TABLE 3-1 — Naturopathic modalities
Naturopathic physicians are trained to use a number of diagnostic and treatment techniques. These modalities include:
• Diagnosis – all of the conventional clinical laboratory, physical diagnosis, and imaging (i.e. X-ray, etc.) techniques, as well as holistic evaluation techniques
• Counseling – lifestyle, nutritional and psychological
• Natural medicines– nutritional supplements (i.e. all food constituents), botanical medicine, and homeopathy
• Physical medicine– hydrotherapy, naturopathic manipulative therapy, physiotherapy modalities, exercise therapy and acupuncture
• Family practice – natural childbirth, minor surgery, natural hormones, biologicals, and natural antibiotics
However, the expression vis medicatrix naturae, by itself, does not provide a clear picture of naturopathic medical philosophy, or an understanding of the practice of naturopathic medicine in all of its varied forms. With the profession’s history of eclecticism, no two practitioners will treat any individual patient exactly alike. While this has its advantages (i.e. individualization of each patient’s care, more therapeutic options, etc.), it also makes it difficult to perceive the profession’s philosophic cohesiveness. Another major disadvantage of this eclecticism is the difficulty in developing consistent practice standards.
To attempt to solve this problem, the modern profession has articulated a general statement of naturopathic principles expanding on vis medicatrix naturae (see Table 3.2 ). However, this statement of principles is probably still not adequate to address the issues that concern modern students of naturopathic medicine or other professionals. Therefore, in order to gain a more in-depth understanding of naturopathic medicine, it is necessary to discuss medical philosophy in general.
MEDICAL PHILOSOPHY
The issues fundamental to medical philosophy have changed little since naturopathy first appeared as a distinct profession at the end of the 19th century. What has changed is the level of understanding of the biological process and the language of science. Most people who study the early writers on naturopathic medical philosophy quickly get lost in the archaic language and arguments used to justify the theories. This chapter translates these concepts and issues into modern terms.
Vitalism vs. mechanism
Historically, there have been two main medical philosophies, those of vitalism and mechanism. Their origins can be traced to the Hippocratic writings of ancient Greece. Throughout history, the line separating these two schools of thought has not always been clear, but their philosophical perspectives have generally been in opposition. The conflicting goals and philosophical foundations of these two concepts remain relevant as the modern practices of conventional and alternative physicians come into conflict. As will be seen, the foundations of naturopathic medical philosophy are found in vitalism. However, naturopathy also recognizes the practical value of the mechanistic approach to health care.
Mechanism
Up to the early part of the 20th century, there was considerable debate over the issue of vitalism vs. mechanism in the field of biology. The mechanists, or materialists, maintained that the phenomenon of life could be explained exclusively as the product of a complex series of chemical and physical reactions. They denied the possibility that the animate had any special quality that distinguished it from the inanimate. It was their contention that the only difference between life and non-life is the degree of complexity of the system.
Mechanism has several other distinctive characteristics. Its most obvious is that it is reductionistic. In fact, “reductionism” is often used as a synonym of mechanism. Mechanistic science is also characterized by an emphasis

TABLE 3-2 — The principles of naturopathic medicine
• The healing power of nature: vis medicatrix naturae
Nature acts powerfully through healing mechanisms in the body and mind to maintain and restore health. Naturopathic physicians work to restore and support these inherent healing systems when they have broken down, by using methods, medicines, and techniques that are in harmony with natural processes.
• First do no harm:primum non nocere
Naturopathic physicians prefer non-invasive treatments that minimize the risks of harmful side-effects. They are trained to know which patients they can treat safely, and which ones they need to refer to other health care practitioners.
• Find the cause:tolle causam
Every illness has an underlying cause, often in aspects of the lifestyle, diet or habits of the individual. A naturopathic physician is trained to find and remove the underlying cause of a disease.
• Doctor as teacher: docere
A principal objective of naturopathic medicine is to educate the patient and emphasize self-responsibility for health. Naturopathic physicians also recognize and employ the therapeutic potential of the doctor–patient relationship.
• Treat the whole person
Health or disease comes from a complex interaction of physical, emotional, dietary, genetic, environmental, lifestyle, and other factors. Naturopathic physicians treat the whole person, taking these factors into account.
• Preventive medicine
The naturopathic approach to health care can prevent minor illnesses from developing into more serious or chronic degenerative diseases. Patients are taught the principles with which to live a healthy life; by following these principles they can prevent major illnesses.
on linear causality. Without its emphasis on reductionism and linear causality, Western science and medicine would probably have not been so successful. As the 20th century advanced, each new discovery in biological and medical science reinforced the arguments for mechanism, until by the middle of the 20th century, the biology community had almost exclusively embraced the philosophy of mechanism.
Mechanism is the philosophical foundation of biomedical science and conventional medicine. Mechanistic medicine identifies disease and its accompanying signs and symptoms as simply the result of a disruption of normal chemical reactions and physical activities. Such disruptions are caused by the direct interference in these reactions and activities of a “pathogenic agent”. (For the purposes of this discussion, the general expression “patho-genic agent” refers to any known or unknown etiological agent or condition. Examples include microbial agents, autotoxins, genetic defects, environmental toxins, non-end-product metabolites, and physical and emotional stress and trauma.) A living organism, then, is simply a very complex machine which, due to external agents and “wear and tear”, breaks down. Because the signs and symptoms of disease are thought to be due only to these mechanical disruptions and interference with reactions, they are considered to be completely destructive phenomena and are therefore to be eliminated. Disappearance of the signs and symptoms indicates that the pathogenic agent and its resulting disease have been eradicated, or at least controlled. The goals of mechanistic medicine tend to be the quick removal of the signs, symptoms, and the pathogenic agent.
Mechanistic medicine is being practiced in cases where the intention of the therapy is to intervene in the perceived mechanism of the disease and/or relieve the symptoms. Examples would be the use of antihistamines to relieve rhinitis, vitamin B6 to help PMS, surgery and emergency care for traumatic injuries, coronary bypass surgery, anti-inflammatory agents in systemic lupus erythematosus (SLE), or insulin in juvenile onset diabetes. Mechanism is also being used when an identified pathogenic agent is directly attacked or eliminated. Instances of this would be the use of antibiotics or the isolation of a patient from a particular allergen. Clearly, mechanistic medicine can be very effective in achieving its goals. In the face of modern medical technology, it is easy to see how this philosophy came to dominate biology, medicine, and the attention of the public.
However, the unsolved problems of mechanistic medicine – particularly those of chronic degenerative disease, authoritarianism which alienates patients from responsibility for their own health, and the increasing cost of health care – suggest that there are limits to the mechanistic perspective and explain why vitalism has not disappeared and is, in fact, in resurgence.
Vitalism
The philosophy of vitalism is based on the concept that life is too well organized to be explained simply as a complex assemblage of chemical and physical reactions (i.e. a living system is more than just the sum of its parts). This is in contrast to the mechanist’s contention that “the only difference between life and non-life is the degree of complexity”. Throughout the 19th century, the debate between vitalism and mechanism was mostly carried on by biologists whose interests were mainly in the study of the organism’s specific cellular activities, such as morphological development. These activities were argued to be “vital” and, therefore, not explainable by mechanistic science. The tendency was to infer a metaphysical quality to this concept. As can be imagined, these earlier debates lurched from one specific argument to the next as modern biology unraveled the secrets of cellular metabolism. Fortunately, the debate has now shifted back to the relevant and holistic general concepts.
