Marketplace of the Marvelous (3 page)

The growing feeling that people could decide for themselves was not limited to medicine. Democratization significantly reshaped religious attitudes as well, as nineteenth-century evangelicals like Charles Grandison Finney, Lyman Beecher, and Francis Asbury focused on sin as a human choice rather than an inherent part of human nature. With salvation no longer left in God's hands alone, an individual could save her soul by turning away from sin to embrace moral action and God's grace. This emphasis on personal choice opened the door to new religious groups like the Latter-day Saints, Millerites, and Seventh-day Adventists who questioned religious orthodoxy and offered more contemporary and personally empowering alternatives as they competed with older denominations for adherents.
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Other people and institutions seized on the democratic impulse to propose social innovations that they hoped would usher in a better world. All of the transformations remaking the nation promised so much hope but came laden with challenges. Poverty, lawlessness, and overcrowding gripped city and town alike. Inequality persisted. To solve these problems, reform organizations dedicated to sanitation, abolition, dress reform, vegetarianism, and countless other issues formed around the country. Utopian communities like the
Transcendentalist Brook Farm in West Roxbury, Massachusetts, and those of Robert Dale Owen at New Harmony, Indiana, and John Humphrey Noyes at Oneida, New York, attempted to remake society. Most of these communal experiments disintegrated quickly, but these reform efforts nonetheless raised expectations about the possibility of perfecting both human nature and its institutions.
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All of these disparate reform efforts shared one overriding goal: to match American reality with American ideals. Early Americans evinced a remarkable faith in the boundlessness and perfectability of the nation. The path to perfection naturally began with the individual. Ralph Waldo Emerson counseled, “Nothing can bring you peace but yourself. Nothing can bring you peace but the triumph of principles.”
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Reformers of all kinds encouraged Americans to work toward the perfection of their individual lives, believing that this would have a cascading effect that uplifted all of humanity.

In this dynamic environment, it's hardly surprising that irregular medicine flourished. When these systems first arose, the country's medical marketplace was already among the most varied in the world. Medical practice in the eighteenth century had been loosely organized and lightly regulated, an activity in which just about anyone could—and did—participate. All tastes and budgets could find a medical system to match. People relied on doctors as well as midwives, lay healers, herbalists, and Indian doctors skilled in the use of native plants. Ministers, often the best-educated people in a community, received frequent calls to heal the body as well as the spirit. Trained doctors were in short supply. The problem was particularly severe in the South and the West as people moved farther and farther into the frontier. Before the telephone, a doctor had to be summoned in person. A farmer traveling eight miles to town for help could lose a whole day of precious work. Even then, there was no guarantee that the doctor would be home. As a result, responsibility for medical care often fell on the sick themselves.
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While Americans had frequented a variety of healers since colonial days, in the nineteenth century, medicine became a war zone as health came face-to-face with a growing commercial society. The capitalist marketplace spawned a business sector of medicine that vended medical services and remedies on a large scale. The pace of change in other health fields only accentuated the lack of progress by regular doctors. For the first time, healers who had generally practiced alone
began to band together. Thomsonians, mesmerists, homeopaths, and hydropaths led the first offensive, while osteopaths, chiropractors, and Christian Scientists launched a second advance later in the nineteenth century.
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Each had different therapies, theories, and techniques, but they all wanted to overturn and supplant regular medical practice—or at least, that's what regular doctors tended to believe. “These systems, however widely they differ in character, all agree in one thing—they are all at war with what they term the ‘regular' profession,” reported Worthington Hooker to the Connecticut Medical Society in 1852. “And this war, which is one of extermination, they have prosecuted from the beginning.”
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Irregulars identified regular medicine with overly aggressive therapies based on old and speculative ideas. They derisively nicknamed regulars “drug doctors” and “knights of calomel and the lancet.” Bloodletting and heroic dosing—and in many cases, drugs altogether—were virtually banished from most irregular practices. Irregulars claimed that common sense and their experience with an alternate form of healing—often gained through some kind of conversion experience—had completely discredited regular medicine's damaging and depletive therapies. Most relied on natural remedies and proclaimed nature the source of both the strongest treatments and the most effective preventative medicines. They presented their case to Americans in simple and direct language that reinforced the era's widespread belief in intuition, practical sense, and accessible knowledge, while exploiting regular medicine's weaknesses. Irregular doctors were no more equipped to cure than regulars, but their treatments tended to be milder, cost less, and cause fewer side effects.

