Knowlton Biography, Chapter 45
Forty-five: Quackery, &c.
The subject before us is certainly one of vital importance to every individual in the community, and one that ought to be discussed in a candid and impartial manner. For my own part, I feel willing to admit the imperfections and inefficiency of the regular system, and of its practitioners, to their true extent; and I hope that you are all willing to lay aside all prejudices, and hold yourselves open and free to receive the truth, let it come from what quarter it may.
Charles was not only committed to advancing medical knowledge among physicians in the Boston Medical & Surgical Journal, he also wanted to help regular people understand the field so they could make informed decisions about their own health. Even before Fruits of Philosophy, Americans had a long tradition of interest in helping themselves, and books such as William Buchan’s Domestic Medicine could be found in many homes. First published in 1769, Buchan’s book remained in print throughout the early nineteenth century. The book was appropriately subtitled, Domestic Medicine: or, The family physician: being an attempt to render the medical art more generally useful, by showing people what is in their own power, both with respect to the prevention and cure of diseases.
But mainstream doctors like Buchan and Knowlton weren’t the only people writing on medical subjects for regular people. The same scientific revolution that encouraged freethinkers like Knowlton and Oliver Wendell Holmes to demand facts over authority, also helped others see the holes in traditional medicine. The ancient theory of humors wasn’t able to account for what doctors and perceptive patients were observing. Worse, the drugs and heroic treatments still used by many mainstream doctors were seen by critics as not only ineffective, but as dangerous and even life-threatening.
Popular suspicion of mainstream medicine attracted dissenting voices, and the early nineteenth century saw an explosion of alternative approaches. Water cures, “electerizing,” radical diets, faith healing, homeopathy, and Thomsonian herbalism were just a few of the popular practices that attracted people by promising results mainstream doctors couldn’t guarantee. Many mainstream doctors dug in their heels, and stubbornly insisted their profession should be respected—and perhaps even protected from these challengers by licensing and a national association. This sounded to many critics like elitism, and ran against the democratic belief that knowledge belonged to no one, and that inquiry should be free to all.
Freethinking physicians like Knowlton found themselves in a strange position. On the one hand, they were painfully aware of the limits of medical knowledge. As a young man, Charles had suffered for three years from the combination of superstition and obsolete science his doctors called medicine. Charles had been suspicious of the drugs in the traditional materia medica since that time—but at the same time, they were all he had to work with. The experiences of his youth, when he’d taken the prescriptions of ten competing doctors, had also taught Charles that it was easy to disagree, but much harder to offer a better solution.
Unlike most mainstream physicians, Charles had spent his life talking openly with people about subjects the authorities preferred to keep under wraps. For Charles, truth didn’t come from who you were, but from what you could prove. Knowlton might not have all the answers, but he’d spent years working on the questions of medicine. If he was struggling to find the most effective treatments for his patients, from whatever traditions he could find, then the most natural approach for someone like Charles would be to tell people what he’d learned.
In April, 1846, the Boston Medical & Surgical Journal carried long report from Knowlton as its lead article. “Quackery, &c.” was the transcript of a speech Charles had given a few weeks earlier at the Lyceum in Shelburne Falls, Massachusetts. Unlike Fruits of Philosophy, which the Journal had been reluctant to endorse, Knowlton’s lecture seemed to defend mainstream medicine against one of its most aggressive antagonists, Samuel Thomson of Alstead, New Hampshire. So this time the Journal declared “Dr. K. is a fearless writer, who, like a bold general, dashes into the very midst of the enemy, and cuts and hews his way through their ranks with irresistible power.”
But Charles was not mounting a simple defense of “regular” doctors, as the Journal’s editor believed. “Although the regulars are all raised pretty much in the same way, as well as pumpkins,” Charles said, “still they differ as much as pumpkins. Some are noble, large and ripe, some are small, some are green, and some are soft and good for nothing.” Although he’d come to speak on behalf of mainstream medicine, Charles was the first to admit it was equally possible that “a Thomsonian, or an incompetent M.D. (and of course the people around), may honestly believe that he has cured a case of consumption, or of peritonitis, when in fact, the former was only a case of bronchitis, and the latter a case of hysteria.”