While modern vitalism is inherently holistic in its view and has an emphasis on circularity as its causality (i.e. feedback loops), there is no conflict with the findings of biomedical science. Eventually, all of the individual chemical and physical reactions that are found in the processes of life will probably be identified. What is significant is not the individual reaction, but the fact that they are all coordinated to such a degree as to produce the special activities of a living organism. An organism’s unique complexity – as demonstrated by its ability to grow and develop, respond to stimuli, reproduce, and repair itself – requires a level of organization and coordination that suggests a distinct quality that is not readily explained by mechanism. This organization and coordination has been identified as “homeostasis” by physiology. All organisms, up to the point of death, are attempting to return to this ideal state when injured or ill. As there is no inanimate counterpart to this level of complexity and organization, this is the most dramatic general argument in favor of vitalism.
A less dramatic argument used to support the vitalistic perspective is the “problem of entropy”. Entropy is the tendency of any closed system to find equilibrium, i.e. the state of least organization. In other words, systems tend to run down and become less complex over time. In defiance of this universal rule, life, up until the point of death, consistently creates more complex systems out of simple ones. To do this, life actively pursues external matter and energy to incorporate into itself, while at the same time selectively eliminating by-products from its utilization of this matter and energy.
When the problem of entropy is examined on the molecular level, the same individual chemical processes and elements may be found in both animate and inanimate systems. In the inanimate system, however, there is a constant move toward a state of chemical equilibrium. This type of system cannot maintain an unstable chemical state and always seeks stabilization. Even after the addition of external exciting energy, the system will return to the simplest, least reactive state possible. The animate system is virtually the opposite. It is continuously in a state of dynamic chemical instability, actively seeking energy to maintain this instability, and consistently moving to more complex and organized states (and back again). It is only at the onset of death that an animate system begins to move towards equilibrium.
The third general argument in favor of a vitalistic view of life is evolution. For evolution to exist as a force in nature, generations of living organisms have to survive long enough to grow, reproduce and then evolve. In order for this survival to take place, the organisms’ homeostatic and repair processes must be consistently directed towards maintaining a state of balance with the external environment (i.e. health). Any organisms that did not behave biochemically and physiologically in this manner would have died and not evolved. Thus the phenomenon of evolution, as the action of countless living organisms over eons, multiplies life’s anti-entropic quality and is incompatible with a mechanistic view of living systems.
These easily observable examples of life’s “special quality” suggest an “organizing force” that goes beyond what is possible from mere chemistry. This quality that makes life unique should not be mistaken as a metaphysical concept, although is not intended to argue here for or against such concepts. The point is only that vitalism is a medical philosophy based on observable scientific phenomena. Unfortunately, a definitive definition of this quality (in the old literature called the “vital force”, defense mechanism, or simply “Nature”) will have to wait for more research.
At this point in the discussion, not many mechanistic practitioners would have reason to be uncomfortable, as the ideas proposed are relatively non-controversial and just follow generally accepted physiological principles. Interestingly, many of these practitioners probably have personal belief systems that are quite compatible with this stage of the vitalistic argument. However, the conflict becomes evident upon examination of the premises upon which the practice of vitalistic medicine is based. What truly separates vitalism from mechanism, and makes it useful as a medical philosophy, is its perspective on disease and the associated symptoms.
Meaning of disease
Vitalism maintains that the pathogenic agent does not directly cause the symptoms accompanying disease; rather, they are the result of the organism’s intrinsic response or reaction to the agent and the organism’s attempt to defend and heal itself. Symptoms, then, are part of a constructive phenomenon that is the best “choice” the organism can make, given the circumstances at any particular point in time.
These symptoms can be further described as arising from two situations. The first and most common situation is when they are from a “healing reaction”, which is the organism’s concerted and organized attempt to defend and heal itself. These healing reactions produce what can be called “benign symptoms”. Examples include fever and inflammation in infections, almost any reaction of the immune system, and many of the symptoms of chronic disease.
This interpretation of symptoms is generally ignored by mechanism. Instead, it views them as the result of a destructive process and focuses on intervening by relieving the symptom or manipulating the pathological mechanism. Mechanistic medicine is therefore most often working contrary to homeostasis and the organism’s healing attempt (in fact, this is usually its intent). When this therapeutic approach is effective, vitalists call the result a “suppression” (see Table 3.3 ). This approach to health care is so pervasive that most people, lay and professional alike, today routinely suppress mild fevers with antipyretics.
In contrast, vitalism considers these symptoms to be the product of a constructive phenomenon and therapeutically stimulates and encourages this directed healing process. Rather than simply trying to eliminate a pathogenic agent, as mechanistic therapy might, vitalism focuses more on augmenting the organism’s resistance to that agent. That is not to say that vitalists object to removing the agent, only that it should be done in the context of simultaneously increasing resistance (in other words, decreasing susceptibility). The importance of this approach becomes evident when one recognizes that disease is only possible when both a pathogenic agent and a susceptibility to that agent are present.
Healing reactions can take several forms, as shown in Table 3.4 . In the first type, an organism’s response to a

TABLE 3-3 — Cure, suppression and palliation
When symptoms improve following treatment (regardless of the therapeutic system), it is for one of three reasons:
• Cure. The symptoms go away and the patient’s overall health improves. In this case the treatment can be discontinued and the patient continues to do well.
• Suppression. The symptoms go away but overall the patient becomes less healthy. The treatment can be discontinued and the symptoms will stay away, but the patient feels worse generally (i.e. deceased sense of well-being, energy or moods), or new, often more limiting, symptoms eventually develop (e.g. suppressed eczema leading to asthma).
• Palliation. The symptoms are improved but only as long as the treatment is continued. At best, palliation is something that is done while a curative treatment is given time to work. In and of itself, palliation will never lead to a cure, but unfortunately, continued palliation may eventually lead to suppression.
TABLE 3-4 — The four types of healing reactions
Reaction
Description
Acute, asymptomatic
Organism easily defends itself
“Healing crisis”
Relative strength of pathogenic agent and organism similar; symptoms of body defending itself apparent
Vigorous but unsuccessful
Pathogenic agent stronger than organism; death if no intervention
Chronic, mildly symptomatic
Healing reaction feeble, but adequate to maintain life; progressive degeneration
pathogenic agent does not produce symptoms. When it is capable of easily defending itself from the agent, no symptoms will be perceivable. This is a common homeostatic process and is demonstrated when a potential pathogen, such as beta-hemolytic streptococcus, is cultured from a healthy person’s throat. However, when the organism is more susceptible or the relative strength of the pathogenic agent is greater, a threshold is reached and symptoms become perceivable. Successful healing reactions of this type would include vigorous acute diseases that quickly resolve. The early naturopaths would have called these acute reactions “healing crises”. As the susceptibility of the organism increases relative to the strength of the pathogenic agent, there is a greater likelihood that the healing attempt will not be successful. When such a reaction is unsuccessful but vigorous, death may result, unless there is timely application of vitalistic or mechanistic therapy. Examples of this situation might be acute bacterial meningitis or cholera.
