Marketplace of the Marvelous (41 page)

Regular medical schools routinely failed to provide opportunities to women and habitually limited the number of women they would even accept at a token 5 percent until the mid-twentieth century.
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School administrators justified excluding qualified women by claiming that most would give up their medical practices after marriages, so they were not worth the investment. Even those men who seemed to support women's participation in the field betrayed certain biases about women. John Dodson, dean of Rush Medical College in Chicago, praised his school's female students as “a credit to themselves and to us” but concluded that “no matter how superior these students may have been in their college work,” they “cannot but do otherwise than rejoice when matrimony claims them.” A medical education also cost more as schools passed the expense of new equipment and faculty, expanded facilities, and lengthened training time on to students. Many women who had once financed their medical education by working could no longer afford to do so.
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At the same time, the propriety of men and women studying the human body together in the same room remained a potent and divisive issue.
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It seems not far-fetched to say that women's involvement in irregular health systems from the very beginning provided all the evidence some regular doctors needed to dismiss it. In 1893, Harvard professor Edward H. Clarke warned that excessive intellectual activity diverted a woman's limited supply of energy from reproduction to the brain, which threatened not only her health but also that of her family and society. It was true that women could pursue the same educational course as men, Clarke declared, but “it is not true that she can do all this, and retain uninjured health and a future secure from neuralgia, uterine disease, hysteria, and other derangements of the nervous system.” Worse, women engaging in men's work “unsexed” themselves by taking on male roles, and thus supposedly male traits, rendering
them unable to have the children that would sustain civilization.
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Medical texts touting the terror of women's equality and autonomy flourished. Many used scientific and medical language to rationalize women's exclusion from active public and professional roles. Dr. Alfred Stille, in his presidential address to the American Medical Association in 1871, declared, “Certain women seek to rival men in manly sports, and the strong-minded ape them in all things, even in dress. In doing so, they may command a sort of admiration such as all monstrous productions inspire, especially when they tend towards a higher type than their own.”
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The reverse was also true, though: those men who performed the same tasks as women lost their masculinity. Dr. Stille warned that “a man with feminine traits of character or with the frame and carriage of a female is despised by both the sex he ostensibly belongs to and that of which it is at once a caricature and a libel.”
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Working with women or spending too much time in the feminizing clutches of mothers, teachers, and wives sapped a man's masculinity. These societal assumptions could not help but influence perceptions about irregular health systems, particularly those like hydropathy and homeopathy where women took active leadership roles. With women in charge, irregular health was marked as both dangerous and ridiculous.
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Even with these barriers, women did not stop practicing medicine. Osteopaths, chiropractors, and Christian Scientists welcomed women into their professional fold. Other women, particularly homeopaths, organized locally and focused on lay practice through the first half of the twentieth century. Still more entered regular medicine in nursing and social work, careers that closely aligned with cultural assumptions about women's more caring nature, and as such were structurally subordinated to the mostly male doctors.
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The AMA's gains and control of public health along with the quickening pace of medical advances in the first decades of the twentieth century significantly challenged the strength of irregular medicine. The introduction of the first antimicrobial drugs, known as sulfonamides, in the 1930s presented a significant breakthrough in the fight against infectious disease and paved the way for the antibiotic revolution in medicine. The mass production of penicillin in the 1940s nearly eliminated diseases that had plagued humans for centuries, including syphilis, meningitis, and rheumatic fever. Streptomycin in 1945 dramatically reduced cases of tuberculosis and plague. Even better,
these drugs were some of the first nonhomeopathic remedies to cause few side effects. Americans clamored for these “wonder drugs,” and doctors dispensed them with what historian James Whorton has called “antibiotic abandon.”
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The 1950s and 1960s saw the introduction of even more antibiotics, vaccines for polio and measles, the CAT scan, heart and kidney transplants, and coronary bypass surgery. In 1953, James Watson and Francis Crick announced their findings on the structure of DNA.
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Controlled clinical trials became the gold standard for assessing the safety and efficacy of new therapies. As deaths from infectious disease dropped, regular medicine rose in public status, trust, and esteem.

