In the final installment of this series of blog posts, "the Regulars" receive help from an unexpected taxonomic ally.
In this, the final installment of my "Follow the Money" review of the competitive beginnings of Alternative Medicine, help for the Regulars comes from an unexpected taxonomic ally and firmly sets organized medicine on its current course.
Let the Race Begin!
The Homeopaths and Thomsonian-Eclectics had the greatest following among the competing sects. Both had established national societies and numerous schools. Historians explain their success as a measure of the popular revolt against the aggressive bloodletting, blistering, purging, and stomach pumping practiced by the “Regulars.”
Equally probable is that the public could not see any difference in outcome between the different approaches and picked practitioners based on availability and reputation. In addition, with an interesting political if not methodological postulate, Homeopaths stated that if someone was first treated by a physician of the “old school,” he would be rendered resistant to later homeopathic techniques. Its founder, Samuel Hahnemann, counseled that once a patient was treated by a "regular" physician his previously existing natural disorder would be irreversibly worsened by the regular's meddling. Thus, subsequent homeopathic attempts would fail and should not even be attempted.
Was the public actually following the intersectarian debate? Absolutely. The 19th-century interest in health was no less a subject for the lay press than it is today. Between 1830 and 1890, 85 health magazines were published for the general public in this country.
The Regulars politically fought to establish themselves against the activities of the different sects. Lay healers saw the Regulars’ early attempts to limit them as a move to create a professional class system similar to Europe's and obtain unfair advantage. Physician requests for regulation and licensure (!) were made frequently, but the feelings of state legislators echoed the lay healers. They, too, feared the creation of a titled, undeserving, privileged class, and this outweighed any fears of unregulated practitioners.
This medical free-for-all brought fierce competition between individual practitioners of all types as they strove to develop successful practices among the wealthy and the middle-class. Fees charged were dependent on the class served and might vary by fivefold for the same service. Success in the "carriage trade" (those patients who arrived by carriage and had separate waiting rooms from those who arrived on foot) meant professional stature and economic security. Goals of early medical societies were not directed so much at improving professional ethics but toward standardization of fees and success over competition.
The birth of the American Medical Association (AMA) in 1847 was a direct result of the Regular physicians' efforts to gain control of their runaway profession, as well as to meet the challenge of the Homeopaths, who were also organizing themselves at this time (the American Institute of Homeopathy was founded in 1844). At a physician convention of 1846, a Committee on Ethics was charged to investigate why Regular physicians were not held in similar high esteem as clergy and lawyers (again, "!"), and why they were held to be the same as the other "ignorant pretenders" who employed "crooked devices and low arts."
The primary target of the new AMA was the Homeopaths. Growing rapidly from its core of German immigrants who provided the initial providers and patients, by the end of the 19th-century the Homeopaths were, on average, better off than the Regulars. They had higher incomes as their patients were generally of higher social standing and better able to pay their fees. Public acceptance of Homeopathy was widespread by this time and often led by the clergy who were attracted to the "spiritualized essence" of their drugs and "repelled by the poisoning and surgical butchery of regular practice."
In perhaps a petulant response to the homeopathic warnings to avoid patients already treated by the Regulars, the AMA strictly forbid any consultation or contact with Homeopaths and others. The bitterness that this financial competition generated reached its lowest point with the regulars’ practice of internecine censure -- expulsion from local medical societies for even consulting with sectarians. Paul Starr points out a particularly ludicrous example in his history of American medicine:
"In 1878 a physician in Norwalk, Connecticut, Dr. Moses Pardee, was expelled from his local medical society under suspicion of having consulted with a homeopath -- his wife, Dr. Emily Pardee.”
State legislators were drawn into the controversy. In Michigan they voted to provide funds for two Homeopaths to join the medical faculty at the University of Michigan, in 1876. In response, the state medical society threatened to sever its connection to any member who ever graduated from that school. In New York State, Homeopaths had enough political power in 1882 to force the state medical society to rewrite its ethical code and reverse the ban on consultations between the two groups. This led to a schism of the New York medical society itself, producing two competing states societies. One had ties to the AMA and the other to the newly formed American Association of Physicians.
Success at Last
The triumph of the Regulars came about with their quick acceptance of the revolutionary "Germ Theory.” Applied to the causality of disease, it was embraced by the leading European physicians, in this country, in the late 19th-century. This reversed the commonly held views of illness as a singular disturbance, with divine overtones, of the patient and his environment. Instead, it became one of a focused, foreign, disturbance in specific organs. We now understood what caused "bad" air, water, and food.
The Sectarians, however, maintained their belief of illness from within, the internal causality of illness. This, in the end, led to their decline as they openly disagreed with what was being discovered without. It was the 1885 demonstration of a vaccine cure for rabies by Pasteur, followed by the work of Koch demonstrating tuberculosis’ causative bacillus, and Lister demonstrating disease vectors being bacterial, that turned the tide for the Regulars. Homeopaths and other sectarians considered germs as merely foreign bodies to be removed, if necessary, like wooden splinters. Vaccines were considered a “dilution” and a vindication of their principles of “similia similibus curantur” (“like cures like”).
The Chiropractics, led by D.D. Davenport in Iowa, responded to the Germ Theory by stating "... why bother so much about the germs that do not affect 99% of the people when it is admitted that there is a condition existing in the other 1% that makes them predisposed to disease and easily affected. Why not find out and correct the cause of this condition or predisposition and so allow nature to use her natural protection against these baleful external influences.”
Our Brothers, Our Microbes
The long struggle by the Regulars against the Sectarians was ultimately won with the help of microbes, their newly recognized allies in the competitive world of medicine. Our brotherly microbes successfully frightened patients into the Regulars' offices, generations before antibiotics were ever discovered. To this day, they still manage to divert the inward reflections of the Sectarians. Remember when everyone thought stress "caused" ulcers? Now we have H. Pylori. Thank you, external causality.
In the current, fearful battle against cancer (the latest "evil eye", once again, sent by man, god or demon), the Sectarians still look to diet ("natural foods"), pollutants ("bad" air and water), and "weak constitutions" (stress, life style, and fiber). The Regulars are looking at gene regulation and immunology. They boldly go where Sectarians cannot travel - as they have no bench science back up.
Yet, despite the ascendancy of laboratory science in the service of mankind’s health, many still chose to look inward, seeking solutions and finding legitimacy in existential, mysterious answers to illness and its causality. And, as long as people believe in "magic" -- mysterious medical cures -- Alternative Medicine will always have a place in healthcare.
But we Regulars still have the largest market share and make the big bucks.