Minutus

Decline of Homeopathy in US

Reasons
1. Decline in quality of homeopaths and schools
2. Flexner report and no money to homeopathic schools

see below for details

http://homeoint.org/books4/kotok/1940.htm

The history of homeopathy in the Russian Empire
until World War I, as compared with other European countries and the
USA: similarities and discrepancies
by Alexander Kotok, M.D.
On-line version of the Ph.D. thesis improved and enlarged
due to a special grant of the Pierre Schmidt foundation.
1.9.4 United States of America

The history of the fast spread, flourishing and swift decline of
homeopathy in the USA presents, probably, the most interesting piece
of the history of world homeopathy, and attracted the attention of
many scholars. The attempts to understand the reasons which led to
the decline and virtual disappearance of homeopathy in the USA, are
not only purely historical, but are also practical. At the present
time, homeopathy in the USA, as in many other countries, is on the
rise. When trying to ascertain why homeopathy, whose future seemed to
be so promising, completely surrendered to allopathy within some
20-25 years, one can foresee the future of contemporary homeopathy.

The reasons, which caused the fast development of homeopathy in the
USA, seem to be clear. The level of the training at medical schools
was then very low:

Even the most credulous of Americans had become skeptical of the
physicians' claims to the dignity of a learned profession. The
requirements for graduation from medical school, complained a
Massachusetts physician, were purely nominal, the final examination a
"mere pretense". In Iowa, six months of reading medicine were
sufficient to win the title of doctor. The prospective healer then
bought a "pound of calomel, an ounce of quinine, a drachma of
morphine," and considered himself ready to locate. [...]. More
damaging to the medical profession than either lack of education or
of ethical standards was the practice of the average physician. His
ministrations provided neither cure nor the illusion of competence
and consistency [...]. 213

Allopathic medicine, especially its indiscriminate bloodlettings and
abusive use of mercury, which were so widely spread in the New World,
was the subject of hard criticism of the contemporaries.

The reasons for the early success of homoeopathy in the USA are not
difficult to understand in the context of the state of orthodox
medicine at the time. American orthodox medicine in the first half of
the nineteenth century was comparable with European medicine but was
if anything more dangerous. Bleeding was of course a sovereign remedy
and was taken to even greater lengths than were fashionable in
Europe... Bloodletting was the correct treatment for almost any
disease but especially for fever. 214

Certainly, this made the way of homeopathy in the USA much easier. Moreover,

Homeopathy, the most widespread of the medical sects competing with
the regular profession, benefited as well from a rapidly increasing
German immigration, which provided both practitioners and patients.
Like hydropathy, [...] homeopathy was comparatively inexpensive and
at worst harmless. At least homeopathic medicines would 'not make
well men sick, nor keep sick men from getting well'. 215

The first American homeopaths, like in Russia, were immigrant
physicians of German origin, graduates of the prestigious German universities.

In the 1830s the new doctrine was carried both West and East by
German immigrants and German graduates of the 'Nordamerikanische
Academie'. The first homeopath of Ohio, in 1839, was a German pupil
of Hahnemann's, and he was joined by a German faculty member of the
Nordamerikanische Academy [created by C. Hering in Allentown,
Pennsylvania; see the chapter 'Homeopathic facilities] [...]. Four of
the first five homeopaths in Maryland were German immigrants [...].
Throughout the century these German pioneers remained the leaders of
the profession". 216

While continuing to grow owing to the conversion of regular
physicians, especially during the epidemics for the treatment of
which allopathy had nothing at all to offer, homeopathy soon became
the most powerful "heresy" within the American medical profession.
Moreover, homeopathy, as distinct from other irregular practices,
like Indian medicine, Thomsonism or Grahamism, appealed to the fast
growing and developing classes:

Homeopathy [...] appealed primarily to those middle and upper class
persons who were seeking an alternative to regular medicine. It was
able to do so for two major reasons. First, unlike its competitors,
homeopathy was extremely fashionable among the European nobility and
upper classes, whose tastes were often copied by affluent Americans.
Second, the leaders of Thomsonism and virtually all the other
movements opposing regular medicine were often uneducated laymen.
Patients, who could afford to pay for the best in medical care, would
hardly be attracted to any movement with this kind of leadership.
Homeopathy was devised by a physician and the early American
homeopaths were all well educated and cultured physicians [...]. Many
of them were also 'persons of the highest respectability and moral
worth', according to the editor of the 'Boston Medical and Surgical
Journal' [...]. 217

It was not immediately that the regular profession recognized that
homeopathy was a real threat. It the first years the attitude toward
homeopathy was rather skeptical and neglecting.

Most regular physicians regarded their homeopathic colleagues first
with skepticism, then with incredulity, and finally with bitter
hostility. They considered many homeopaths to be opportunists who
practiced both homeopathy and regular medicine, not from conviction,
but 'according to order, on the whims and caprice of their medical
patrons' [...]. This statement summarizes the regular physicians' two
basic objections to homeopathy: 1. That the doses prescribed by
homeopaths were too small to have any physiological effect
whatsoever; and 2. that the cures which homeopaths attributed to
their drugs were actually brought about by the "recuperative efforts
of nature". The most interesting aspect of the criticism of the size
of the dose was the almost complete absence of any reference to the
law of similars on which it was based [...]. 218

In accordance with H. L. Coulter, I am inclined to see this hostility
not just as a resentment against the spread of an "unscientific
method", but as a demonstration of their unwillingness to share the income:

[...]. A second and related point was allopathic dismay at the high
fees the public was willing to pay homeopaths, especially in the
early years after the doctrine's introduction, when there were still
few practitioners [...]. 219

In the 1840s, the two different streams within medicine, parted
entirely. Allopaths began either to expel homeopaths from medical
societies or to look for some other methods of parting:

[...] Early in the 1840's, some regular physicians took the first
steps to purge their ranks of homeopaths. In 1843, the Philadelphia
Medical Society expelled all homeopathic physicians, a position with
which the influential Boston Medical and Surgical Journal agreed
[...] In New York City, regular physicians pursued a different
course. Unable to throw the homeopaths out of the county society
because of the provisions of its act of incorporation, they formed
their own private medical society, the New York Academy of Medicine,
in 1847. A leader of the Academy asserted at one of its first
meetings that the organization 'would not admit irregular men... Any
swerving from the path of professional rectitude will not be
recognized by us [...].' 220

The American regular profession had to unite and work out a certain
position against irregulars. The founding of the American Medical
Association (AMA) served this aim. The chief vehicle of collaboration
within the profession, i.e., consultations, were banned:

The problem of homeopathy was a major factor in the founding of the
American Medical Association and was one reason for its survival and
success. [...] The major vehicle in the AMA for dealing with
homeopaths was the code of ethics established in 1847. This document
devoted several important sections to relations with "irregular
practitioners" as homeopaths and other non-regular were called by the
regular profession. The most important section concerned
consultations, traditionally a major point of contention among
physicians. By keeping irregular practitioners out of all
consultations, the regular physicians hoped to destroy public
confidence in them, deprive them of their clientele, and increase the
gulf between them and the regular profession. 221

In reply, homeopaths established in 1844 their own powerful
institution, namely the American Institute of Homeopathy [AIH]:

[It was] Resolved [at the first session in April, 1844], that it is
deemed expedient to establish a society entitled "The American
Institute of homeopathy", and the following are declared to be the
essential purposes of said Institute:

1. The reformation and augmentation of the Materia medica;

2. The restraining of physicians from pretending to be competent to
practice homeopathy who have not studied in a careful and skilful manner...

At the second session of the Institute, in May 1845, it was resolved:

Not to admit as a member of this Institute any person who has not
pursued a regular course of medical studies according to the
requirements of the existing medical institutions of our country,
and, in addition thereto, sustained an examination before the censors
of this Institute on the theory and practice of Homeopathy [...].

