Knowledge in the Time of Cholera (11 page)

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 regu
lars
held over medicine, reframing the tragedy of cholera as an exemplar of what happens when a profession with monopolistic power 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.

Underlying the rhetoric of homeopathic statistics was a social order of knowing inconceivable to allopaths. While the accuracy of the homeopathic statistics is difficult to measure—and indications are that they were generously inaccurate—they reflected an open and public epistemology based on demonstration. Present-day criticisms about lying with statistics aside,
during
this period, statistical analysis held the promise of solving a crisis of trust brought about by modern society (Porter 1988,1995). Statistics, and numbers generally, were understood in the nineteenth-century context as preevaluative and noninterpretive (Poovey 1998). As the boundaries of the local were transgressed and anonymity rose, statistics were seen as a way to make knowledge transparent, solving the problems of trust created by an increasingly impersonal society. While the United States lagged far behind Europe in the development of sophisticated statistical techniques, statistical thinking and numeracy in general assumed a prominent role in everyday American life (Cohen 1982). In his observations of U.S. society, de Tocqueville (2002 [1835], 285) found Americans' minds to be “accustomed to definite calculations.” Thus, statistical data came to assume great importance during the Jacksonian period, as it came to be viewed as essential for good government and achieving consensus in a country in which numeracy was on the rise (Cohen 1982). Homeopathic statistics accommodated these structural and political changes, resonated with the shifts in governance and, in turn, stood in stark opposition to the traditional modes of authority of regulars.

Statistical rhetoric induced trust through participation. Data was presented to the public in a manner much different from allopathy's appeals to authoritative testimony. Homeopaths embraced the identity of Baconian scientists who gathered facts and laid them before the public to judge. They presented their findings in tables, enabling the public to assess their claims, asking them to serve as discerning judges in a manner that respected public opinion. For example, Edwin Miller Kellogg (1872, 2), after giving his statistical report of mortality rates in New York City for 1870 and 1871, concluded, “These statistics and the logical inferences therefrom we leave to the consideration of the thoughtful public.” Rather than
dictating
knowledge like allopaths, homeopaths
demonstrated
claims through the presentation of facts. In reducing complexity to numbers and then presenting numerical data, homeopaths invited the public to assess medical knowledge. This respect for lay knowledge was built into the practice of homeopaths, as patients were expected to assume an active role in their treatment. Consequently, while homeopaths identified as Baconian scientists, their expertise was built on a cooperative, rather than didactic, interaction with the lay public, who were accorded the right to judge homeopathic claims. They embraced an identity founded on democratic ideals, for as homeopath Arthur Lippe (1865, 26) decreed, “The Homeopathician represents the true democratic principle in the
healing
art, he courts inquiry and lays facts before the people by which they may judge of the validity of his claims to superiority.”