Lydia Pinkham marketed a patent medicine that bore her name and, unusually for the time, her face. She was one of few woman entrepreneurs in a crowded and predominantly male patent-medicine marketplace. (Wikimedia Commons)
Despite the common belief, most patent medicines did not contain snake oil. Snake oil did exist, however. Clark Stanley, better known as “The Rattlesnake King,” likely inspired the association with his “Snake Oil Liniment,” which cured everything from rheumatism and sciatica to lumbago, frostbite, and sore throat. Stanley claimed to have learned of snake oil’s healing powers from his years as a cowboy out west with the Hopi Indians in the 1870s and 1880s. He shared his discovery with the public at the 1893 World’s Columbian Exposition in Chicago, where he pulled live snakes out of a sack, slit them open, and plunged their bodies into boiling water. As the fat from the snakes rose to the top, Stanley skimmed it off, mixed it with his previously prepared oils, and sold his liniment freshly made to the crowd that gathered to watch the spectacle. A few years later, in 1897, he published The Life and Adventures of the American Cowboy: True Life in the Far West by Clark Stanley, Better Known as the Rattlesnake King, which explained cowboy life, contained lyrics to cowboy songs, and, of course, promoted the healing wonders of his snake-oil liniment. Stanley’s liniment became so successful that a reporter who visited his office in Beverly, Massachusetts, found it filled with snakes, some more than seven feet long, slithering around the room and up his arms. He claimed to have killed three thousand snakes in 1901 alone to meet demand for his product. Stanley’s was not the only snake-oil remedy on the market. Consumers could also find Tex Bailey’s Rattle Snake Oil, Tex Allen’s Rattlesnake Essential Oil Compound, and Monster Brand Snake Oil, among others, which capitalized on American fascination with cowboys, the Wild West, and Native Americans. Snake oil itself had an even longer history in Chinese medicine, in which people had rubbed the fat of the Erabu sea snake, not rattlesnakes, on aching joints for centuries.1
Snake-oil salesmen like Stanley exemplify the image most people have of “quack medicine”: the charlatans making outlandish claims to make a buck off the gullible. These quacks, as popularly conceived, marketed bottles of alcohol blended with a few herbs and spices as cure-alls for dread diseases both real and imaginary. They hawked medicine on street corners and onstage, turning medicine into magic and beguiling audiences with the idea that anything was possible.2 Medicine was serious, not a game, cried regulars, and it was certainly not entertainment. Regular doctors tended to paint those who sold patent medicines and medical devices with the broad brushstroke of quackery, but the lines of legitimacy remained far from clear in the nineteenth century.
Nicholas Boone of Boston placed what is believed to be the first American patent-medicine ad, in the Boston News-Letter in 1708: “Daffy’s Elixir Salutis, very good, at four shillings and sixpence per pint Bottle.”3 The remedy was not Boone’s own invention but an English remedy from the late seventeenth century said to cure innumerable ailments from rheumatism, gout, and scurvy to the King’s Evil, a lymph infection popularly believed only curable by the royal touch, a commodity even harder to find in colonial America than a trained doctor.4 Colonial Americans imported English patent remedies that they learned about from newspaper ads. These ads tended to be mostly lists and not the drawings and screaming headlines yet to come. Although many colonists concocted their own home remedies from herbs and other botanicals, British patent medicines remained the premade remedy of choice for those that could afford them until the American Revolution disrupted trade. American pharmacists, who before the war had sometimes counterfeited medicines by refilling and reselling old British bottles with their own remedies, found a robust market for their wares in an independent United States eager to break ties with all things British. Struck with a new nationalist fervor, Americans began to demand made-in-America medicines.5 These homegrown remedies rarely contained any new or special ingredients. Most consisted of herbs and drugs found in the standard drug formularies and home medical guides of the day.6
An advertisement for one of many patent-medicine “cures.” (Library of Congress, from a print by Hughes Lithographers, Chicago, via Wikimedia Commons)
