Knowledge in the Time of Cholera

by Owen Whooley

  The Thomsonian system by no means offered a revolution in medical ideas. In some respects, it was even more traditional than the medical system practiced by regulars, committed as it was to the type of rationalism that allopathy was in the process of discarding (Kett 1968). Drawing on the humoral system of disease, Thomsonians held that all illness arose from an imbalance of heat in the body. Tracing all disease to this single cause, Thomson believed that effective therapy required increasing the body’s heat through natural remedies like botanic medicine and sweat baths. Rather than combating nature through depletive therapies like regulars, Thomsonians viewed nature as inherently ameliorative and used it as their guide. In turn, they employed milder treatments with fewer side effects than allopathy’s use of calomel and bloodletting—two practices Thomsonians viewed as “unnatural and injurious” (Thomson 1825, 206). The milder treatments served them well during the cholera epidemic as they were less harmful than allopaths’ extreme heroic treatments.

  Although conventional in its medical ideas, Thomsonism aspired to revolutionize the relationship between the physician and the patient by exploding all hierarchies in medical knowledge. Foremost, the Thomsonian challenge was an epistemological one that denied authorities in medical knowledge. Appealing to egalitarianism, it stressed common sense and the common man as a knower (Haller 2000). The Boston Thomsonian and Lady’s Companion (BTLC) (1840, 338) championed the medical potential of folk knowledge: “The exercise of our reasoning faculties at once puts us in the right road to discover truth.” Thomson intentionally developed his system to be used by anyone, regardless of education. The system was written and distributed in an accessible handbook that anyone could purchase for a small price and subsequently use to treat his or her family. And Thomson promoted his system through stories, popular lectures, and poems that served as mnemonic devices (Haller 2000). Every individual could digest medical information presented in these forms. Everyone could practice medicine. Doctors were not needed.

  Thomson put faith in the agency of the patient to such a degree that the distinction between doctor and patient would be eliminated. Thomson’s own narrative embodied the ideals of his system, and he appended it to the numerous editions to his New Guide to Health. Uneducated himself, Thomson discovered the herb Lobelia inflata when he was four, his consumption of which quickly induced vomiting. While he did not yet recognize the significance of his discovery, this herbal emetic would become central in his therapeutic arsenal. In 1788, at the age of nineteen, he badly injured his ankle and after enduring the painful failures of regular therapeutics, treated himself successfully using folk knowledge culled from experience. In doing so, Thomson was simultaneously the patient and the doctor—an arrangement he later championed in his system. He began treating his family and neighbors, and as his reputation grew, he abandoned farming to become a full-time practitioner. The remainder of the narrative recounts Thomson’s healing successes in the face of hostility and challenges from regulars. The lesson of his narrative is explicit: the talent for healing is not restricted to the profession; it is in everyone.

  According to Thomson and his followers, regular physicians, acting out of avarice and self-interest, would stop at nothing to prevent the public from learning this revolutionary lesson. In making medical knowledge available to all, Thomsonians juxtaposed themselves to regulars, who tried to maintain a monopoly over medical knowledge by obscuring its simplicity (Haller 2000). Education was a tool that regulars used to monopolize and mystify medical knowledge. Sarcastically challenging the intellectual pretensions of allopathy, the Thomsonian Messenger (1843, 74) dismissed regular educational elitism:

  We admit that we are not so wondrous wise as some of our would-be medical Solomons, nor can we so readily mouth the vocabulary of learned technicalities, as some of the M.Ds. But we consider that to understand LIVING ANATOMY, and how to KEEP ALIVE, is of infinitely more importance to both the patient and practitioner, than weeks, months, or even years spent in comparatively useless studies, or in shaking the dry bones of the human skeleton.

