Theissen Polygon Zones of Influence
Prior to the War of 1812, there were just six or seven schools established. If we look at the distribution of population in 1810, one way of interpreting the influences of these schools is to draw Theissen polygons using the schools as centroids and the 1810 population distribution area as the out boundaries of these polygons, referred to as Zones of Influence. This provides us with the following map.
Chapel Hill, upstate New York school in Fairfield, and Dartmouth have pretty large areas surrounding them. Each school has an immediate surrounding community that it influences, an area surrounding this that demonstrate lesser influences, mostly due to news and commerce, and an area that is well outside the immediate region being influenced that demonstrate little to no influence on behalf of the school at all, except for the occasional physician from this school serving the local community setting. These three schools essentially are located at the edge of well-populated regions and due to this have influences that are distributed well beyond the rural settings of the country into the hinterland community settings. We would expect these regions to be the least controlled regions by the regular medical profession, and so other forms of medicine are anticipated for these regions.
In part this logic to determining where irregular medicine evolves is true. Along the Canadian border, a few examples of culturally-defined practices are provided in Maurice Gordon’s Aesculapius comes to the Colonies. In the northern parts of New Hampshire and Vermont, there are some French Canadian influences percolating down into the United States region. Since Indian establishments are still present in these hinterlands, a little bit of missionary and Native American may be seen in this part of the country as well. These Canadian influences are expected to continue in a northeastward direction into parts of Maine, and southwestward until the edge of the Fairfield school’s zone of influence is reached.
The Fairfield school has impacts that impact pretty much all of upper and western New York. In terms of New York history this includes the Burned-Over district where many spiritual revivals were developed, evolved and distributed between 1790 and 1830. Even though the Fairfield school was developing in the mid-New York region, it did not hinder the migration of Thomsonianism through this region from the states of New Hampshire and Vermont. Rutgers began to develop a medical school around 1790/2.
Typically considered a New Jersey school due to its current status, this school was initiated in affilliation with the school in New York City and the associated Medical Repository journal. Rutgers is therefore treated as part of the New York influence due to the location of its professors for the time. Likewise, most of the other common writers of Medical Repository such as Noah Webster and Samuel Mitchell are treated as further examples of this New York influence, even though Webster resided in Connecticut and Mitchell very active in New Jersey.
Also according to the above map, schools in Philadelphia and Baltimore pretty much have control over the entire state of Pennsylvania. New York has some minimal influence on Pennsylvania in that it has some slivers of areas penetrating the north border ot Pennsylvania. Otherwise, Pennsylvania is pretty much a self-managed state in terms of medical practice and prowess.
Also for Pennsylvania, note the diffusion of the 1790 population area edge into that part of Pennsylvania around Pittsburgh. A significant number of the residents of this area were German speaking settlers, who would later play a role in the esgtablishment of the first German-bred alternative form of medicine to impact the country–Hahnemannism or homeopathy. One could evaluate this western territory beginning with the assumption that this hinterland region is going to demonstrate strong rural German farming influences, more so than other regions being settled in the hinterlands by 1810.
To the far west, southwest and south of Pennsylvania is the remaining school–Chapel Hill–an island essentially in terms of human ecological influences. There is a massive amount of territory potentially influenced by this school, but due to a variety of features these influences never really develop. Several key human behaviors prevent the diffusion of irregular medical practices through this part of the United States.
This unique history of this mid-Atlantic and Inland region provides us with important insights into what a region needs to possess in order become non-allopathic in tradition. As was seen for the Canadian border region in New England, we might expect some cultural influences to strongly dominate those cultural settings where regular medicine and MDs play little to no role in day-to-day living practices. This is pretty much what is observed. The western parts of Kentucky are Tennessee have religion as a prime cultural feature. Religion along with social isolation and poverty as a part of the Appalachian way of living for this region influenced greatly how the final decisions would be made regarding trust in the church versus trust in the medical school. During these years (1790-1810) the schools were playing moral games with the church in general, by initiating cadaver studies in the anatomy programs and defaming local neighbors’ parents and grandparents along the way by unearthing the bodies of deceased family members.
