake their heads. They know that the patient is not clinically dead because the brain stem is intact. But he has suffered the almost total disintegration of his cerebral cortex. He is thus in a state of wakefulness without any kind of awareness: he neither sees, feels nor hears. He cannot communicate in any way. He is profoundly and permanently insensate. For, a person in this condition, the medical profession has coined an acronym: PVS. The patient, usually an accident victim, is in a ‘persistent vegetative state’.

Morals and politics occupy themselves, if not exclusively, then at any rate centrally, with questions of value. Politicians and moralists deplore the alleged decline of values while pressing supposedly new ones upon us. The fiercest sympathies and antipathies, whether between individuals or between societies, are those which stem either from a community or from a divergence of values. ‘So natural to mankind,’ said Mill, ‘is intolerance in whatever they really care about.’

Let us ignore the obvious question, raised in their different ways by both Marxism and sociobiology, as to whether values are ultimately reducible to interests. It might even be a somewhat dull question, since whatever one really cares about must almost by definition constitute an interest. So what, practically speaking, is gained by grounding it in some other kind of interest, when one already has all the information about it one needs? Why should one's caring about a thing require any explanation, so long as it belongs to the class of things commonly recognized, even by Mill, to be worth caring about?

Some more questions: what is it to say that something is valuable, or a value? Is there a difference between a thing's having a value and its being a value? If I say I prefer x to y, I am saying that I set a higher value on x; but is that quite the same as saying that as far as I personally am concerned x constitutes or embodies a value?

In a recent book devoted to giving an overview of cognitive science, Justin Lieber writes:

It is the aim of hundreds of workers in the allied fields of Cognitive Science and Artificial Intelligence to unmask these computation processes and install them in digital computers.

Professor Kevin Warwick of the University of Reading says that within fifteen years there will be machines appreciably more intelligent than any human being and, echoing John McCarthy, he foresees: ‘a machine-based intelligent environment, and we're just what we would regard as animals within that’.

The image of the computer or robot endowed with genuine mentality resonates deeply in the collective psyche of late twentieth-century Western culture, and that image often has the dark overtones hinted at by Professor Warwick and made explicit in films such as Westworld. And no wonder. The computer is the most complex technology ever devised by man, and we hold it up as a mirror to our own souls.

This book, perhaps like many works of history, began as much by accident as by design. The idea for it originated through research on an entirely unrelated topic – the violent political history of the anarcho-syndicalist movement among the farm workers of the South of Italy during the height of the Liberal regime between 1900 and the First World War. Field work for that purpose revealed frequent references to Asiatic cholera during the summer of 1910 and the social responses it provoked, which included riots, assaults on physicians, a xenophobic fury against gypsies, mass flight and the revival of religiosity and superstition. These events were intriguing and unexpected in a modern industrial state in the twentieth century. Furthermore, it rapidly began to appear that the disease offered as illuminating a means of examining the structure of southern Italian society as the original political history on which I had embarked. My interest grew further with the realization that, despite the tumults that marked its passage, the epidemic had never been the subject of study by a modern historian, and was almost totally ignored in general histories of the period. The intention of writing a history of the epidemic of 1910 in Italy began to take firmer shape.

Recent writings on Asiatic cholera made the idea of a study of a twentiethcentury epidemic still more appealing. There is an extensive international literature on cholera, with monographs on Britain, France, Spain, Germany, Canada, Russia, Sweden and the United States. But there is a serious imbalance in the field with an overwhelming emphasis on the dramatic first European experiences with the disease, and almost nothing at all on Italy.

History is a collective enterprise, and one of my chief pleasures as an author is to express my appreciation to the many people who have contributed to this project. Professors Francesco Barbagallo and Paolo Frascani generously provided me with helpful advice on archives in Naples. Dr M. Soscia, Medical Director of the Cotugno Hospital, was a kind host, and he graciously assisted me in locating materials in the Hospital library and archive. The staffs at the National Library of Medicine at Bethesda, Maryland; the National Archives in Washington; the National Library at Naples; the Archive of the Bank of Naples; the State Archive at Naples; and the Sterling Library at Yale University provided endless and invaluable assistance in locating sources.

Colleagues at Royal Holloway, University of London and at Yale University have given helpful advice and support. Professors Henry Turner, Jr and John Harley Warner read the first draft of the manuscript, and made wise and valuable suggestions. The anonymous readers at Cambridge University Press offered helpful and informed criticism. Naturally, I alone am responsible for any errors that remain.

Research also requires financial support, and the Wellcome Trust made possible numerous field trips to Naples and to Washington, and enthusiastically encouraged my early research proposal. Sabbatical leave from Yale University and a grant from the Griswold Humanities Fund enabled me to bring the work to completion.

Most of all, however, I would like to express thanks to my wife, Judith. She was an inexhaustible source of enthusiasm, advice and humour. It is more than a rhetorical flourish to state that this book would not have appeared without her.