A MOTIVATIONAL AND SOCIOLOGICAL ANALYSIS OF HOM(EOPATHIC PHYSICIANS IN THE U.S.A. AND U.K.*

By MARCIA MOORE, B.A. (Concord, Mass.), and JAMES STEPIIENSON, M.D. (New York City)

(Supported by the Harrington Foundation; Boston, Mass. Administered by the Homeopathic Information Service)

THE decrease in the number of practising homoeopathic physicians in the U.S.A. has been much discussed and speculated upon by the members of the American Institute of Homeopathy. However, no systematic evaluation of possible reasons which lead physicians to enter homceopathic pract ice has been made. Therefore, this study.

MATERIALS AND METHODS

Questionnaires on the motivations and sociological backgrounds of homceopathic physicians were composed by the two authors (of whom Miss Moore is a psychologist, recently graduated from Radcliff). They were mailed to the 251 members of the American Institute of Homeopathy and the 198 members of the Faculty of Homceopathy (of Great Britain).

Of the 449 questionnaires sent out 196 were completed and returned, making an overall response of 44 per cent. One hundred and fifteen of the 251 members of the American Institute of Homeopathy responded (or 46 per cent) and 81 of the 198 members of the Faculty of Homceopathy (or 41 per cent). Whether this response truly represents the attitude of the total membership of both groups is beyond the scope of this article to say. However, lacking any more accurate information, analysis of the data from these questionnaires provides at least a speculative framework for dealing with the problem of homceopathic recruitment.

DATA

Because they represented a small culturally variant group not significant to physician recruitment in the U.S.A. or in Great Britain, questionnaires of the 11 Oriental members of the Faculty of Homceopathy resident in India, Pakistan and Ceylon were omitted. The remaining 185 questionnaires were analysed for certain of the questions specifically:

Age. Sex. Whether the father was a homceopathic physician. Whether the physician was under homceopathic treatment as a child. Whether relatives used Homceopathy. Age of introduction to Homceopathy. Per cent of practice devoted to Homceopathy. Stated reason for becoming a homceopathic physician. Religion. Attitude toward reincarnation.

* This report is being published jointly with the Journal of the American Institute of Homeopathy.

297

298 THE BRITISH HOM(EOPATHIC JOURNAL

The respondents were analysed in four age groups: I. Age 60 or more.

I I . 59-50. III . 49-40. IV. 39 or less.

And in two educational groups: I. Those who attended homceopathic medical schools.

I I . Those who attended non-homceopathic medical schools.

CONCLUSIONS

A simple percentage analysis reveals that nine-tenths of the group were male. One half were over 60; were graduates of homceopathic medical schools (in the U.S.A. three-quarters were homceopathie graduates); had been under homceopathic t reatment as children; had families who believed in Homceopathy and either belonged to a religious minority group and/or believed in reincar- nation. About a quarter had fathers who were homceopathic physicians; became homceopathie physicians because their family physician was homoeopathie, or because the family had been under homceopathie t reatment when the respondent was a child. About one-tenth became homceopathic physicians as the result of their colleagues' example or from personal benefits received from Homceopathy. The average age on introduction to Homoeopathy was 22, and the total group derived about half their income from Homceopathy.

On closer examination, the division into halves by medical school training is seen to extend into many areas other than education. Actually, two physician profiles emerge: one of homceopathic medical school graduates, the other of non- homceopathic medical school graduates. Because of their bearing on physician recruitment these two group profiles will be considered in some detail. The general observations made may, of course, not apply for any particular member of a specific group. Possibly it should also be emphasized that these profiles are based on objectively determined data. No judgements of either group are meant or implied. The purpose of this s tudy is solely to find some factual basis for a more efficient physician recruitment to Homceopathy.

HOM(EOPATHIC MEDICAL SCHOOL GRADUATES PROFILE

These are all residents of the U.S.A. Three-fifths of the members are over 60, one-quarter over 50 and one-seventh under 50 (total number 12). They are practically all men. The older they are the more of their practice is devoted to Homceopathy. The younger members of the group, under 50, practise little Homceopathy (about 20 per cent). The age of introduction to Homceopathy was about 18. Nearly three-quarters of them were treated homceopathically as children and/or came from families sympathetic t o Homceopathy. Among the members over 50 about one-third belong to a religious minority group and/or believe in reincarnation. Only one member under 50 had this orientation. One-third of those over 40 were at t racted to Homceopathy by their family physician.

In the U.S.A. there were 72 homceopathic medical school graduates over 50 as compared to 12 under 50.

NoN-HoM(EOPATHIC M~EDICAL SCHOOL GRADUATES PROFILE

Although two-thirds of this group is resident in the U.K. and one-third in the U.S.A. there was little difference between the two different national sub- groups.