When the healing attempt is feeble and therefore ineffective, it usually goes into the “chronic disease” stage of the reaction. Vitalists observe that suppression seems to increase the likelihood that the reaction will be forced to go into such a chronic stage. In this situation the reaction is “smoldering”, and most often the organism cannot overcome the pathogenic agent unassisted. It just “holds its own”, and if the organism’s general health decreases over the years, the reaction gradually degenerates, producing symptoms that become less benign as it moves to an end-stage pathology. If the organism can be therapeutically stimulated to produce a more vigorous healing reaction, it can often successfully complete the original healing attempt. This augmented reaction is another example of a naturopathic healing crisis and would also be called an “aggravation” by the vitalists who practice homeopathic medicine.
Intervening in the mechanism of disease by relieving symptoms does little to stimulate or encourage the healing response; in fact it usually actually inhibits the healing response. In contrast, vitalistic therapies can be very effective in helping these healing reactions, because their goals are precisely the same as those of the organism. Thus, it is thought that vitalistic medicine works because, by honoring this process and thereby strengthening the whole organism, it encourages a more effective healing effort. Ideally, the organism is then able to accelerate and complete its reaction against the pathogenic agent, leading to the permanent disappearance of the symptoms as it returns to a state of health.
It would be naive to say that every stage of the healing reaction is positive and in the best interest of the organism, or that no symptoms should be palliated. The modern vitalist acknowledges that intervention is sometimes necessary. On the other hand, it is important to note that routine intervention can encourage its own worst-case scenarios. When mechanistic therapies successfully suppress an organism’s chosen healing reaction, a less effective and less desirable response is often produced. Therefore, when suppression occurs, it can lead to a more complicated medical situation. Consequently, the very practice of mechanistic medicine tends to reinforce its practitioner’s conviction that intervention is usually necessary. It should be noted, however, that not all intervention leads to suppression. It happens less often when the pathogenic agent can be readily eliminated, such as in non-recurring acute bacterial infections, or when relatively non-invasive therapies are used, such as natural medicines.
The second type of symptom-producing situation occurs when the organism produces symptoms in response to an organic lesion that arises from the direct pathological influence of a pathogenic agent. These can be called “morbid symptoms” and examples would include symptoms from the mass of an invasive tumor, shortness of breath from emphysema, and pain of an injury or MI. It should be mentioned that even these symptoms are the result of the organism’s overall effort to maintain homeostasis; benign symptoms are also often present. In addition, a morbid symptom is not necessarily produced for a negative reason. For instance, pain is valuable as an indication of tissue damage. As can be seen, many, if not most, of these situations involve “end-stage” pathology. Here mechanistic therapies can be very positive when the goals of the therapy do not conflict with those of the organism.
There are instances when invasive intervention will probably be required to save “life and limb”. These include such conditions as birth and genetic defects, serious traumatic injuries, crisis situations, overwhelming infections, and many malignancies. Unfortunately, conventional intervention does not guarantee a successful outcome either. Even in these situations, however, the effectiveness of vitalistic and natural therapy should not be underestimated, and their concurrent use will certainly augment any mechanistic intervention.
Although the concept of benign and morbid symptoms can be a useful tool to help understand the healing and disease process, in many situations it may not be possible to categorize the type of symptoms produced. A rough rule of thumb, however, would be that virtually all symptoms accompanying “reversible” or functional pathology are benign. On the other hand, many of the symptoms associated with traumatic injury and end-stage pathology would be morbid symptoms.
Changing society
After this discussion of vitalism’s perspective on disease, the question that comes to mind is: “If most health problems are likely to respond to vitalistic medicine, then why is mechanism dominant?” The best answer is probably found in examination of the general attitudes held by society during the Industrial Age just ending. Mechanism came into dominance during this period because it neatly fit into the Industrial Age’s world-view. This is the “man conquers nature” view that holds humanity as above and separate from the world in which it lives. It follows that nature is simply a resource that technology will eventually subdue or subjugate and put into order. Although this perspective is still very strong in Western society, there has been a dramatic change within the last 30 years.
Attitudes are now shifting in favor of the ecological integration of humanity into the environment. This “new” world-view holds that humanity is part of an orderly nature and that to ignore this creates situations that eventually become problems. Most ecological disasters are excellent examples of the results of the old view. In addition, the new view contends that if an effort is made to understand how nature functions and an attempt is made to work within that understanding, humanity’s needs can be more efficiently met.
Mechanistic medicine, as part of the “old” world-view, generally sees disease as something to conquer and put into order. Vitalistic medicine, on the other hand, looks at the order that is already present and attempts to integrate its therapy into that orderly process. As a result, vitalism is becoming increasingly popular as society shifts from the old to the new world-view.
The belief systems of many mechanistic practitioners recognize this order. However, due to education and peer pressure, these personal beliefs are rarely translated into clinical practice. The mechanistic view is still relatively pervasive in society, and because mechanism is convenient (e.g. taking aspirin for a headache), vitalistic practitioners can generally shift their perspective and successfully use mechanistic therapy (although their therapeutic goals may be different). On the other hand, since mechanists dispute the premises upon which vitalistic medicine is based, they generally have great difficulty when attempting to practice or research a vitalistic therapy and frequently cannot demonstrate its efficacy.
Scientific medicine
While mechanism and vitalism represent opposing perspectives, the systems of medicine that represent these philosophies can be successfully tested and examined with the scientific method.* That is not to say that the philosophy of vitalism has been unquestionably proven – only that the validity of vitalistic interventions can be scientifically demonstrated. If a therapy can be proven effective, then that implies the accuracy of the philosophy upon which it is based. Unfortunately, very few of the vast resources of the 20th century biomedical community have been directed toward investigating vitalistic medicine.
Conventional medicine, as the dominant health care system and a representative of mechanism, has claimed for itself the title of “scientific medicine”. However, it is inherently no more or less scientific than vitalistic medicine. A system is scientific only when it has met the criteria of the scientific method. This method requires the collection of data through observation and experimentation, and the formulation and testing of hypotheses. Non-prejudicial science can effectively study any system, but the researcher must understand the system’s particular paradigm. Experiments on a vitalistic therapy based on a reductionistic and mechanistic model are going to be less than satisfactory.
The criteria of the scientific method can be met by vitalistic medicine, but only when the researchers recognize that it cannot be studied as though it is reductionistic or based on a simplistic model of linear causality. When the experimental model acknowledges the complexity of a living system in a social context (i.e. holism and circularity), vitalistic medicine proves to be both verifiable and reproducible, and thus scientific. Unfortunately, due to conventional medicine’s current political and economic dominance, it is in the position to dictate (through economic and publication control) that research, and therefore the scientific method, will primarily be applied to itself. The result is that most conventional practitioners dismiss vitalistic medicine, along with all alternatives, as unscientific.
This is unfortunate because most vitalistic physicians also have extensive training in mechanistic and/or conventional medicine. Generally, they are capable of practicing mechanistically, and do so to greater or lesser degrees. The conflict between the practitioners of these different systems is very often due to a lack of constructive dialog. This can be attributed to two general causes: the first is simply that each system defines the world of “correct” medicine in terms of its own principles; the second is the issue of who controls the economic and political power.
