Knowledge in the Time of Cholera (13 page)

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
Commi
ttee 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.

In justifying repeal, the legislature promoted debate, recognizing no one
way
to knowledge as inherently superior to others, for to do so was to “march
to
error.” Unlike under the politics of assent, learned men should not automatically command deference. Instead, the legislature championed the importance of debate in cultivating knowledge. Rather than discuss the
merits
of Thomsonism or homeopathy, the legislature took the occasion of licensing disputes to discuss the approach to medical knowledge generally. In this, the New York Assembly Select Committee on Petitions (1843, 7) shared a vision of knowledge similar to the Thomsonian and homeopathic view:

And it is also clear that in the minds of your committee that such enactments operate to
restrain
rather than incite research and investigation into the hidden truths of science, by placing it in the power of one school of the profession, encircled as they now are by the strong arm of the law, to apply the epithets of quack and empiric with great force and effect to those (perhaps equally scientific as themselves) who in their investigations venture to overstep the prescribed limits of the legalized profession, and discover what to their minds is the evidence of error in the old system, and reason sufficient to induce them to propose a new and different one.

Medicine would benefit from a free market of ideas.

The importance of this epistemological resonance is underscored by the fact that the legislature supported repeal even though it remained skeptical about the validity of the Thomsonian and homeopathic systems of medicine. Indeed, many legislators were vocal in expressing their contempt toward Thomsonian and homeopathic ideas. In considering the incorporation of a homeopathic college in 1846, the Select Committee on Medical Colleges and Societies of the New York Senate (1846, 4) portrayed homeopathic thought in a decidedly negative light:

Your committee feels that whatever may be their present convictions regarding the importance of homeopathy, as a new era in the treatment of disease, it is impossible to deny great industry to its advocates, and a furious zeal in the propagation of its doctrines. . . . And it certainly does require zeal of no common character to uphold principles
so adverse to common sense
(emphasis added).

Such negative assessments are rife in the legislative reports. Committees produced either scathing or ambivalent critiques of the alternative medical systems but supported repeal anyway. The New York State legislature may
not
have believed in the merits of the alternative medical systems, but it did recognize their right to take place in the debate as legitimate knowers. Without formally recognizing the legitimacy of Thomsonian or homeopathic thought, the legislature endorsed their vision of an open market of ideas, much to the chagrin of regulars: “And they [the committee] also most confidently entertain the belief, that a
discerning and enlightened people
will ever be found to award to it [a given medical sect] a generous confidence and due appreciation commensurate with its merits” (New York Assembly Select Committee on Petition 1843, 6, emphasis added). The logic of the repeals, therefore, was based on a vision of
how
medical knowledge should be produced (i.e., by open debate), not on the merits of the particular medical systems.

Regulars tried to deny the legitimacy of the alternative medical movements' claims by defining them as invalid. They denounced Thomsonians as quacks, likening them to religious fanatics and primitives who sought a return to the medicine of the Dark Ages. As the editors of the
Boston Medical and Surgical Journal
(1842, 217) argued, “Neither has the quack a right to meddle with what, to him, is as incomprehensible as a steam engine to a Hottentot.” Dismissing homeopaths similarly, regulars condemned all efforts to air medical debates in public. The crux of their position was to deny the public's (and by extension, the legislatures') capability to judge medical knowledge. Their hierarchal view of knowledge held that medical knowledge could emanate legitimately only from within the ranks of regular physicians. According to regulars, “the prejudices of the public are always on the side of feeling, and never on the side of reason” (Hull 1840, 60). Medical matters were simply too complicated for the public to understand. Worthington Hooker, future president of the AMA and author of a scathing critique of homeopathy, claimed, “The science of medicine is so much a mystery to the common observer, that he cannot, as you have already seen, apply his tests to a direct examination of the physician's knowledge. He is not competent to make the estimate in this way; and if he is not aware of this, he will certainly be deceived” (Hooker 1849, 227). The denigration of the public as knowers was manifest in allopaths' use of Latin, their resorting to authoritative testimony, and their refusal to comparatively test their system against homeopaths or Thomsonians, instead dismissing them as quacks, unworthy of serious engagement. Fundamentally, regulars condemned outsiders for meddling in medicine as it contradicted their hierarchal epistemology. They rejected the legislature's ruling on medical matters, refused to endorse open debate as a valid way to attain better knowledge, and decried the pernicious
eff
ects that the repeals would have. Joseph Bates (1849, 26) expressed regulars' concerns:

