Thomson’s system was little more than a systematization of Mrs. Benton’s combination of herbs and steam, which in turn was derived from Native American healing lore. But it was a great success with the people Thomson visited, perhaps because by this time so many people had had a brush with regular medicine. Thomson could, at this point, have settled down to become a respected local healer, but his medical philosophy involved much more than a set of techniques. His goal was to remove healing from the Market and utterly democratize it; every person should be his or her own healer. To this end he set out to spread his healing system as widely as possible among the American people. In 1822 he first published his entire system as the New Guide to Health, which sold a hundred thousand copies by 1839,38 and in the decades that followed he set up hundreds of “Friendly Botanical Societies” in which people met to share information and study the Thomsonian system.
At its height the Thomsonian movement claimed four million adherents out of a total United States population of seventeen million.39 The movement was strongest among farmers in the Midwest and South (the governor of Mississippi claimed in 1835 that one half of the state’s population were Thomsonians)40 and among working-class people in the cities. Five Thomsonian journals were published, and, at a time when hardly anybody traveled much beyond the nearest town, the Friendly Botanical Societies attracted large numbers of members to their annual national conferences. Although other healing systems arose in the eighteen thirties, such as Sylvester Graham’s system based on whole-grain cereal, none rivaled Thomsonianism in popularity. Thomsonianism was, for all practical purposes, the core of the Popular Health Movement.
Thomsonianism, at least at first, was concerned with much more than health. The Thomsonian journals included discussions of women’s rights and attacks on such affronts to female health as tight-lacing and “heroic” obstetrical practice. Thomson himself strongly disapproved of male, regular obstetrical practice. The doctors were less experienced than midwives, he argued (at this time most regular physicians received their degrees without having witnessed a delivery), and too prone to try to rush things with the forceps, a practice which often resulted in crushed or deformed babies. Women were “natural” healers, according to the Thomsonians. John Thomson (Samuel’s son) wrote:
We cannot deny that women possess superior capacities for the science of medicine, and although men should reserve for themselves the exclusive right to mend broken limbs and fractured skulls, and to prescribe in all cares for their own sex, they should give up to women the office of attending upon women.41
Women were attracted to Thomsonianism in large enough proportions for regular doctors to be able to claim that the success of the movement was all due to the gullibility of the female sex. In Thomsonianism women could find a dignified and neighborly system of care for themselves, plus public validation for their traditional role as healers for their families and friends.
Thomsonianism identified itself with the workingmen’s movement to the extent that one historian could write, in a negative vein, that it “… appealed to a class bias and a class consciousness in a way unacceptable to many Americans.”42 Echoing the philosophy of the workingmen’s movement, the Thomsonian literature attacked the nonproducing classes as parasitical and glorified manual labor. The universities which trained the experts of various sorts only bred snobbery:
They [university students] learn to look upon labor as servile and demeaning, and seek their living in what they consider the higher classes of society.43
Other healing systems grew in the radical climate of the eighteen thirties which were equally opposed to the regular practice. Sylvester Graham (ignominiously remembered today only in the “graham cracker”) founded a movement for “physiological reform”—the Hygienic movement—which rejected even the botanical remedies of the Thomsonians as well as drugs of any kind. Graham called for a vegetarian diet with plenty of raw fruits and vegetables and whole-grain breads and cereals (far-fetched ideas in his day, when the medical profession often counseled that uncooked produce was injurious, and white bread was considered a mark of status). The Grahamian movement was popular and influential. Grahamian restaurants, boardinghouses, and “health food stores” opened; a Grahamian table was set at utopian Brook Farm and at Oberlin College.
The Grahamians were as radical as the Thomsonians, equating natural living habits with liberty and classlessness. A latter-day leader of the Hygienic movement, Dr. Herbert Shelton, expressed this vision of a world in which people had not surrendered their autonomy to experts:
Any system that, of itself, creates a privileged class who can by law, or otherwise, lord it over their fellow men, destroys true freedom and personal autonomy. Any system that teaches the sick that they can get well only through the exercise of the skill of someone else, and that they remain alive only through the tender mercies of the privileged class, has no place in nature’s scheme of things, and the sooner it is abolished, the better will mankind be.44
Both Thomsonians and Grahamians were incensed by the regulars’ drive to gain a monopoly over healing; monopoly in medicine, like monopoly in any area of endeavor, was undemocratic and oppressive to the common people. All of this meshed exactly with what the workingmen’s movement was saying in general; in fact, early Thomsonianism was little more than the health wing of a general movement. Working-class activists rallied to the Thomsonian assault on medical licensing laws. In New York, which had the most punitive law against irregular medicine, the legislative battle was led by Job Haskell, of the Workingman’s Party of New York.
It was a disastrous rout for the regular doctors—one which contemporary medical historians often prefer to forget. In state after state the Popular Health Movement forces triumphed over the “medical monopolists.” Every state which had had a restrictive licensing law softened it or repealed it in the eighteen thirties. Some, like Alabama and Delaware, simply changed their laws to exempt Thomsonian and other popular kinds of irregular healers from persecution.45 This was an enormous victory for the “people’s medicine.” At least one of the movement’s principles—antimonopolism—had been driven home.
