The Herbal Consumer

Western Herbalism Part II: The Value of History

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HerbalConsumer-PNG-8-SmallHerbal medicine wasn’t new to the United States in the 1800s, but homeopathy and eclectic medicine were. These two approaches rose to popularity and were in competition with the regular medicine at the time. This time in history was an important one in the evolution of both herbal and modern medicine. Learning about this part of medical history can help provide an important perspective on today’s medical marketplace.

Some Background First

We covered what homeopathy is in Western Herbalism Part I: The Basics. Hans B. Gram opened the first homeopathic practice in the U.S. in 1825. Eclectic medicine was founded by Wooster Beach in the 1820s. The basic approach of eclectics was to be open to using treatments from any medical tradition although they did favor botanical medicines.  If a treatment worked, they could be used without regard to strictly following one particular set of principles.

Regular medicine was the standard medical practice brought over from England/Europe. This tradition followed principles that had been in place for centuries from the time of Hippocrates and Galen. The body was viewed as having four humors – yellow bile, black bile, phlegm, and blood. The belief was that if these were out of balance in the body, the person would become ill. Treatments consisted of trying to rebalance the humors by getting rid of the excess. This typically involved blood-letting, the use of herbs in the forms of blistering plasters, purgatives (causing bowels to evacuate) and emetics (causing vomiting). After alchemy become popular in Europe around the 13th century, mercury and other heavy metals were included as treatments. This was the standard medical practice in the U.S. up into the late 1800s.

Through the centuries some people as well as doctors began to question these treatments, but never to the extent that they were abandoned. This was the approach taught in the universities and was the approach of civilized and learned men. Folk herbal medicine always existed but was typically pushed to the side. It was the option for those too poor to afford professional medical care and therefore acquired a stigma. It was old and often viewed as outdated or unfashionable.

Competition and an Open Marketplace

Part of the reason that the competition arose was that the treatments of the regular medicine were unpleasant, to say the least. The success rate of these treatments, especially against different disease outbreaks, was mediocre. Those that did survive both the disease and the treatment were often in ill health for the remainder of their lives. In addition, “Heroic Medicine” was popular in the U.S. in the 1800s which called for large and constant doses of purgatives, emetics and heavy metal medicines along with copious amounts of blood-letting. Homeopathy and eclectic medicine offered gentler treatments that had similar, and sometimes better, success rates.

In the late 1820s and 1830s when Andrew Jackson was president, there was prejudice against the “special privileges” and monopolies of corporations. This prejudice extended to physicians and the outcome was the removal of licensing for being a doctor. Without licensing there was no set standard for education or other requirements. This opened the marketplace for all types of competition, both good and bad. The “irregular” medical practices, such as the homeopaths and eclectics, were able to build their practices and establish their own universities. Their popularity increased which led to adversarial relations between the regular and irregular physicians. The professional organization for the regular physicians forbade them from interacting with the irregulars in any way. If they did, the punishment was to be thrown out of the organization. The irregulars were constant and vocal critics of the regulars. There was constant back-and-forth in the different periodical medical journals and newspapers with each side criticizing the other.

The Rise of the AMA and Their Influence

The American Medical Association (AMA) which is the professional association for regular doctors was founded in 1847 as part of this turf struggle. They worked for many years to gain control over the profession in order to limit competition. A lack of licensing led to an overabundance of doctors which drove down the prices the doctors could charge for their services. Toward the end of the 1800s, licensing became an issue once again. This time the regulars and irregulars set aside their squabbles and united to push for state regulations. The requirements were minimal at first (simply having a medical diploma) and then eventually grew stricter over the years.

Beginning in the 1870s, certain medical schools began to raise their requirements for acquiring a diploma. Many schools were flexible on the requirements for gaining entrance and earning a degree. Facilities, such as laboratories and libraries, were either minimal or non-existent. This was true for both regular and irregular schools. A few schools were shells where someone could simply buy a diploma. Harvard raised their requirements to three years of study (9 months a year) with students needing to pass all classes. Rival schools that could afford to make these changes followed suit. The remaining schools continued with business as usual.

