On the cutting edge of extinction : how the quest for modernity led to the erosion of identity in american homeopathy from 1865-1900 - The seeds of separation

- On the cutting edge of extinction : how the quest for modernity led to the erosion of identity in american homeopathy from 1865-Craig Repasz (Craig Repasz)

 The new sciences did not cause the schism in homeopathy in the United States. They instead helped to magnify a separation that had always existed. The internal conflict within homeopathy was as old as homeopathy itself, historians have argued. "From its inception," writes medical historian Harris Coulter, "the homeopathic movement has been divided into those who accepted Hahnemann's views in their entirety as the only correct guide to therapeutics, and those who were unwilling or unable to adhere to Hahnemann's rigid formula."xi
 This schism can be traced to the roots of many of those who began to practice homeopathy. Many of the converts to the homeopathic sect were initially drawn from old school medicine. Hahnemann himself pointed this out, speaking of this trend in Europe in the early decades of the 19th century. "The converted," he claimed in 1823, "are only hybrids, amphibians, who are most of them still creeping out in the mud of the allopathic marsh and who only rarely venture to rise their heads in freedom toward the ethereal truth."xii
 Constantine Hering, in reviewing the trends in the first half of the 19th century, stated in 1873 that the majority of homeopaths of the past forty years were not purists and had come to the new school during the cholera epidemics of the 1830s and 1840s. xiii The conversion of allopaths to homeopathic methods during these and other epidemics occurred as a result of a simplification in homeopathic methods.
 Hahnemann wrote in 1828 that in a typhus epidemic in 1813, the symptomatic picture of the patients corresponded to two homeopathic remedies, which he made available to homeopathic physicians in Europe to meet the crises of the epidemic. xiv A similar approach was used in the cholera epidemics mentioned by Hering. The new converts from the old school believed homeopathy was simply giving a specific remedy for a specific disease, providing the remedy was prepared in minute doses. In their minds, the entire process could be termed homeopathy. This was a gross oversimplification of the principle of similia.
 The division between the purists and the practitioners who compromised the Hahnemannian fundamentals reached a milestone on April 10, 1844, when the American Institute of Homeopathy (AIH) was formed. The formation of the AIH, as stated in its preamble, "was not to defend the followers of Hahnemann... against the shafts of the enemy, nor to retaliate in kind...but the chief purpose of organization...was protection of the profession and its materia medica against the misrepresentations of quacks, charlatans and medical pirates."xv Ironically, the AIH would change over the decades from being the watchdog of homeopathy to embracing the very principles that compromised homeopathy by the time the Hahnemann monument was dedicated.
 The new-found freedom advocated by Dunham affected homeopathy and its institutions for decades to come.

Extinction

Historians have labeled the two factions: "Highs" for the conservatives and "Lows" for the liberals. xvi The terms conservative and liberal are descriptive as they describe an adherence or rejection to one or more of Hahnemann's laws. They also refer to the choice of dilution of the remedy by the practitioner. The dilution follows the principle of dynamization of the remedy. The more it is diluted, the more powerful it becomes. The Lows used remedies that had been diluted one part to ten parts solvent, repeating the dilution process three or five times. The Highs diluted remedies one part to 100, 1000 or more, and repeated the process from five to 200 times. Paradoxically, the high dose followed the law of minimum dose; which means that the more diluted the remedy, the higher the dose. These remedies required skill in case management and in prescribing. The lower doses did not require the same vigilance and care on behalf of the practitioner, therefore they appealed to the less skilled, claimed historian Harris Coulter. xvii
 One historian claims that pure Hahnemannian homeopathy was very stringent and the practitioner's freedom was curtailed. If there was failure, the method was not to blame; the doctor was, for not following the method properly. The less-adept practitioners complained that more freedom was needed in medical therapies to overcome their deficiencies. xviii The liberals needed to justify the adaptation of the new sciences and the use of other therapies that were not homeopathic. Their call for more freedom was a way to include those non-homeopathic therapies into their therapeutics. The rebellion against Hahnemannian dogma was underway.
 The actual act of the AIH to free homeopathy from Hahnemannian dogma can be traced to an initiative by the Institute in 1870. During their annual meeting, Dr. Carroll Dunham, an American-born homeopath, initiated a policy that would change the face of homeopathy.