Medicine also grew more bureaucratic, structured, and regulated throughout the twentieth century. That trend was already apparent to Mark Twain in 1900. “The doctor's insane system has not only been permitted to continue its follies for ages, but has been protected by the State and made a close monopoly,” he wrote, calling it “an infamous thing, a crime against a free-man's proper right to choose his own assassin or his own method of defending his body against disease and death.”
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Twain had long supported free choice in medicine, even as he sometimes ridiculed the options, but that freedom became increasingly constrained as the century wore on. More medical care happened in hospitals, where regular doctors controlled access and tended to exclude irregulars from practicing in their wards. Specialty boards licensed and certified practitioners, and the federal government took a more active role in subsidizing medical research and approving drugs and therapies for public use. For regular doctors, these institutional and political structures eliminated many of the economic and political uncertainties that had plagued the profession in the nineteenth century. Competition with irregulars no longer provoked the same anxiety and financial peril, even if it seemingly did little to blunt professional handwringing over irregular practice.
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These structures of bureaucratic control, according to historian Charles E. Rosenberg, tightened the boundaries between regular and irregular doctors. Regular doctors tended to view the growing inflexibility of medicine as an affirmation of their system's scientific validity and stature. To regulars, the fight over public perception and for medical authority appeared finally won.
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Yet despite all of these advances in medical science, it was also becoming apparent that many of the wonder drugs were less than
wonderful. Patients eager for the latest miracle drug they had learned about in newspapers and on television came asking for remedies and treatments by name. Under pressure both to cure disease and to satisfy their patients, some doctors overprescribed. Many people became addicted to the amphetamines and tranquilizers they took for anxiety, depression, insomnia, and other chronic ailments—a problem that persists to this day. The dangers became even more apparent during the thalidomide tragedy of the 1960s. The drug, marketed as a sedative, one of the most popular and widely used classes of drugs in the United States, was found to produce serious birth defects.
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Suddenly, the drugs that had seemed so promising now seemed to many Americans to be more dangerous than good.

More than just the physical threat of these drugs, some also decried the breakdown of the doctor-patient relationship. Few could dispute that scientific and technical advances in medicine had improved the health of the nation and decreased the dangers of infectious diseases, but at what cost to personal health and individualized attention? Doctors gave drugs for everything, critics claimed, without listening to the particular ailments of their patients. The exam and patient history that had long defined the medical experience now took a backseat to the medicine bottle, surgical procedures, and test results. Regulars worked under growing structural and financial constraints that eroded the amount of time they could spend with patients, leading to a strained discussion of the specific problem rather than a longer conversation that took account of the context of the problem. As a result, some patients complained that their doctors paid them little attention and were unwilling to communicate with them about their health in a clear and understandable way.
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Regular medicine's increasing fragmentation into specialties also made medical care more expensive, even out of reach for many Americans. Doctors, who had already been concentrated in urban areas, accelerated their movement to city and university hospitals, leaving medical shortages in rural areas. That these specialists also made more money only encouraged this trend. Unlike before, though, the nation's hills and back roads no longer crawled with the herb doctors, midwives, itinerant folk healers, and bonesetters who had provided care where no other existed. Critics derided the medical profession as self-serving, elitist, and insensitive to the needs of patients for these holes in the system: a condemnation as familiar in 1960 as 1860.

