Knowledge in the Time of Cholera (10 page)

Th
e end result of this epistemological discord was a lack of coherence in accounting for cholera. In the face of such confusion, regulars dug in their heels, leaning more and more on authoritative testimony. Rather than reaching conclusions on cholera, allopathic journals produced little more than incessant testimony and irresolvable debates. For example, take the endless, circular discussion on treatments for cholera. In an 1832 article in the
Boston Medical and Surgical Journal
, Dr. Robert Lewins (1832, 273) argued that a cure “may be accomplished by injecting a weak saline solution into the veins of the patient. . . . The most wondrous and satisfactory effect is the immediate consequence of the injection.”
⁴
In the very next edition of the same journal, Dr. P. Bossey (1832, 245), however, offered the opposite claim; saline injections were found “totally inert and injurious.” Yet another doctor was told by an English doctor “that common table salt—a spoonful in a tumbler of water—not only speedily relieved him [the patient] from violent pains, but ultimately restored him to perfect health” (
BMSJ
1831b, 170). Every author supported his claims with personal testimony which was inevitably followed by counterclaims. With no way to assess these competing claims, with no evidence beyond individual testimony, regular medical knowledge devolved into an endless proliferation of divergent claims, and the public was left confused as to what it all meant.

DEMOCRATIZING MEDICAL KNOWLEDGE

The use of authoritative testimony did not resolve internal epistemological debates within allopathy, but it did mask them via the omission of evidence of these debates in allopathic journals and meetings. However, the attempt to justify knowledge on authority, problematic
within
the profession, was even more dubious
outside
of the profession, as alternative medical movements began to demand an epistemological account from allopaths to justify their professional privileges. While regulars sought to avoid epistemological conflicts, alternative medical sects afforded them no such opportunity, leveraging the epidemic to force an epistemic contest over medicine.

In part, the challenge to
medical
authority reflected the tenor of the times, in which challenges to authority were becoming rife throughout American culture. During the early nineteenth century, “the politics of assent” of the previous era gave way to the rough and tumble world of political parties (Schudson 1998). Democratization touched all sectors of American
society—
in religion through the Second Great Awakening, in reform movements like temperance and abolitionism, and in government with the rise of mass political parties and the extension of voting rights. And the growth of a vibrant press literally made knowledge more available to the public (Schudson 1981). Anti-intellectualism accompanied Jacksonian democracy, which “completed the disestablishment of a patrician leadership that had been losing its grip for some time” (Hofstadter 1963, 51). Cholera arrived precisely at the time that these democratic trends were crystallizing into conditions ripe for an epistemic confrontation in medicine. The crutch of regular testimony solved some problems, but it faced an increasingly hostile environment. Authoritative testimony declared rather than showed, leading to problems for regulars when entering public institutions that asked them to engage in debate by
showing
their reasoning.

Alternative medical movements seized these trends and married them to critiques of regulars' handling of cholera to mount a forceful attack on allopathy's professional program. Cholera provided an opportunity for alternative medical movements that, in different ways, sought to democratize knowledge. The lesson of cholera was clear enough to the public; regulars' heroic therapies inflated the mortality of the disease (Rosenberg 1987b, 72). Many turned to the milder alternative medical sects, and their ranks swelled. Regulars lamented these conversions, complaining that the public “through sheer ignorance of the steps leading indirectly to the temple of science . . . swallows with avidity the monsters of quackery
practice
” (
BMSJ
1831a, 13). Regular physicians' concern for their professional status grew, as did their sense of panic. By 1835, Edward Deloney (1835, 111) complained, “At no period of the world, even in the dark ages of superstition, has the profession of medicine been thronged with imposters of the most daring effrontery than at the present time.”

The failure of regulars to stem cholera, or even provide a coherent account of it, became a crucial symbolic resource for alternative medical sects. Armed with alternative framings of cholera, these sects took aim at regular therapeutics, their use of authoritative testimony, and their privileged professional position. But most important, the cholera epidemic offered an occasion for alternative medical movements to force medical debates onto the level of epistemology. By offering competing medical epistemologies resonant with increasing democratic sentiments, these alternative medical sects made allopathy's elitist orientation seem retrograde.