This strong religious influence would continue to prevail in these regions well past the 1810s, and even influence how many medical schools could be formed in this region and what types of medicine were most respected. It is no surprise that the most traditional irregular schools opened in this region called themselves “Thomsonian”, not “Botanic Medicine” most of the time in their early years, suggesting their followers were more adherent to the underlying religious nature of Thomsonianism versus the slightly to moderately excommunicated philosophy borne by the natural philosophers residing in an around the heart of botanic medicine–the states of Ohio, Indiana and Illinois.
Homeopathy Migration, based on German Culture and Medical Schools. 1825-1850
If we look at the diffusion of homeopathy briefly using the above map, this practice made its way through New York city and Philadelphia, and from there westward towards Pittsburgh, and from this part of Pennsylvania southwestward towards St. Louis, where the greatest cluster of homeopathic schools would be operating by 1850. (There is the possibility of a route via Richmond still being checked.) Whereas Cincinnati, Ohio was the primary city supporting Botanic Medicine, St. Louis was the primary city support homeopathy. In the very 1800s, St. Louis was at the edge of the hinterlands and no man’s land. Socially speaking, it was far away from the core of regular medical thinking and practice found along the metropolitan region now developing between Washington, D.C. and Boston.
Possible Migration Paths for Irregular Medicine (Preliminary Results)
There is also a well define population-based communication of diffusion route heading from Nashville, Tennessee, southwestward towards Natchez and New Orleans. The establishment of a regular medical school as the first of its kind in New Orleans prevented this region from losing important political power on behalf of the regular profession between 1800 and 1840. Due to its culturally different upbringings, the settlers of this region bore their French, Cajun-Creole traditions alongside some Native American-French Metis upbringings accompanied with some of the practices related to the Bible-thumpers residing in urban settings just to the north like in Memphis, and the Afro-American teachings and preachings typical of the southern states just to the East. These surrounding histories make this part of the country a very culturally diverse social setting where the potential for irregular medical practices are expected. This regional history never led to the opening of a number of diversely trained medical professions. One possible reason for this is the opening of medical schools is primarily an economic process, where the development of alternative thinking, especially the kinds of teachings not typically practiced in a school setting, is more a sociocultural process. The latter can always happen regardless of population density for a given region. The former requires a stable income source for the birth and continuation of a medical school program. Population density across the very diverse region west to south of Chapel Hill made this region unlike to give birth to too many new medical schools outside of just a few chief commercial settings for this part of the rapidly expanding country. The region west of Chapel Hill was a focal point for the birth of new religious and cultural practices engaged in at some community and domestic level, but not new professional practices.
The commercial routes of the Mid-Atlantic and New England would in the end decide the diffusion routes for irregular medical thinking, and therefore define the zones of influence and spheres of influence spatial patterns for decades to come with regard to regular versus irregular medical practices. Beginning with the War of 1812, there was a temporary lull in this continued evolution of irregular medicine, as the military need for physicians and surgeon’s mates once again became the primary reason and way in which someone became a physician in this country. From 1812 to approximately 1815 or 1816, regular medicine remained regular medicine in the school setting. In the community setting, domestic medicine and other forms of home-borne methods of practicing were developed, such as the use of patent medicine, domestic medical guides, local Indian doctoring, midwifery, the practice of “antient” medicine (versus modern medicine), and the practice of Thomsonianism as a completely personal form of doctoring.
War of 1812
- 1812. NY. REGULAR. College of Physicians and Surgeons of Western New York, Fairfield, NEW YORK. Org. 1812. REGULAR.
- 1814. NY. REGULAR. New Medical Institute (Queens College), NEW YORK. Org. 1814, –1830. REGULAR.
The War of 1812 lasted from 1812 to 1815, and is the third period in American history during which medicine was under the regulation of military services, for the purpose of asuring medical services to regimens and administrative staff. The first military period is of course the Revolutionary War. (The preceding French-Indian and prior British-Canadian and Colonist-Indian skirmishes are ignored for the time being.) This was followed by a period in medical history when the post-Revolution military demands almost required that anyone who wished to become a surgeon or physician learn this practice as an apprentice to a famous ship surgeon or field physician. In 1807, it was required that a physician serve the military for a year before receiving his certification. Whereas for the years prior (ca. 1804-1806), physicians were dexcluded from having to serve in the military, this exclusion was temporarily rewritten to not include physicians in 1807; due to complaints from regional medical associations this was reversed one year later.