NATUROPATHIC PHILOSOPHY
Historically, naturopathy is a vitalistic system of medicine. However, over the last 100 years it has also incorporated a number of therapies that can function mechanistically. What makes them acceptable, given naturopathic medicine’s vitalistic foundation, is that they are natural therapies. Natural medicines and therapies, when properly used, generally have low invasiveness and there is little evidence that they cause suppression or side-effects. When used mechanistically, they allow some intervention while still allowing the organism’s healing abilities the opportunity to continue unopposed, especially when used to support the body’s own healing processes.
Vis medicatrix naturae
Naturopathic physicians assert that all true healing is a result of vis medicatrix naturae (the healing power of nature). Unfortunately, some people in the field of alternative medicine (including some naturopathic physicians and students) have mistakenly translocated this concept to the therapy. These practitioners tend to operate as though this “healing power” is an intrinsic property of the natural therapy or medicinal substance itself. In contrast, vitalism and naturopathic medicine have always understood that the “healing power of nature” is an inherent property of the living organism. Vis medicatrix naturae is the living organism’s “desire” and ability to heal itself.
The application of this principle in practice is, of course, dependent upon the patient’s needs. Ideally, it involves only the use of therapies that support the organism and encourage its intrinsic healing process to work more effectively. It also avoids the use of medicines and procedures that interfere with natural functions or have harmful side-effects. Natural medicines and therapies are therefore preferred, since, when used properly and in appropriate circumstances, they are the least harmful, least invasive, and best able to work in harmony with the natural healing process.
Since the total organism is involved in the healing attempt, the most effective approach to diagnosis and treatment is to consider the whole person. In addition to physical and laboratory findings, important consideration is given to the patient’s attitude, psychological and spiritual state, social circumstances, lifestyle, diet, heredity, and environment. Careful attention to each person’s unique individuality and susceptibility to disease is critical to the proper evaluation and treatment of any health problem.
Naturopathic physicians contend that most disease is the direct result of the ignorance and violation of what would be traditionally called “natural living laws”. These general lifestyle (including diet) rules are based on the concept that there is an environment (both internal and external) that optimizes the health of an organism. Analysis of the lifestyles of Paleolithic and healthy primitive and modern cultures gave naturopathic physicians and their progenitors many clues as to what a healthy lifestyle should include.
Throughout most of modern history, biomedical science has focused primarily on researching the sick. Recently it has finally begun to evaluate what makes for a healthy lifestyle. To no-one’s surprise, this lifestyle looks like the same one advocated by naturopaths for the last 100 years. A healthy lifestyle could be generalized to include: the consumption of natural unrefined foods; getting adequate amounts of exercise and rest; living a moderately paced lifestyle; having constructive and creative attitudes; avoiding toxins and polluted environments; and the maintaining of proper elimination. During illness, it is also important to control these areas in order to remove as many unnecessary stresses as possible and to optimize the chances that the organism’s healing attempt will be successful. Therefore, patient education and responsibility, lifestyle modification and preventive medicine are fundamental to naturopathic practice.
While the practice of naturopathic medicine is grounded in vis medicatrix naturae, it also recognizes that intervention in the disease process is sometimes efficacious and, at times, absolutely necessary. Naturopathic physicians treat patients using a wide variety of therapeutic modalities. Some of these are vitalistic and some mechanistic. It is the goal of the therapy that ultimately determines which approach is utilized. Naturopathic physicians have a long-standing tradition of integrating the best aspects of traditional, alternative, and conventional medicine in the interest of the patient. As appropriate, patients are referred to other health care practitioners. Whenever possible, every effort is made to use all treatment techniques in a manner that is harmonious with the naturopathic philosophy.
Natural medicines and therapies
The medicines administered and prescribed by naturopathic physicians are primarily natural and relatively unprocessed. Although it is recognized that some situations may require the use of synthesized medicines, their use is considered less desirable. Some of the arguments in favor of natural medicinal substances have already been discussed. In addition to the reasons noted above, natural agents are preferred because their constituents have been encountered in nature for millions of years. This long period of exposure has enabled the body to develop metabolic pathways capable of effectively utilizing, processing, and detoxifying these medicines.
Four categories of natural medicines can be defined. The first includes substances found in nature that have been only minimally processed. Examples would include, but are not limited to, foods, clean air and water, and whole herbs. The early “nature cure” practitioners used this category primarily. The second category includes agents extracted or made from naturally occurring products. Although these have undergone pharmacological processing, the constituents of the medicines are still in the form found in the original natural substance. These first two types of natural medicinal substances have synergistic constituents that allow their use at lower doses with a resultant broader and safer therapeutic index. Examples of this category include tinctures and other botanical extracts, homeopathic medicines, glandulars and other substances of animal origin.
The third type of natural medicines are those highly processed medicinal substances that are derived from a natural source. These often have everything removed but the identified active ingredient and no longer have any synergistic constituents. Examples include many new phytotherapeutic agents, constituents of biochemical pathways, enzymes, amino acids, minerals, vitamins, and other food extracts.
The fourth category that may be considered “natural” are those manufactured medicines which are presumed to be identical to naturally occurring substances. These have the advantage of being less expensive and are typically available in higher concentrations. However, their use is less desirable due to:
• the difficulty of determining whether they are indeed the equivalent of the natural product
• their lack of natural synergistic components
• the inclusion of contaminates from the manufacturing process. These contaminates are often chemically and structurally similar to the desired medicine, but generally interfere with the normal pathways rather than enhance them.
Examples of these manufactured “natural” medicines include hormones, synthetic vitamins and analogs of plant and animal constituents.
Increasingly, medicines of the types identified in cate-gories three and four are being grown “synthetically” by microorganisms specially engineered to produce the desired medicinal substance. It is difficult to say which of these categories best describes this situation. There are also potential problems with this kind of manufacturing process as evidenced by the tryptophan disaster of several years ago.
Naturopathic physicians also use many natural therapies. What makes a therapy “natural” is that it is derived from a phenomenon of nature and is used to stimulate the body to heal itself. Examples of these phenomena are air, light, heat, electricity, sound and mechanical force. Some of these natural therapies include mechanical and manual manipulation of the bony and soft tissues (naturopathic manipulative therapy), physiotherapy modalities (e.g. electrotherapy and ultrasound), hydrotherapy, and exercise therapy. Naturopathic physicians also use lifestyle modification, counseling and suggestive therapeutics. These therapies are all discussed in more detail in other chapters.
Family and specialty practice
Naturopathic physicians, like other types of primary care providers, develop practices that meet their personal interests and skills. While most are engaged in general and family practice, many have also specialized in particular therapeutic modalities and/or types of health problems. However, in all situations the emphasis is still on treating the whole person. The practice of family medicine requires the use of some techniques and devices that are not, in the strict sense of the word, natural therapies, but belong among the comprehensive family practice services offered by the naturopathic profession.