  Thomson himself (1825, 199–200) argued, “The practice of the regular physicians, that is those who get a diploma, at the present time, is not to use those means which would be most likely to cure disease; but to try experiments upon what they have read in books, and to see how much a patient can bear without producing death.” Furthermore, the regulars sought to confuse patients and obfuscate their inability to cure by using Latin, which concealed knowledge “in a dead language” (Thomson 1825, 193). Regulars “have learned just enough to know how to deceive the people, and keep them ignorant, by covering their doings under a language unknown to their patients” (Thomson 1825, 41). The secrecy of the regulars was opposed to the transparency of the Thomsonian system, which “so far from concealing discoveries or seeking to make a mystery of them” labored “to make them known for the benefit of the whole human race” (Thomson 1839, 50). Such a commitment to openness was on display during the 1832 epidemic, as Thomsonians made their anticholera recipe widely available to the public (Haller 2000).

  Contra allopaths, Thomsonians believed that relevant knowledge was not found in books, but in the common sense of the people. Folk wisdom was prized over education. Thomson (1825, 34–35) wanted to unlock the inherent, good sense of the people, hoping

  that it (the Thomsonian system) will eventually be the cause of throwing off the veil of ignorance from the eyes of the good people of this country, and do away with the blind confidence they are so much in the habit of placing in those who call themselves physicians, who fare sumptuously every day; living in splendour and magnificence, supported by the impositions they practice upon the deluded and credulous people; for they have much more regard for their own interest than they do for the health and happiness of those who are so unfortunate as to have anything to do with them.

  Underlying this egalitarian epistemology of common sense was a view of truth as transparent and acceptable, as nature provided the requisite clues for those careful enough to observe. The notion that truth was mysterious was anathema to Thomsonians: “Truth never seeks to be sheltered in mystery, she delights in simplicity, because it adorns her by laying all her beauties open to general inspection” (BTLC 1841, 114). Nature made itself readily comprehensible to all. The public therefore had the capacity to grasp medical knowledge. The flattened hierarchy of knowers and egalitarian Thomsonian epistemology was defined in opposition to the authoritative, paternalistic approach of regulars, who mystified medical knowledge for selfish ends to the point where “the acquirement of medical knowledge having been considered a matter beyond the ordinary pursuits of life, the people have fallen into a complete state of darkness and superstition on this important subject” (Colby 1839, 2). If the public shed the belief in the authority of the regulars, medical insight was there for the taking. By juxtaposing their epistemology of folk wisdom and common sense with allopathy, Thomsonians demanded epistemological account from allopathy that did not fall back on obfuscation.

  Cholera offered a powerful symbol of regular failure that Thomsonians exploited to undermine licensing laws. As part of their rhetoric, they consistently contrasted the self-proclaimed success of their therapeutics with the dismal record of the regulars. Thomsonian periodicals were rife with condemnations of regular therapeutics like calomel and contrasting stories of the successes of Thomsonism. Bloodletting was viewed as not only ineffective, but deadly in treating cholera (Thomson 1825), as regulars “destroy more frequently than they can save” (Whitney 1833, 319). As for their own success, Thomsonians claimed, in a fit of hyperbole brash even for the period, to have saved 4,978 of the 5,000 cholera patients they treated in New York City (Haller 2005, 98). The critique of the allopathic handling of cholera was a common refrain among all alternative medical movements. The innovation Thomson brought was to link this failure to the monopoly regulars held over medicine, reframing the tragedy of cholera as an exemplar of what happens when a profession with monopolistic powe
r cannot be held to account. The cruelty of heroic medicine in treating cholera was a direct outcome of licensing laws that encouraged callous experimentation. These laws were framed as part of a concerted campaign by regular physicians to stifle freedom in a way that violated the spirit of American democracy: “Exclusive privileges are incompatible with those for civil rights for which the martyrs of the revolution fought and bled and died!” (Thomsonian Botanic Watchman 1834a, 131). Furthermore, the monopolies attained through licensing laws created an apathetic public, stunting their intellectual capacities and, in turn, stifling medical progress. An editorial in the Boston Thomsonian Manual (1841, 98) noted the pernicious effects of monopolies on the intelligence of the public: “Every individual who permits himself to be ignorant of medical knowledge, exposes his life to a banditti, who are ‘regularly’ drilled and legalized to go out into the world and experiment on human life. It is a duty we owe our God, ourselves and families, to exercise our reasoning faculties, in order that we may not only benefit ourselves but those of our species.” Because the talent for healing could develop in anyone regardless of educational attainment, licensing laws were not just inefficient; they were immoral.