Charles described the competing approaches of the Thomsonian, whom he called Dr. Lobelia, and the “regular,” whom he called Dr. Calomel. The names were based on the principal drugs in each system. Lobelia was a botanical emetic, used to induce vomiting, and Calomel was a mercury-based purgative, also used to clear the digestive system. Both were dangerous, Charles said, and both were used to do roughly the same thing. And that was the problem, Charles continued. Thomsonian medicine didn’t really add any useful, original insights. It just threw stones at the “regular” system and then used herbal remedies to do the same old, “regular” jobs.
The “action excited by a medicine is never exactly a healthy action,” Charles said, “be it excited by cayenne, lobelia, alcohol, mercury, or any other drug.” What distinguished honest practitioners from quacks, Charles continued, was the way they worked. Honest doctors, whatever tradition they began in, were always trying to find new ways to help their patients. Quacks, on the other hand, were:
all management. They study this more than anything else. Their motto is, “The business of a physician does not depend on what he really is, but on what the people think he is;” and it is a true motto. It is not their great aim to merit patronage, but to get it. They always keep one eye out for the popular, and are ever ready to join a popular cause or clamor, be it right or wrong…[they] are all things to all men.
The specialized language of physicians made it difficult for people to understand mainstream medicine, Charles said. In the 1840s, many sciences hadn’t yet reached the point where non-specialists were unable to keep up with the latest developments. Medicine was the exception, and critics like Thomson took advantage of medicine’s complexity and went out of their way to write about their systems in plain language. This made the Thomsonians seem more “democratic,” Charles said.
People naturally rooted for the underdog, Charles continued, “sprung up on his own hook, self-made, never enjoyed the advantages of the regular physician; and to see him whip out the big M.D.s is just what pleases them.” But in spite of its plain language, Charles said, nearly everything in Thomson’s Materia Medica and Anatomy had been plagiarized from mainstream medical texts. The original elements of Samuel Thomson’s system amounted to three claims: “that heat is life, that all disease is a unit, and that this unit consists in a loss of the natural, healthy distribution or equilibrium of the heat.” This was no better than Galen’s ancient theory of humors, Charles said. Even Thomson’s main drug, Lobelia, had been known long before the herbalist made it the center of his system. And it was the perfect drug to impress the inexperienced:
Lobelia greatly promotes the mucous secretion of the stomach…Hence those who take it generally vomit up much viscid, glairy matter, into which the Thomsonian doctors are in the habit of rolling the end of a stick, and then pulling up a rope of this matter some feet long, and calling to it the attention of the patient and those around, they remark, “No man could be well with such a lot of cold, heavy phlegm in in his stomach as that. I thought it was there.” And I have no doubt but that most of them honestly believe that this matter is in the stomach before the patient swallows the emetic, and are not aware of the fact, that lobelia may cause this matter to be vomited from a stomach that was in the most healthy condition.
“That this Thomsonian course” of treatment, Charles concluded, “may be beneficial in a very small proportion of the cases that arise (if not pushed too far), I am very ready to admit.” The problem with lobelia was the “well-known, alarming, and death-like prostration to which its narcotic property is liable to give rise.” Worse, the problem with Thomson’s system was that it attacked the dogmatic authority of traditional mainstream medicine, only to substitute its own dogmatic authority. “I am bound to no party, school, or system,” Charles said, “but am free to choose from among the whole…and dare say I have on hand as much lobelia, cayenne, barberry bark, and certain other roots and ‘yarbs,’ as any Thomsonian in the county.”
“Quackery, &c.” was Knowlton’s final contribution to the Boston Medical & Surgical Journal. The Journal’s editor mistook the article for a defense of mainstream medicine against the dangerous quackery of Samuel Thomson. Charles meant it as criticism of both Dr. Lobelia and Dr. Calomel. Although he lived a generation too soon to see the empirical, scientific search for truth he advocated become the foundation of modern medicine, Charles Knowlton deserves some of the credit for pushing his profession into the future.