In the beginning of the 1900s, the AMA created their Council on Medical Education to evaluate all the medical schools in the country in an effort to expose the weaker schools. The inspections proved expensive and AMA professional ethics called for regulars to not criticize one another in public. So the AMA made an agreement with the Carnegie Endowment for the Advancement of Teaching for them to take on the evaluation and present the findings to the public in 1910. The report was called the Flexner Report and played a definite role in the closing of many medical schools, both for regulars and irregulars. Eventually the AMA’s ratings for medical schools became the standard for state licensing boards.

Initially at odds with the irregulars, the AMA opened their association to the homeopaths and eclectics at the turn of the 20th century, thereby making them regulars as long as they pledged their allegiance (and dues) solely to the AMA. Any remaining homeopath or eclectic associations eventually dissolved along with their universities.

Providing Perspective

There are a few important points to take from this time in history. Turf wars in the medical marketplace are not new. A major factor in these divisions has been the desire for money and higher class ranking.  In England, the physicians jockeyed for position over the surgeons and apothecaries. In the U.S. it was the regulars against the irregulars against the apothecaries and patent medicine makers. No doubt some of the attacks, though seemingly based on disagreements on principles and procedures, were really ways of rationalizing the fight over turf.

Professional herbal medicine isn’t new either. Before I read about this part of history, I thought professional herbal medicine came about in the 20th century growing out of folk medicine. I was surprised to learn that it was already established over a century ago and was developed as a reaction to regular medicine. It provides an interesting perspective especially as these professions are once again establishing their schools and trying to gain licensing.

The medical establishment has been historically slow to adopt changes. Regular medicine existed for centuries even though it operated on incorrect principles and treatments. Knowing what we know now, it’s mind-blowing that the blood-letting, purging and metal medicines persisted for so long even after the discoveries that came from autopsies and the invention of the microscope. It points to the value of research, being willing to questioning the status quo and being open to new ideas. It’s commonplace to feel that we’ve reached a plateau in terms of what there is to know in medicine and there’s only a few more hurdles to overcome (i.e. cancer, Ebola, Alzheimer’s). Perhaps herbal medicine can provide new perspectives on the approach. Being distracted by another turf war could cause us to lose out (again) on valuable discoveries.

Competition in the medical marketplace is a good thing for consumers, not just in multiple providers but also in approaches. In the 1800s consumers wanted kinder treatments that worked. When they chose irregular medicine in sufficient enough numbers, regular doctors sat up and took notice. Granted, the irregulars didn’t initially survive, but we’ve come back around to similar circumstances. Some of us are dissatisfied with and/or suspicious of modern medicine, and herbal medicine is again rising in popularity and creating competition. Certain medical providers have responded by having a complementary or integrative approach with alternative medicine. Consumers, then and now, influence the marketplace by how they choose to spend their money.

So What’s a Consumer to Do?

I understand that the mention of learning more about history can make people’s eyes glaze over. The average consumer doesn’t have time to sit down and read through 400+ page books on this stuff. But, we do lose a bit as consumers when we don’t understand how our government and institutions work and how we’ve come to our current mode of operation. As they say, those who don’t learn from history are doomed to repeat it.

One thing to remember about history is that it’s very hard to tell the whole story partly because there are many different perspectives. Think about it as an accident happening on a busy street. As people relay to the officer what happened, each person’s version of the story can differ depending on what they saw from their location at the time of the accident.

Another issue with history-telling is the influence of any agendas or prejudices that the history teller may have. For example, Christopher Columbus was either a great discoverer or a horrible butcher depending on who’s telling the story. As the saying goes, history is written by the victors.

Historical information can be used to enlighten as well as mislead and consulting different sources is a good idea. Whenever snake oil salesmen or herbal medicines laced with opium and cocaine are brought up to discredit herbal medicine, consumers should ask what the rest of the story is. The synopsis I’ve written above about the regulars and irregulars tells only part of what happened and why. There was a lot going on in the 1800s and many different things influenced how medical practice evolved during this time. Don’t just take my word for it. Check it out for yourself.

Resources to Learn More

The History of Medicine: A Very Short Introduction by William Bynum

Green Pharmacy: The History and Evolution of Western Herbal Medicine by Barbara Griggs

The Social Transformation of American Medicine by Paul Starr

Encyclopedia.com website – Medical Education

US National Library of Medicine website – History of Medicine Timeline

National Humanities Center website – Timeline: 1800 – 1860