Knowledge in the Time of Cholera Read online

  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.”

  LICENSING REPEAL AND PROFESSIONAL COLLAPSE

  The visions of medicine proposed by Thomsonians and homeopaths differed in the degree to which they sought to flatten hierarchies in medical knowledge (see table 1.1). Nevertheless, both offered a more democratic epistemology than allopathy. And in articulating competing epistemological visions and demanding an account of regular medical knowledge, Thomsonians and homeopaths shifted medical debates over particular issues, like cholera, onto the level of epistemology. By provoking comparisons between sects, these alternative medical sects suggested the possibility of choice in medicine. Seizing the opening afforded by the epidemic, they transformed cholera into an epistemic contest.

  As argued above, epistemic contests play themselves out in institutional arenas, whose natures affect their trajectory. After the first cholera epidemic, no arena was more significant than state legislatures, where medical sects vied for authority through licensing laws. Prior to 1832, regulars looked optimistically to their professional future, having gained a measure of professional recognition with the passage of licensing laws in thirteen states (Numbers 1988). Laws varied across states but generally they either prohibited the practice of medicine by nonlicensed physicians (punishable by fine or imprisonment) and/or prohibited nonlicensed practitioners from suing for fees, an economic prohibition that could cripple a practice. Licenses were granted by medical schools, societies, or board of examiners, all bodies under allopathic control. While these laws were mainly symbolic, as it was difficult to enforce them (De Ville 1990; Kett 1968; Shryock 1967; Haller 2000), they had important symbolic value, for despite their limitations, they endorsed allopathy’s claim to a privileged professional position. Allopathic optimism dissipated after the 1832 cholera epidemic, as the Thomsonians and homeopaths used regulars’ cholera failure to advocate for the repeal of such laws. Rapidly, the regulations were repealed. Beginning with Alabama and Ohio in 1833 through the final elimination of all regular legal privileges in New York in 1844, states deregulated medical practice, the exceptions being New Jersey and the District of Columbia.8 The repeals both humbled the profession and ushered in a period of intense competition between medical sects (Numbers 1988). By 1848, the arrival of the second cholera epidemic in the United States, government regulation of medicine had reached its “nadir” (Kett 1968, 27).

  Table 1.1. Contrasting styles of reasoning among nineteenth-century medical sects

  Map of repeal of state licensing laws. Mark Treskon.

  How did alternative medical movements achieve such success in their campaigns against licensing? By examining the legislative debates over licensing laws in the New York State legislature—the state with the longest and most protracted struggle—we can gain a general sense of how these competing rhetorics and epistemic visions played out in the state legislatures. In the New York State legislature, alternative medical movements’ vision of knowledge found an audience generally receptive to their democratic ethos and hostile to regulars’ appeals to authority. Thomsonism’s elevation of common sense and homeopathy’s recognition of the public as legitimate judges shared affinities with the culture and organizational practices of the legislature, which, despite its failings and contradictions, had been influenced by Jacksonian democratic ideals. In the end, Thomsonians and homeopaths offered something more substantial to the legislatures than better efficacy in addressing cholera. They offered a new vision of medicine that democratized knowledge.

  Deregulation in New York

  During the Jacksonian era, American political institutions underwent a democratic transition (Pessen 1969), as political reforms expanded suffrage and sought to make government more responsive to the people (Kass 1965). In the new era of mass political parties (Schudson 1998), politicians had to placate a growing electorate, if not in substance, at least in rhetoric. Certainly within the political realm, the rhetoric of democracy and the common man became common currency among all political parties and actors. Historians have long debated the extent to which the egalitarianism as espoused by politicians during this period was genuine (see, for example, Feller 1990; Kohl 1989). Even if the appeal to the common man was cynical, it provided an important cultural trope used by both political parties, Whigs and Democrats (Kohl 1989; Wilson 1974). The use of such rhetoric—the instrumental and, yes often, cynical appeals to democracy by politicians—reflected a substantive shift in political calculus toward a participatory role for the public, and politicians adapted accordingly, clamoring to present themselves as attentive to public input.