About two-fifths are over 60, one-fifth over 50, two-fifths are under 50 (a

A N A L Y S I S OF HOlV[(EOPATHIC P H Y S I C I A N S I N U . S . A . A N D U . X . 299

total of 39 individuals). One-fifth are women. All age groups devote 60-70 per cent of their practice to Homceopathy. The age on introduction to Homceopathy was about 26 (30 in the U.K.). Only about one-third were treated homceopathically as chilch'en. About half came from families sympathetic to Homceopathy.

About 80 per cent belong to religious minorities and/or believe in reincarnation. One-third of the members in the U.S.A. were at t racted to Homceopathy via

their family physicians. None of the members in the U.K. were. On the other hand about one-quarter were at t racted to Homceopathy via colleagues and friends, or via personal results, whereas few of the homceopathic graduates were attracted. A specific British attraction to Homceopathy was because it works better, and because they were bored with non-homceopathic medicine.

In the U.S.A. there were 11 non-homceopathic medical school graduates over 50, as compared to 12 under 50. In the U.K. 41 were over 50, and 29 under 50.

COMPARISON OF THE TWO PROFILE GROUPS In general the non-homceopathic medical school graduates are younger,

more apt to be women, devote more of their practice to Homceopathy, and tend more often to be connected with minority religious groups and/or to believe in reincarnation. They came to Homceopathy at a later age than did the homceopathic graduates (particularly those in the U.K.), and fewer of them were treated homceopathically as children or came from families sympathetic to Homceopathy. They more frequently came to Homceopathy via their family physician or through a colleague or friend or because of personal benefits from homceopathic treatment.

In the U.S.A. the great majori ty of the homceopathic graduates were over~ 50, whereas proportionally there were as many non-homceopathie graduates under 50 as over 50.

D I s c u s s i o N

An optimistic note is that in the U.S.A. the percentage of members under 50 in both groups is not the same. The non-homceopathic graduates over and under 50 are in a ratio of 1:1 whereas the homceopathic graduates are in a ratio of 6:1. In the absence of any accurate figures on the number ofhomceopathic and non-homceopathic graduates in the American Insti tute of Homeopathy during the past century, their relative increase or decrease cannot be found. However, it may be possible to take the age-ratio over and under 50, as shown by this study, as an indirect measure of the growth or recession of each group. I f the present age-ratios are maintained, in another 10 years the majori ty of the members of the American Insti tute of Homeopathy will be non- homceopathic graduates. Historically, this would mark a return to the position of Homceopathy in the U.S.A. during the period following its introduction by Gram in 1825 in New York City until the 1840's when the graduates of the first homceopathic medical school (the National Academy of Homeopathy, founded in Allentown, Pa., in 1835 by Constantine Hering) started to decrease the proport ion of non-homceopathic graduates in the American Insti tute of Homeopathy.

In these terms, HHomceopathy in the U.S.A. can be divided into a number of historical periods:

I . 1825-1835, made up entirely of non-homceopathie medical school graduates.

I I . 1835-1945, made up of a gradually increasing percentage of homceopathie medical school graduates.

300 T H E B R I T I S H H O M ( E O P A T H I C J O U R N A L

III . 1845-1972 (prospective), dominated by homceopathic medical school graduates.

IV. 1972 . . . . . , made up largely of non-homceopathic medical school graduates.

Period I I I could be divided into a number of sub-periods: IIIa . 1845-1910, FOUNDING PERIOD, during which 26 additional

homceopathic medical schools were founded, 1 in the following order:

1848 The Homeopathic Medical College of Pennsylvania. 1850 The Western College of Homeopathic Medicine at Cleveland,

Ohio. 1852 The New York Opthalmic Hospital. 1860 The Homeopathic Medical College of New York.

The Hahnemann Medical College of Chicago, Illinois. 1865 The New York Medical College for Women. 1867 Hahnemann Medical College of Philadelphia, Pa. 1868 The Cleveland Homeopathic College for Women.

,, Dix Homeopathic Medical College of Missouri for the Education of Women.

1872 Detroit Homeopathic College. Pulte Medical College, Ohio.

1873 Boston University. 1875 University of Michigan Homeopathic Medical School. 1876 Chicago Homeopathic Medical College.

The State University of Iowa College of Homeopathic Medicine. 1879 The Homeopathic College of Physicians and Surgeons of

Buffalo, New York. 1884 Hahnemann Medical College of San Francisco (of the Pacific). 1886 The University of Minnesota Homeopathic Medical College. 1888 The Homeopathic Medical College of Missouri.

The Kansas City Homeopathic Medical College. 1890 Cleveland Medical College. 1891 Southern Homeopathic Medical College at Baltimore, Md. 1892 Hering Medical College of Chicago. 1893 Southwestern Homeopathic Medical College at Louisville, Ky. 1894 Denver Homeopathic College. 1895 Dunham Medical College of Chicago, Ill.

