Review by Eric Dorman, 2009
Nature Cures: The History of Alternative Medicine in America. By James C. Whorton. Oxford University Press, 2002. 368 pages. $30.00.
If you have ever taken the time to observe web statistics on the multitude of websites related to health and medicine, you will have noticed that the homepages of Deepak Chopra and Andrew Weil amass an astonishingly high number of hits–far more than the famous medical journal The Lancet. Behind these numbers lies a truly fascinating sociological trend in our era: complementary and alternative medicine (CAM) is alive and flourishing. Esteemed medical historian Dr. James C. Whorton seeks to cast light on this trend and furnish a rich historical context for understanding it in Nature Cures: The History of Alternative Medicine in America. Whorton packs his book with historical information, primary-source research, detailed analysis, and the occasional apt poem to blend the diverse sections together into a comprehensive textbook that is both illuminating and accessible.
Whorton sets out to tell us that we should not be so shocked about the thriving interest in CAM, especially given the history of America. In Nature Cures he details the history of CAM in the U.S., focusing on the major figures, trends, and schools of thought from the early 19th century to the present. As a professional historian, Whorton's goal is to educate his audience about CAM practices, including their history, their major social forms, and the worldviews that underlie them.
From the outset Whorton states that he is writing “not as an advocate of alternative medicine, but as an advocate for its fair evaluation” (xiv). While he maintains a fairly objective tenor throughout Nature Cures, he does tend to accentuate the silliness of some beliefs. His occasional jaunt into the tongue-in-cheek does not detract from the overall fairness of his presentation, however, and by the end of the book one can sense his sympathy for CAM.
The book is sectioned into three parts. Part I covers the origins of CAM, namely the schools of “natural healing” in America during the 19th century. Part II continues the history of CAM into the 20th century as the schools shifted their focus to “drugless healing.” Finally, Part III brings us to the modern day expressions of CAM that have culminated in “holistic healing.”
Part I begins with an introductory chapter on the general worldview of CAM. Like mainstream medical practitioners, CAM practitioners see themselves as heirs to Hippocrates. They believe in a naturalistic orientation that assists the vix medicatrix naturae–the healing power of nature–rather than interfering with it. Practitioners of “irregular medicine,” as it was called, centered their practices around the ideals of being “natural” and “drugless.” During the formative years of CAM in America, the pervasive use of calomel, bleeding, purging, and other “heroic therapies” heightened the appeal of less invasive practices that sought to assess the problem, not merely attack the symptoms. CAM embraced vitalism, saw the body as a whole being–not just the sum of its parts–and thus opposed the dominant mechanistic worldview that had engulfed conventional medicine. As one would expect, the knee-jerk reactions to irregular medicine from the establishment were direct, harsh, and antagonistic–a trend that would continue up to the present day.
The second chapter introduces the first major figure in American CAM, Samuel Thomson (1769-1843). Embodying the essence of Jacksonian America, the unlettered and unfettered Thomson introduced a collection of herbal treatments based on a post hoc system of “testing,” which merely observed which herbs correlated to which effects. Most famous for his “Emetic Herb,” described as causing “a degree of nausea and depression which amounts to anguish” (26), Thomson built his medicine around a theory that life is sustained through an internal fire located in the stomach. Thus, like a true fireplace, clearing the stomach of its “ash and slag” would improve the individual's condition (28). Outside the practice itself, Thomson grabbed on to the spirit of freedom running rampant in America and marketed his system as an alternative to conventional medicine. His influence carried into politics as practitioners of “irregular medicine” worked to get rid of licensing laws that hindered free practice. After his death, though, Thomson's legacy dwindled as his system splintered under its own principles into oblivion.
Homeopathy, the topic of the third chapter, was the most popular form of CAM during the last half of the 19th century. Originated in Germany by Samuel Hahnemann (1755-1843), homeopathy operated under the theory that drugs that cause certain symptoms in healthy people would cure those same symptoms in ill people. Immediately blasted by the medical establishment for cataloging a litany of absurd symptoms, such as “excessive trembling of the whole body, when dallying with females” (55), Hahnemann retorted that these data were individualized for each patient so as to determine an appropriate remedy, as opposed to allopathic (a term Hahnemann coined) methods that sought a common cure for multiple patients. Harder still for conventional practitioners to accept was the homeopathic theory for its infinitesimal remedial dilutions. Hahnemann believed that by grinding or shaking the remedy into its dilutions, a spiritual potency is released that transcends the laws of matter. Fitting in with the reactionary anti-mechanistic worldview growing in the U.S., homeopathy caught on with the public and maintained a strong presence. Antagonism from the medical establishment, though, was intense, leading up to the levying of the Consultation Clause by the AMA in 1847 that forbade MDs from cooperating with homeopaths.