The proliferation of medical systems and alternative routes to wellness spoke to the lack of scientific advancement and to American hunger for new and potentially more effective treatments. Irregulars speculated on the cause of disease and devised coherent and unified theories that made sense of many confusing and often vague symptoms. They promised a clear path to health and wellness. In many ways, irregulars could make greater claims to scientific authority than regular medicine. Most based their theories on their own observations and experimentation, a method generally considered the most modern form of scientific induction of the time. Irregulars observed the effects of certain drugs or procedures and then made claims based on what they saw. They even got a few things right.
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Even before the irregular assault gained force, regular medicine as a profession had started to lose status. “Medicine has ever been and is now, the most despised of all the professions which liberally-educated men are expected to enter,” lamented the
Medical Record
in 1869.
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Most doctors commanded little respect. Some could barely scrape together a comfortable living and took on second jobs, usually farming, to get by. One dissatisfied doctor even took to robbing stagecoaches on the side, but he was eventually captured and imprisoned.
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Jokes about doctors filled newspapers and magazines. When a nation abounds in doctors, one wit said, it grows thin of people.
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English journalist William Cobbett remarked that American physician Benjamin Rush's penchant for extreme bleeding and purging regimens was “one of those great discoveries which are made from time to time for the depopulation of the earth.” Even Thomas Jefferson got in on the critique, attesting that doctors tended to be ignorant, uneducated, and extreme in their therapies, especially considering how little they actually knew about health and disease. Looking to the future, Jefferson hoped “that it is from this side of the Atlantic, that Europe, which has taught us so many other things, will at length be led into sound principles in this branch of science, the most important of all, being that to which we commit the care of health & life.”
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Stories of medical men grave robbing for anatomical material and dissection also did little to win public favor to the medical profession. One of the most notorious incidents occurred in New York City in April of 1788 when medical student John Hicks allegedly waved a cadaver's arm at some children peering through the window of a hospital dissecting room. Hicks then called out, “This is your mother's arm! I just dug it up!,” likely unaware that one of the children had recently lost his mother. The boy ran home and told his father, who exhumed his wife's coffin and found it empty. As the story got out, an angry mob gathered around the hospital. Hicks and his fellow students and teachers ran as the crowd broke into the hospital. One doctor and five students remained inside, determined to protect a valuable specimen collection. James Thacher, a physician who witnessed the riot, reported that the mob found several human bodies “in various states of mutilation. Enraged at this discovery, they seized upon the fragments, as heads, legs and arms, and exposed them from the windows and doors to public view, with horrid imprecations.” Bands of rioters moved across the city reporting what they had seen inside the
hospital as they searched for Hicks. To protect the medical students from the crowd, Mayor James Duane had several escorted to jail. The unrest continued overnight and into the following day until eventually more than five thousand people gathered outside the jailhouse throwing rocks and demanding retribution. Finally, the governor sent the cavalry charging up Broadway to break up the jeering crowd. In the end, at least three and as many as twenty people died in the riot or from wounds sustained in the melee.
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The New York Doctors' Riot, as it came to be known, was not the first or the last medical riot—others broke out in Philadelphia and Baltimore—and public anger at doctors lingered long after the disturbances ended.
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Standard medical practice was partly to blame. Medicine in 1820 was little better than it had been in 1700. Heroic interventions remained the doctor's primary tools, just as they had for centuries. Most of the methods to truly understand disease had yet to be discovered. Medical science was not completely stagnant, of course. Physicians and scientists continued to discover more about the body's structure and function, but they had little in the way of new treatments. Many regular doctors sought to draw a line between themselves and those they saw as quacks by proclaiming their devotion to science, but in truth, the boundary between regular and irregular medicine was hazy at best.
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British physician Matthew Baillie remarked, “I know better perhaps than another man, from my knowledge of anatomy, how to discover disease; but when I have done so, I don't know better how to cure it.”
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Doctors watched helplessly, and not without a bit of jealousy, as scientific discovery and progress rapidly remade nearly every other aspect of nineteenth-century life. The complete ignorance of the cause of disease prevented effective methods of healing or even lessening symptoms, creating a dilemma for doctors trying to heal those who hungered to be well.

Public dissatisfaction with doctors was likely not helped by the poor training most received. Medical schools often had minimal entrance requirements, and degrees could be granted in as few as six months. Most doctors, though, had attended no medical school at all. Medical schools of any kind were slow to develop in the United States. The first medical school, at the College of Philadelphia, opened in 1765, more than a century after the founding of Harvard in 1636. Before 1840, only a third of practicing doctors in New England had attended medical school or completed an apprenticeship.
The number was far lower in the West and South.
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Poor training persisted throughout the nineteenth century. It was so bad that one physician bemoaned in the
Medical Record
that “after a man has failed in scholarship, failed in writing, failed in speaking, failed in every purpose for which he entered college … there is one unfailing city of refuge—the profession of medicine.”
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Medical licensing systems, weak as they were, were mostly repealed in the 1820s and 1830s. This encouraged the rise of irregular movements by eliminating the legal boundaries between regular and irregular medicine. Many colonies had chartered medical societies in the eighteenth century with the power to administer licenses that placed a nominal penalty on practicing without a license. But even when in force, these licensing systems did not require doctors to demonstrate any of the principles or practices of medicine. Under pressure from proponents and practitioners of irregular medicine, nearly every state legislature removed restrictions on medical practice in the nineteenth century. These irregular healers seized on the democratic spirit of the time to protest restrictions that they said limited choice and fostered elitism. Unlike Europe, where medical practice received some state and institutional support, the United States adopted a laissez-faire approach to medicine. Irregular healers claimed that their common sense and personal experience with alternate forms of healing completely discredited heroic medicine and its terrible side effects. “The practice of physic requires a knowledge that cannot be got by reading books; it must be obtained by actual observation and experience,” proclaimed botanic healer Samuel Thomson.
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Irregulars reminded regular doctors that the first rule of Hippocrates had been to do no harm: only pain and suffering resulted from bleeding, blistering, and purging. Refusing to submit to the pretenses of regular medicine, irregular healers believed in their own right to practice and in the public's right to choose how and by whom they were treated.
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Regular doctors viewed these irregular systems with derision. They considered irregular medicine a random mix of inert and sometimes dangerous therapies passed off as legitimate on a gullible and unknowing public. “This subterfuge cannot avail,” lamented physician Caleb Ticknor. “Call himself by what name he will, a quack is still a quack—and even if the prince of darkness should assume the garb of heavenly innocence, the cloven hoof would still betray the real personage.”
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But who qualified as a quack was a matter of perspective.
Irregulars were “quacks” in the eyes of regulars. In these prescientific times, a quack was always that other guy whose methods seemed improper, unscientific, or deceitful to someone else. That someone else often happened to be losing business to these so-called quacks.