But, at the same time, ironically, the life was going out of the Popular Health Movement. By the late eighteen thirties, the Thomsonian movement was becoming a cult. A sizable faction within Thomsonianism began to hanker for respectability and something very much like professionalism—even though this meant reversing the original tenets of the movement. If Thomsonianism was going to fit with the personal ambitions of these upwardly mobile healers, it would have to break with the old “do it yourself” philosophy and ragtag collection of radical causes which had kept company with the early movement.
Thus Alva Curtis, a Thomsonian healer in Virginia, publicly denounced some fellow Thomsonians who were implicated in a slave insurrection in Mississippi in 1835:
We greatly fear a number of botanic practitioners of Mississippi, have been led by blind fatuity to embark with other misguided citizens in a scheme of folly and madness, that has not only called down the vengeance of an exasperated community upon their head, but will justly cover their names and memories with execrations and infamy.46
Next, the would-be professionals within the movement maneuvered to take Thomsonianism out of the hands of the masses and concentrate it in a few approved healers. John Thomson (Samuel’s son) founded the New York Thomsonian Medical Society in 1835 on the basis of two grades of membership: one for lay people and one for society-licensed practitioners. Alva Curtis went further, splitting from the 1838 annual Thomsonian convention to set up the Independent Thomsonian Botanic Society for professionally minded Thomsonian practitioners. When Curtis founded the first Thomsonian medical school (the Literary and Botanico-Medical Institute of Ohio), old Samuel Thomson sputtered:
We had heard a great deal about Dr. Curtis and his school … but we never dreamed that it was his intention to make the healing art an odious monopoly and imitate the regular medical profession by conferring a sh
eepskin diploma.47
Thomson protested vigorously that his discoveries were being “taken from the people generally, and like all other crafts monopolized by a few learned individuals.” But the trend was irresistible. Post-Thomsonian botanical medical colleges were mushrooming into existence; groups which had campaigned against all licensing laws were now demanding accreditation for their own schools.
The Popular Health Movement had always ridden along on a much deeper current of social unrest. Now that current had slowed, or turned off in new directions. Feminism, as it grew into a more articulate and organized force, was turning away from health and “body issues” and concentrating on the struggle for women’s rights in the public world controlled by men. By the mid-thirties the workingmen’s movement no longer existed as a distinct thrust in American politics. Its radical analysis trailed off in the end, toward Andrew Jackson’s Democratic Party rather than toward socialist revolution.† Without being pushed from below by a mass constituency, the Thomsonians easily succumbed to the very forces they had set out to challenge. Where once they had denounced the transformation of healing into a commodity, now they sought to package their own alternative into a new commodity. Where once they had denounced medical elitism, they now aimed for a patrician exclusiveness of their own.
The Hygienic movement also suffered eclipse. Its very principles were incompatible with commercial success. Dr. Russell Trall, once a regular doctor who had crossed over to druglessness and then had systematized the Grahamian principles into a distinct school, had said:
We cannot practice our system without educating the people in its principles. No sooner do they comprehend them, than they find themselves capable of managing themselves, except in rare, and extraordinary cases, without our assistance. Not only this, but our patrons learn from our teachings, examples, and prescriptions, how to live so as to avoid, to a great extent, sickness of any kind. When you become physicians, you will be continually teaching the people how to do without you.48
The business and professional ethics of the Hygienic movement, then, had once amounted to a plea for no business and no profession. Some Hygienists did open schools which offered the degree “Doctor of Medicine,” and began to describe themselves as “physicians” and practitioners of “hygienic medication.” But these feeble attempts to imitate the medical profession were short-lived and later lamented even within the movement as a “very unfortunate mistake.”
In the meantime, regular medicine “adopted enough Hygiene to save itself.”49 The Hygienic movement credits itself with these accomplishments, incorporated into regular medicine:
People learned to bathe, to eat more fruits and vegetables, to ventilate their homes, to get daily exercise, to avail themselves of the benefits of sunshine, to cast off their fears of night air, damp air, cold air and draughts, to eat less flesh and to adopt better modes of food preparation.
It has been forgotten who promulgated these reforms; the record has been lost of the tremendous opposition to these reforms that the medical profession raised; it is believed that the medical profession was responsible for the decline of disease and death, the decline of the infant death rate, the inauguration of sanitation, and the increased lifespan.50
Lady Doctors Join the Competition
The assaults of the Popular Health Movement left the regular doctors—who were still aspiring to become the medical profession—as debilitated as if they had been forced to undergo their own heroic treatments. But the worst was yet to come. Between the eighteen forties and seventies, the banner of professionalism, already tattered by populist attacks, fell into the mud of crude commercial competition. The regulars’ drive for a medical monopoly became a defensive holding operation.