The nineteenth century revolutionized the patent-medicine trade. The commercial and printing advances of the new century changed the relationship between seller and consumer from one that was face-to-face to one at a distance—and one of trust gained through the printed word. The greater numbers of newspapers, books, and magazines in circulation gave Americans more and new ways to learn about and engage with science. It also exposed them to ads for patent medicines. Consumers eager to exercise their purchasing power found an ever-increasing array of medical devices, pills, and health regimens to try, the megavitamins, glucosamine, and green coffee beans of their day. The flood of products made for a fiercely competitive marketplace among sellers. To make their products stand out, medicine makers developed name brands with distinctive packaging and bottle designs, proclaimed testimonial success, and made extravagant healing claims.7
Thomas W. Dyott became the first American patent-medicine baron. A pharmacist in Philadelphia, Dyott marketed his Robertson’s Infallible Worm Destroying Lozenges nationally. He claimed the pills were named for his Scottish physician grandfather, but the line was likely a lie. Agents sold his lozenges in cities and towns across the country. Together with his newspaper advertisements, Dyott became nationally known for his cure in the 1810s. By the 1820s, Dyott had generated a quarter-million-dollar fortune off the sale of his remedy. He purchased a glass factory to bottle his own medicines and constructed a model company town, Dyottville, for his employees. The town included a hospital, athletic fields, a church, schools, and farms. He also opened a bank that printed its own money. Dyott’s face graced every bill. The 1837 national economic panic did Dyott in, though, and he lost much of his fortune.8
Despite the use of the name, most of these remedies were never patented. The name “patent” likely came from the British practice of granting a “patent of royal favor” on eighteenth-century remedies, which then allowed medicines to feature the crest of the king on the label. To actually file for a patent in the United States would have required sellers to reveal the ingredients, which most were loath to do. The mystery added to a remedy’s selling power and mystique. It also provoked some of the biggest complaints about patent medicines from regular doctors and represented a sharp break from other forms of irregular health care that made a virtue of their transparency. Makers did, however, trademark their product names and label design. Ads and product labels tended to boast that the remedies were painless, nice tasting, and nonmineral, direct shots at the practices of regular doctors and right in line with their irregular compatriots. In fact, many patent-medicine makers were motivated by the same factors that contributed to the rise of Thomsonism, homeopathy, hydropathy, and the other irregular health systems: the arrogance of regular doctors and the dangers of heroic medicine.9
Impatient with doctors who “physic us to death,” Lydia Estes Pinkham devised her own remedy that she promised would make her the “Saviour of her Sex” in the 1870s.10 Born in Lynn, Massachusetts, in 1819, Pinkham grew up in a reforming household in a town well known for its passion for agitation and social improvement. Pinkham’s parents left the local Quaker church after members refused to endorse the abolition of slavery in the 1830s. In its place, Pinkham’s mother Rebecca introduced the family to the science-based theology of Emanuel Swedenborg and later to spiritualism. The Pinkhams’ devotion to the antislavery cause made their home a popular meeting place for abolitionist leaders, including journalist William Lloyd Garrison, writers and activists David and Lydia Maria Child, and the Quaker poet John Greenleaf Whittier. The family counted Frederick Douglass, Lynn’s most famous resident, as a close friend. Just down the street lived the Hutchinsons, a family of singers who would later become famous for their social reform ballads, including the satiric song “Go Call the Doctor, & Be Quick, or Anti-Calomel” with its dozens of verses highlighting the greed, ignorance, and indiscriminate dosing of regular doctors. Raised in this environment, it’s hardly surprising that the adult Pinkham supported abolition, spiritualism, women’s rights, temperance, and eventually, irregular medicine.11
Lydia married Isaac Pinkham in 1843, raised four children, and took on the traditional role of domestic healer for her family. She used old family remedies and cures from home medical guides, particularly John King’s American Dispensatory, which combined traditional European botanic remedies with plants from the New World. She carefully noted all her favorites in a notebook labeled “Medical Directions for Ailments.” Her healing acumen brought neighbors to her door seeking advice and the homemade medicines she brewed on her stove and generally gave away for free to those in need. One of her most popular was a remedy designed especially for the health of women. But Pinkham wasn’t selling—at least not yet.12
