The history of homeopathy in the Russian Empire – Alexander Kotok, M.D.

The
history of homeopathy in the Russian Empire

until World War I, as compared with other European countries and the
USA: similarities and discrepancies

by Alexander Kotok, M.D.

On-line version of the Ph.D. thesis improved and enlarged

due to a special grant of the Pierre Schmidt foundation.

   

1.9.4 United States of
America

The history of the fast spread, flourishing and swift
decline of homeopathy in the USA presents, probably, the most
interesting piece of the history of world homeopathy, and attracted the
attention of many scholars. The attempts to understand the reasons which
led to the decline and virtual disappearance of homeopathy in the USA,
are not only purely historical, but are also practical. At the present
time, homeopathy in the USA, as in many other countries, is on the rise.
When trying to ascertain why homeopathy, whose future seemed to be so
promising, completely surrendered to allopathy within some 20-25 years,
one can foresee the future of contemporary homeopathy.

The reasons, which caused the fast development of
homeopathy in the USA, seem to be clear. The level of the training at
medical schools was then very low:

Even the most credulous of Americans had become
skeptical of the physicians’ claims to the dignity of a learned
profession. The requirements for graduation from medical school,
complained a Massachusetts physician, were purely nominal, the final
examination a “mere pretense”. In Iowa, six months of
reading medicine were sufficient to win the title of doctor. The
prospective healer then bought a “pound of calomel, an ounce of
quinine, a drachma of morphine,” and considered himself ready to
locate. […]. More damaging to the medical profession than either
lack of education or of ethical standards was the practice of the
average physician. His ministrations provided neither cure nor the
illusion of competence and consistency […]. ²¹³

Allopathic medicine, especially its indiscriminate
bloodlettings and abusive use of mercury, which were so widely spread in
the New World, was the subject of hard criticism of the contemporaries.

The reasons for the early success of homoeopathy in
the USA are not difficult to understand in the context of the state of
orthodox medicine at the time. American orthodox medicine in the first
half of the nineteenth century was comparable with European medicine
but was if anything more dangerous. Bleeding was of course a sovereign
remedy and was taken to even greater lengths than were fashionable in
Europe… Bloodletting was the correct treatment for almost any
disease but especially for fever. ²¹⁴

Certainly, this made the way of homeopathy in the USA
much easier. Moreover,

Homeopathy, the most widespread of the medical
sects competing with the regular profession, benefited as well from a
rapidly increasing German immigration, which provided both
practitioners and patients. Like hydropathy, […] homeopathy was
comparatively inexpensive and at worst harmless. At least homeopathic
medicines would ‘not make well men sick, nor keep sick men from
getting well’. ²¹⁵

The first American homeopaths, like in Russia, were
immigrant physicians of German origin, graduates of the prestigious
German universities.

In the 1830s the new doctrine was carried both West
and East by German immigrants and German graduates of the ‘Nordamerikanische
Academie’. The first homeopath of Ohio, in 1839, was a German pupil
of Hahnemann’s, and he was joined by a German faculty member of the
Nordamerikanische Academy [created by C. Hering in Allentown,
Pennsylvania; see the chapter ‘Homeopathic facilities] […]. Four
of the first five homeopaths in Maryland were German immigrants […].
Throughout the century these German pioneers remained the leaders of
the profession”. ²¹⁶

While continuing to grow owing to the conversion of
regular physicians, especially during the epidemics for the treatment of
which allopathy had nothing at all to offer, homeopathy soon became the
most powerful “heresy” within the American medical profession.
Moreover, homeopathy, as distinct from other irregular practices, like
Indian medicine, Thomsonism or Grahamism, appealed to the fast growing
and developing classes:

Homeopathy […] appealed primarily to those middle
and upper class persons who were seeking an alternative to regular
medicine. It was able to do so for two major reasons. First, unlike
its competitors, homeopathy was extremely fashionable among the
European nobility and upper classes, whose tastes were often copied by
affluent Americans. Second, the leaders of Thomsonism and virtually
all the other movements opposing regular medicine were often
uneducated laymen. Patients, who could afford to pay for the best in
medical care, would hardly be attracted to any movement with this kind
of leadership. Homeopathy was devised by a physician and the early
American homeopaths were all well educated and cultured physicians
[…]. Many of them were also ‘persons of the highest respectability
and moral worth’, according to the editor of the ‘Boston Medical
and Surgical Journal’ […]. ²¹⁷

It was not immediately that the regular profession
recognized that homeopathy was a real threat. It the first years the
attitude toward homeopathy was rather skeptical and neglecting.