The third period of military medical service was during the War of 1812. The war itself consisted of minimal field surgeon or physician activities. It was more a series of skirmishes and a few large battles on the oceanside between New York and Louisiana than anything like the Revolutionary War . The Canadian border at the north end of New York was of military concern, leading to the formation of regiments with the purpose of protecting this border. Like any war period, medicine was improved as it once again became a primary concern of both the military and the government. Like the Revolutionary War, at a social and societal level, medicine could pretty much function on its own as a continuation of some of the next steps needed for intellectual growth and professional advancement to occur in this profession. In the Hudson valley area, it was the second generation of doctors who inherited their great uncle’s or great grandparent’s heritage as a war physician who engaged in this form of training or first years of clinical practice. They were led by a former field surgeon and physician in the Revolutionary War.
Two medical schools were formed during the War of 1812, both in New York. The Fairfield school opened in Herkimer County and the New Medical Institute later known as Queens College in Queens, New York. We develop a better understanding of medicine locally during this time based on the notes made is Aesculapius Comes to the Colonies, James Thacher’s Biography of Physicians and a New York doctor’s Recollections published in 1840.
Spheres of Influence before Reformed Medicine
Spheres of Influence and Medicine
Up to this point in the history of medical schools, the influences of these schools have been easy to trace, and not that difficult to predict. Soon after War of 1812 was over, attempts to establish new medical schools were about to begin. As pioneers made their way westward into the interior, the need for medicine and someone who could practice medicine were both very common needs. Some physicians and physicians to be took on the responsibility of making their way westward into the unsettled territory and those who were most ambitious decided to open their own school once they were out there. To open a school, you need a population of potential students. Only a few places were therefore adequate for engaging in such a business devoted to you work and personal beliefs.
For someone who opens a school or place to teach people medicine, there has to be a local community and the kind of medicine you teach has to be attractive for others to try to learn the skills. As a medical school professor you school’s traditions and philosophy have to be in touch with the traditions, philosophy and expectations of the people making up your community. People who migrated out west and brought with them some new method of understanding and practicing medicine could either receive no support from the people in the town, or obtain the town’s full appreciation for the skills and knowledge you have and are about to share. As the Midwest became more populated and its pioneer settlement very much in tune with their personal belief, the kinds of medicine taught in this region had to satisfy the most local status quo. This means that when a new school succeeds and remains it is location, without being forced to evacuate its premises due to some mob scene, this school is more than likely going to remain in the location for at least a while, and begin to influence the population that surrounds, in spite of any agreements or disagreements certain households might have with the doctor’s teachings.
The ability of a physician and school to influence individuals, families and ultimately an entire population immediately surrounding his school defines the teachers’ Sphere of Influence. The Sphere of Influence represents the extent to which a teacher’s or series of teachers’ preachings and philosophy impact the people located close to his school. A sphere of influence is that region or area where people conversing with one another speak about the teachings of their medical school. A sphere of influence represents how far someone needs to be away from these teachings for it toi have minimal to no impact on their life. Whether or not these teachings impact some depend upon such things as the speed of travel, the frequency or regular travel such as by horse and wagon, stage-coach, train, or boat, and the amount of distance that can be covered during the normal course of one’s travels for ordinary personal, family and business relationships. In other words, a sphere of influence for some is typically about a day or two’s travels at most. For more frequent sharing of knowledge and experiences, a half-day to a day and half travel might be more in tune with the kinds of information being dispersed in this fashion.