Included in family practice are such services as the prescription and fitting of birth control devices, first aid, and minor surgery. Minor surgery includes the repair of minor wounds and lesions and the removal of growths and foreign bodies from superficial tissues. When necessary, it includes the use of local anesthetics and appropriate first aid procedures. First aid includes the treatment of ambulatory acute injuries and conditions that are routinely seen and handled in general practice.
Many naturopaths have also developed advanced expertise in different natural therapeutic modalities. These practitioners have usually invested in postgraduate training, such as that available through residencies. Three therapeutic specialties that merit mention are natural childbirth, acupuncture, and homeopathy.
THE PHILOSOPHICAL CONTINUUM
When the various healing systems are examined and placed on a philosophical continuum, mechanism and vitalism are on different ends of the same health care spectrum. Both ends of this health care continuum have their strengths and weaknesses. Mechanistic medicine is effective for trauma, crisis care, end-stage pathology and many acute diseases. It is essentially a failure with chronic disease. In fact, conventional medicine considers most chronic diseases incurable. Vitalistic medicine, on the other hand, has its most dramatic successes with chronic disease and is effective with many kinds of acute disease. It is not very effective with trauma and crisis care and end-stage pathology, although it can be a very useful complement to conventional medicine. As can be seen, both ends of the health care spectrum are necessary if every patient’s health care needs are going to be met.
Although aspects of naturopathic (e.g. constitutional hydrotherapy) and conventional medicine (e.g. chemotherapy) represent the archetypes of vitalism and mechanism, the area between the ends of this spectrum is a gray area within which both naturopathic and conventional physicians operate on a continual basis. While naturopathic physicians integrate vitalistic therapies with some mechanistic therapies, it is not possible for everyone to be experts in everything. The vast majority of naturopathic or conventional physicians are not going to be able to learn and competently practice all types of health care. Consequently, to effectively meet society’s health care needs, it is necessary to create an integrated health care system. Such an integrated system would have both vitalistic and mechanistic practitioners working together in the same clinical settings.
The trends of popular culture and a biomedical science that is finally beginning to study alternative medicine suggest that the creation of an integrated health care system is now underway. However, it takes no great skill for a mechanistic medical doctor to switch from giving a synthetic drug for a disease to giving a natural medicinal substance. If naturopathic medicine becomes just another mechanistic system using natural medical substances to treat disease (instead of a system identified with treating the whole person vitalistically), it will lose its unique niche in an integrated health care system. For naturopathic medicine to survive and thrive in this new environment, it will need to keep its vitalistic roots. With a thorough grounding in vis medicatrix naturae, modern naturopathic medicine will flourish and achieve a leadership position as the dominant health care paradigm shifts to the integrated medicine of the future.
CONCLUSION
The practice of naturopathic medicine can be summarized most simply as helping the body/mind heal itself in the least invasive, most fundamentally curative manner possible. This approach is not tied to any particular therapy or modality, but rather is oriented to a rational blend of vitalistic and mechanistic principles working with the whole person, and educating the patient in the ways of health.
As naturopathic knowledge of health and disease grows, new therapies and approaches to health care will be added as they satisfy the principle of vis medicatrix naturae. As the larger health care system becomes more integrated, naturopathic medicine’s place is assured as the profession that truly understands each unique human being’s power to heal.

1.Vincent Preissnitz (1799–1851)

2.Johann Schroth (1798–1856)

3.Father Sebastian Kneipp (1821–1897)

4.Arnold Rickli (1823–1926)

5.Louis Kuhne (c. 1823–1907)

6.Henry Lahman (no dates known)

7.F. E. Bilz (1823–1903)

8.Adolph Just (?–1939).
Also of note were Theodor Hahn and Meltzer, who, in the 1860s, were well-known for their work in the movement called, in German, Naturatz or “naturism”.
In photographs accompanying his article “The principles, aim and program of the nature cure system”, Lust described each of these thinkers as follows:
1. VINCENT PREISSNITZ, of Graefenberg, Silesia. Founder of Hydropathy. Born October 4, 1799. A pioneer Naturopath, prosecuted by the medical authorities of his day, and convicted of using witchcraft, because he cured his patients by the use of water, air, diet and exercise. He took his patients back to Nature – to the woods, the streams, the open fields – treated them with Nature’s own forces and fed them on natural foods. His fame spread over the whole of Europe, and even to America. His cured patients were numbered by the thousands. The Preissnitz compress or bandage is in the medical literature. Preissnitz is no more, but his spirit lives in every true Naturopath.
2. JOHANN SCHROTH, a layman, not described in Lust’s directory, but often talked of in later works and prominently mentioned for his curative theories in Bilz’s master work The Natural Method of Healing. Schroth smashed his right knee in an accident with a horse and it remained stiff in spite of repeated medical treatment. At last, a priest told Schroth that Preissnitz’s methods might help, and Schroth decided to give them a try. In order to avoid frequent changing of the packs that were directed by Preissnitz, he placed several packs on top of one another, wrapping the whole portion with a woolen cloth. He left this pack on the injured knee for several hours and produced a moist heat which he theorized to cause the poisonous toxins to dissolve and be swept away. These packs are still used as part of the “Schroth cure” and have reportedly become famous for their blood-cleansing effect. (From an article in the March 1937 Naturopath and Herald of Health by Dr. T.M. Schippel.) As noted by Bilz, the Schroth cure, called by Bilz “the regenerative treatment,” was developed for treatment of chronic diseases through the use of an extreme diet following total fasting by withdrawing of all food and drink and then the use of totally dry grain products and the eventual reintroduction of fluids.
3. FATHER SEBASTIAN KNEIPP, of course, is much described and the photos include one of Kneipp lecturing to the multitudes at Wandelhale at Woerishofen, attending Pope Leo XIII in 1893, noting this is the only consultation on health care matters that Kneipp ever consented to outside of Woerishofen, though many famous and aristocratic individuals desired his counsel, and a picture of Kneipp with the Archdukes Joseph and Francis Ferdinand of Austria walking barefoot in new-fallen snow for purposes of hardening the constitution. It was noted that the older Archduke was cured by Father Kneipp of Bright’s disease in 1892, and it noted that the Archduke Joseph, in appreciation of this cure, donated a public park in the town of Woerishofen at a cost of $150,000 florens. The Archduke Francis Ferdinand, the son of Archduke Joseph, was the individual whose murder precipitated World War I. There is a further picture of Father Kneipp surrounded by “Doctors” from different parts of the world while he gave consultation to numerous patients.
4. ARNOLD RICKLI, founder of the light and light and air cures (atmospheric cure). Dr. Rickli was one of the foremost exponents of natural living and healing. In 1848, he established at Veldes, Krain, Austria, the first institution of light and air cure or as it was called in Europe the “atmospheric cure”. In a limited way (rather very late) his ideas have been adopted by the medical profession in America for the cure of consumption. He was an ardent disciple of the vegetarian diet and exemplified the principles of natural living in his own life. The enclosed photo shows him at the age of 97, when he was still active and healthy. He has since passed on, but his work still lives as a testimonial of his untiring efforts. He was the founder and for over 50 years the President of the National Austrian Vegetarian Association.
