Knowledge in the Time of Cholera (26 page)

Homeopathic Incursions

Arguments for allopathic control over the boards faltered in the face of the recognition of the diverse components relevant to public health. But even more troubling for regulars was their failure to maintain control over
medical
knowledge. The establishment boards not only encouraged other sanitarians to challenge allopathy; it emboldened the homeopathic challenge, as homeopaths increasingly demanded equal status to regulars. Furthermore, the manner in which the boards were justified epistemologically—as producing apolitical knowledge—constrained regulars' attempts to exclude other medical sects from participation. In this favorable context, homeopaths jockeyed for, and typically won, inclusion on the boards. More than anything else, the inclusion of homeopathy aggravated rank-and-file regulars.

Take
the experience of the New York Board of Health. Initially, when the Metropolitan Health Bill was being debated in the legislature, homeopaths petitioned for inclusion. Anticipating an allopathic effort to exclude them, the Homeopathic Medical Society of the State of New York (1866b, 131–132) warned the legislature that a “great injustice would be done if a provision is not made for the appointment of at least one of the medical men composing the board from the ranks of the homeopathic school; and also, if at least, one fourth part of all the public hospitals and dispensaries in the city of New York, should not be placed in the care of homeopathic physicians.” The legislature was in a bind. Politically, it agreed with homeopaths, but it could not risk alienating allopaths. Rather than addressing such a contentious issue, the legislature punted, remaining silent and declining to make any specifications as to which sect should be represented in the appointments. Once the bill passed, however, the governor appointed four regular physicians who had been active in the sanitary movement. Although this group was less explicitly engaged in the professionalization project of the AMA and NYAM, regulars celebrated the exclusion of homeopaths from the board.

The enthusiasm was short-lived. As the board made preparations for cholera, homeopathic physicians lobbied for control of at least one cholera hospital. Many homeopaths wanted to use the cholera epidemic as an opportunity “to show the superiority” of their system (Homeopathic Medical Society of the State of New York 1866a, 247). Homeopaths believed that the existence of a homeopathic cholera hospital would create a real-life experiment, whereby the treatment outcomes of the homeopathic hospital could be compared to those under allopathic control. Appealing to past statistical evidence, homeopaths were confident that their system would prove to be more effective—“In no disease has the value of our treatment been more satisfactorily shown, than in epidemic cholera, the statistics of which have been frequently published” (Homeopathic Medical Society of the State of New York 1866c, 322)—and sought to make use of the epidemic to put to rest allopathy's arguments that homeopathy was quackery and need not be taken seriously.

Rather than merely requesting recognition, homeopaths
demanded
it “as a right, that so large a portion of our tax-payers should be fairly represented in our medical institutions” (Homeopathic Medical Society of the State of New York 1866c, 322). E. A. Munger (1865, 22), president of the Homeopathic Medical Society of the State of New York, argued that homeopaths were “entitled to all rights and privileges enjoyed by allopathy.” This position was
grounded
not only in homeopathy's equal legal standing, won in the repeals of medical licensing laws, but also in the very rationale of the board. Homeopaths adopted the same trope used by sanitarians generally: adequate sanitary knowledge had to be, by necessity, apolitical and disinterested. Base political motives, professional or otherwise, corrupted knowledge and hampered sanitation. Thus, homeopaths denounced all allopathic arguments as political; exclusion from public health was equated with political “oppression” (Cornell 1868, 4). By painting allopathic physicians with the same political brush that sanitarians painted corrupt politicians, homeopaths offered a rationale for their inclusion that mirrored the rationale of the boards more generally. Underlying this was the familiar homeopathic appeal to democracy that had been successful in the past. Dialogue, transparency, and participation would lead to better knowledge, and, in turn, better sanitation. In demanding inclusion, homeopaths were only asking to “let the public judge of the candor, intelligence, and honesty, with which the claims of homeopathy are treated by men from whom we have a right to demand justice” (Bowers 1868, 406–407).