Growing American disillusionment with regular medical practice and the high cost of care in the 1960s and 1970s led some to explore irregular medicine. Just as in the nineteenth century, broader cultural forces were at work. The Cold War, Vietnam, and atomic energy, among other social and political forces, made life feel uncertain and beyond individual control. In response, a counterculture emerged that rebelled against the authority of the government, science, and experts. Its members, mostly white and middle class like many of the nineteenth-century reformers, focused intently on tolerance, natural living, and individual rights. They embraced a simpler, more spiritual orientation to life that integrated the mind and body into well-being. These cultural trends burnished the appeal of irregular medicine. Americans rediscovered homeopathy and botanical remedies as well as a host of other therapies like naturopathy and the hydropathic Kneipp Cure. Health foods, exercise routines, and vitamins became topics of broad popular interest. To a new generation, irregular health-care approaches represented freedom, self-reliance, personal empowerment, and affordable care, the familiar chords that had stoked American health reform in the nineteenth century.
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Of course, most of these new alternatives were not new at all. Nor had Americans ever stopped self-dosing and using irregular medicine. It was certainly true that many popular nineteenth-century health systems were not as strong or as visible in the mid-twentieth century as they had once been. Many Americans did not even realize the significant historic challenge irregulars like homeopaths had once posed to regular medicine when they began to emerge again in the 1960s and 1970s. But these healers had never disappeared. The number of homeopaths, phrenologists, mesmerists, and botanic healers sharply declined in the early twentieth century, but osteopaths, chiropractors, and many other kinds of healers made up for the retreat of older systems.
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In the 1920s, the Illinois Medical Society found that among six thousand Chicago residents, 87 percent reported using what regular medicine had taken to calling “cult medicine.” A similar national survey carried out by the federal government between 1929 and 1931 found that irregular practitioners comprised 10 percent of all health-care visits.
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And in 1965, homeopath Wyeth Post Baker released confidential reports from the Senate Finance Committee revealing that an estimated twelve million people used homeopathic remedies without the advice or consent of their doctors.
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The tenacity of irregular health care's appeal to the general public alarmed regulars: many had assumed irregular
medicine's demise decades earlier and had consigned its remaining users to a small fringe on the margins of society. These surveys told a different story. While it was mostly true that regular medicine had seized political and institutional authority in the twentieth century, at the level of daily practice and individual therapeutic choice, the ground remained highly contested.

The renewed interest in and popularity of irregular medicine in the 1960s led to the adoption of the words “complementary” and “alternative” to describe the systems that regulars had labeled “irregular,” “unorthodox,” “cultish,” and “quackery” for more than a century. These terms better reflected how many Americans saw and used irregular therapies for centuries—as an accompaniment or substitute for regular medicine.
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Calling something “regular” or “irregular” implied a common understanding of what constituted legitimate medical practice that many Americans (and many of their doctors) may not have shared even as they used these names to describe their healers. It's doubtful that nineteenth-century Americans saw their healers as “irregular” or as “quacks” in the negative way that we have come to understand the words. Based on how many people used irregular treatments and with what frequency they sought an irregular's help, irregular health was a regular part of daily life.

Irregular medicine also became known as “holistic” in the 1980s. Broadly speaking, holistic meant anything alternative and “natural” that took into account patients' mental status and their social and physical situation. Unique as the concept seemed, though, holistic principles could be found in medical practices as ancient as Ayurveda in India and Qigong in China as well as in hydropathy, mesmerism, Thomsonism, homeopathy, osteopathy, and even the humoral theory that underlay regular medicine. Until the mid-nineteenth century, prevailing therapeutics and understandings of disease assumed multiple causes. Environmental, emotional, moral, and social factors all determined sickness and its cure. Advances in physiology, chemistry, bacteriology, and pharmacology as well as medical technology in the late nineteenth century began to change regular medicine's perceptions of disease and what counted as medicine. The diagnostic precision and objectivity of scientific medicine promised one path to the truth, not multiple paths. Disease became less amorphous, recast as a specific thing with characteristic patterns and mechanisms best understood
through laboratory analysis rather than social and environmental factors. Holistic treatments designed to treat the whole person rather than to attack any specific disease largely fell by the wayside in regular medicine while irregulars tried, with varying success, to incorporate the science without sacrificing their holistic approach.
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