Most regular physicians regarded their homeopathic
colleagues first with skepticism, then with incredulity, and finally
with bitter hostility. They considered many homeopaths to be
opportunists who practiced both homeopathy and regular medicine, not
from conviction, but ‘according to order, on the whims and caprice
of their medical patrons’ […]. This statement summarizes the
regular physicians’ two basic objections to homeopathy: 1. That the
doses prescribed by homeopaths were too small to have any
physiological effect whatsoever; and 2. that the cures which
homeopaths attributed to their drugs were actually brought about by
the “recuperative efforts of nature”. The most interesting
aspect of the criticism of the size of the dose was the almost
complete absence of any reference to the law of similars on which it
was based […]. ²¹⁸

In accordance with H. L. Coulter, I am inclined to
see this hostility not just as a resentment against the spread of an
“unscientific method”, but as a demonstration of their
unwillingness to share the income:

[…]. A second and related point was allopathic
dismay at the high fees the public was willing to pay homeopaths,
especially in the early years after the doctrine’s introduction,
when there were still few practitioners […]. ²¹⁹

In the 1840s, the two different streams within
medicine, parted entirely. Allopaths began either to expel homeopaths
from medical societies or to look for some other methods of parting:

[…] Early in the 1840’s, some regular
physicians took the first steps to purge their ranks of homeopaths. In
1843, the Philadelphia Medical Society expelled all homeopathic
physicians, a position with which the influential Boston Medical
and Surgical Journal agreed […] In New York City, regular
physicians pursued a different course. Unable to throw the homeopaths
out of the county society because of the provisions of its act of
incorporation, they formed their own private medical society, the New
York Academy of Medicine, in 1847. A leader of the Academy asserted at
one of its first meetings that the organization ‘would not admit
irregular men… Any swerving from the path of professional rectitude
will not be recognized by us […].‘ ²²⁰

The American regular profession had to unite and work
out a certain position against irregulars. The founding of the American
Medical Association (AMA) served this aim. The chief vehicle of
collaboration within the profession, i.e., consultations, were banned:

The problem of homeopathy was a major factor in the
founding of the American Medical Association and was one reason for
its survival and success. […] The major vehicle in the AMA for
dealing with homeopaths was the code of ethics established in 1847.
This document devoted several important sections to relations with
“irregular practitioners” as homeopaths and other
non-regular were called by the regular profession. The most important
section concerned consultations, traditionally a major point of
contention among physicians. By keeping irregular practitioners out of
all consultations, the regular physicians hoped to destroy public
confidence in them, deprive them of their clientele, and increase the
gulf between them and the regular profession. ²²¹

In reply, homeopaths established in 1844 their own
powerful institution, namely the American Institute of Homeopathy [AIH]:

[It was] Resolved [at the first session in April,
1844], that it is deemed expedient to establish a society entitled
“The American Institute of homeopathy”, and the following
are declared to be the essential purposes of said Institute:

1. The reformation and augmentation of the Materia
medica;

2. The restraining of physicians from pretending to
be competent to practice homeopathy who have not studied in a careful
and skilful manner…

At the second session of the Institute, in May
1845, it was resolved:

Not to admit as a member of this Institute any
person who has not pursued a regular course of medical studies
according to the requirements of the existing medical institutions of
our country, and, in addition thereto, sustained an examination before
the censors of this Institute on the theory and practice of Homeopathy
[…].