5. LOUIS KUHNE wrote, in 1891, The New Science of Healing, the greatest work of basic principles in natural healing. In the tradition of Natural Healing and prevention, Kuhne has been described as one who “… advocated sun, steam baths, a vegetarian diet, and whole-wheat bread …” in these relatively early days”. His renowned work constitutes the only true scientific philosophy for the application of all Drugless Methods. He was the first to give to the world the comprehensible idea of pathology and the first to proclaim the doctrine of the “unity of cure.” His book Facial Expression gives the means of diagnosing a patient’s pathological condition and determining the amount and location of the systemic encumbrance. He is the founder and first Master of Naturopathy.
6. DR. H. LAHMAN. When the University of Leipzig expelled H. Lahman for his spreading medical sedition among the students, it added a staunch advocate to natural healing. Dr. Lahman finished his medical education in Switzerland and returned to Germany to refute in practice the false ideas of medical science. He later founded the largest Nature Cure institution in the world at Weisser Hirsch, near Dresden, Saxony. He was a strong believer in the “Light and Air” cure and constructed the first appliances for the administration of electric light treatment and baths. He was the author of several books on Diet, Nature Cure and Heliotherapy. As noted in Other Healers, Other Cures: “Heinrich Lahmann came along to stress no salt on foods and no water with meals …”* His works on diet are authoritative and his “nutritive salts theory” forms the basis of rational dietetic treatment. This work has but recently come to light in America, and progressive dietitians are forsaking their old, worn-out, high protein, chemical and caloric theories for the “organic salts theory.” Carque, Lindlahr, McCann, and other wide awake food scientists have adopted it as a basis for their work. Dr. Lahman was a medical nihilist. He denounced medicine as unscientific and entirely experimental in its practice and lived to prove the saneness of his ideas as evidenced by his thousands of cured patients.
7. PROFESSOR F.E. BILZ. That real physicians are born, not made, is well illustrated in the case of Dr. Bilz, who achieved his first success in healing as a lay practitioner. As a mark of gratitude, a wealthy patient presented him with land and a castle in which to found a Nature Cure sanitarium… The Bilz institution at Dresden-Rdebeul, Germany, became world renowned and was long considered the center of the Nature Cure movement. Professor Bilz is the author of the first Naturopathic encyclopedia, The Natural Method of Healing, which has been translated into a dozen languages, and in German alone has run into 150 editions. He has written many works on Nature Cure and Natural Life, among them being The Future State, in which he predicted the present World War, and advocated a federation of nations as the only logical solution of international problems.
8. ADOLPH JUST, famous author of Return to Nature and founder of original ‘Yungborn’ in Germany.
Both Adolph Just’s Return to Nature and Louis Kuhne’s The Natural Science of Healing were translated into English by Lust and released through his publication house.
The convergence with American influences
The Universal Naturopathic Directory was truly eclectic in its compilation and composition. Besides the Lust article noted previously, the volume included: “How I became acquainted with nature cure” by Henry Lindlahr MD ND (which has been reproduced in large part in the introduction to volume 1 of Lindlahr[13] ); “The nature cure” by Carl Strueh MD ND; “Naturopathy” by Harry E. Brook ND; “The present position of naturopathy and allied therapeutic measures in the British Isles” by J. Allen Pattreiouex ND; “Why all drugless methods?” by Per Nelson; and “Efficiency in drugless healing” by Edward Earle Purinton (a reprint of the 1917 publication, referred to earlier, which was composed of a series of articles published in The Herald of Health and Naturopath between August 14 and February 1916).
The volume also contained Louis Kuhne’s “Neonaturopathy (the new science of healing)” in the first publication of the translation by Lust, and articles on electrotherapy, neuropathy, dietology, chiropractic, mechanotherapy, osteopathy, phytotherapy, apyrtropher, physical culture, optometry, hydrotherapy, orthopedics, pathology, natural healing and living, astroscopy, phrenology, and physiology – all of which were specially commissioned for the directory from practitioners and authors considered expert in these subjects.
The volume also included the directory of drugless physicians in alphabetical order, geographically arranged, and itemized by profession; biographical notes on American contributors of note; the naturopathic book catalog; a guide to natural healing and natural life books and periodicals; a classified list of medical works, a series of book reviews; a buyer’s guide for naturopathic supplies; and, in addition to extensive indexes, a “parting word” by Lust.
In addition, the volume contained numerous advertisements for naturopathic schools, sanitariums and individual practices, and closed with the following note:
This, then, completes Volume 1 of the Naturopathic Directory, Drugless Yearbook and Buyer’s Guide for the years 1918 and 1919.
Into it, has been placed the conscientious labor of many willing hearts, hands and minds. It is their contribution to the noble cause of natural healing. It will stand as a monument to their endeavors, as well as a memorial to the great souls, the fathers of natural healing, who have passed on.
Let this, then, herald a new era – the era wherein man shall recognize the omniscience of Nature, and shall profit through conforming to her laws.
In the biographical section, it becomes apparent that Lust owed a great deal of the feeling of camaraderie in the nature cure movement to some varied American practitioners. The most prominent of these have had their biographical sections as contained in the 1918 directory. Two of them deserve specific note and attention: Palmer and Still.
Lust met A. T. Still in 1915 in Kirksville, Missouri, shortly before Still’s death. From their meetings, Lust noted later in the Naturopath and Herald of Health (June 1937) that Still believed that osteopathy by “… compromising with medicine … is doomed as the school that could have incorporated all the natural and biological healing arts …”. Lust wanted naturopathy to fill this void.
Lust also had lengthy acquaintance with B. J. Palmer (the son of D. D. Palmer, the founder of chiropractic), who, following in his father’s footsteps, put Davenport, Iowa, and the Palmer Chiropractic College on the map.
Lust also became connected with Henry Lindlahr MD ND of Chicago, Illinois (as noted in the autobiographical sketch contained in the directory[14] and reprinted in the volume 1 of Lindlahr[13] ). Lindlahr was a rising businessman in Chicago with all the bad habits of the “gay nineties” era. Only in his 30s, he had begun to be chronically ill. He had gone to the orthodox practitioners of his day and received no relief.
Then he was exposed to Schroth’s works, and in following them began to feel somewhat better. Subsequently, he liquidated all his assets and went to Germany to stay in a German sanitarium to be cured and to learn nature cure. He then came back to Chicago and enrolled in the Homeopathic/Eclectic College of Illinois. In 1903, he opened a sanitarium, which included a residential sanitarium, located in Elmhurst, Illinois, a “transient” clinic (office) on State Street in Chicago, and “Lindlahr’s Health Food Store”.
Shortly thereafter he founded the Lindlahr College of Natural Therapeutics, which included hospital internships at the sanitarium. The institution became one of the leading naturopathic colleges of the day. In 1908, he began to publish Nature Cure Magazine and began publishing his series of Philosophy of Natural Therapeutics, with volume 1 (“Philosophy”) in 1918. This was followed by volume 2 (“Practice”) in 1919, volume 3 (“Dietetics”; republished with revisions as it had originally been published in 1914), and, in 1923, volume 6 (“Iridiagnosis”). The intended volumes 4 and 5 were in production at the time of Lindlahr’s death in 1927. As described in Other Healers, Other Cures:
Henry Lindlahr, another American, is remembered for his conviction that disease did not represent an invasion of molecules, but the body’s way of healing something. In other words, he viewed symptoms as a positive physiological response-proof that the body is fighting whatever’s wrong. Accordingly, a fever is a “healthy” sign and one should be let alone, unless it is dangerously high, of course.
