History is written by the victors. 

The official history of American Medicine is written and disseminated, predictably, by medical professionals. Most of us have never had a reason to question this official history, and have accepted the idea that medicine is and always has been a monolithic entity without serious competition. The year 2010 marked the 100^th anniversary of the Flexner Report that revolutionized medical education in America. One-hundred years later, there is no memory of the true story.

And the true story, while less complementary to organized medicine, is infinitely more interesting. Filled with heroes and villains, intrigue at the highest levels of power, and epic battles of wits, the true tale seems more worthy of the annals of the Roman Senate or a Shakespearean drama. And nowhere was that true story more interesting, or more filled with fascinating characters, than in Alabama. During the late 19^th Century, this play reached its climactic second act, and it is a story that deserves to be retold, especially at this pivotal time in the history of American Medicine.

Part One:  The Garden of Eden

Alabama medicine had never been monolithic. 

Alabama’s original physicians were, naturally, Native Americans. Cherokee and Creek medicine men were particularly skillful in the use of indigenous herbs – so skillful, in fact, that some of the earliest white settlers in the region simply adopted Indian techniques wholesale, along with many other native survival methods. After 1813, when white settlers began to pour into the area in greater numbers, physicians were among them. Unlike today however, where “doctor” means something rather specific, these early Alabama physicians belonged to a number of different traditions or sects, each subscribing to a different medical treatment concept. The most important of these sects, at least to our story, were the Mainstream Allopaths or “Regular” Physicians (the ancestors of today’s doctors), and the Reformed Physicians – also called the “Eclectics”.

Mainstream Medicine was built on a centuries-old European practice concept. It emphasized a scientific approach to disease, a thorough understanding of anatomy and physiology, the value of experimentation, and later, the use of increasingly-complex chemicals to treat illness. But despite their purported scientific approach, mainstream doctors of the mid-1800s had been reluctant to stop the practices of bleeding, chemical purging, and the use of toxic mercury compounds, despite clear evidence that these methods were harmful. It was this almost religious devotion to these dangerous methods that led some to begin to question the infallibility of the ancient art’s torchbearers.

Protests against mainstream medicine took on many forms. In the U.S., one of the more interesting was led by an uneducated but business-savvy New England farmer named Samuel Thomson. In the early years of the 19^th-century, Thomson was reputed to have saved his family from a deadly fever after a number of local doctors had failed, using only hot baths, cayenne pepper, and “puke weed” (Lobelia). Capitalizing on a growing popular mistrust of mainstream doctors, and utterly dismissive of the value of scientific knowledge and formal medical education, he began to sell his patented methods through the mail. It seems shocking today, but for a small fee, anyone at the time could become a Thomsonian physician.

Eventually, Thomsonianism died out, but it had sparked a larger fire. Soon some physicians themselves were questioning the mercury-obsessed establishment, some even leaving the ranks in protest. Some of these physicians merged with the existing populist herbalism movement characterized by the Thomsonians, but they increasingly brought a more scientific and experimental approach. And although the Reformed Physicians (Eclectics) had successfully purged the anti-scientific influence of Samuel Thomson from the practice of botanical medicine by the mid-1800s, they were nevertheless always haunted by the association. 

As their name implied, Eclectics embraced the concept of using whatever modality could be shown to be effective. They were, at their core, herbalists, and in this sense were the natural descendants of the Indian Doctors who had been practicing in Alabama for centuries. Possessing an herbal pharmacopoeia of well over 300 items, the vast majority of which were native plant species, they also embraced mainstream medical techniques when they served their purposes. Eclectics did not see themselves as outsiders. Rather, they felt they were performing the critical function of reform within the medical establishment of the day. They vigorously opposed the use of mercury and bleeding, and were decades ahead of their time with respect to their focus on wellness and disease prevention. 

Well-suited to being practiced in isolation, and requiring little special equipment other than the physician’s five senses, Eclectic Medicine was practically made for rural primary care practice, and thrived in early Alabama as a result. So many Alabama doctors were adherents to this school of thought, in fact, that a short-lived Eclectic medical college – the Grafenberg Institute – was established in Wetumpka. It died in 1861, but not before supplying dozens of botanical physicians to the State.

Official history teaches us that all that was not mainstream was fundamentally flawed.  We might then imagine that mainstream doctors would have nothing but contempt for these herbalist pretenders to their throne. Rather than being locked in perennial philosophical war, however, the relationship between them was originally one of laissez faire and mutual benefit. With one foot firmly in mainstream scientific medicine, the Eclectics constantly reviewed the methods of their mainstream brethren, incorporating or rejecting them based on their experiences. Likewise, mainstream medicine benefited from Eclecticism. For example, although mercury was the orthodox treatment for syphilis in that era, the quintessential mainstream physician and Alabama native Dr. J. Marion Sims actively promoted the use of Queen’s Root (Stillingia sylvatica) extract as a superior treatment. The use of Stillingia had been learned from the Creek Indians, and was a common Eclectic remedy. No less an authority than the venerable Father of American Gynecology, Dr. Sims apparently had no major disagreement with Botanical Medicine. 

This arrangement was beneficial for patients in Alabama. Competition made doctors plentiful and inexpensive. There were a number of different health care options for patients, ranging from the gentle (Eclectic) to the more aggressive (mainstream).  Nevertheless, there were problems. In an unregulated environment, practically anyone could practice medicine with few qualifications. Doctor salaries were very low by today’s standards and many doctors resorted to second jobs to pay the bills. Finally, it was difficult to establish standards for practice with all the different sects operating simultaneously. There was a legitimate concern that rogue physicians posed a risk to the public. Contrary to the official history, however, this was a concern that was shared by all the formally-trained doctors, including the medical-college-trained Eclectics.

It is difficult to pinpoint the precise moment when inter-sect tensions began to build, but by 1860, a feeling of animosity clearly existed. Rivalry descended into name-calling.  Eclectics were characterized as uneducated, unsophisticated, and incompetent. Allopaths were accused of “quackery” (a literal reference to mercury or “quicksilver”) – of prescribing mercury for everything. The mainstream physicians responded by organizing into groups, which began to lobby government for their particular interests. Both MASA and the AMA were thus formed. This practice of organization and lobbying was what eventually sealed the fate of the alternative doctors. Fomenting, then capitalizing on public fear about an army of poorly-trained physicians, groups of this sort began to bludgeon their competition with elected government as their chosen weapon.

This was possible partially because of who the mainstream doctors were. Allopathic medical schools were old, elite institutions, which largely admitted the sons of the rich and powerful. Mainstream doctors, compared to their Eclectic counterparts, were well-connected, privileged white males. And while allopathy would take nearly another 100 years to fully integrate its campuses, Reformed medical colleges had been churning out minority and women physicians since their beginning. Despite the admirable nature of Eclecticism’s more egalitarian world view, it certainly put them at a decided disadvantage when fighting the powerful allopaths on their home ground – the halls of power.

The Civil War brought these growing tensions to a halt in Alabama – mainstream doctors and Eclectics served side-by-side in the Confederate Armies, and in nearly equal numbers. After the shooting war ended in 1865, all these doctors returned to civilian life, and the professional war resumed. One of these war-doctors – a Confederate Army surgeon and mainstream physician from Mississippi – was soon to be thrust into the national spotlight, and his new-found fame would make him the de facto leader of the mainstream doctors in a battle that would leave only one sect standing. The doctor’s name was Jerome Cochran.

For more on Cochran’s part in the Alabama doctor war, stay tuned for part two, which will appear in the March Birmingham Medical News.