An alternative path: the making and remaking of Hahnemann Medical College and Hospital in Philadelphia

The historic weaknesses of America's schools of homoeopathy are well known. Born in an era of untrammelled, free-for-all competition among divergent theories of medicine, they followed the organizational and pedagogical practices of mainline schools of medicine-except for courses in homoeopathic therapeutics-and like them relied on student fees for operational expense. As laboratory instruction, hospital experience, and some full-time instruction became de rigeur towards the end of the century, the homoeopathic schools, like the others, were forced by rising costs and increased public control to either consolidate, find a sheltering university, or go out of business. But the homoeopaths faced the additional obstacle of a growing impatience and scepticism of their anachronistic therapeutic doctrines. "While traditional medicine tended to divide physicians," writes William Rothstein, "scientific medicine tended to unify them." One by one, the marginal irregular schools began to close their doors. Among the homoeopathic schools, only those in Philadelphia and New York survived the Flexner report of 1910 by more than a decade or so. What is most striking about the Hahnemann College of Philadelphia, the longest-lived of all the homoeopathic schools, is how it was able to survive at all in the whirlwind of change that blew away its competitors. Clinging unsteadily to its homoeopathic roots, seeking acceptance by mainline medicine, lacking a university connection, endowment, full-time clinical teachers, or a real teaching hospital, Hahnemann made its tortuous way to safety through a series of hairbreadth escapes looming bankruptcies, student dissension, public scandals, and a threatened loss of accreditation by the American Medical Association. For much of its history, despite its dependence on attracting students, it remained a white, Protestant, middle-class, male institution. Only the imminent loss of accreditation in the 1940s brought "the final pressure to push the school into the orthodox mainstream" (p. 82). Until the late 1940s the school made few changes in its curriculum or teaching methods and the faculty conducted its teaching much as it had in the 1890s. My major criticism of the book is that it does not adequately answer the puzzling question of why such a school survived when so many others-some far more promising than the Philadelphia school-did not. The author suggests that it survived the Flexner era by becoming more diverse, through admitting a greater variety of students, but then admits that women and blacks were still excluded until the 1940s, and that a quota sharply restricted the number …