The Pinkhams were hit hard by the economic depression that followed the fiscal panic of 1873, and they struggled to remain financially afloat in the 1870s. In 1875, several women from Salem ventured to the Pinkhams’ home seeking to purchase six bottles of her female remedy. Although Pinkham usually refused payment, with her family’s money troubles, she reluctantly accepted five dollars.13 Her son Daniel immediately saw the marketing potential. “Mother, if those ladies will come all the way from Salem to get that medicine, why can it not be sold to other people,” he reportedly exclaimed. “Why can’t we go into the business of making and selling it, same as any other medicine?”14
He was right. Advertisements for Radway’s Relief, Holmen’s Liver Pad, Dr. Williams’ Pink Pills for Pale People, and Hale’s Honey of Horehound and Tar filled newspapers, netting many of their makers a healthy income. She would not even be the only woman selling in the Boston area, as Elizabeth Mott already offered an herbal remedy and hydropathic regimen to women based on her Medicated Shampoo. Pinkham had her doubts, but Daniel and his brother Will’s enthusiasm and her family’s declining circumstances finally convinced her to go forward. By the spring of 1875, “Lydia E. Pinkham’s Vegetable Compound” for “female weakness” entered the crowded patent-medicine marketplace.15
Pinkham registered her label and trademark with the United States Patent Office in 1876. Like most patent medicines, Pinkham’s Vegetable Compound was actually a proprietary remedy. Only the name and label were trademarked and enjoyed government protection. The recipe remained a closely guarded secret.16
Both the name of Pinkham’s remedy and the ingredients she chose owed much to Samuel Thomson and other botanic healers. Pinkham’s notes for her original formula called for unicorn root, life root, black cohosh, pleurisy root, and fenugreek seed, botanical elements used for generations. Many irregulars still recommend both black cohosh and fenugreek seed to women suffering symptoms of menopause today. The ingredients and perhaps even the basis of the recipe itself came from Pinkham’s favorite American Dispensatory, which contained descriptions, properties, and uses for every known medical botanical remedy. Even the author of American Dispensatory, John King, owed much to Thomson, as he was a practitioner of Eclecticism, a medical movement that came out of the splintering of Thomsonism earlier in the century. Thomsonism had also spawned strains of imitator patent-medicine makers who cashed in on public enthusiasm for botanicals and their distaste for mineral drugs to market plant preparations throughout the nineteenth century. Despite a general unwillingness to reveal their active ingredients, patent medicines happily screamed what they did not contain: namely calomel. While other irregular systems, too, influenced patent medicines making related theoretical claims, Thomson’s influence in this field was far wider and longer lasting, with Lydia Pinkham a clear successor of his botanical enthusiasm.17
The public disgust with heroic therapies that helped to make botanicals as well as homeopathy and hydropathy so popular began to make inroads into the practices of regular medicine by the middle of the nineteenth century. In 1835, prominent regular physician Jacob Bigelow argued that some diseases would naturally cure themselves in a critique of heroic therapy presented before the Massachusetts Medical Society. Bigelow understood that it was difficult for doctors to stand by and do nothing but warned that their attempts to intervene too often left them unsure “whether the patient is really indebted to us for good or evil.” He counseled caution and, sounding every bit like an irregular healer, suggested that the role of the doctor was to remove obstacles in nature’s healing path.18 Easier said than done for many practicing doctors, who wondered why anyone would call for a doctor if all they could do was stand aside and wait. Those that did try to implement more conservative use of bleeding and calomel faced resistance from some patients conditioned to expect a big effect from medical care. It was a problem that both regular and irregular medicine wrestled with throughout the nineteenth century.19