Chapter Four introduces hydrotherapy and its progression into hygeiotherapy. Vincent Priessnitz (1799-1851) formulated hydrotherapy, which operates exactly as it sounds, under the theory that soaking the patient in cold water for long periods of time “brings 'bad stuff' out of the system” (81). Due to its apparent effectiveness, hydrotherapy made its way from Austria to the U.S. (wherein tepid water was allowed!). Around the same time Sylvester Graham (1794-1851) began his “Science of Human Life,” a program aimed at promoting good hygiene. This hygiene included, among many things, right living and moral duty to the Creator, the result of which would be good health. These two systems merged and became hygeiotherapy under the guidance of Russell Trall (1812-1877). Trall popularized hygeiotherapy and established it as a proto-holistic, progressive, and feminist-leaning system. One colleague even went so far as to claim hygeiotherapy as the greatest “revolution since the days of Jesus Christ” (99). Like other revolutions, though, hygeiotherapy fell into the cynicism of the Gilded Age and declined in prominence.
The fifth chapter discusses practices that took the step from body to mind as primary in healing. Franz Anton Mesmer (1734-1815) began with a theoretical framework that magnetism inherent in the body could be manipulated to cure illness. His practices and the resulting convulsions of patients struck fear into the medical (and religious) establishment, causing a strong backlash. John Dods furthered this framework by formulating “electrical psychology,” which postulated that electricity is the link between mind and matter and thus mesmerism is natural, not mystical. With this theory, though, Dods suggested that mesmerism was actually the healing method of Jesus and thus his “electrical psychology” was the true science of the soul. Phineas Quimby dismissed magnetism and suggested that the mind alone can balance a human being into health, reuniting “the error-prone human mind with the unfailing divine spirit...Christ” (119). Quimby's teachings were taken to heart by Mary Baker Patterson (later Eddy), who founded Christian Science with her writing of Science and Health in 1875. Unlike the previous CAM schools, Christian Science claimed status as an official religion operating under the belief that evil and illness are unreal and need merely be prayed away.
Part II of Nature Cures, which focuses on the “drugless” schools of the early 20th century, begins with the legal and political side of CAM. Chapter Six discuses the licensing and medical freedom issues that emerged around the turn of the 20th century. MDs had been relying on the 1847 Consultation Clause (mentioned above) but now sought to further strangle CAM out of the system. Practitioners of alternative methods welcomed criticism as it gave them free publicity. Behind the political struggles, conventional medicine was gaining strength with the public due to the discovery of germ theory. Consequently, alternative practitioners realized that they needed to catch up and subsequently supported equal licensing laws for themselves in order to weed out the true quacks.
Chapter Seven covers the first of the major turn-of-the-century schools, osteopathy. Andrew Taylor Still (1828-1917), the South's version of Thomson, was convinced that knowledge of anatomy is the key to healing illness, and through empirical trial and error he established a theory that was half science, half “natural theology” (146). Still believed that nature proves God through its order and that this order is represented by the human body. Drugs or other foreign substances disrupt this order since the human body is merely a machine that needs occasional adjustment. (This worldview differentiates Still from the other early founders of CAM practices.) He claimed that “an Osteopath is only a human engineer” (146) and that “the brain of man was God's drug store...” (147). Though the theory was speculative, the practice was effective and osteopathy grew. Over time there was a split over whether or not to allow some surgeries and drugs into the practice as a matter of integration. In the end, the integrationists won and by 1973 all 50 states allowed osteopathy.
One thing both sides of the osteopathic split agreed on was their hatred of rival Chiropractic, the subject of the eighth chapter. Its founder, D. D. Palmer (1845-1913), felt he had solved the great questions of life with his “New Theology” of healing–the integration of physical health and God (169). Palmer dismissed germ theory, claiming that “95% of diseases were caused by subluxated vertebrae” and the other 5% by joints (171). Though a concerted effort by means of laws (178) and love story novelettes (180), chiropractic maintained a strong presence in American culture. Like osteopathy, though, the effectiveness of the practice outlasted both the implausible theory and the controversy, and by the end of the 20th century chiropractic became somewhat respectable within mainstream medicine.
Chapter Nine discusses Sebastian Kneipp's school of naturopathy and its growth in the U.S. under Benedict Lust (1872-1945). Underlying original naturopathy was Kneipp's belief that people suffer from the “effemination” (191) of society and therefore need to go through a “hardening” (192). Lust believed germ theory was a hoax–the flu epidemic, for example, was caused by too much barley and cornmeal (192)–and that disease is rooted in a violation of natural laws which can only be righted through natural means of cleansing. The use of natural methods–which includes herbs since they are gifts from heaven (195)–with a good, active, and moral life could bring about a return to Eden. In this sense Lust viewed Christ as the greatest naturopath (197). Legally difficult to define and universalist in nature–due to its proclivity to accept any and all practices as long as they were “natural”–naturopathy neither made significant gains nor suffered tremendous decline over the course of the 20th century.