The later charges of the American Medical Association that homeopaths
were uneducated physicians, were politically motivated and had no
foundation in fact. The founding of the American Institute of
Homeopathy meant the emergence of homeopathy as the spearhead of the
opposition to orthodox medicine. 222

The AMA initiated the full breaking-off with homeopaths:

In 1856 the American Medical Association resolved that homeopathic
works should henceforth no longer be discussed or reviewed in
allopathic periodicals. After this time there was no formal
communication whatever between the two branches of the profession [...]. 223

As in other countries chosen for comparison, homeopathy was attacked
by special anti-homeopathic books and pamphlets:

While several anti-homeopathic works appeared in the 1830's, Oliver
Wendell Holmes's 224 "Homeopathy and Its Kindred Delusions" (1842)
was the first serious counter-attack by orthodox medicine [...].
During the course of the nineteenth century about seventy-five
anti-homeopathic books and pamphlets were published in the United
States and Great Britain. 225

The situation of homeopathy in the USA at the turn of the century
seemed to be excellent and was the subject of the pride of homeopaths
everywhere in the world: American homeopaths possessed 22 homeopathic
colleges, dozens of purely homeopathic hospitals, dozens of
homeopathic periodicals; the number of the graduates of homeopathic
institutions counted by thousands (see the chapter "Homeopathic
facilities"). Nevertheless, already the first decade of the 20th
century showed a fast decline of homeopathy, first in the number of
colleges: by 1913, only 10 remained, whilst by 1919 only 5 were still
alive. Together with the disappearance of the colleges, homeopaths
lost their control over hospitals (the latter dropped their
homeopathic image and became purely allopathic facilities), whilst
the homeopathic periodicals were gradually discontinued. By 1950,
nearby nothing remained from the past glory of the homeopathic
doctrine in the USA.

So, what happened? This problem has been actively debated these last
years. No doubt that the decline of homeopathy was partially
connected to the publication of so-called Flexner Report 226 followed
by the "misuse" of the Carnegie and Rockefeller Funds, which enabled
the regular profession to improve its educational standards and to
strengthen its economical positions.

Yet the Flexner Report did not change the general negative trend
within American homeopathy:

The Flexner Report, published in 1910, had no bearing on the failure
of homeopathy in America. In the decade prior to the appearance of
the Flexner Report seven homeopathic colleges closed and enrollment
in homeopathic colleges declined by half. In the decade following the
publication of the Flexner Report, eight homeopathic colleges closed.
In other words, the decline which had started before the appearance
of the Flexner Report, continued unchanged after its publication
[...]. In fact it was more critical of homeopathic medical colleges
than allopathic ones, favoring the elimination of two-third of each
type. It judged five homeopathic colleges worthy to continue as
medical colleges. 227

Why did "the homeopathic movement" collapse? No answer is possible
without previously briefly analyzing of the internal processes which
had occurred within American homeopathy during the second part of the
19th century.

First of all, homeopathy in the USA had slowly changed to the bad.
First it became evident in the manpower:

The earliest students of homeopathy in this country [America] were
extremely serious and dedicated. They possessed not only the keenness
of mind to consider this new system of medicine, but also the
discipline and perseverance to study it in a foreign language, since
at that time all the texts were in German [...]. The demands of the
curriculum kept away all but the most dedicated individuals. As a
result, homeopathy was initially represented by men of great
integrity and commitment, who were thoroughly grounded in the
fundamental texts and principles of homeopathy. They had great
success in their practice. 228

Later the decline became evident also in the teaching of homeopathy
as a complete doctrine:

Almost without exception, the twelve thousands physicians calling
themselves homeopaths in 1900, received no training in homeopathic
doctrine, homeopathic method, or homeopathic Materia medica. Between
1840-1890 a structured course on the subject of homeopathic doctrine
and principles was presented at only two homeopathic colleges! [...]
The most important textbook of homoeopathy, the Organon of Medicine
by Samuel Hahnemann, sold only about five hundreds copies during the
entire era of the supposed golden age of homoeopathy in America.
Hahnemann's Chronic Diseases, an essential supplement to the Organon,
sold even fewer copies and was "long out of print" in 1889 [...]. 229