Allopaths also rehashed old arguments. As in the debates over licensing, regulars balked at the suggestion that homeopaths should receive official government recognition. They adamantly opposed homeopaths treating
any
cholera patients, much less an entire hospital's worth. Many rank-and-file regulars derisively mocked homeopaths' interest in public health, facetiously wondering how their commitment to infinitesimal dosages would translate into public health interventions: “We have never known such remedies applied there for cleaning the streets, the removal of nuisances, the repair of defective sewage, except in the most diluted
infinitesimal
doses. What is needed are not little homeopathic wheelbarrows, but big, ‘allopathic' four-horse teams, to remove the dirt and filth from New York City” (
Medical and Surgical Reporter
1866b, 95–96). Having defined homeopathic knowledge prima facie as quackery, regulars felt no compunction to engage in “wanton experimenting” (Blatchford 1852, 136) with homeopaths. The
Medical and Surgical Reporter
(1866a, 477) warned that if homeopaths had the “right to ask that the public charities shall be made to afford to them an opportunity to experiment with the poor,” then “the Metropolitan Board of Health would soon become the laughing stock of the profession throughout the world, were it to open the door promiscuously to all these parasitic outgrowths of the healing art.” Allopathic physicians went so far as to submit a false report to the board from supposedly well-recognized homeopaths that testified to
the
inadequacy of homeopathy. The report not only failed to sway the non-physicians on the board; it also alienated them. Judge Joseph S. Bosworth, member of the board, dismissed it as a political attack, and board president Jackson Schultz regarded it as “a mere bundle of opinions” (quoted in Bowers, 1868, 411). When this failed, regulars drew on the AMA's no consultation clause to argue that inclusion of homeopaths would place those allopathic physicians on the board in violation of professional ethics. Beholden to the clause, allopathic participants would have to sever themselves from the profession or resign from the board. The board was, therefore, risking the loss of all allopathic cooperation.

Unfortunately for allopathy, homeopaths had considerable support on the board and in the local press. George W. Bradford, a regular physician on the board, lamented in his report to the Medical Society of the State of New York (1867b, 41–42):

It was so found that a strong element in favor of Homeopathy existed in the Board from the start. The President of the Health Board, the President of the Metropolitan Police Commission, were strong adherents of Homeopathy; and another member of the latter body employed as a family attendant one regarded as a leading exponent of its doctrines and precepts. We successfully opposed this element in its attempt to gain for its friends a foothold in the Board by the appointment of homeopathic inspectors, despite the leanings of some of the newspapers to the heresy, and the zeal of three homeopathic reporters, ever ready to catch at any remark detrimental to the claims of the causes which they had espoused.

While Bradford overstated the extent of the association of the “homeopathic reporters” with the actual sect, it was true that local reporting on the controversy favored homeopaths, depicting the actions of allopathy as a crass power grab—precisely the type of political maneuvering and patronage that the board was established to combat. The
New York Times
' (February 20, 1867, 4) call for homeopathic inclusion employed a rationale that mirrored, almost word for word, the rationale given by state legislatures in the repeal of licensing laws:

It seems to us—without pretending for a moment to judge of the merits of different schools—that simple justice argues in favor of this petition. It is not part of the case to discuss now the relative merits of any system
of
medical practice that appeals to the faith of the community. All may be good in their way; none are infallible; each can show a record most convincing in terms; each endeavors now and again to show the others to be foolish and weak. All that needs be said can be summed up in few words. A very large number of the wealthy and intelligent people of New-York and Brooklyn prefer the practice of Homeopathy, the system has passed through the ordeal of much sharp criticism, and in spite of ridicule and opposition has become established on a firm foundation. It has its schools, colleges, dispensaries and clients; it makes converts, and its successful treatment of cholera, of the disease more especially of women and children, has gained for it the confidence of large number so families.