  By 1832, democratic reform had already reached the New York State legislature. In the 1820s, New York expanded the franchise by repealing property qualifications for voting. Throughout the 1830s and 1840s, Jacksonian Democrats, organized under Martin Van Buren’s Albany Regency, controlled the legislature, but the Whigs maintained a significant minority status. Regardless of who was in control, however, the similarities between the parties outweighed their differences (Benson 1961; Kass 1965). An emerging consensus among historians i
s that Whigs and Democrats shared a commitment to key unquestioned values—the permanence and immutability of the Constitution, the defense of liberty and republicanism as the prime goal of political activity, and the liberal economic precepts of private property and free enterprise (Feller 1990). More important, both political parties sought to gain mass appeal, differing only in their conceptions of and means to individual freedom, not in the significance of freedom as an ideal (Wilson 1974). Both learned to act and talk within a democratic universe, where “everyone loved the people, bowed gladly to their sovereignty, celebrated their virtue and their judgment” (Meyers 1957, 257).

  While the actions of politicians rarely lived up to their professed democratic ideals, they did shape how the legislature viewed knowledge. The appeals to the common man by both New York Whigs and Democrats implied a view of knowledge production that advocated common sense and a mistrust of authoritative accounts. De Tocqueville (2000, 512) was struck by Americans’ self-reliance on intellectual matters, their suspicion of authorities, and their continued appeals to common sense, noting “each American appeals to the individual exercise of his own understanding alone.” The Jacksonian era represented the first flowering of anti-intellectualism in America, as citizens adopted “the widespread belief in the superiority of inborn, intuitive, folkish wisdom over the cultivated, over-sophisticated, and self-interested knowledge of the literati and the well-to-do” (Hofstadter 1963: 154). Legislators were not immune to such anti-intellectualism. As historian Jean H. Baker (1983) shows, they were also socialized into these anti-intellectual values through shared educational experiences that promoted challenges to authority and organized dissent, values that were later reinforced by political parties.

  This anti-intellectual, democratic view of knowledge informed the institutional practices of the legislature. While the legislature was by no means a bastion of measured deliberation, its structure of decision-making processes stressed debate and encouraged the exchange of competing viewpoints. Pressing issues were sent to committees for investigation. Committees gathered information (often statistical data) and submitted reports, along with their recommendations, to the entire chamber. Committees were required not only to give their recommendations but also to demonstrate their reasons for their conclusions. Thus, even if political machinations operated behind the scenes, in its formal procedures, the legislatures championed ideals of open debate. Arguments needed to be justified in front of the whole chamber as well as to the public through the media. The operating ideal implicit in these institutional practices bowed toward a democratic epistemology in which competing arguments were presented, debated, and then collectively decided upon. The epistemologies of Thomsonians and homeopaths, which sported flatter hierarchies in knowing, mirrored the changing conception of the public evident in the New York State legislature. Alternative medical movements did not succeed in the legislature simply because they rode a favorable cultural wave. Nor was it because they spoke the legislature’s language or because they successfully framed cholera. Rather, the epistemologies tacit in their rhetoric aligned with the legislature’s own understanding of knowledge.

  Take for example the ideological resonance between legislators and Thomsonians—their shared commitment to common sense, anti-intellectualism, and self-sufficiency in matters of knowledge. Both viewed knowledge production through the lens of democracy and the egalitarian ideals of the Jacksonian era. The Boston Thomsonian Manual’s (1841, 98) complaint that “the art of healing, as it is called, has been long confided to a few interested individuals, who by degrees obtained sufficient power and influence to sway the public mind and chain posterity to whatever they might indicate for the health and lives of the people” could have easily been written by Jacksonian political reformers. Just as the people should choose and challenge their politicians, so should patients choose and challenge their doctors. In many ways, Thomsonians applied Jacksonian political logic to medicine, for their appeal to the common man, laissez-faire economic arguments, and condemnation of monopolies mimicked that of Andrew Jackson and the Democratic Party. Thomsonian rhetoric against monopolies was familiar to legislators, who often employed similar arguments in political matters, like the controversy over the Second Bank of the United States.9