This point of view is shared by most researchers:

The [American] Institute [of homeopathy] grew rapidly in number but
the new members lacked the proselytizing fervor of the old guard,
whom they looked on as obscurantist old German fuddy-duddies. The
purists, for their part, regarded the new recruits as upstarts who
were ignorant of Materia medica, did not know to individualize their
cases, and never read The Organon, and did not even believe in the
law of similars. [...] The low-potency group, which had always
greatly out-numbered its rivals, drew gradually closer and closer to
orthodoxy. Eventually, the distinction between homeopathy and
allopathy became so slight that there seemed no point in perpetuating
it, and the vast majority of American homeopaths quietly switched
their allegiance. 230

Indeed, the German immigrants, who occupied the positions of those
who taught and those who were taught, gradually were replaced by
poorly educated American graduates, mainly recent converts from
allopathy, who had no desire to deepen their knowledge of homeopathic
principles, merely applying homeopathic medicines instead of
allopathic ones. One should not forget that homeopathy as a whole
doctrine is very difficult to be studied and applied (especially the
need of individualizing each case), as compared with rather primitive
allopathic prescriptions of that time. Thus, many pseudo-homeopathic
colleges certainly preferred to teach uncomplicated allopathy instead
of seeking and further attracting talented homeopathic practitioners
to be introduced into teaching staff in order to provide the teaching
of true homeopathy.

In 1870, the A.I.H. declared that pathological indications were more
important than the individualizing symptoms of the case in the
selection of the remedy. In 1880 it did away with the provision that
mixtures should not be a part of homoeopathy, and mixtures were
welcomed. By 1882 it voted that a homeopath need not restrict himself
to practicing according to the law of similars, but could practice
any kind of medicine he wanted and still be called a proper
homeopath. [...] The AIH by 1880 was so overwhelmingly eclectic that
the real homeopaths among them formed a separate association, the
International Hahnemannian Association (IHA). Interest in real
homeopathy was so small that no more 150 people ever belonged to it,
while the roster of AIH numbered over 10,000. 231

Thus, American homeopathy, if we understand under "homeopathy" the
complete system of teaching and training of homeopathy, lost its
homeopathic purity long before it began to loose colleges,
periodicals and hospitals. The process of the merging of homeopathy
into allopathy which began in the second half of the 19th century,
was speeded up by the successes of allopathy, essentially in the
field of bacteriology.

One should also mention that the American regular profession, like
the case of Britain, adopted at the beginning of the 20th century a
new approach toward homeopathy. Instead of open hostility, which gave
to homeopaths public sympathy and brought no appreciable fruits,
allopaths began to regard homeopathy as an important step in the
steady development of medical science:

In the twentieth century the AMA and the allopathic profession
adopted a different interpretation of homeopathy - denial that it
possessed therapeutic efficacy combined with acceptance of its
reforming role. This new policy was formulated by William Osler
(1849-1919), 232 who liked to declare that 'no one individual had
done more good for the medical profession than Hahnemann' in showing
that the natural tendency was toward recovery - but insisted that
homeopathy and allopathy had both been superseded by 'scientific
medicine' [...]. The conviction that the homeopathic medicines were
nothing but placebos led Osler to his doctrine of 'therapeutic nihilism'.233

1.10 Summary

When reviewing our brief study of the relationship between allopathy
and homeopathy in the countries selected to be compared with the
Russian Empire, one may note that, in essence, the forms and methods
adopted by the regular profession in its struggle against homeopaths
and their "heresy" were similar in all countries. The homeopathic
theory was labeled as "absurd", "denial of science", "propaganda of
ignorance". Nevertheless, the appeals of homeopaths offering to prove
the efficiency of homeopathy by experiment and not on the ground of
theoretical speculations, steadily remained unanswered.

