Lecture Five: Therapeutics and Sectarianism

Therapeutics

The American Therapeutic Contradiction

1. We Love: the most complicated, intrusive, body-transforming technologies, surgeries, and drugs
2. We Also Love: Nature's simple laws of health, righteousness, and hygiene

Pathological Presumptions

1. The Phenomenological Problem: How do we perceive the bodily interior?
   • The seat of the soul, emotional life, and intellect?
   • The wandering of the womb
   • Solid or liquid: the body dead versus the body living
   • Doctrine of sympathies versus seat of disease
2. How do you discern health?
   • Primitiveness of diagnostic technology
3. Humoralism
4. Solidism: the structures and fibres
5. Empiricism: the body as a black box
6. Brunonianism (1790s): sthenic and asthenic states

Classical Therapeutics

1. Individualized medicine
   • Disease specificity (to the individual), not specific disease
   • Rosenberg's "metabolic gyroscope"
   • Helping, managing disease: disease as natural process
     1. Place
     2. Season
     3. Life Stage
   • Problem of driving the disease inward
2. Healing within divine governance; healing as communion

Classical Concepts

1. Naturales
   • Vis medicatrix naturae
2. Contranaturalales
   • Poisons
3. Six things non-natural
   • Exercise
   • Diet
   • Air
   • Passions of the mind
   • Excretions and secretions
   • Sleep

Types of Medicines

1. Supportives
   • Tonics, bark
   • Cordials, wine, cod liver oil
2. Depletetives
   • Emetics
   • Cathartics
3. Alteratives

Therapeutic Regimes: physic to operate, ease, and comfort

1. Herbals
   • Simples: lobelia, senna
   • Compounds: theriac
2. Chemicals
   • Calomel
3. Tonics, etc.
   • Wine, bark
4. Phlebotomy
   • Venesection, leeching, scarification, cupping
5. Blisters, poultices

Heroic Therapy: Benjamin Rush (1745-1813), 1790s

1. The power of the American constitution
   • 100 leeches, 75 grains opium, 1 pound calomel
2. Heavy venesection
   • 40-50 oz. blood
   • Bleed to syncope, then leech
3. Why?
   • Cultural unity: exhibition of the medicine
4. What is our modern heroic therapy?

Sources of therapeutic nihilism

1. Pathological-anatomical correlation and the doctrine of disease universality (specific diseases)
2. The numerical method (therapeutic statistics and the presumption of universalism)
3. Physiology (pathology) at the expense of therapy
4. From medical communion to elite (Calvinist?) exclusivity
   • Holmes: damning of medicines, health (or death) through nature
   • The faith of the placebo: "The principal influence ... of materia medica ... drugs supply material upon which to rest the mind while other agencies are at work in eliminating disease from the system" (quoted in Rosenberg, 19)
5. In 2007: the attractiveness of clinical trials

Natural to normal: The rise of universalism

1. We are all the same: If the standard dose doesn't work, whose fault is that?
2. "In a sense, almost all drugs now act as placebos, [ex. Diuretics, etc.] ... the patient experiences no perceptible physiological effect" (Rosenberg, 21)

Sectarianism: The First Wave - to 1870

Reasons for Sectarianism

1. Triumph of medical licensing by 1830; the fall of medical licensing by 1850
   • The period: "know nothingism," millenarian (slavery) issues; the "great disappointment"
2. Pleasure over pain; health-orientation vs. disease-orientation
3. Evidence of regular-induced deaths
4. Jacksonian populism
5. Religious expression
   • Medicine as cultural style
   • Medicine as existential statement

Sects or Quacks?

1. Empiricism vs. "exclusive dogma"
2. "Nature speaks to me alone"
3. Single cures
4. Single secret cures
5. Antinomian character - in a sinful world, only through me...
6. The AMA's 1847 consultation clause

Thompsonianism

1. Samuel Thompson (1769-1843)
2. Indian pukeweed lobelia
   • Pyramid scheme and family licensing system: $20
   • The problem of a democratic medicine
   • Can there be progress in botanic medicine?
   • Can there be expertise in botanic medicine?
     1. Beechite and Eclectic versions

Homeopathy

1. Samuel Hahnemann (1755-1843)
   • The doctrine of simiilars
   • The analogy of similars; vaccine?
   • The theory of similars
   • The doctrine of potentization
2. Proofing as a clinical science
3. Constituency: German-Americans, the Boston elite
4. Opposition: Fraudulent? Unproved? Implausible?

Hydropathy

1. Vincent Preissnitz (1799-1851)
2. Water as: cold, force, solvent, diluent
3. Add exercise, vegetarianism
4. Mens sana corpore sano
5. Water as the essence of purity
6. European spas and hydropathy vs. American hydropathy
7. Joel Shew, Russell Trall: The Water Cure Journal
   • Harsh water or harsh regimen

Grahamism

1. Sylvester Graham (1794-1851) and his cracker
2. No booze, no smokes, no meat, no sex, and no white bread
   • If a little moderation is good, a lot of moderation is better
   • No pain, no gain
   • Galen and Calvinism = Grahamism [original sin can be overcome; all can be saved; eternal life is at hand]
3. Attraction to the reformist left
   • Emancipation and social renewal
   • The narrow road of righteousness
4. Women's health and (sexual) freedom
5. Amelia Bloomer and the dress reform movement

The Influence of the Sects

1. Assimilation of Homeopathy into the AMA: 1882 (N.Y. Medical Association) to 1903 (AMA Acceptance)
2. The Ohio State University - Beechite
3. Hahnemann Hospital and Medical School (now Drexel University Medical School) - homeopathic
4. University of Michigan Medical School - partially homeopathic
5. Emergence of new sects in 1870s-1880s: Christian Science, chiropractic, osteopathy