  Similarly, the sympathetic hearing given to the homeopaths by the New York State legislature stemmed from the resonance of their statistical rhetoric, and the fundamental epistemic assumptions underlying this rhetoric, with the legislature’s epistemology. This elective affinity (Weber 2002 [1909])10 between homeopaths and the legislature operated on a number of levels. First, there was a technical affinity. Both homeopaths and the legislature were engaged in gathering and producing statistical data. In a period of negative liberalism, when the government remained hesitant in acting, “one thing a government that saw itself as doing very little did do was gather statistics” (Kelman 1987, 275). Legislatures were familiar with statistical and numerical data, as they were prevalent in policy debates. Second, the homeopathic approach to knowledge production shared certain homologies with the legislature’s own understanding of debate and deliberation as expressed through its institutional practices. The decision-making processes of the legislature stressed demonstration and encouraged the exchange of competing viewpoints. Contrasted with the authoritative testimony of allopathy, which attempted to convey medical knowledge through a monologue, homeopathic rhetoric embraced transparency and dialogue. Finally, the rise of statistical thinking and numeracy was tied up in the very changes in the conception of the public during this period as embodied in the legislature, which mandated that claims had to be demonstrated to the public and endorsed by it in order to be legitimate. No longer passive bystanders, the public was encouraged to participate both in the politics of the day and, for alternative medical sects, in shaping medical knowledge.

  This epistemological resonance explains the success of alternative medical sects in convincing the New York State legislature to repeal the licensing laws, despite strong allopathic resistance. Thomsonians took the lead in the fight for repeal. In 1834, they gathered over thirty thousand petitions in a successful effort for the repeal of a law prohibiting unlicensed practitioners from using botanicals when treating patients (Haller 2000). Homeopaths also petitioned against licensing, and while they accumulated fewer petitions, they had the support of their more influential patients. After a decade of fierce advocacy and near misses, the legislature voted to repeal all restrictions on medical practice in 1844, placing the alternative sects on equal legal footing with allopathy.

  The legislature’s official justifications for the repeal reflected the affinity between the legislatures and the alternative medical epistemologies. Members of the New York legislature made two arguments for repealing the statutes, both of which demonstrated logic aligned with the democratized epistemologies of homeopaths and Thomsonians. First, the legislature respected the right and ability of citizens to draw their own conclusions about medicine. They were unwilling to infringe upon citizens’ right to exercise common sense and make their own decisions. The New York Senate Select Committee on Petitions (1844, 1), appointed with the task of assessing the antilicensing petitions, argued, “A people accustomed to govern themselves, and boasting of their intelligence, are impatient of restraint; they want no protection of their intelligence but freedom of inquiry and freedom of action.” The New York Assembly Select Committee on Petitions (1842, 1) defined the Thomsonian program in terms that mirrored the Senate’s vision of public discretion: Thomsonians “believe the people are capable of appreciating worth and learning in the physician, and if unembarrassed by any other circumstances will do so.” Concerns about protecting the public from quackery were dismissed as unnecessary, for “light and knowledge are breaking through the barriers of darkness and superstition; education has taken deep root in the minds of an enlightened people” (New York Assembly Select Committee on Petitions 1844, 3). Believing in enlightened common sense, legislators put their
trust in the people to make medical decisions for themselves. The restrictive laws were deemed illegitimate, for they contradicted the “spirit of republican institutions” (New York Assembly Select Committee on Petitions 1844, 2). Like homeopaths and Thomsonists, the legislature was willing to put its trust and faith in the common sense of the public.

  Second, the legislature endorsed a view of knowledge production that stressed argumentation and debate as the means to achieve better knowledge and, in turn, better policies. The development of science, according to this view, necessitated free and open debate. The New York Senate Select Committee on Petitions (1844, 3), employing an analogy to the freedom of religion, argued,

  Science is not confined to medical societies or colleges, more than religion to councils or synods; the one is not more the providence of the legislative regulation than the other. The march of error has ever been the same; men are not content with propagating their creeds and leaving reason free to combat or embrace them—they ask the strong arm of government to decree the true religion and the true science for the sake of the souls and bodies of the people. . . . It is not the province of your committee to decide which school of medicine is the true one; it is enough to say, we believe it is the duty of the legislature to interfere with none, and to protect free inquiry.