This period ended with the Flexner report 2 on medical education in the U.S.A. and increasingly stronger control of medical education by the state and federal governments, as opposed to the period 1840-1910 when medical education was able to operate in a free manner with little state or federal control.

Although not generally known, between 1850 and 1900 there was little control of medical practice by the states in this country, and none at the federal level. As pointed out by King a, it was during this period that the U.S.A. pioneered in new therapeutic avenues such as osteopathy, Christian Science, chiropractic, nutrition, etc. New scientific breakthroughs often come from gifted amateurs like Pasteur or Mendel. Standardization in any field tends to wither away conceptual creativity. Since 1900 the U.S.A. has made few conceptual breakthroughs in medicine but has rather, like ancient Rome, specialized in the engineering perfection of the strokes of genius of other nations.

A N A L Y S I S O F H O M E E O P A T H 1 C P H Y S I C I A I ~ S I1~ U . S . A . A N D U . K . 301

I I Ib . 1910-1940's, DISSOLVING PERIOD, during which the state governments established ever tighter control on medical education, taking as their criteria the views of one therapeutic group, the AMA, so that gradually a STATE MEDICINE appeared. The homceopathic medical schools a t tempted to co-operate by changing their curricula to fit standards set b y the AMA and by fusing with various non-homceopathic medical schools. During this period most of the homceopathic medical schools closed down, those remaining reducing the required courses in Homceopathy to a minimum until in the 1940's Homceopathy became an elective subject.

I I Ie . 1940's to 1960, TERMINAL PERIOD, during which the federal government entered into the health field via massive grants to medical schools and institutions (all AMA approved) and increasingly stringent domination of the food and medicine industries by the FDA (again, on AMA approved criteria). During this period even the elective courses in Homceopathy were gradually decreased until in 1961, with the retirement of Professor Garth Boericke at Hahnemann Medical School in Philadelphia, the last elective course in Homceopathy offered to undergraduates in medical schools in the U.S.A. was dis- continued.

The American Insti tute of Homeopathy has also undergone certain organizational as well as educational periods. These are:

I. 1844-1873, P E R I O D OF UNITY, from the founding of the American Insti tute of Homeopathy in New York City until the t ime when a significant number of members differed in their criteria as to what makes a medicine homoeopathic; how the patient should be evaluated homceopathically; and the number, and degree of dilution, of the medicines to be administered to patients. During this period applicants for membership were required to submit to an examination in and/or submit evidence of their knowledge of Homceopathy.

I I . 1873-1880, P E R I O D OF DISSOLUTION, ending in the withdrawal from the American Insti tute of Homeopathy of a large number of its members and the founding, by them, of The International Hahnemannian Association. This group felt that many of the members of the American Insti tute of Homeopathy had fallen away from the original teachings of Hahnemann. The new organization required applicants to submit evidence of their practise of "Hahnemannian Homeopathy" , as defined by the Board of Trustees of the International Hahnemannian Association.

I I I . 1880-1960, P E R I O D OF SCHISM, during which the American Inst i tute of Homeopathy gradually reduced its educational require- ments for membership until they were eliminated and membership became open to any licensed physician in the U.S.A. or Canada, whether they practised Homceopathy or not. During the 1940's and 1950's some of the leaders of the two organizations worked toward a compromise position which culminated in 1960 with the disbanding of the International Hahnemannian Association and the merging of its journal with tha t of the American Inst i tute of Homeopathy.

302 T H E B R I T I S H H O M ( E O P A T H I C J O U R N A L

IV. 1960 . . . . . , P E R I O D OF REUNION, in which the majori ty of homceopathic physicians in the U.S.A. arc united both in aims and at the organizational level for the first t ime in a century.

Since a knowledge of the past may provide a wise guide to future action, homceopathie recruitment should be more effective if the historical facts of Homceopathy in the U.S.A. are kept in mind. An experiment in Homceopathy undergraduate education was made in this country from 1835-1961, which has also extended to Mexico, Argentina and India, in particular. Apparently, at least in the present legislative climate in the U.S.A., homceopathic education cannot be effectively carried on at the undergraduate medical school level. This hard fact cannot be wished away but must be accepted and dealt with. At least for the moment, homceopathic recruitment appears to be committed to the post-graduate approach. Recognition of this, and reorganization of the American Insti tute of Homeopathy along these lines will aid the transition of Homceopathy in th is country from Period I I I to IV both at the educational and organizational level.