  In promoting their vision of a democratized medical epistemology, Thomsonians often sounded more like a political and economic movement for egalitarianism than medical reformers. Indeed, the great innovation of Thomsonism was to take the rhetoric from democratizing religious and political movements and apply it to medicine. John Thomson (1841, 172), Samuel Thomson’s son and ardent disciple, made this connection explicitly: “People who are competent to judge who shall be their Legislators, are also equally qualified to select their doctors.” Prohibiting people from exercising their ingrained intelligence was an unspeakable evil, a “tyranny for a free country!” (Thomsonian Botanic Watchman 1834b, 86). It was also, according to Thomsonians, bad medicine.

  Homeopathy and the Democratic Rhetoric of Statistics

  Homeopaths adopted a subtler approach to democratization. Rather than make every person his or her own physician, homeopaths retained their position of expertise but invited the public to assess their knowledge claims. As such, they championed an active role for the public that contrasted with allopathic elitism without succumbing to what they perceived to be the radical excesses of Thomsonism. The manner in which the homeopathic approach to democratizing medical knowledge diverged from Thomsonism reflected the different clientele of each sect. Unlike the anti-intellectual Thomsonians, homeopaths were well educated, growing their ranks by luring converts away from allopathy (Kaufman 1988). Homeopathy was a decidedly cosmopolitan medical system, strongest in the urban centers of New England, New York, Pennsylvania, and the Midwest (Coulter 1973, 108). Homeopaths’ high level of education, their scientific bona fides, and their patronage by urban elites facilitated their rise. By wielding a conscious and explicit epistemological vision that laid claim to the mantle of medical science, homeopathy called allopathy to account in a way that the uneducated, rural Thomsonians could not. As such, they would become the most persistent and successful challengers to allopathy (Coulter 1973; Kaufman 1988).

  Homeopathy was imported to the United States in the 1820s, winning significant American converts after the perceived success of its milder treatments during the 1832 cholera epidemic. Samuel Hahnemann, the founder of homeopathy, was a German physician who became disillusioned with regular medical practice, arguing that it did more harm than good. In opposition to the heroic practices of his peers,6 Hahnemann developed a milder, less intrusive form of medicine.

  Hahnemann viewed disease as an imbalance of the vital force. As Hahnemann conceived it, the vital force encompassed physical, mental, and spiritual properties, and disease represented disequilibrium in any of these properties. This would seem to place homeopaths in a more traditionally rationalist camp. But this was not the case. While the vital force served as the philosophical underpinning of the homeopathic system, it was considered essentially unknowable. Given the vital force’s inscrutability, homeopathy adopted a posture toward medical knowledge quite distinct from rationalist system building. Disparaging the search for disease etiologies as misguided, homeopaths focused instead on the rigorous empirical investigation of physical manifestations (i.e., symptoms) of how the vital force was responding to disease. Homeopath C. L. Spencer (1857, 9) outlined the homeopathic method: “The real fundamental principle of vital life, the great motive power of our existence, never has been seen, nor never will be seen; none but the Supreme Ruler of the universe can fathom this mystery. But we have symptoms in all of their various phases left us for our guide; each disease develops symptoms peculiar to itself.” The vital force left crucial clues that when attended to could inform homeopaths of how to help it heal. Thus, in a counterintuitive way, homeopathy’s mystical understanding of the vital force did not devolve into speculation or mysticism, but rather promoted an ethos of rigorous scientific empiricism.