First there was the problem of “irregular” competition. Where there had once been a health movement, there was now a bevy of organized medical sects—eclectics, botanicists, homeopaths, hydropaths—each with its own schools, journals, and claims to scientific superiority. Trained botanical healers and eclectics (so-named because they aimed to combine the best of both regular and Thomsonian-type approaches) inherited the loyalty Thomsonianism had won earlier among small farmers and the urban working class. A far worse threat to the regulars was homeopathy: first, because it was popular among upper-class consumers. And in those days before Medicaid and Medicare when gentlemanly physicians still liked to think of their fees coyly as “honoraria” paid out of sheer gratitude, it was the upper-class consumer who counted in the struggle for occupational survival. The second challenging feature of homeopathy was that it did not hurt people. (The botanical healing practices of the Popular Health Movement had been harmless too, but they were unacceptable to upper-class consumers because of their radical associations.)
Homeopathic therapy was, in a sense, heroic therapy inverted. While the regular physician recklessly escalated doses and mixed medications in order to produce a maximal affront to human physiology, the homeopath’s maxim was—the less the better. The homeopathic physician began by diluting the basic medicine (usually a plant extract of some kind) to 1/100 of its original strength; the second dilution brought it to 1/10,000 of its original strength; the third to 1/1,000,000 of its original strength. According to Hahnemann, the founder of homeopathy, one should then proceed to the thirtieth dilution.51 A drop of this could then be administered to the patient in a sugar cube. As any chemistry student could tell you, the chances of such a drop containing even a single molecule of the original medicine would be infinitesimal. But the homeopaths claimed to have discovered a new physical principle: that substances gained in curative power as they were diluted.
They had, in fact, discovered something extremely valuable: they had found a way to make a commodity out of doing nothing at all. The regular doctor feverishly dosed, probed, and (increasingly as the century went on) cut his patient. This produced a commendable and altogether marketable display of effort—but only at the risk of mortal injury to the patient. An honest and intelligent doctor might have admitted his helplessness in most cases and refrained from doing anything, but this would hardly have merited a fee. Thus the homeopathic compromise: to expend a great deal of effort and time without doing a bit of harm. To the patient who had known the bitterness of calomel, there must have been balm indeed in the homeopath’s moistened sugar cube.
Then, quite aside from the competing sects, there was a mounting problem of competition within the ranks of the regular doctors themselves. To open a medical school, a group of doctors had to do little more than rent a building, collect a skeleton, a preserved fetus, and perhaps a few other visual aids, and then advertise to the public. Students paid the professors by the course, and were virtually guaranteed a degree in two years or so, so long as they kept up their payments. Thanks in large part to these medical degree mills, the number of regular doctors in the United States increased from a few thousand in 1800 to over 40,000 by mid-century.52 And, of course, the stiffer the competition for paying patients, the more doctors were tempted into the business of occupational reproduction—medical teaching—to supplement their incomes. So the cycle went: poverty and “overpopulation,” as the doctors saw it, going hand in hand as the profession marched toward ruin.
In the second half of the nineteenth century, occupational prestige sank so low that the days when Benjamin Rush could confer with statesmen and take tea with countesses began to look like a lost paradise of professionalism. The regular doctors banded together in 1847 to form their first national organization, pretentiously entitled the American Medical Association, and one of the AMA’s first tasks was to survey the competition—the 40,000 regulars plus a “long list of irregular practitioners who swarm like locusts in every part of the country.” The report concluded, “No wonder the profession of medicine has measurably ceased to occupy the elevated position which once it did; no wonder that the merest pittance in the way of remuneration is scantily doled out even to the most industrious of our ranks.”53
The regular doctors were
caught in a contradiction of their own making. Medicine had once been embedded in a network of community and family relationships. Now, it had been uprooted, transformed into a commodity which potentially anyone could claim as merchandise, a calling which anyone could profess to follow. So long as medical education was cheap, and medical fees were not too cheap, there was no limit to the numbers of regular doctors. Thus the patrician ideal of the gentleman doctor could never be realized. And of course, the deeper the doctors sank into commercialism, and the more they spawned in this fertile muck—producing new doctors simply for profit—the less likely they were to achieve the status and authority of their collective dreams. Ahead lay nothing but humiliation. Dr. C. H. Reed of Toledo wrote poignantly in the Journal of the American Medical Association about “a doctor who was found crying because he was hungry.”54
A great deal—it is impossible to say exactly how much—of the competition which was reducing male regular doctors to tears was coming from women. By mid-century there were not only female lay healers to contend with, there was a new breed of middle-class women who aspired to enter the Market as regular, professional physicians. Like the women who had become involved in the Popular Health Movement earlier, they were motivated by a spirit of reform: they were opposed to the excesses of heroic medicine and—equally important—they were outraged at the implicit indecency of the male doctor–female patient relationship. The extreme division between “men’s sphere” and “women’s sphere” had put the male doctor in a decidedly awkward position. How could a woman, especially a lady, expose her most private parts to his peerings and pokings? Doctors were fond of citing female patients who died in quiet agony rather than submit to male medical care. “If I could have been treated by a lady doctor my worst sufferings would have been spared me,”55 a friend confided to the young Dr. Elizabeth Blackwell.
For Her Own Good: Two Centuries of the Experts Advice to Women Page 8