Even so, by the Civil War, heroic medicine was in retreat. Regular doctors could no longer ignore the criticism of Thomsonians, mesmerists, and hydropaths or the economic threat posed by homeopathy. Reflecting evolving attitudes and the shifting medical landscape, Surgeon General William Hammond banned the prescription and use of calomel and tartar emetic from the healing arsenal of the Union army in 1863. Hammond’s decision created a furor in medical journals.20 Hammond was compared to the “irregular charlatans” who “habitually seek popular favor by denouncing well-known remedies employed by the regular profession.”21 The criticism was not enough to overturn Hammond’s order, however, and the use of calomel and bleeding decreased after the war. Some regular doctors continued to use heroic medicine exclusively into the 1880s, but most began replacing bloodletting and calomel with new pharmacological remedies containing primarily alcohol, opium, and quinine.22
Despite these changes, these new drugs were not a far departure from heroic medicine’s emphasis on demonstrable relief from illness, as well as its often horrific consequences. Large doses of opium and alcohol produced side effects just as bad if not greater than those of calomel. Regular medicine’s increasing reliance on drugs also produced an economic and cultural climate particularly well suited to a boom in patent medicine. Alcoholic proprietary tonics, bitters, and opiate-laced elixirs found a ready market among Americans habituated to their increasing use by regular doctors. During the Civil War, soldiers eagerly consumed medicines laced with alcohol. The US Army had abolished the alcohol ration in 1832, replacing it with coffee and sugar, so patent medicines provided an affordable way for soldiers to imbibe without running afoul of military rules. Patent medicines soared in popularity during and immediately following the Civil War, with total sales of $75 million by 1900. Improved transportation, wider circulation of newspapers, and cheaper manufacturing costs also enabled patent-medicine makers to expand distribution in the late nineteenth century. At the same time, professional mudslinging over the use of patent medicines became a favorite pastime of regular doctors, who seemed to have no problem overlooking their own misuse of alcohol, morphine, and quinine, liberally prescribed. Regulars were likely just as responsible as the patent medicines they viciously attacked for poisoning people and contributing to the rise of medically induced alcoholism.23
Pinkham’s Vegetable Compound, too, contained alcohol. Brewing her early batches on a stove in her cellar, Pinkham first macerated the herbs and then suspended them in 19 percent alcohol for preservative purposes. The end product came in at forty proof. Pinkham was herself a temperance advocate. But she had no problem with using alcohol as medicine.24
Alcohol was a medical mainstay of the late nineteenth century for its low cost and wide availability. Though it was first prescribed for its stimulant effects, the discovery of germs turned alcohol into an internal cleanser, able to kill germs in the body’s hard-to-reach places. Alcohol was prescribed for a variety of ailments, from anemia and heart disease to typhoid and tuberculosis. In 1878, Pinkham prescribed herself a teaspoon of whiskey mixed in two tablespoons of milk before meals for pneumonia. This was a small dose, however. Many regular doctors recommended doses the equivalent of five shots a day. Alcohol was not just for adults. Medicinal doses for children ranged from half a teaspoon to two teaspoons given every three hours, certainly enough to inebriate a small body. Pinkham’s own alcohol-based remedy advised three spoonfuls a day, hardly enough to cause serious drunkenness and certainly no threat, Pinkham believed, to everyday temperance.25
Pinkham’s business operated as a family venture. Her sons spread the word through handbills and pamphlets while Pinkham worked on production and ad copy. Although hesitant at first to get in the medicine-selling game, she had clearly done her homework on the type of marketing language likely to appeal to customers. The bright blue label proclaimed “LYDIA E. PINKHAM’S VEGETABLE COMPOUND: A Sure Cure for PROLAPSUS UTERI or falling of the Womb, and all FEMALE WEAKNESSES. . . . Pleasant to the taste, efficacious and immediate in its effect, It is great help in pregnancy, and relieves pain during labor. For All Weaknesses of the generative organs of either Sex, it is second to no remedy that has ever been before the public, and for all diseases of the Kidneys it is the Greatest Remedy in the World.”26
Although the label claimed to offer relief to both women and men, Pinkham aimed her remedy squarely at women. Like Lydia Fowler, Mary Gove Nichols, and many other irregulars, Pinkham believed that women suffered needlessly and ignorantly at the hands of regular doctors. She offered her Vegetable Compound as a way to help women, and she used her gender as a selling point. “Only a woman understands a woman’s ills” became her ad slogan.27 Purchasers could trust that she was in fact who she said she was, too, after her grandmotherly image became the public face of the remedy.