The later charges of the American Medical
Association that homeopaths were uneducated physicians, were
politically motivated and had no foundation in fact. The founding of
the American Institute of Homeopathy meant the emergence of homeopathy
as the spearhead of the opposition to orthodox medicine. ²²²

The AMA initiated the full breaking-off with
homeopaths:

In 1856 the American Medical Association resolved
that homeopathic works should henceforth no longer be discussed or
reviewed in allopathic periodicals. After this time there was no
formal communication whatever between the two branches of the
profession […]. ²²³

As in other countries chosen for comparison,
homeopathy was attacked by special anti-homeopathic books and pamphlets:

While several anti-homeopathic works appeared in
the 1830’s, Oliver Wendell Holmes’s ²²⁴
“Homeopathy and Its Kindred Delusions” (1842) was the first
serious counter-attack by orthodox medicine […]. During the course
of the nineteenth century about seventy-five anti-homeopathic books
and pamphlets were published in the United States and Great Britain.
²²⁵

The situation of homeopathy in the USA at the turn of
the century seemed to be excellent and was the subject of the pride of
homeopaths everywhere in the world: American homeopaths possessed 22
homeopathic colleges, dozens of purely homeopathic hospitals, dozens of
homeopathic periodicals; the number of the graduates of homeopathic
institutions counted by thousands (see the chapter “Homeopathic
facilities”). Nevertheless, already the first decade of the 20^th
century showed a fast decline of homeopathy, first in the number of
colleges: by 1913, only 10 remained, whilst by 1919 only 5 were still
alive. Together with the disappearance of the colleges, homeopaths lost
their control over hospitals (the latter dropped their homeopathic image
and became purely allopathic facilities), whilst the homeopathic
periodicals were gradually discontinued. By 1950, nearby nothing
remained from the past glory of the homeopathic doctrine in the USA.

So, what happened? This problem has been actively
debated these last years. No doubt that the decline of homeopathy was
partially connected to the publication of so-called Flexner Report ²²⁶
followed by the “misuse” of the Carnegie and Rockefeller
Funds, which enabled the regular profession to improve its educational
standards and to strengthen its economical positions.

Yet the Flexner Report did not change the general
negative trend within American homeopathy:

The Flexner Report, published in 1910, had no
bearing on the failure of homeopathy in America. In the decade prior
to the appearance of the Flexner Report seven homeopathic colleges
closed and enrollment in homeopathic colleges declined by half. In the
decade following the publication of the Flexner Report, eight
homeopathic colleges closed. In other words, the decline which had
started before the appearance of the Flexner Report, continued
unchanged after its publication […]. In fact it was more critical of
homeopathic medical colleges than allopathic ones, favoring the
elimination of two-third of each type. It judged five homeopathic
colleges worthy to continue as medical colleges. ²²⁷

Why did “the homeopathic movement”
collapse? No answer is possible without previously briefly analyzing of
the internal processes which had occurred within American homeopathy
during the second part of the 19^th century.

First of all, homeopathy in the USA had slowly
changed to the bad. First it became evident in the manpower:

The earliest students of homeopathy in this country
[America] were extremely serious and dedicated. They possessed not
only the keenness of mind to consider this new system of medicine, but
also the discipline and perseverance to study it in a foreign
language, since at that time all the texts were in German […]. The
demands of the curriculum kept away all but the most dedicated
individuals. As a result, homeopathy was initially represented by men
of great integrity and commitment, who were thoroughly grounded in the
fundamental texts and principles of homeopathy. They had great success
in their practice. ²²⁸

Later the decline became evident also in the teaching
of homeopathy as a complete doctrine:

Almost without exception, the twelve thousands
physicians calling themselves homeopaths in 1900, received no training
in homeopathic doctrine, homeopathic method, or homeopathic Materia
medica. Between 1840-1890 a structured course on the subject of
homeopathic doctrine and principles was presented at only two
homeopathic colleges! […] The most important textbook of
homoeopathy, the Organon of Medicine by Samuel Hahnemann, sold
only about five hundreds copies during the entire era of the supposed
golden age of homoeopathy in America. Hahnemann’s Chronic
Diseases, an essential supplement to the Organon, sold even fewer
copies and was “long out of print” in 1889 […]. ²²⁹