  Such empiricism was reflected in the major contribution that Hahnemann claimed for his system—similia similibus curantur, or law of similars. According to this law, disease symptoms, rather than reflecting the pathological effects of disease, revealed the body’s efforts to bring the vital force back into equilibrium. Homeopaths claimed the law of similars as scientific; it was “discovered” by Samuel Hahnemann through a careful consideration of facts, for “nature’s laws are ascertained in just one way—by observation” (Hand 1874, 18). The goal of homeopathic therapeutics was to assist the vital force toward equilibrium, by providing treatments that induced similar symptoms. While the story of Hahnemann’s discovery may be apocryphal, it speaks to the homeopathic commitment to observation in illuminating universal laws. Treatments were determined by matching the symptoms induced by these treatments to those that the patient was experiencing. Building a therapeutic system demanded the accumulation of fine-grained observations of symptoms. Consequently, the recognition of the limits of human reason led to a commitment to empiricism and induction as a means of uncovering facts (Coulter 1973). Francis Hodgen Orme (1868, 35), a southern homeopath with expertise in yellow fever, claimed, “The logic of the homeopathist, then, is the logic of facts.” It was in their embrace of facts that homeopaths staked their claim to science. “The present age demands, and rightly, that no element of medical science, of which we possess the means of gaining positive knowledge, shall any longer be left to conjecture. It demands facts,” argued homeopath P. P. Wells (1864, 91). Accumulated facts would lead homeopaths to laws regarding the underlying uniformities in nature. This commitment to induction and observation was reflected in their experimental orientation, whereby insights were gained through tests of nature. They determined treatment regimens by conducting experiments they called “provings” in which a single drug was given to a healthy individual, often the doctor himself, who was carefully monitored for symptoms by taking elaborate case histories.7 The goal was to accumulate a large body of knowledge on the symptoms induced by a given medication in order to later match the symptoms of the ill patient to the symptoms induced by the drugs in the healthy person.

  In no area was homeopaths’ commitment to gathering facts more evident than in their use of statistics. Unlike regulars, homeopaths accumulated a mass of detailed quantitative data to discover the specific drug remedy for the totality of symptoms experienced by a patient. Managing all this data required a sophisticated understanding of numbers. Homeopathic editors regularly solicited statistical reports, while homeopathic societies collected statistical data on diseases in their region (Cassedy 1984, 126).

  Statistics have rhetorical dimensions (Carruthers and Espeland 1991); they are “figures of speech in numerical dress” (McCloskey 1985, 56) used by actors to gain an argumentative advantage through the perception of their disinterestedness and sober objectivity. Both allopathy and homeopathy lacked a coherent explanation for cholera, but the homeopathic use of statistics conveyed a confidence and measure of control that stood in marked contrast to
the fuddled accounts of allopathy. Homeopaths used the rhetoric of statistics with aplomb as a tool of persuasion to promote a particular interpretive framing of cholera. Statistics reduce complexity (Starr 1987, 40), and homeopaths’ statistical rhetoric transformed the messy ignorance toward cholera into a single number—the mortality ratio of the different systems used to treat it. Frederick Hiller (1867, 11) offered a typical framing of cholera by homeopaths. After presenting tables of comparative statistical data, Hiller argued, “The numerous, authentic, statistical reports from 1831 to 1863, from various countries, give the following comparative difference of mortality in this fearful disease: Allopathic mortality, 57 per cent; homeopathic mortality, 9 per cent.” Cholera was reduced to comparative data points—statistical rates of mortality of the two systems—that were presented as self-evident. The data behind such statistical comparisons was suspect for a number of methodological reasons; this was not a case of homeopaths having superior information. But the rhetorical functions of statistics did much to bolster homeopaths’ standing, especially in state legislatures. Through “uncertainty absorption” (Carruthers and Espeland 1991, 57), this statistical reduction suggested a degree of control over the phenomenon lacking in regulars’ meandering discourse on cholera’s etiology, while also providing homeopaths with information that traveled well across contexts. Homeopathy took the confusing information regarding cholera and repackaged it into a single comparative statistic that they wielded against regulars.