When information travels across large distances and is spread into new territory, a new birthplace or nidus for the information is established, and the information diffuses out from this new place in many or all possible directions. A new sphere of influence is then established, as people surrounding this place become involved in the new knowledge being shared. More people then become involved in this process and a new region is defined in which these new skills are supported both professionally and socially. Medical philosophy behaves according to the sphere of influence ideology. We can use the sphere of influence to define where certain medical forms are being practiced. If we know the places where those who learn these new philosophies reside, then we can trace them as well to learn better how far away from the medical school such a belief system can migrate and remain intact. Sphere of influence also tells us where certain belief systems or medical practices cannot go due to the leading belief system for the region and its related social, political and legal support. The migration of a new medical philosophy seems to travel in this fashion without any such intent. It is the behavior of people responsible for this kind of migration or diffusion pattern, not the validity of the teachings or the plans made by people trying to promote these new teachings. Social settings and populations define the ways in which a medical belief systems propagates, not the preachers of this faith or the preachers of any other faith in conflict with alternative medical teachings.
The relevance of Spheres of Influence to this review pertains to the history of what has traditionally been referred to as irregular by the regular MDs for the time, as reformed medicine by practitioners in support of it and who have regular medical training, and as non-allopathic, alternative, complementary or integrative medicine by contemporary historians trying to be politically correct.
The Sphere of Influence is meant to represent the social, cultural, professional and political impacts the particular field of care has on medicine in general. Generally speaking, over time and place these spheres expand and contract depending on the local population features, transportation routes and topographic features. Contemporary researchers of economic impacts regionally use 3 hours as their first sphere of influence, meaning that someone will be willing to spend three hours driving or partaking in public transportation to get to a final destination related to some sort or personal health quest, such as driving to a summer camp or taking a train for a weekend long massage class. In 19th century medical history, this travel time can probably be expanded to a full day, meaning that if an individual is going to partake in something unique that he/she might be willing to spend much of a day travelling to that destination. Expanding this way of modelling the diffusion of people in relation to human behavioral practices related to medicine, the knowledge of a particular form of medicine itself will in the long run travel further and longer than a physician travelling to some acquaintance or family members in precious need of some unique form of health care.
The diffusion of knowledge produced by physicians, and practiced and taught at medical schools, will have an impact on the local community immediately, and those a few hours way through publication and the dissemination of these new discoveries by way of regular newspaper articles or by way of the dissemination of a magazine devoted to these findings and/or the medical profession. Even though a medical journal or magazine may be delivered to places located a considerable distance from the publisher, the actual impacts of these writings upon physicians is more a very well localized thing. A physician who makes a discovery in New York City is going to have some direct connections with members of his/her immediately local professional community, and he/she with other members of this community located a certain distance from hid/her practice as well. This way of disseminating information follows transportation routes, and can tend to diffuse a little further away from the original source when travelling along one route versus another, but in general, this one-half to one-day principle of dissemination of practice-related experiences (items professed to and practiced as physicians) holds true. There are some items that will be picked up distance covered after a day to two of travel and dissemination as well, but for the most part, those places closer to the site of discovery or invention are more likely to immediately pick up on these practices than sites with less of a personal and professional connection to the place of origin for a discovery.
The diffusion of 19th century forms of alternative medicine tend to follow this type of diffusion behavior. Since the non-allopathic professions are in competition with the allopaths, a certain relationship between the “irregular” and regular is worth noting. Irregular practitioners try to disseminate their teachings into the local larger towns and cities, but since these more heavily population regions are also more heavily populated by regular doctors, there is a kind of political and socioculturally-generated suppression of this knowledge or its sharing in the local community. The regular MD or physician would have to engage in some sort of practice that was so demeaning or risky in the eyes of the patient population, that this practice was worth avoiding, in order for the population to begin to accept the newly introduced forms of practice over the traditional practices with a certain amount of political control in each of these regions.
For this reason, the diffusion of alternative medicine does frequently fail in its attempts to develop a following in fairly densely population regions, and succeed in attempts to develop a following in regions where there is less professional, political and social pressure to resist such a change. In the case of regular medicine versus irregular medicine, the schools in which regular medicine is being taught defines these major spheres of influence. These institutions are where the most learned members of the profession teach their knowledge and skills. They are often where the trade magazine for that profession is published. They are usually fairly close to the residence of the most learned and most published writers in the medical profession. When a new “alternative” though passes through such a region, profession-driven resistance and even mobbing effectively prevents these new teachings from taking hold. We see evidence for this in nearly every non-allopathic medical profession developed between 1800 and 1850.