 Carroll Dunham (1828-1877) embodied many of the traits of the ideal 19th century physician. He was the son of a wealthy New York doctor, was well-educated and had studied in Europe. During his time in Europe, he met and trained under Carl von Boenninghausen, a disciple of Hahnemann. Upon returning to the United States, Dunham established a successful practice. He also became a prolific writer with many of his papers appearing in national homeopathic journals. In 1865, he accepted the professorship of materia medica at the New York Homeopathic School and he later became the dean. His biographers stated that he was a modest, quite man. Although he never sought positions in the AIH or state organizations, he was frequently nominated and elected to office and eventually served as president of the AIH in 1876. xix
 He was well-known as a conservative follower of Hahnemannian tenets in his medical practice and writings. He was, however, liberal-minded in his efforts to reform and protect homeopathy as a medical system that could sustain itself. "I plead for liberty," Dunham proclaimed during a speech at the AIH annual meeting, "for I am sure that perfect liberty will the sooner bring knowledge of the truth and that purity of practice which we all desire."xx
 Dunham recognized the alienating aspect inherent in conservative homeopathy: it was too austere and rigid. His hope was, by liberating homeopathic practice and relaxing the strict standards, that more physicians would be retained as members of the Institute and newer members would be attracted. He further hoped that the more lax physicians would, by association with the more conservative minority of the Institute, eventually adopt stricter Hahnemannian tenets. Dunham's speech called for freedom of choice for physicians, however, his stature and example called for medical responsibility.
 The new-found freedom advocated by Dunham affected homeopathy and its institutions for decades to come. The response was that the conservatives in the AIH felt the speech abandoned homeopathic standards, while the liberals felt they could now use therapeutic methods that were not homeopathic and still call themselves homeopaths.
 Homeopathy had been clearly separated from Hahnemann's foundation. In 1874, Dr. William H. Holcombe, a homeopath living in Natchez, Mississippi, wrote a pamphlet, What Is Homeopathy? A New Exposition of a Great Truth. In the preface he created a fictitious conversation between two physicians: one a homeopath, the other an allopath. The allopath is asked, "What is Homeopathy?" He answered, by exaggerating the main points established by Hahnemann. For instance, "You put a grain of aconite into the Mississippi River at St. Paul, and give a teaspoon of the same river water at New Orleans to cure fever." "The hair of the dog that bit is good for the bite." The allopath in the pamphlet states that homeopathy ignores pathology and that it is "the grave of scientific medicine." Additionally, "it never permits a purgative, an emetic, a blister."xxi To this, the homeopath countered that all of these statements by the allopath are wrong.
 In the pamphlet Holcombe provided a description of homeopathy: "A dynamic natural disease (not a mechanical or chemical deviation from the normal standard) is best cured by producing a similar (not the same) dynamic disturbance in the same parts and tissues, which therefore manifests itself by similar symptoms."xxii By this, he tried to redefine Hahnemann's definition by only addressing the Law of Similars with no mention of the single remedy or the smallest dose.
 Holcombe further claimed all controversial points about homeopathy were insignificant. "All other questions-of large or small doses, of pellets or tinctures, of dynamization, of what Hahnemann said, of what this or that disciple said or did, of imagination, or diet, or nature, or imposture, etc., etc.-all these questions and many other such, have no bearing on the point under trial, and are altogether collateral and impertinent."xxiii He felt so strongly about his description of homeopathy that he believed the future depended on it. "No matter what solution they receive, Homeopathy remains intact, vital, indestructible, and sure to be the medicine of the future, unless you overturn this grand pedestal, this natural or vital law on which it has been erected."xxiv
 Holcombe was initially an allopath, who was trained at the University of Pennsylvania medical school in 1847. He was converted to homeopathy during the cholera epidemics in 1849, 1850 and 1851. He had great success using homeopathy during the yellow fever epidemics in Mississippi from 1853-1855. He was typical of the liberal homeopath doctors who shared the belief that homeopathy had a small but important role in medicine. "It [homeopathy] is no new gospel, no new revelation to the medical world. All such claims are preposterous. It is not Science, but a part of it. It is not medicine, but a grand reform in one of its departments... It is not the grave of scientific medicine but its cradle."xxv
 In this statement is the expressed need for homeopathy to be in accord with "science" not at odds with it. Holcombe's final definition of a homeopathic physician was in terms of allopathic medicines not in contrast to them. "A Homeopathic physician," he wrote, "is one who uses the surgical, obstetrical, mechanical and chemical measures of the Old School: who, in the vital or dynamic sphere, is guided by the Homeopathic Law: and who, beyond its natural and necessary limitations, is an empirical and eclectic in the most liberal and enlightened sense of these words."xxvi Homeopathy existed for Holcombe and other liberals as a system of therapeutics only, which could be used as the physician saw fit. It was no longer a cohesive system that explained health, disease and cure.
 Holcombe tried to go one step further in his definition: to divorce Hahnemann from homeopathy. "If Hahne-mannianism were Homeopathy, the system would have long ago been demolished. But Hahnemann is a man of straw. Homeopathy is a different thing altogether, and demands a very different kind of answer-not yet given."xxvii
 Although Holcombe was writing in 1874, his words were a harbinger for the trend in homeopathy in the closing decades of the nineteenth century. In 1875, he became president of the AIH.
