Marginality, stigma and conversion in the context of medical knowledge, professional practices and occupational interests : a case study of professional homeopathy in nineteenth century Britain and the United States
During the development of medicine in nineteenth century Britain and the United States, the 'regular' profession was faced with severe competition from 'unorthodox' practitioners. Most significant amongst these were the professional homeopaths. They were just as ~ell educated and qualified as the regulars, and so they posed the deepest threat to their continued plausibility as the source of all that was 'Good', 'True' and 'Scientific' in professional medicine. The cognitive anxiety which professional homeopathy raised was further intensified by the fact that recruitment to the ranks of homeopathy was made from the regular profession itself. Many converts to homeopathy were prepared to pay the professional and personal costs of being labelled a 'quack' for the sake of their own integrity and the apparently more effective therapeutic certainties of homeopathy. They were prepared to abandon the systems of regular medicine, be they heroic, sceptical, neovigorous or eclectic, in order to be at peace with their own conscience, and to practice a system of medicine they were now convinced was far more effective than any form of regular therapy. During this period, regular medicine passed through three basic styles of theory and practice. These were the Heroic-Bedside, Clinical-Hospital and Bacteriological-Laboratory Medical Cosmologies. Particularly during the Heroic and Clinical phases, the regulars developed an anti-homeopathic ideology which they deployed in the various conflicts which ensued. I ts purpose was to define the homeopaths as 'deviants' and medical 'heretics'. The regulars did this by the use of a 'vocabulary of insult' which stigmatized their opponents. By further employing the tactics of intolerance and social control they were able to secure their own claims to political and 'scientific' legitimacy. However, the supposedly 'rational' and 'scientific' refutations of homeopathy by many eminent regular practitioners (such as Oliver Wendell Holmes and James Young Simpson) were actually constructed at a time when the therapeutic, pharmacodynamic and aetiological knowledge of regular medicine was immature and highly uncertain. I shall argue that the claimed refutation of homeopathy during the 1830's to 1860's was not, indeed could not be, accomplished on scientifically 'objective' grounds (i.e. on the grounds of intersubjectively testable, empirical and experimentally reproduceable knowledge). Therefore, its actual grounds were those of conventional professional social norms, practices and traditions. The defence of regular medicine by means of an anti-homeopathic, anti-quack ideology and the rhetorical claim to 'scientificity' was a sign of an insecure and crisis-ridden profession. It was dangerous for regulars to admit, both professionally and personally, the therapeutic efficacy of homeopathy claimed by its adherents. For the majority of the regulars, the cost - emotional, cognitive and social – would be too high. In these terms (rather than mere professional duplicity) we can explain the attempted suppression of the statistical returns of the London Homoeopathic Hospital, which showed the success of their treatments, from the official report on the 1853/54 cholera epidemic. A mature scientific therapeutics began to develop with the emergence of the bacteriological research programme, based upon the work of Robert Koch. He was able to provide a secure experimental, methodological and ontological basis for the germ theory of disease causation. However, its therapeutic fruitfulness was not realised in practice (for people that is) until the 1890's, with the mass manufacture of diphtheria anti-toxin based upon the research of Emil von Behring. Therefore, the known development of medicine, and especially of therapeutics, does not support the claim by the regulars during the nineteenth century (and after) that homeopathy was refuted by unambiguous experimental, clinical and 'scientific' means. The actual means to do that did not emerge upon the historical scene until 1876 at the earliest (with Koch's bacteriological work) and with fuller effect not until the 1890's. However, by that time the conflict between regular and homeopathic practitioners was no longer of any interest to the centres producing standardized scientific knowledge; the bacteriological laboratories of university-hospitals, the proprietary drug industry, and various government and private research institutes. The 'refutations' of homeopathy developed a half-century earlier, were taken to be sufficient warrant to continue to (a) reject homeopathy cognitively, if not legislatively,- and (b) refuse it the courtesy of agreed experimental test when the actual means to do so were then available. Therefore, within the asymmetries of power, structures of domination and mechanisms of social control developed by the regulars in their pursuit of 'scientific' legitimacy, occupational closure and market monopolisation, the homeopaths were marginalized. However, they were not completely powerless against the regulars. They were able to obtain some important compromises and concessions from them, even if what was gained in America turned out to be far more temporary compared to the moral and legislative achievements of their less numerous British counterparts. The medical historians standard model to explain the 'success' of 'scientific' regular medicine and the 'failure' of 'unscientific' homeopathic medicine, as the result of the progressive, linear, accumulation of 'facts' is no longer adequate to the task. This is because of the model's/historian's assumptions that the ideological evaluations already performed in relation to those it has stigmatized as 'unscientific' and (or because) 'unorthodox', during the nineteenth century, were (and are) epistemologically 'True' and l:npolluted by political/ideological interest. It is the purpose of this work to demonstrate that such a science/ideology polarity is unable to adequately explain the historical rejection of homeopathy throughout the century and to propose a conception of monopoly, marginality, power and ideology which is adequate to that task.