Possibly the chief function of the American Insti tute of Homeopathy will be as a year round post-graduate organization. The committee on post-graduate ,education could aid in this by the establishment of a post-graduate training centre in whatever towns in the U.S.A. have enough qualified and motivated homceopathic physicians in residence. As recognized functions of the Inst i tute they might apply for government support such as Fulbright scholarships, etc. .Some of the European post-graduate teaching centres, such as the Faculty of Homoeopathy, could be asked for their suggestions. In addition, the homceopathic proficiency requirement for membership in the Institute, as passed in 1960, should be put into effect without delay. Also, Professor Guttentag 's suggestion of 19404 that the Insti tute adopt the designation of Fellows and Members might be reconsidered. The titles F.A.I.H. and M.A.I.H. could be copywritten. In all of this we would be following the advice of Senator Royal S. Copeland, a distinguished past member of the Insti tute, who suggested in 19165 that we set our own standards and not allow therapeutic medical organizations with different orientations to speak for us at the state or national level. Dr. Copeland's article appears as t imely today as it was then. Because o f their change in orientation, the members of the Inst i tute may be in a bet ter position today to appreciate his advice than we were at tha t time.

In addition to the educational needs of the Inst i tute we also need to prevent a n y further encroachment on homceopathic therapeutic freedom by the state or federal government. A group of lawyers and legislators who were sympathetic towards Homceopathy could be formed to act as watchdogs on pending legislation which might affect homoeopathic practice. Existing organizations, like the National Health Federation, which are working toward similar ends -could be co-operated with. Greater recognition of Homceopathy might be sought for in official circles, particularly in medical indexes, pharmacopoeias, etc.

Other than educational and legislative prerequisites for hom~eopathic recruitment, certain techniques might also be of value. Our survey has shown the importance of personal or family experience with Homceopathy as a motivating force for homceopathic physicians. Each member of the Inst i tute could comb his files for the names and addresses of patients, or relatives of patients, who are non-homceopathic physicians, medical students or pre-medical students. In addition to following each of these leads up himself, the physician .could send their names and addresses to a central bureau which would be responsible for contacting the candidates in the most effective manner. Questionnaires on each candidate could be prepared and individualized

ANALYSIS OF HOM(EOPATHIC PHYSICIANS IN U.S.A. AND U.K. 303

brochures of homceopathic reprints selected to harmonize with the candidate's background and interests. Inst i tute members, or selected laymen, in the candidate 's community could take the responsibility for personal contacts. Ideally, this should all be done under the control of a professional public relations director, with legal guidance.

Since certain minority religious groups provide more than their proportionate :share of homceopathie physicians, they might be asked (preferably at the personal, executive level) if they would make available the names and addresses of their physician members. These groups are: Anthroposophy; Theosophy; Swedenborgianism; Society of Friends; Universalist; Buddhism; Plymouth (Christian) Brethren. Other minority groups, religious or scientific (like the Inst i tute of General Semantics, the History of Science Society, etc.) might also be contacted. Minority medical groups, such as the Physicians' Forum, the American Women's Medical Association, etc., might be investigated. Some a t t empt could be made to isolate the philosophical elements common to Homceopathy and minori ty religious groups and use them as a guide to future recruitment of homceopathic physicians.

Finally, those members of the Inst i tute who have had the greatest success in bringing in new members might be invited to share their " trade secrets" with the rest of us. Also, the non-hom0eopathic medical graduates in the Inst i tute might be asked for their suggestions, as well as the older, more experienced homceopathic groups in Europe.

REFERENCES

1 King, William Harvey, editor "History of Homeopathy in America", New York. 1905. Flexner, A., "Medical Education in the United States", Carnegie Foundation Bulletin,

4, 1910. z King, William Harvey, editor "History of Homeopathy in America", New York. 1905,

p. vi 4 Guttentag, Otto E., "Trends Toward Homeopathy", Bull. Hist. Med., 8, 1172. Oct.

1940. Copeland, Royal S., "Homeopathy's Declaration of Independence", J. Amer. Inst.

Homeop., 1916.

POINTERS AND POINTED PARAGRAPHS

Contributed by BENJ. GOLDBERG, M.D.

"WHEN the tenderness in a perforated wound is worse than the appearance would suggest think of Hypericum rather than Ledum."---John H. Clarke.

Ledum is superior to Arnica or Rhus for sprained ankle. I t is almost a specific. Hypericum is superior to Arnica before or after tooth extraction. Deep acting sinus remedies: Tuberculinum, Medorrhinum, Thuja or Spigelia. Silica: easily heated, quickly chilled. Infantile Asthma: Think of Medorrhinum. The late Dr. Dixon has cured many

as thma cases, especially in infants, and many of these were very, very sick, by giving the antipsorie remedy Medorrhinum. Drs. Grimmer, Spaldin, Farrington and Kent and many others concur in this. The bowel nosode Morgan-Pure may give surprising results when others fail. Dr. Green recommends Morgan very highly for asthma while Dr. Griggs says that another nosode, Colon mutabile, is the best of the nosodes for infantile asthma.