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 fever²¹⁴.

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 profession²²¹.

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 medicine²²².

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's²²⁴ "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 Britain²²⁵.

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 Report²²⁶ 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 colleges²²⁷.

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 practice²²⁸.

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 allegiance²³⁰.

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 10,000²³¹.

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.

Copyright © Alexander Kotok 2001
Mise en page, illustrations Copyright © Sylvain Cazalet 2001