Pinkham’s son Daniel had hit on the idea of putting a woman’s face on the label in 1879. On an earlier trip to Brooklyn, he’d noticed that “folks seem to be all tore up on home made goods” and he wondered how he could use that to his family’s advantage. Several years later, he looked at his mother and realized that he had found the perfect model for made-at-home goods. At sixty years old, Pinkham had a maternal air and a warm and caring face. She truly had made her remedy on her home stove, and had used it effectively for years before making it commercially available. No advertising man could have made up someone better. Pinkham’s grandmotherly face conveyed sympathy and compassion in a single image. Her gray braid pulled back in a bun and her respectable black silk dress and white collar instilled trust in her authority and the safety of her remedy. Who could believe that this kindly woman would intentionally hurt anyone? The label also convinced skeptics that there was a real person behind the product. The same could certainly not be said for all patent remedies bearing someone’s name.28
The Vegetable Compound was not the first patent remedy to feature a portrait, but it was the first to use a woman. Pinkham’s photograph made her a national figure. It appeared in newspapers and on druggists’ counters. Newspapers found other uses for her image as well. Because editors had so few pictures of women, Pinkham’s face stood in for other news-making women, including the much younger actress Lily Langtry and even Queen Victoria.29 Pinkham’s face made advertising history.
Patent-medicine sellers pioneered American advertising techniques and strategy. In part, they had no choice. With thousands of remedies available for sale and dozens of new medical systems, patent-medicine makers had to keep their product names on the tips of people’s tongues with near continuous ad campaigns. Demand tended to drop precipitously when the ads stopped. In the 1830s, the emergence of the penny press, which generally sold sensational tabloid news at just one cent per issue, caused circulation to soar and bolstered the advertising of patent medicines.30
Critics condemned the penny press for running patent-medicine ads. The papers defended themselves by appealing to the common sense of their readers to judge the truth of the advertising claims. “Some of our readers complain of the great number of patent medicines advertised in this paper,” declared the Boston Daily Times. “To this complaint we can only reply that it is our interest to insert such advertisements . . . without any inquiry whether the articles advertised are what they purport to be. That is an inquiry for the reader who feels interested in the matter, and not for us, to make.” It was the same pitch made by irregulars to the common sense and judgment of ordinary Americans, and to their ability to make their own decisions. Patent medicines proved a perfect match for the penny papers since the incredible claims of the sellers nearly matched the sensational stories appearing inside.31
Advertisements for patent medicines exploited nearly every human need and emotion. They also appealed to the common man and woman using the same simple and direct language shared by all irregular healers. Fear played a significant role. Death, disease, suffering, and evil became familiar and grim advertising themes. Labels, too, came filled with skulls and tombstones. Pinkham’s own early advertisements ran in single columns with blaring headlines that resembled news stories to trick readers into thinking they were news so they would keep reading. “LIFE’S WOES,” began one headline. “THOUSANDS DYING ANNUALLY, From Causes to the World Unknown, While Other Thousands Are Being Restored to Health, Hope and Happiness by the USE OF LYDIA E. PINKHAM’S VEGETABLE COMPOUND, The Positive Cure for Female Complaints.” Another ad capitalized on a recent murder case to suggest the horrors that could result from untreated female weakness. “A FEARFUL TRAGEDY—A Clergyman of Stratford, Conn., KILLED BY HIS OWN WIFE. Insanity Brought on by 16 years of Suffering With Female Complaints the Cause. LYDIA E. PINKHAM’S VEGETABLE COMPOUND, The Sure Cure for These Complaints, Would Have Prevented the Direful Deed.”32
Sex sold. Many patent medicines promised to restore sexual vitality. The Reinhardt brothers of Milwaukee declared themselves specialists in “private and secret diseases particular to men,” which was the polite way of saying they treated erectile dysfunction and STDs. Sexual weakness and other sexual diseases, both real and imaginary, ran rampant throughout the nation in the late nineteenth and early twentieth centuries—or at least that’s what the Reinhardts led their patients to believe. Roping in patients with printed literature and advertisements making hard-to-resist promises, Willis Reinhardt and his brothers handed out diagnoses of sexual dysfunction and took in thousands of dollars in return.33
