¶ 1 Leave a comment on paragraph 1 0 Welcome. Please read the instructions for reviewing before commenting. We ask contributors to be generous when thinking along with our pieces and to keep in mind that the final chapters are intended to be short essays. Visit matteringpress.org for more information on its other books. Readers might also want to have a look at this resource created by one of the book’s editors, Emily Yates-Doerr, which catalogues key Open Access anthropology publications.
¶ 2 Leave a comment on paragraph 2 0 By Annemarie Mol
¶ 3 Leave a comment on paragraph 3 0 In 1976, when I was eighteen and he was eighty-four, my grandfather told me the case of the young farmer and the turpentine. By then this case was more than fifty years old. It stemmed from the time that my grandfather, Chris Mol, worked as a general practitioner in what was then a poor, sandy region of the Netherlands. When he settled there, the people and the land still looked pretty much as they had when, forty years earlier, Vincent van Gogh had been drawing and painting the local farmers. At the time, being a family practitioner meant receiving people who came to see ‘the doctor’ in his house throughout the day. His was a big house, painted a warm yellow, in the style of Vienna (where after graduating in Amsterdam my grandfather had extended his studies). Farmers regularly came for a consultation after Sunday mass, when they had already made the walk to the village centre. And, when a young boy running, or a neighbour with a bicycle, were sent to fetch him, my grandfather would go and pay house visits to the spread out farms, traveling by the motorbike that he had bought as soon as he could afford it.[i]
¶ 4 Leave a comment on paragraph 4 0 The case of the young farmer began with such a house visit. The doctor found the young man in bed with a fever and a nasty, infected wound in his left leg. He made a cut in the skin of the abscess, to allow for the escape of the pus bonum et laudabile: the good and praiseworthy pus. A body liberated of pus would heal faster. But the young farmer didn’t heal. When the next day the doctor was called in once again, he feared an imminent sepsis, from which the patient was likely to die. What to do? There were as of yet no antibiotics. There were no other treatments either. Or were there? My grandfather remembered a case history that he had heard from an older colleague. In that case, too, the problem had been an infection in a leg that had become compartmentalised, festering and putrefying, while the rest of the body had not got itself involved in the defence.[ii]
¶ 5 Leave a comment on paragraph 5 1 This is where the turpentine comes in. Chris Mol asked the young farmer permission to engage in an experiment. The patient readily agreed. “Yes doctor,” he said, “if you do nothing I will die, I feel I will.” So my grandfather steered his motorbike to the workshop of the local painter and asked for dirty turpentine. Back in the farm he injected a small amount of this into the dying man’s right leg, the other leg. The experiment worked out well. The nasty stuff injected aroused a fierce, overall reaction of the immune system. This vehement immune response also reached the wound in the left leg and the bacteria infecting it. For a while the patient was critically ill, but he healed. That is the case of the young farmer and the turpentine. My grandfather told it to me as a lesson about both the human body and medical practice, a layered pedagogy that is typical of medical case histories. This is the lesson about the human body: it is complex and not quite predictable. And this is the lesson about medical practice: don’t just depend on your textbooks, they may fail you. If they do, be inventive, daring. Case histories may help here as they relate what, often surprisingly, worked out well in other sites and situations.
¶ 6 Leave a comment on paragraph 6 0 As I reiterate this story here I seek to add another lesson, a lesson about sharing knowledge. To my mind ‘the case of the young farmer and the turpentine’ is an exemplary case of a case. A case carries knowledge, not in the form of firm rules or statistically salient regularities, but in the form of a story about an occurrence that, even though it may have happened just once, is still telling, indicative, suggestive. It condenses expertise that is not general, but inspirational. As cases are idiosyncratic, those who seek inspiration from them still have to think for themselves. They have to adapt the lessons learned to the situation in which they find themselves.
¶ 7 Leave a comment on paragraph 7 0 Cases, then, do not transport knowledge smoothly. It requires work to draw on them. The implications here of a case that occurred elsewhere have to be carefully thought through and tinkered with. Such tinkering may serve highly varied goals. Medical cases may inspire doctors who, under slightly different circumstances, with other specificities kicking in, have to solve a similarly intractable problem. Judges may seek guidance from cases as they consider how to judge the next particular intractability. For ethicists, discussing past cases or imaginary vignettes is a way of sharpening their skills of appraisal. For historians a case begs questions about its conditions of possibility: what all had to be in place for this particular event to occur?[iii]
¶ 8 Leave a comment on paragraph 8 0 Cases are also good for those of us who craft theory as we work with empirical materials. For even if cases index situated events, it is still possible to make them pertinent elsewhere. Not everywhere, mind you. It remains to be seen where a lesson travels and where it doesn’t hold. The genre of theory that cases inspire does not aim to be empirically encompassing or universally valid. Instead it carries a set of sensitivities that emerge from the case at hand. And then begs the question what might be different elsewhere. For example. The case of anaemia may exemplify relations between clinical and laboratory ways of separating out the normal from the pathological.[iv] (But in cancer the clinic relates differently to the lab.)[v] The case of diabetes may be used to argue that ‘choice’ is not a particularly helpful term in the context of living with a chronic disease, where other terms, like ‘care’, make better sense.[vi] (But within caring practices there are moments when choices impose themselves.)[vii] The case of meat may illustrate the multiplicity of natures within the so-called West – for however much this ‘West’ is mono-naturalist in theory, in many of its practices, meat-practices included, reality multiplies.[viii] (A complicated message for there are also instances where mono-naturalist visions impose themselves upon practices).[ix]
¶ 9 Leave a comment on paragraph 9 0 And the case of the young farmer and the turpentine? Since 1976 I have tenaciously kept it in the back of my head as I worked on other cases. And as finally I now write it down, I am curious if beyond my specific situation, that of a granddaughter to whom it was passed on as a heritage, it may hold up as both a compelling story and a convincing case of a case.