Th
omsonism: Every Person, His or Her Own Doctor

The most radical attempt to democratize medical knowledge arose out of rural New Hampshire. Samuel Thomson, a combative, somewhat paranoid, and yet charismatic farmer, suspected regulars of withholding information from the people so as to garner power and wealth. In response, he developed his own herbal system of medicine—Thomsonism—that was simple enough for anyone to use. His vision was nothing less than a system of medicine without doctors.

When he first published his
New Guide to Health
in 1822, Thomson saw his system as the defender of true medical knowledge—knowledge that was available to all. Under the Thomsonian system every person was to become his or her own physician (Kett1968).
⁵
The antiauthoritarian and even conspiratorial character of Thomson's critique fell on fertile soil during the Jacksonian era, and his system spread throughout the country via a network of itinerant “healers.” It caught on, especially in poorer, rural areas (Coulter 1973, 92), growing through the careful exploitation of popular sentiments, egalitarianism, nationalism, and romanticism (Whorton 1982, 24). Although statistics from the era are notoriously imprecise, historians believe that during its height in the 1830s, Thomsonism claimed over a million followers (Berman and Flannery 2001; Haller 2000). In 1833, a Thomsonian magazine published a list showing authorized agents in twenty-two states and territories (Rothstein 1992, 45). By 1840, Thomson had sold one hundred thousand family rights, and approximately half of the citizens in Mississippi and Ohio were curing themselves using Thomsonian methods (Numbers 1988).

The Thomsonian system by no means offered a revolution in medical ideas. In some respects, it was even more traditional than the medical system practiced by regulars, committed as it was to the type of rationalism that allopathy was in the process of discarding (Kett 1968). Drawing on the humoral system of disease, Thomsonians held that all illness arose from an imbalance of heat in the body. Tracing all disease to this single cause, Thomson believed that effective therapy required increasing the body's heat through natural remedies like botanic medicine and sweat baths. Rather than combating nature through depletive therapies like regulars, Thomsonians viewed nature as inherently ameliorative and used it as their guide. In turn, they employed milder treatments with fewer side effects than allopathy's use of calomel and bloodletting—two practices Thomsonians viewed as “unnatural and injurious” (Thomson 1825, 206). The milder treatments
served
them well during the cholera epidemic as they were less harmful than allopaths' extreme heroic treatments.

Although conventional in its medical ideas, Thomsonism aspired to revolutionize the relationship between the physician and the patient by exploding all hierarchies in medical knowledge. Foremost, the Thomsonian challenge was an epistemological one that denied authorities in medical knowledge. Appealing to egalitarianism, it stressed common sense and the common man as a knower (Haller 2000). The
Boston Thomsonian and Lady's Companion
(
BTLC
) (1840, 338) championed the medical potential of folk knowledge: “The exercise of our reasoning faculties at once puts us in the right road to discover truth.” Thomson intentionally developed his system to be used by anyone, regardless of education. The system was written and distributed in an accessible handbook that anyone could purchase for a small price and subsequently use to treat his or her family. And Thomson promoted his system through stories, popular lectures, and poems that served as mnemonic devices (Haller 2000). Every individual could digest medical information presented in these forms. Everyone could practice medicine. Doctors were not needed.

Thomson put faith in the agency of the patient to such a degree that the distinction between doctor and patient would be eliminated. Thomson's own narrative embodied the ideals of his system, and he appended it to the numerous editions to his
New Guide to Health
. Uneducated himself, Thomson discovered the herb
Lobelia inflata
when he was four, his consumption of which quickly induced vomiting. While he did not yet recognize the significance of his discovery, this herbal emetic would become central in his therapeutic arsenal. In 1788, at the age of nineteen, he badly injured his ankle and after enduring the painful failures of regular therapeutics, treated himself successfully using folk knowledge culled from experience. In doing so, Thomson was simultaneously the patient and the doctor—an arrangement he later championed in his system. He began treating his family and neighbors, and as his reputation grew, he abandoned farming to become a full-time practitioner. The remainder of the narrative recounts Thomson's healing successes in the face of hostility and challenges from regulars. The lesson of his narrative is explicit: the talent for healing is not restricted to the profession; it is in everyone.