Those on the board sympathetic to homeopathic inclusion, like President Schultz, were in a difficult position. On one hand, homeopaths made a compelling argument for inclusion that drew on the very arguments that justified the independent board's existence. On the other hand, the board could not risk alienating allopathic physicians to such a degree that they refused to cooperate. In the end, they compromised. Homeopaths would not be granted control of an entire cholera hospital but would be granted positions within the hospitals and assigned certain wards in which treatments were under their control. This compromise, unsurprisingly, left both protagonists unhappy. Homeopaths decried the fact that they would have to practice under the control of allopathy, and while they continued to petition the board for autonomous working conditions, they ultimately cooperated.

The board's recognition of homeopaths was more complicated for allopathic physicians, pitting rank-and-file regulars against the elite, sanitary-minded physicians. The no consultation clause, adopted by New York city and state medical societies under the guidance of the AMA, prohibited regulars from working with homeopaths and, in turn, raised questions about the fidelity of sanitary-minded physicians. NYAM went so far as to debate whether to withdraw its resolution of cooperation with the board. This debate centered on what to do about the allopathic members of the board who tacitly recognized the legitimacy of homeopathy by allowing this compromise. These members justified their acquiescence to the urgency surrounding the epidemic: “The sanitary committee, placed as they were in the position of soldier upon the eve of an important battle—to refuse to participate in the fray because another, whose principles they did not admire, insisted upon fighting at their side—would have been cowardice. The committee
could
not resign, because they were charged with a very grave responsibility as conservators of the public health” (Medical Society of the State of New York 1867b, 43). The rank and file pushed back, noting that “the interests of the public and the profession are too sacred to allow us to overlook for
this
reason an error of judgment which might have led to such disastrous results, and the tendency of which was to degrade the profession” (Hutchinson 1867, 68–69). Their argument reflected the AMA's general disdain of homeopathy—its system was absurd and therefore should not be indulged in any way, shape, or form. In the end, as in the case of the University of Michigan, the medical society avoided a major rift by narrowly defining the no consultation clause to only involve issues related to private practice. Board members, participating in government service, were not beholden to the no consultation clause. Rather than withdrawing its cooperation, the academy instead passed a resolution criticizing the board's position on homeopathy (Duffy 1968, 64).

Still the damage was done. The controversy over homeopathy solidified the rank and file's suspicion of public health. Immediately after the epidemic, allopathic physicians clamored to claim that the board of health had “originated in the Academy of Medicine and that the Health Bill should be regarded as the legitimate offspring of the Academy” (NYAM April 28, 1866, 7). But as the epidemic receded in memory and as the ecumenical colors of public health were revealed, allopaths distanced themselves from the board. It was no longer considered an allopathic offspring but rather a misguided endeavor susceptible to the pernicious influence of homeopaths. Even in New York, where reform efforts were initiated by a preeminent allopathic medical society, sentiments toward the board cooled.

CONCLUSION: A PLAN ABANDONED

In the end, the struggle between homeopathy and allopathy on the board followed a similar script to the debates over licensing, albeit with additional actors included in the fray. Regulars, initially viewing the boards as an opportunity to suppress homeopathy and promote their professional goals, saw these hopes dashed by a public institution unwilling to grant them a privileged epistemic recognition. Both the state legislatures and the boards of health supported a measure of transparency and inclusivity that clashed with the exclusionary program of the AMA. Just as democratic legislatures were suspicious of allopathy's claim that its knowledge should be granted
a
privileged position, so too were the boards. As subsequent chapters will show, the boards of health, which were held in high public esteem and possessed many resources, remained a key arena for the epistemic contest over cholera. However, the boards' understanding of disease as filth, their ecumenical organizational form, and their apolitical justification of epistemic authority prohibited regulars from harnessing them to advance their own professional agenda. They were too susceptible to democratic influences to provide allopathy's desired outcomes.