This point of view is shared by most researchers:

The [American] Institute [of homeopathy] grew
rapidly in number but the new members lacked the proselytizing fervor
of the old guard, whom they looked on as obscurantist old German
fuddy-duddies. The purists, for their part, regarded the new recruits
as upstarts who were ignorant of Materia medica, did not know to
individualize their cases, and never read The Organon, and did
not even believe in the law of similars. […] The low-potency group,
which had always greatly out-numbered its rivals, drew gradually
closer and closer to orthodoxy. Eventually, the distinction between
homeopathy and allopathy became so slight that there seemed no point
in perpetuating it, and the vast majority of American homeopaths
quietly switched their allegiance. ²³⁰

Indeed, the German immigrants, who occupied the
positions of those who taught and those who were taught, gradually were
replaced by poorly educated American graduates, mainly recent converts
from allopathy, who had no desire to deepen their knowledge of
homeopathic principles, merely applying homeopathic medicines instead of
allopathic ones. One should not forget that homeopathy as a whole
doctrine is very difficult to be studied and applied (especially the
need of individualizing each case), as compared with rather primitive
allopathic prescriptions of that time. Thus, many pseudo-homeopathic
colleges certainly preferred to teach uncomplicated allopathy instead of
seeking and further attracting talented homeopathic practitioners to be
introduced into teaching staff in order to provide the teaching of true
homeopathy.

In 1870, the A.I.H. declared that pathological
indications were more important than the individualizing symptoms of
the case in the selection of the remedy. In 1880 it did away with the
provision that mixtures should not be a part of homoeopathy, and
mixtures were welcomed. By 1882 it voted that a homeopath need not
restrict himself to practicing according to the law of similars, but
could practice any kind of medicine he wanted and still be called a
proper homeopath. […] The AIH by 1880 was so overwhelmingly eclectic
that the real homeopaths among them formed a separate association, the
International Hahnemannian Association (IHA). Interest in real
homeopathy was so small that no more 150 people ever belonged to it,
while the roster of AIH numbered over 10,000. ²³¹

Thus, American homeopathy, if we understand under
“homeopathy” the complete system of teaching and training of
homeopathy, lost its homeopathic purity long before it began to loose
colleges, periodicals and hospitals. The process of the merging of
homeopathy into allopathy which began in the second half of the 19^th
century, was speeded up by the successes of allopathy, essentially in
the field of bacteriology.

One should also mention that the American regular
profession, like the case of Britain, adopted at the beginning of the 20^th
century a new approach toward homeopathy. Instead of open hostility,
which gave to homeopaths public sympathy and brought no appreciable
fruits, allopaths began to regard homeopathy as an important step in the
steady development of medical science:

In the twentieth century the AMA and the allopathic
profession adopted a different interpretation of homeopathy – denial
that it possessed therapeutic efficacy combined with acceptance of its
reforming role. This new policy was formulated by William Osler
(1849-1919), ²³² who liked to declare that ‘no one
individual had done more good for the medical profession than
Hahnemann’ in showing that the natural tendency was toward recovery
– but insisted that homeopathy and allopathy had both been superseded
by ‘scientific medicine’ […]. The conviction that the
homeopathic medicines were nothing but placebos led Osler to his
doctrine of ‘therapeutic nihilism’.²³³

   

1.10 Summary

When reviewing our brief study of the relationship
between allopathy and homeopathy in the countries selected to be
compared with the Russian Empire, one may note that, in essence, the
forms and methods adopted by the regular profession in its struggle
against homeopaths and their “heresy” were similar in all
countries. The homeopathic theory was labeled as “absurd”,
“denial of science”, “propaganda of ignorance”.
Nevertheless, the appeals of homeopaths offering to prove the efficiency
of homeopathy by experiment and not on the ground of theoretical
speculations, steadily remained unanswered.