The impact of all of these gentlemen on the development of naturopathy in America, under Lust’s guidance, was profound.
From these beginnings, the naturopathic movement gathered strength and continued to grow through the 1920s and 1930s, having a major impact on natural healing and natural lifestyle in the United States.
Along the way, Lust was greatly influenced by the writings of John H. Tilden MD (largely published between 1915 and 1925). Tilden was originally a practicing physician in Denver, Colorado, who became disenchanted with orthodox medicine and began to rely heavily on dietetics and nutrition, formulating his theories of “auto-intoxication” (the effect of fecal matter remaining too long in the digestive process) and “toxemia”.
Lust was also greatly influenced by Elmer Lee MD, who became a practicing naturopath in about 1910, and whose movement was called the “hygienic system”, following the earlier works of Russell Trall. Lee published Health Culture for many years.
In addition to John Tilden MD and Elmer Lee MD, another medical doctor, John Harvey Kellogg MD, who turned to more nutritionally based natural healing concepts, was greatly respected by Lust. Kellogg was renowned through his connection with the Battle Creek Sanitarium. The sanitarium itself was originally founded in the 1860s as a Seventh Day Adventist institution designed to perpetuate the Grahamite philosophies of Sylvester Graham and William Alcott. The sanitarium was on the verge of being closed, however, due to economic failure, when in 1876 Kellogg, a new and more dynamic physician-in-chief, was appointed.
Kellogg, born in 1852, was a “sickly child” who, at the age of 14, ran across the works of Graham and converted to vegetarianism. At the age of 20 he studied for a term at Trall’s Hygio-Therapeutic College and then earned a medical degree at New York’s Bellevue Medical School. He maintained an affiliation with the regular schools of medicine during his lifetime, due more to his practice of surgery, than his beliefs in the area of health care.
Kellogg designated his concepts, which were basically the hygienic system of healthful living, “biologic living”. Principally, Kellogg defended vegetarianism, attacked sexual misconduct and the evils of alcohol, and was a prolific writer through the late 19th century and early 20th century. He produced a popular periodical, Good Health, which continued in existence until 1955. When Kellogg died in 1943 at the age of 91, he had had more than 300,000 patients through the Battle Creek Sanitarium (which he had renamed from Western Health Reform Institute shortly after his appointment in 1876), including many celebrities, and the “San” became nationally well known.
Kellogg, along with Tilden and Elie Metchnikoff (director of the prestigious Pasteur Institute and winner of the 1908 Nobel Prize for a contribution to immunology), wrote prolifically on the theory of “auto-intoxication”. Kellogg, in particular, felt that humans, in the process of digesting meat, produced a variety of intestinal self-poisons that contributed to “auto-intoxication”.
As a result, Kellogg became a near fanatic on the subject of helping humans to return to a more healthy natural state by returning to the naturally designed usage of the colon. He felt that the average modern colon was devitalized by the combination of sedentary living, the custom of sitting rather than squatting to defecate, and the modern civilized habit of ignoring “nature’s call” out of an undue concern for politeness. Further, Kellogg concentrated on the fact that the modern diet had insufficient bulk and roughage to stimulate the bowels to proper action.
Kellogg was also extremely interested in hydrotherapy. In the 1890s, he established a laboratory at the San to study the clinical applications of hydrotherapy. This led, in 1902, to his writing Rational Hydrotherapy. The preface espoused a philosophy of drugless healing that came to be one of the bases of the hydrotherapy school of medical thought in America.
Tilden, as mentioned, was of a similar mind. Indeed, he had to have been to have provided natural health care literature with his 200-plus page dissertation entitled “constipation”, with a whole chapter devoted to the evils of not responding when nature called.
This belief in the “evils” drawing away from the natural condition of the colon was extremely important to Kellogg’s work.[3] Because of Lust’s interest, Kellogg’s The New Dietetics (1921) became one of the bibles of naturopathic literature.[15]
Lust was also influenced by the works of Sidney Weltmer, the father of “suggestive therapeutics”. The theory behind Professor Weltmer’s work was that whether it was the mind or the body that first lost its grip on health, the two were inseparably related. When the problem originated in the body, the mind nonetheless lost its ability and desire to overcome the disease because the patient “felt sick”, and consequently slid further into the diseased state. Alternatively, if the mind first lost its ability and desire to “be healthy” and some physical infirmity followed, the patient was susceptible to being overcome by disease.
Weltmer’s work dealt specifically with the psychological process of desiring to be healthy. Lust enthusiastically backed Weltmer’s work and had him on the program at various of the annual conventions of the American Naturopathic Association (which commenced after its founding in 1919).
Lust was also personal friends with and a deep admirer of Bernarr MacFadden. MacFadden was the founder of the “physical culture” school of health and healing, also known as “physcultopathy”. This school of healing gave birth across the country to gymnasiums at which exercise programs, designed to allow the individual man or woman to maintain the most perfect state of health and human condition possible, were developed and taught.[3] As described in Other Healers, Other Cures (p. 182):[16]
The next Naturopathic star, after Kellogg, was Bernarr MacFadden, the physical culturist who built a magazine-publishing empire (his first magazine was Physical Culture founded in 1898.) MacFadden proselytizes for exercise and fresh vegetables, hardly eccentric notions. But his flamboyant efforts to publicize them and his occasional crack-pot ideas (like freezing the unemployed, then thawing them out when the Depression was over) alienated many people. Still, he was his own best advertisement. He fathered nine children by four wives and was parachuting from planes in his 80s. One of MacFadden’s admirers was that arch-foe of the medical profession, George Bernard Shaw, the longevous eccentric in his own right …
Lust was also very interested in, and helped to publicize “zone therapy”, originated by Joe Shelby Riley DC, a chiropractor based in Washington, DC, and one of the early practitioners of “broad chiropractic”. Zone therapy was an early forerunner of acupressure as it related “… pressures and manipulations of the fingers and tongue, and percussion on the spinal column, according to the relation of the fingers to certain zones of the body …”.[14]
Several other American drugless healers contributed to a broad range of “-opathies” that Lust merged into his growing view of naturopathy as the eclectic compilation of methods of natural healing. The Universal Directory also contained a complete list of osteopaths and chiropractors as drugless healers within the realm of Lust’s view of naturopathic theory. His other significant compatriots at the time of the publication of the directory were Carl Stueh, described by Lust as “… one of the first medical men in this country who gave up medicine and operation for natural healing”, F. W. Collings MD DO DC, an early graduate of the American School of Naturopathy (1907) who went on to graduate from the New Jersey College of Osteopathy (1909) and the Palmer School of Chiropractic (1912), another “broad chiropractor”, Anthony Matijaca MD ND DO, the naturopathic resident expert in electrotherapy and an associate editor of the Herald and Health Naturopath (the inverted name of the Lust journal at the time of the directory), and Carl Schultz ND DO MD, president and general manager of the Naturopathic Institute and Sanitorium of California, essentially the second school in the country to pursue the education of physicians under the name of “naturopathy.”