¶ 10 Leave a comment on paragraph 10 1 Annemarie Mol is professor of Anthropology of the Body at the University of Amsterdam. In her work she combines the ethnographic study of practices with the task of shifting our theoretical repertoires. She is author of The body multiple: Ontology in medical practice and The Logic of Care: Health and the Problem of Patient Choice.
¶ 11 Leave a comment on paragraph 11 0 Notes
¶ 12 Leave a comment on paragraph 12 0 [i] For the separation between work and private space and time of general practitioners in the course of the twentieth century (in Britain, but the Dutch case is strikingly similar) see: David Armstrong, (1988). Space and time in British general practice. In Lock, M., & Gordon, D. (Eds.) Biomedicine examined, Springer (pp. 207-225).
¶ 13 Leave a comment on paragraph 13 0 [ii] For the immunology that was rising at the time, see: Cohen, E. (2009). A body worth defending: Immunity, biopolitics, and the apotheosis of the modern body. Duke University Press.
¶ 14 Leave a comment on paragraph 14 0 [iii] A great example of an history quest for conditions of possibility is Michel Foucault (1973/1963), The birth of the clinic, trans. A. Sheridan, London: Tavistock.
¶ 15 Leave a comment on paragraph 15 0 [iv] Mol, A., & Berg, M. (1994). Principles and practices of medicine. Culture, medicine and psychiatry, 18(2), 247-265; Mol, A. (1998). Lived reality and the multiplicity of norms: a critical tribute to George Canguilhem. Economy and Society, 27(2-3), 274-284.
¶ 16 Leave a comment on paragraph 16 0 [v] Jain, S. L. (2013). Malignant: How cancer becomes us. University of California Press.
¶ 17 Leave a comment on paragraph 17 0 [vi] Mol, A. (2008). The logic of care: Health and the problem of patient choice. Routledge.
¶ 18 Leave a comment on paragraph 18 0 [vii] Callon, M., & Rabeharisoa, V. (2004). Gino’s lesson on humanity: genetics, mutual entanglements and the sociologist’s role. Economy & Society, 33(1), 1-27.
¶ 19 Leave a comment on paragraph 19 0 [viii] Yates-Doerr, E., & Mol, A. (2012). Cuts of meat: Disentangling western natures-cultures. Cambridge Anthropology, 30(2), 48-64.
¶ 20 Leave a comment on paragraph 20 0 [ix] Bonelli, C. (2012) ‘Ontological Disorders: Nightmares, Psychotropic Drugs and Evil Spirits in Southern Chile’, Anthropological Theory 12(4): 407-26.
Michael Guggenheim
Russell Prince
Torsten Heinemann
This piece is so well constructed and effectively argued I have little to say about its specific components or overall argument, so I will just indulge in the thoughts it raised for me, which perhaps just restates in slightly different form what is in the text.
Most, maybe all, knowledge, even the ‘firm rules and statistically salient regularities’ start out as cases, or collections of cases. But some knowledge stays in the case form, and it is the tacitness of it that makes it so. Its lesson is that when we build a knowledge edifice, such as of medical knowledge, we end up hiding things. A case, as explained here, makes those parts of knowledge hidden by the codified edifice visible. So I think the ‘case of a case’ tells us something about the nature of knowledge as well as practices of knowing.
It seems to me the case only makes its lesson clear when it is put in relation to another case, or to the statistical regularities or rules of practice, otherwise it is just a story. As the author puts it here, it is a warning for people who rely on book learning, a kind of cautionary-tale-in-reverse, and so is perhaps not much use to others. It makes me wonder under what conditions a case will exhaust its usefulness, not just in the sense that it ‘doesn’t hold’ in a different context, but because the knowledge edifice itself has changed. Perhaps when it becomes a rule itself (‘always inject dirty turpentine into the uninfected leg’), rather than the lessons that underpin it.
Russell Prince
See my comment above. I think this is the main lesson here, but then I am not sure why the lesson above could be: “don’t just depend on your textbooks…” Isn’t what you write here running against that lesson? What in the turpentine story allows us to check how far that lesson travels? As indicated above, I think there is a problem here, because it is not an ethnographic case but more something like a parable. The way the story is made up makes it on the surface too easy to travel, while at the same time does not contain enough detail to indicate where it does not travel.
You can make the points below precisely because these are not parables, but cases about which you know in detail what some of their specificities are that limit their transportability and moreover, you know something about the other cases of comparison (for example cancer).
Or to reverse the point: What would be the point of comparison for the turpentine story?
To summarize, I think there is an unexplored tension in the text: It is about what is a case, and I think there are two very different cases you rely on: parables and ethnographic cases. You then ask how we can travel from one case to another, but I think this is constrained very much by the kind of case we deal with.
I think there is something there about the way you treat cases as theoretical cases, or what Walton (“Making the theoretical case” in the Becker/Ragin collection) calls an analytical case as opposed to a substantive case.
A parable lends itself very well to creating analytical cases, precisely because it gets rid of many of the complexities of ethnographical cases. I am not worried about doing so, but I am a bit puzzled that you do not note the gulf between the analytical cases and ethnographical cases. Rather than pretending they are the same, I would suggest you could explore in far more detail what the differences are between the two.