In the following map of Spheres of Influences, there is a gap noticed in New York where the various medical schools forming between 1780 and 1815 lacked sociocultural influence. This enabled local systems employing non-allopathic practices to form, without the political pressures expected in the cities located closer to the medical schools. The founder of Thomsonianism, Samuel Thomson, tried to promote his profession in the major urban settings of Boston and Philadelphia, which he was successful with to some extent. Thomson’s greatest success occurred by influencing the rural and hinterland community settings. By diffusion westward past the spheres if influence for each of the medical schools operating soon after his profession became popular, he was able to establish some political routes in regions south of the southern most school in Baltimore, and west of the westernmost school of Fairfield, NY, Baltimore, MD., and perhaps even the university in Transylvania, Kentucky during tits pre-medical school years.
Several other alternative or non-allopathic practices followed this sociopolitical path as well, including homeopathy, which first began to grow as a profession well west of Philadelphia, near Allentown and the mid-state German settlements, one or two off-shoots of Thomsonianism, which developed in Ohio and much further south in Georgia, the Indian Root Doctoring of Kentucky, Indiana, Illinois and Ohio, Eclectic medicine, born in New York, but soon after closed by a mob, and reopened a few years later in Ohio. The new medical schools to open from 1815 to 1830 will have their own spheres of influence that are developed, in turn impacting the local communities and the overall diffusion behaviors of the alternative healing practices during this period in American history.
The Migration of Thomsonianism (TH) in relation to Spheres of Influence
Summary
Through the use of several nethods of analyzing the spatial doffisuion of something like medical philosophy and sectarian practices, we are provided with important insights into how the various irregular medical institutions were developed. The large number of schools for homeopathy in St. Louis around 1850 was the primary instigator of my decision to review these histories in more detail. It is not uncommon for some larger urban settings to have regular and irregular schools developed in different sections of the urban setting or in adjacent urban centers. In Colorado, for example, (although this is a late 19th century history being used as an example), there was a regular school in Denver and 20 miles away in Boulder a very unique homeopathic school. In an urban Ohio setting, the regular school had it homeopathic competitor in an adjacent urban setting, but with both sharing the same church-managed hospital with each having similar patient privileges.
Theissen’s polygons help to define some of the distribution features needed to understand communication and transportation routes relative to medical philosophy diffusion process. Obviously, these are not territorial indicaitors but rather social and population impact indicators with potential for considerable overlap and the need for applying a considerable amount of fuzzy logic to this methodology, numerically or qualitatively.
Sphere’s of influence can also help provide us with insights into how and where a diffusion process may be forced to undergo its travels to new regions.
Two separate routes are demonstrated above for Thomsonianism for example. The first is a fairly logical route following the economic pathways (in the above example, one oceanic route from NYC/Philadelphia to Charleston is excluded in this case, but covered in detail elsewhere). The second is simple, basic multidirectional diffusion process, demonstrating the pathways Thomsonians were pretty much restricted to due to medical politics. Together these help to define some processes previously not reviewed in significant detail regarding the history of medicine. Along with physical and human geographical conditions defining these diffusion routes, there are certain sociocultural features which play into the diffusion process for medical philosophy and practice. Culture plays a role when economics does not have a strong impact. In these culturally-defined diffusion settings, schools are not necessary, just perpetuators of a given philosophy and a way of practicing medicine. In the more politically-defined school-related settings, trade routes and spheres of influence play more important roles in the overall regional history. The maps above demonstrate how and why there was a mixture of philosophies and traditions that got in the way of allowing the Memphis school to stay open much past the 1860s during its later years (more of this in next section). Memphis is situated at the border of three or more regular and irregular medical faiths and traditions.
An obvious extension of the above primary and secondary Thomsonian routes comes to mind based on the above maps that were produced. The next level of Thomsonianism is schools to develop in American history took place in Texas, where these Thomsonianism-favoring alternative schools have been in and out of economic stability for nearly a century. This migration to Texas follows both the cultural-religious and economic trade routes related to Thomsonianism in general, and is an obvious sequel to the above demonstrated pathways to professional growth and development for a given type of medical philosophy being practiced.
Brian Altonen, MPH, MS 