The beginnings of “scientific medicine”
While the hygienic movement was making its impact, the orthodox medical profession, in alliance with the homeopaths and eclectics, was making significant advances. The orthodox profession, through the political efforts of the AMA, had first tried to remove sectarian and irregular practitioners by segregating them from the medical profession altogether. It did so by formulating and publishing its first national medical code of ethics in 1847. (In 1846, the orthodox profession formed the American Medical Association to represent their professional views.) The code condemned proprietary patents (even carrying over into a physician’s development of surgical or other medical implements, which led to its greatest criticism); encouraged the adoption of uniform rules for payment in geographical areas; condemned the practice of contract work, prohibited advertising and fee-sharing even among specialists and general practitioners; eliminated blacks and women; and, most significantly, prohibited any consultation or contact with irregulars or sectarian practitioners. As the code stated:
… no one can be considered as a regular practitioner, or a fit associate in consultation, whose practice is based on an exclusive dogma, to the rejection of the accumulated experience of the profession, and of the aids actually furnished by anatomy, physiology, pathology, and organic chemistry. 
In the late 1870s and into the 1880s, the major sects – the orthodox, or allopathic school, the homeopaths and the eclectics – began to find more reason to cooperate to obtain common professional goals. These included the enactment of new licensing laws and the creation of a “respectable” medical educational system. Also at this time, the concept of “scientific medicine” was brought to America. (Although Starr differs with Rothstein about the cause of the death of the homeopathic and eclectic sectarian schools, he notes that Rothstein clearly documents the transition, during the 19th century, of medicine to a recognized professional class composed of both the minority sects and the orthodox school.)
This transition from conflict between the major sects resulted in the erosion of the implementation of the code of ethics, the cooperation among the sects to revive medical licensing standards, the admission of sectarian physicians to regular medical societies and, ultimately, a structural reorganization of the American Medical Association, which took place between 1875 and 1903.
Once the cooperation between the three medical views had begun, the medical class as dominated by the regular school came fully into power. And the homeopathic and eclectic schools of thought met their demise, which was finally brought about by two significant events: the rapid creation of new medical educational standards between 1900 and 1910, culminating in the publication of the famous “Flexner Report” (1910); and the effective infusion of millions of dollars into selected allopathic medical schools by the newly created capitalistic philanthropic foundations, principally the Carnegie and Rockefeller foundations.
The foundations
The impact of the monies from the Carnegie and Rockefeller foundations has been clearly documented and is described in detail, albeit for the advancement of a particular political point of view, in Brown’s Rockefeller Medicine Men. The impact of the monies from these foundations, as contributed to medical schools that met the AMA’s view of medical education and philosophy, cannot be underestimated.
This process has been well documented.  As discussed by Burrows, this educational reform allowed the AMA to form a new alliance with legislators, and push quickly for medical licensing designed to reward the educational and medical expertise of the new orthodox “scientific medicine”, and the exclusion of all others.
Medical education in transition
Based upon the rising example of scientific medicine and its necessary connection to research, the educational laboratory, and a more thorough scientific education as a preamble to medical practice, Harvard University (under the presidency of Charles Elliott) created a 4-year medical educational program in 1871. The primal modern medical educational curriculum was devised and set in motion over 20 years later at Johns Hopkins University under the leadership of William Osler and William Welch, using the resources from the original endowment of the hospital and university from the estate of Johns Hopkins. Other schools followed suit. By the time the American Medical Association set up its Council on Medical Education in 1904, it was made up of five members from the faculties of schools modeled on the Johns Hopkins prototype. This committee set out to visit and rate each of the (160) medical schools then in operation in the country. The ratings used were class “A” (acceptable), class “B” (doubtful), and class “C” (unacceptable).
Eighty-two schools received a class “A” rating, led by Harvard, Rush (Chicago), Western Reserve, the University of California and, notably, Johns Hopkins. Forty-six received a class “B” rating, and thirty-two a class “C” rating. The class “C” schools were mostly in rural areas and many of them proprietary in nature.
Flexner report
Subsequently to the AMA ratings, the Council on Medical Education applied to the Carnegie Foundation to commission an independent report to verify its work. Abraham Flexner, a young, energetic and noted educator was chosen for this task by the Carnegie Foundation and accompanied by the secretary (Nathan Colwell MD) of the Council on Medical Education, who had participated in all of the committee site visits.
Flexner visited each of the 162 United States medical schools then operating. The publication of the “Flexner Report”, which was widely publicized, put the nails in the coffins of all schools with class “C” ratings and many with class “B” ratings. Significantly, the educational programs of all but one eclectic school (in Cincinnati) and one homeopathic school (in Philadelphia) were eliminated by 1918.
The eclectic medical schools, in particular, were severely affected by the report. According to Griggs (p. 251):[2]
Of the eight Eclectic schools, the Report declared that none had “anything remotely resembling the laboratory equipment which is claimed in their catalogs.” Three of them were under-equipped; the rest “are without exception filthy and almost bare. They have at best grimy little laboratories … a few microscopes, some bottles containing discolored and unlabeled pathological material, in an incubator out of commission, and a horrid dissecting room.” The Report found them more culpable than a regular school for these inadequacies: “… the Eclectics are drug-mad; yet, with the exception of the Cincinnati and New York schools, they are not equipped to teach the drugs or drug therapy which constitutes their sole reason for existence.”
The other regular schools that had conducted homeopathic or eclectic programs had by that time phased them out in the name of “scientific medicine”.
Pharmaceutical industry
During this same period of time, the American Medical Association, through several of its efforts, began a significant alliance with the organized pharmaceutical industry of the United States, shaping that industry in a manner acceptable to the allopathic profession.
The new “sects”
The period from 1890 through 1905 saw the rise of three new medical sects and several other smaller “irregular” schools which replaced those soon to pass away. In Missouri, Andrew Taylor Still, originally trained as an orthodox practitioner, founded the school of medical thought known as “osteopathy”, and in 1892 opened the American School of Osteopathy in Kirksville, Missouri. In 1895, Daniel David Palmer, originally a magnetic healer from Davenport, Iowa, performed the first spinal manipulation, which gave rise to the school he termed “chiropractic”. He formally published his findings in 1910, after having founded a chiropractic school in Davenport, Iowa. And, in 1902, Benedict Lust founded the American School of Naturopathy in New York.
Although some of the following discussion will be devoted to the schools of healing called osteopathy and chiropractic, only that portion of their histories related to the history of naturopathy will be mentioned. (A full study of osteopathic medicine in America may be found in The D.O.’s by Gevitz[11] , and a reasonable sketch of chiropractic medicine may be found in Ronald Lee Kapling’s chapter in Salmon.
As noted by Starr,[1] these new sects, including Christian Science, formulated by Mary Baker Eddy (see Silberger[12] for further discussion), either rose or fell on their own without ever completely allying with orthodox medicine. Starr theorized that these sects arose late enough that the orthodox profession and its political action arm, the AMA, had no need to ally with them and would rather battle with them publicly. This made these sectarian views separate and distinct from the homeopathic and eclectic schools.