What effect has this? It has this democratic effect: It not only allows, but even holds out faltering inducements for every person to tamper with disease, and trifle with human life!! It cripples the energies of medical science, and degrades and paralyzes the influence of the profession. It throws open wide the fountains of wretchedness and crime, from which emanate those foul exhalations, that supply the polluted torrent whose invidious billows break, and dash against the time honored temples of medical science, infecting and poisoning the social horizon with their spray, far more malignant than the miasmata from the Pontine marsh.

Allopaths believed that this “democratic effect” would spell disaster for medicine.

Their arguments, however, fell on deaf ears, as allopathic appeals to paternalistic authority and their restricted notion of the community of legitimate knowers clashed with the democratic culture of the legislatures. This disconnect was not lost on regulars; the
New York Journal of Medicine
(1844a, 283) lamented that “a large portion of the public think that education and science are not necessary to qualify men for medical practice.” Regular physician Dan King (1849, 371) wondered how it was possible that “the wild man of the forest, or the wilder quack in society, is deemed amply qualified” to practice medicine. For allopaths, the repeal of medical licensing laws represented nothing less than “a triumph of quackery over the Medical profession” (
New York Journal of Medicine
1844a, 283).

CONCLUSION: KNOWING IN DEMOCRATIC SPACES

Disputes over licensing laws followed a similar pattern in other states, producing time and again the same outcome of repeal (see
table 1.2
).
¹¹
Alabama and Ohio repealed their laws in 1833, hardly waiting for cholera to even clear out. From there, repeal spread throughout the thirteen states that had licensing laws on the books. In Georgia, alternative medical sects argued that licensing laws were monopolistic and ultimately detrimental to medicine (“Have not some of the most important discoveries in science been made by those in the humblest walks of life?” [Powell quoted in Haller 2000, 132]).
Th
ey won repeal in 1837, with the legislature eliminating all former restrictions so that they “shall cease to operate on, or have any relation to any free white person now practising, or who may hereafter, practice medicine in this State” (“An Act” March 4, 1837, 1). In Maryland, where Thomsonians refused to be “slaves to medical aristocrats” (Rose 1838), no licenses were required after 1839.

Table
1.2. Repeals of state medical licensing laws, post-1832

State after state, alternative medical sects effectively transformed cholera into licensing repeals, validating their democratized medical epistemologies in the process. Thomsonians and homeopaths racked up victories, not because the legislatures necessarily agreed with their knowledge claims (and specifically those regarding cholera), but rather because they supported the
way
in which they envisioned medical knowledge. However cholera might be defined, the state legislatures recognized openness as an ideal in knowing and established an unregulated medical system that ensured the perpetuation of the debate. In 1843, the New York Assembly Select Committee on Petitions (1843, 5–6) articulated what would be the legislatures' approach to medical knowledge for the remainder of the century:

Is
it natural or reasonable to suppose, that if left free to act upon their judgments and the unbiased dictates of reason, exempt from the influences of sympathy, the people would be any more willing to entrust their health and lives in the hands of known, ignorant and unskillful pretenders to the healing art, than they would their money or property in the hands of a pretender to mechanical knowledge, without evidence of skill in or acquaintance with the pursuit in which he proposes to render service? . . . Your committee cannot conceive that such would be found to be the fact or result; nor do they see any good reason to believe that those who should be disposed to enter upon the practice of the honourable and responsible profession of physic and surgery, would suppose themselves absolved from any of the obligations or necessities of acquiring a full and perfect knowledge of the science, when placed before the public, to rise or fall entirely upon their own resources and merits. But on the contrary, that it would open a broader field of competition, operating, as in all other pursuits, to produce greater and more efficient exertion to qualify themselves to meet and successfully combat their competitors for eminence and fame.

Better medical knowledge would be obtained through competition, not control. State legislatures refused to recognize one sect over another as the legitimate source of medical knowledge; instead a “broader field of competition” won out.