 The position of homeopathy must be understood outside of Dunham's audience of homeopaths and Holcombe's audience that he wished to persuade. It must be seen within the greater framework of American society at the time. There existed in antebellum America an appearance of plurality within social institutions. The freedom that came with this plurality was an opportunity for advancement on both the personal and community level. "America seemed to have transcended the frameworks and restraints of European political and social models," writes one historian. "Many believed that the absence of social barriers, distinction of rank, and prescribed identities provided unprecedented opportunities for individual and national improvement."xxviii
 Harris Coulter has interpreted the split within homeopathy between the liberal practitioners and the conservative adherents to Hahnemannianism from the standpoint of human fallibility. He writes: "From its inception the homeopathic movement [in the United States] had been divided into those who had accepted Hahnemann's views in their entirety as the only correct guide to therapeutics and those who had were unwilling or unable to adhere to Hahnemann's rigid formula... A small proportion of the New School were willing to take the trouble and make the sacrifices implicit in the pursuit of Hahnemannian homeopathy."xxix Implicit in his interpretation is the branding of the liberals as lazy and inept. Coulter overlooks the intellectual climate of the time. Americans were widely committed to allowing each individual the opportunity to better their character through selfimprovement and grant others the freedom to do the same, and not judge them according to a prescribed standard. Most homeopaths felt Hahnemannian dogma was such a standard.
 These works of Dunham and Holcombe themselves hold no clues as to what the general public felt towards homeopathy's place in society and the construed scientific identities of both schools of medicine. Starting in 1863 there was a series of household health guides that showed the public was more concerned with medical plurality and choice than the rhetoric -between and among the medical schools of thought- would suggest.
 Warren's Household Physician for the Use of Physicians, Families, Mariners and Miners of all the Diseases of Men Women and Children by Ira Warren was first published in Boston in 1863, and within four years had gone through three editions. It was revised and went through more editions throughout the 1880s after Warren's death. The book was unique as it contained an "Allopathic" section, written by Ira Warren, a fellow of the Massachusetts Medical Society, and a "Homeopathic" section, written by A. E. Small, president of the Hahnemann Medical College in Chicago. The book, which grew to over 900 pages, was written for the common man. "It is based on the assumption," Warren writes in the preface, "that every man-the mechanic, the farmer, the day laborer, as well as the professional man-has the right to all the knowledge he is capable of acquiring, on all subjects, medicine not excepted. The book aims, therefore, to popularize, and adapt to the many what has been claimed as belonging only to a few."xxx Warren's words of personal freedom, opportunity and responsibility resonated with the common man who apparently purchased enough of the books to warrant future editions.
 In the 1889 edition, Warren offered remarks on the progress of medicine. Understanding that the general public was the audience and the book was to appeal to the masses as a health guide and not a piece of rhetoric, his views on science and the rival medical groups could be considered widely held by the public. "As a science," he wrote, "medicine is chiefly indebted to, and must ever be, to the members of what is called the 'regular profession.'... It is the writings of this class that every student must go who could qualify himself for the proper discharge of the duties of the physician; and he who attempts to the practice of medicine without the knowledge of standard medical writings is either a fool or a knave-either without the brains to understand science, or destitute of the honesty to deal fairly with men."xxxi
 Warren further expounded about the "One-Idea Men," which he also called "irregulars." He claimed these men hold to an idea of a medicine or therapy that is devoid of the scientific method and push like fanatics until the idea becomes mainstream. Nonetheless, he claimed, "wise and generous men thank them for their gift to the profession, small, though it may be, and use it in the light of a clearer knowledge."xxxii He called for diversity and plurality within medical thought, however he suggested all medical groups be subject to a standard set by science and the regular medical profession.
 Warren illustrated his point with a discussion of the different medical groups that were prevalent in the United States. His treatment of homeopathy was in accord with Holcombe's beliefs that homeopathy was simply a branch of therapeutics in medicine, not a distinct medical system. He stated that homeopathy "has drawn to its support many of the wealthy, the cultivated, and the intelligent, in our most refined communities." xxxiii He claimed, "I do not profess to comprehend and appreciate its principles, nor would it be honest of me to pretend to see how its infinitesimal doses can produce the results which it often shows, and which it is fair to confess look like singular success." He stated his disapproval of the denunciations and censures by other allopaths toward homeopathy, considering such rhetoric as "fashionable." He further stated the same sentiment held by Holcombe that "[Homeopaths are] useful members of the profession, and mean to cultivate toward them fraternal feelings."xxxiv
 Warren's statements suggest that through the 1860s and into the 1880s, the public had viewed the conflict and rhetoric between the rival medical groups largely with apathy suggesting that contention was to be found chiefly within the medical profession. Furthermore, Warren, an allopath, clearly denounced the antagonism between the rival medical groups suggesting that the majority of physicians within their respective groups did not hold these points of contention. Warren further suggested that the public did not discern the differences between the rival medical groups, and homeopathy in particular was closely aligned with regular medicine, indicating that the strong homeopathic identity earlier in the century had eroded.