Homeopaths were expelled from societies common with
allopaths, marginalized and blackmailed in the press as
“quacks”, “wizards”, and “betrayers of
science”. In order to prevent the further spread of homeopathy
through personal contacts, enabling a comparison of different methods of
treatment, British and American regulars prohibited consultations with
homeopaths; although in Russia this ban did not exist officially, the
anxiety before a moral condemnation of “brethren” in the
atmosphere of anti-homeopathic hysteria, was no less powerful than a
direct ban.

In fact, the struggle with homeopaths has been
nothing else but a struggle for the market of medical services. In the
countries where the medical market was overcrowded with manpower
(Britain and the USA) the resistance to homeopathy was especially
irreconcilable, as homeopaths not only competed with allopaths, but also
attracted the most solvent public. In the USA this attitude changed at
the beginning of the 20th century for by allopaths (William Osler in
first) initiated “reconciliation” within framework of
“scientific”, i.e. allopathic, medicine.

Homeopaths from the very beginning were divided into
the camps of “purists” and “homeo-allopaths”; each
of these had its outstanding representatives. Yet the vast majority was
always represented by the “homeo-allopathic” camp. This
derived probably from the fact that the steadily happening conversions
to homeopathy, provided an influx of doctors who had no intention to
break off with allopathy entirely. Contradictions of this kind increased
the tension within the homeopathic profession. This was true for all
countries but Russia. The “pure” homeopathy had never been
practiced there. Like their “mixed” colleagues in other
countries, Russian homeopaths rejected the doctrine of potentisation.
Both domestic self-treatment books and manuals for doctors favored the
use of mother tinctures or low potencies, usually not higher than the 6^th
centesimal dilution; the book by Richard Hughes, one of the most
important representatives of this trend within homeopathy, was
frequently republished, whilst the books by J. T. Kent, as well as
“The Chronic Diseases” by Hahnemann, were ignored.

In the countries selected for comparison there were
various reasons which caused the decline of homeopathy by the end of the
19^th century, like overidentification with aristocracy in
Britain, anti-German dispositions and personal conflicts in France,
rejecting the homeopathic doctrine for allopathic theories in the USA,
caused by the rapid scientific progress at the end of the 19th century
and by “allopathic predispositions” both of new converts and
teaching stuff at homeopathic colleges. Moreover it should be stressed
that no country in Europe succeeded to establish a firm system of
homeopathic education as compared with that of allopaths. At the
emergence of homeopathy on the medical scene, all European countries had
already a firmly constituted system of allopathic training; no
high-ranking support could introduce homeopathy into it. On the
contrary, the example of the USA where homeopaths succeeded to obtain
equality of rights with allopaths, also in the field of education,
provided a large representation of homeopathy (or what was called
homeopathy) in that country.

Homeopathy in pre-WWI Russia had no clear-cut timing
for its decline. The very difficult period of Russian history, from the
Russia-Japan war (1904) to the First World War (1914) explained in part
the stagnation of Russian homeopathy. The tight connection of Russian
homeopaths with their high-ranking lay supporters was, in fact, rather
fragile, for these supporters (the nobility, the clerical estate), were
especially sensitive to the social shocks experienced by
pre-Revolutionary Russia. Except for St. Petersburg and, to some extent,
Moscow, homeopathic societies everywhere in the Russian Empire were
based on very few (2-3) physicians hired to receive patients in the
dispensary of the society. Thus, homeopathy in Russia had mainly a
lay-domestic character, and was practiced by rural clergymen, by the old
village nobility, by petty officials in provincial towns, etc.
Certainly, no competition with regular medicine was possible.
Nevertheless, before a general threat when allopaths turned to closing
homeopathic pharmacies) Russian homeopaths proved to be able to unite,
to organize a common meeting and to work out a common position. If
Russian homeopathy would have had any future, in the absence of wars and
revolutions, I suppose that it would have had to rely mainly upon their
lay supporters, as was the case of German homeopathy.