Finally, Part III of Nature Cures brings us to the contemporary situation. Chapter Ten describes the social and political events in the late 20th century that shifted the understanding of unconventional practices from “irregular medicine” to “alternative medicine.” As Whorton comprehensively documents, most schools of CAM were cults of personality built around their founders that adopted an antagonistic stance toward “scientific medicine” (222). The major shift in direction took place following the 1910 survey of medical school education conducted by Abraham Flexner. Probing both conventional and “irregular” schools, Flexner's findings were initially negative for both. The resulting raising of standards was much more detrimental at first to alternative schools because of their history of accepting anyone with a desire to heal (or make a quick dollar) and the subsequent “ignoramuses” and “dumbbells” they produced (229). However, this pressure, along with the enactment of basic science laws beginning in 1925, lifted CAM to a higher level of respectability.
The eleventh chapter covers the holistic explosion of the late 20th century. After a period of relative prosperity and stability, the U.S. medical establishment faced a crisis. Patients were unhappy having their suffering pressed into the biomechanical-disease framework; MDs had no answer for the whole patient. Antibiotics (mocked as “blindmycin”) replaced calomel as the rallying call of CAM (247). Descartes' mind-body duality became the “arch-villain” as people realized they were more than machine (248). Patients were paying more money for less health and, with the emergence of the counter-culture movement, the influence of Eastern practices like acupuncture and ayurveda, and the awareness of other worldviews, the time was ripe for CAM to blossom.
Chapter Twelve finally brings us to the era in which the “complementary” part of CAM emerges as the focal point. CAM fully entered into the mainstream mainly through the influence of nurses, who tended to be more sympathetic to holistic medicine. This acceptance, though, raises more questions and concerns for CAM. How will CAM stand up in the face of the almighty random, controlled, double blind clinical study (292)? Is such a criterion even applicable? One researcher commented that to hold alternative methods to these standards is akin to “setting the agenda for a convention of anarchists” (294).
Whorton concludes Nature Cures by arguing that “complementary” and “integrative” understandings of CAM will win the day. In order for medicine to progress, we need the best of both medicines. Through CAM does need to submit itself to scrutiny, we must also accept the fact that one cannot study individualized medicine with a large-scale randomized trial (303). If CAM must become more scientific, “mainstream medicine must become more philosophical and give more serious attention to the holistic interpretation of health and healing” (304).
Nature Cures offers a marvelous survey of the history of CAM in America. Whorton provides a very fluid presentation in an almost narrative format while maintaining a consistent structure within each chapter to keep the reader in a rhythm. His use of poetry and light humor lets the audience breathe from time to time amid the sheer density of material while his occasional highlighting of certain overriding themes forces us to think critically about how they apply even in our own time. Above all, though, the strength of Nature Cures lies in its rigor. Whorton has embraced Clifford Geertz's “thick description” and presented his audience with an intricate portrait of the origin, rise, and progression of each of the CAM schools. The use of both current secondary research and contemporary primary snippets assures an exhaustive study that is both interesting to the casual reader and useful for the academic researcher.
Nature Cures, though, is not without flaws. While Whorton maintains a tempered tone throughout the vast majority of the book, certain quips and presentations verge on a kind of condescension that is not necessary for either description or humor. For example, the admittedly clever pun in the title of the third chapter, “Dilutions of Grandeur: Homeopathy,” immediately saddles the homeopathic school with a messianic complex that may dissuade a less critical reader from extracting its efficacious elements. Similarly, some of the treatments of the founders and their contemporaries carry a heavy tone of after-the-fact superiority and mockery over their “silly” beliefs. This criticism is not for the sake of empathizing with long-deceased CAM practitioners, but instead to highlight a certainly unintentional hypocrisy in promoting the toleration of an unfamiliar worldview while simultaneously dismissing past beliefs for being what we now know to be highly ridiculous. Finally, though Nature Cures does go in-depth into most of the major schools of alternative medicine in America, I cannot help but pine for the American traditions that did not make the cut. Specifically, I would like to have seen inclusion of Native American traditions of healing.
Criticism aside, James C. Whorton's Nature Cures is a treasure for anyone, scholar or not, who wants to learn about CAM, its history, and its place within American culture. While he pokes fun at some of the more peculiar aspects of alternative medicine and its history, Whorton has a strong sympathy with the underlying worldview of CAM. And, as the telling direction of web hits reveals, the public at large shares this sympathy. CAM is not going away and we would do well to understand it.