Homeopaths were expelled from societies common with allopaths,
marginalized and blackmailed in the press as "quacks", "wizards", and
"betrayers of science". In order to prevent the further spread of
homeopathy through personal contacts, enabling a comparison of
different methods of treatment, British and American regulars
prohibited consultations with homeopaths; although in Russia this ban
did not exist officially, the anxiety before a moral condemnation of
"brethren" in the atmosphere of anti-homeopathic hysteria, was no
less powerful than a direct ban.

In fact, the struggle with homeopaths has been nothing else but a
struggle for the market of medical services. In the countries where
the medical market was overcrowded with manpower (Britain and the
USA) the resistance to homeopathy was especially irreconcilable, as
homeopaths not only competed with allopaths, but also attracted the
most solvent public. In the USA this attitude changed at the
beginning of the 20th century for by allopaths (William Osler in
first) initiated "reconciliation" within framework of "scientific",
i.e. allopathic, medicine.

Homeopaths from the very beginning were divided into the camps of
"purists" and "homeo-allopaths"; each of these had its outstanding
representatives. Yet the vast majority was always represented by the
"homeo-allopathic" camp. This derived probably from the fact that the
steadily happening conversions to homeopathy, provided an influx of
doctors who had no intention to break off with allopathy entirely.
Contradictions of this kind increased the tension within the
homeopathic profession. This was true for all countries but Russia.
The "pure" homeopathy had never been practiced there. Like their
"mixed" colleagues in other countries, Russian homeopaths rejected
the doctrine of potentisation. Both domestic self-treatment books and
manuals for doctors favored the use of mother tinctures or low
potencies, usually not higher than the 6th centesimal dilution; the
book by Richard Hughes, one of the most important representatives of
this trend within homeopathy, was frequently republished, whilst the
books by J. T. Kent, as well as "The Chronic Diseases" by Hahnemann,
were ignored.

In the countries selected for comparison there were various reasons
which caused the decline of homeopathy by the end of the 19th
century, like overidentification with aristocracy in Britain,
anti-German dispositions and personal conflicts in France, rejecting
the homeopathic doctrine for allopathic theories in the USA, caused
by the rapid scientific progress at the end of the 19th century and
by "allopathic predispositions" both of new converts and teaching
stuff at homeopathic colleges. Moreover it should be stressed that no
country in Europe succeeded to establish a firm system of homeopathic
education as compared with that of allopaths. At the emergence of
homeopathy on the medical scene, all European countries had already a
firmly constituted system of allopathic training; no high-ranking
support could introduce homeopathy into it. On the contrary, the
example of the USA where homeopaths succeeded to obtain equality of
rights with allopaths, also in the field of education, provided a
large representation of homeopathy (or what was called homeopathy) in
that country.

Homeopathy in pre-WWI Russia had no clear-cut timing for its decline.
The very difficult period of Russian history, from the Russia-Japan
war (1904) to the First World War (1914) explained in part the
stagnation of Russian homeopathy. The tight connection of Russian
homeopaths with their high-ranking lay supporters was, in fact,
rather fragile, for these supporters (the nobility, the clerical
estate), were especially sensitive to the social shocks experienced
by pre-Revolutionary Russia. Except for St. Petersburg and, to some
extent, Moscow, homeopathic societies everywhere in the Russian
Empire were based on very few (2-3) physicians hired to receive
patients in the dispensary of the society. Thus, homeopathy in Russia
had mainly a lay-domestic character, and was practiced by rural
clergymen, by the old village nobility, by petty officials in
provincial towns, etc. Certainly, no competition with regular
medicine was possible. Nevertheless, before a general threat when
allopaths turned to closing homeopathic pharmacies) Russian
homeopaths proved to be able to unite, to organize a common meeting
and to work out a common position. If Russian homeopathy would have
had any future, in the absence of wars and revolutions, I suppose
that it would have had to rely mainly upon their lay supporters, as
was the case of German homeopathy.