Pox_ An American History - Michael Willrich [148]
By 1900, the United States had an estimated 110,000 orthodox physicians and roughly 20,000 practitioners of alternative medicine. The bestestablished irregulars were America’s 9,000 homeopaths (who treated disease by administering minute doses of remedies known to produce symptoms in a healthy person that were similar to those of the disease) and the eclectics (who favored botanical remedies). Relative newcomers to the medical culture included practitioners of osteopathy, chiropractic, and naturopathy—all forms of drugless healing. Although adherents of each of the unorthodox schools viewed their own system as superior, they shared a general belief in the therapeutic and preventive power of nature—emphasizing the virtues of sound diet, a daily regimen to maintain the integrity of the body, and the administration, in times of illness, of gentle remedies such as herbs. The irregulars rejected the mercurial drugs, bleedings, and other strenuous measures of mainstream practice. They prided themselves on their holistic, empirical, “common sense” approaches to disease. For much of the nineteenth century—the age of heroic surgeries and toxic mercurials—the irregulars’ gentler medicine seemed to many patients the safer approach.26
For years, the unbridled contempt of the mainstream medical societies had only enlarged the irregulars’ self-esteem, and, not incidentally, their market share. From its inception in 1847, the American Medical Association had strived to drive the irregulars (particularly the homeopaths) from the temple of medicine. The association imposed on its members a “consultation clause,” which forbade them to consult with doctors who lacked “proper” (regular) medical credentials. Even in the absence of exclusive state licensure laws, this clause effectively barred homeopaths from practicing in many publicly funded hospitals. Regulars who consulted with unorthodox practitioners faced expulsion from their medical societies. The consultation clause was increasingly perceived by the public as petty and dangerous. (The AMA would eventually do away with the mandatory provision in 1903.) And as Dr. Oliver Wendell Holmes acknowledged as early as the mid-nineteenth century, every insulting comment from a regular physician was “a gratuitous advertisement” for his irregular rival. The irregulars, Holmes observed, “understand the hydrostatic paradox of controversy: that it raises the meanest disputant to a seeming level with his antagonist.” This was a truism of public debate that the antivaccinationists understood as well.27
The final decades of the nineteenth century brought a new campaign for state medical licensing laws, precipitating a struggle between the regulars and irregulars that remained heated well into the early twentieth century. The advent of the germ theory of disease enabled extraordinary advances in medicine, particularly in the field of surgery, an area that alternative practitioners had generally conceded to mainstream physicians. Rising standards of medical education and the general culture of middle-class professionalization in late nineteenth-century America helped win the support of state lawmakers. Nearly every state enacted some form of medical licensing statute. Though homeopaths and eclectics were by that time too well established to legally exclude from the practice of medicine, many still resented the government imprimatur that the new laws conferred upon the regular-dominated state medical societies. In most states newcomers in fields such as chiropractic and naturopathy found themselves subject to prosecution for practicing medicine without a license.28
During its long struggle for authority, the regular medical profession established uneasy but increasingly close ties with American state and local governments. As the AMA and the state medical societies pushed for laws to eliminate their irregular competitors, the AMA helped establish the authority of orthodox practitioners through its pursuit of laws criminalizing abortion and the distribution of information