According to Thomson and his followers, regular physicians, acting out of avarice and self-interest, would stop at nothing to prevent the public from learning this revolutionary lesson. In making medical knowledge available
to
all, Thomsonians juxtaposed themselves to regulars, who tried to maintain a monopoly over medical knowledge by obscuring its simplicity (Haller 2000). Education was a tool that regulars used to monopolize and mystify medical knowledge. Sarcastically challenging the intellectual pretensions of allopathy, the
Thomsonian Messenger
(1843, 74) dismissed regular educational elitism:

We admit that we are not so wondrous wise as some of our would-be medical Solomons, nor can we so readily mouth the vocabulary of learned technicalities, as some of the M.Ds. But we consider that to understand
LIVING ANATOMY,
and how to
KEEP ALIVE,
is of infinitely more importance to both the patient and practitioner, than weeks, months, or even years spent in comparatively useless studies, or in shaking the dry bones of the human skeleton.

Thomson himself (1825, 199–200) argued, “The practice of the regular physicians, that is those who get a diploma, at the present time, is not to use those means which would be most likely to cure disease; but to try experiments upon what they have read in books, and to see how much a patient can bear without producing death.” Furthermore, the regulars sought to confuse patients and obfuscate their inability to cure by using Latin, which concealed knowledge “in a dead language” (Thomson 1825, 193). Regulars “have learned just enough to know how to deceive the people, and keep them ignorant, by covering their doings under a language unknown to their patients” (Thomson 1825, 41). The secrecy of the regulars was opposed to the transparency of the Thomsonian system, which “so far from concealing discoveries or seeking to make a mystery of them” labored “to make them known for the benefit of the whole human race” (Thomson 1839, 50). Such a commitment to openness was on display during the 1832 epidemic, as Thomsonians made their anticholera recipe widely available to the public (Haller 2000).

Contra allopaths, Thomsonians believed that relevant knowledge was not found in books, but in the common sense of the people. Folk wisdom was prized over education. Thomson (1825, 34–35) wanted to unlock the inherent, good sense of the people, hoping

that it (the Thomsonian system) will eventually be the cause of throwing off the veil of ignorance from the eyes of the good people of this country, and do away with the blind confidence they are so much in the habit of
placing
in those who call themselves physicians, who fare sumptuously every day; living in splendour and magnificence, supported by the impositions they practice upon the deluded and credulous people; for they have much more regard for their own interest than they do for the health and happiness of those who are so unfortunate as to have anything to do with them.

Underlying this egalitarian epistemology of common sense was a view of truth as transparent and acceptable, as nature provided the requisite clues for those careful enough to observe. The notion that truth was mysterious was anathema to Thomsonians: “Truth never seeks to be sheltered in mystery, she delights in simplicity, because it adorns her by laying all her beauties open to general inspection” (
BTLC
1841, 114). Nature made itself readily comprehensible to all. The public therefore had the capacity to grasp medical knowledge. The flattened hierarchy of knowers and egalitarian Thomsonian epistemology was defined in opposition to the authoritative, paternalistic approach of regulars, who mystified medical knowledge for selfish ends to the point where “the acquirement of medical knowledge having been considered a matter beyond the ordinary pursuits of life, the people have fallen into a complete state of darkness and superstition on this important subject” (Colby 1839, 2). If the public shed the belief in the authority of the regulars, medical insight was there for the taking. By juxtaposing their epistemology of folk wisdom and common sense with allopathy, Thomsonians demanded epistemological account from allopathy that did not fall back on obfuscation.