A repetitive emphasis on suffering in many ads forged what came to be known as the “pain and agony” pitch still used in medical advertising today, though with a slight reduction in the melodrama.34 “Grim death has taken darling little Jerry, The son of Joseph and Seveva Vowels; Seven months he suffered with the dysentery, And then he perished with his little bowels,” read one ad for Castoria.35 Others emphasized feelings of “constant pain,” “dull, heavy pains,” and “severe burning and sharp pains.” Critics charged that the extensive detail gulled the healthy into believing themselves sick. Ad men countered that detailed lists of symptoms instilled confidence in users that the manufacturer knew what he was doing, and that “most ailing people get a morbid satisfaction in reading vivid descriptions of their sickness.”36
Mythical and historic figures sold remedies for all kinds of complaints. Before moving to Milwaukee in 1901, the Reinhardts operated a fraudulent medical institute in Minneapolis known as the Heidelberg Institute, as famous for its cures as its fantastical waxworks window displays. Among the most dramatic was “The Dying Custer,” which featured Custer flat on his back while a machine pumped his chest up and down as though he were taking his last breaths.37 The Roman goddess of medicine, Minerva, sold a pill for venereal disease while Ben-Hur offered cures for kidney ailments. Patriotism was frequently called into service as were ads that capitalized on the foreign and mysterious, such as Mexican Mustang Liniment and Dr. Drake’s Canton Chinese Hair Cream. American Indian remedies also proved sufficiently exotic and ancient as to have been a major selling point, reflecting a belief that Indians possessed secret healing wisdom unknown to whites.38
Patent-medicine manufacturers did not rely solely on newspaper and magazines, however. They promoted their products in every way imaginable. They distributed pamphlets, books, calendars, joke books, and cookbooks. January, the New York Times sarcastically noted in 1860, has become the month of the “medicated almanac,” a “tremendous engine for the dissemination of its author’s views—approaching the unsuspecting victim, as it does, in the delusive guise of a calendar, and seducing him into the purchase of three bottles before the first eclipse.”39 The W. H. Comstock Company, better known as the home of Dr. Morse’s Indian Root Pills, sent out millions of almanacs annually, including editions in Spanish and German, beginning in the 1850s and continuing several decades into the twentieth century.40 Pinkham initially distributed a four-page “Guide for Women” that discussed health issues particular to women and explained how her remedy could provide much-needed relief. The Pinkhams also printed posters and illustrated cards.41 The Reinhardt brothers seized on the long tradition of home medical manuals and produced their own, known as The Home Private Medical Advisor, which they sent free of charge to people around the country. Written in “plain language for the young people, the unmarried, and the married,” the Reinhardts’ guide was part instructional text and part advertisement, supposedly written by an unnamed doctor known as “The Master Specialist.” Since they claimed to treat sexual diseases, a home guide was also a good way for patients to avoid the embarrassment of making a trip to their offices.42
Other sellers took their messages outdoors. They splashed advertisements on the sides of buildings and on fence rails. Promoters offered to repaint entire barns for those farmers willing to give one side over to an advertisement. Anywhere a train, ship, or wagon passed was prime territory. Rocks, trees, and even the faces of cliffs were called into service for medical sales.43
Still others hit the road to win customers. Scientific shows emerged in the United States in the 1830s on the heels of the explosion in printed materials that made science more accessible to the general public. Public demonstrations of science and technology found enthusiastic audiences eager to see and decide for themselves what they had only had the opportunity to read about in books and newspapers. It’s what made Johann Spurzheim’s phrenological tour of New England the hit of the 1832 season, and what drew hundreds to the mesmeric displays of Charles Poyen in 1836. The nineteenth-century science lecture and entertainment circuit did not just include people on the margins of science and medicine, though. Without the state support and patronage system that existed for science in Europe, American scholars had to cultivate audiences to win popular backing for their research and projects.44 “He must exhibit his disinterestedness, enthusiasm, and learning before large audiences; he must be constantly before the public in newspapers, periodicals and popular books,” lamented one writer in an 1867 article in the Nation.45 Eminent Yale chemist and geologist Benjamin Silliman gave frequent public lectures in the 1830s and 1840s. Perhaps to distinguish himself from the theatrics of other itinerant lecturers, Silliman asserted that he “had been successful in making the subjects on which I had spoken intelligible and attractive, without diminishing the dignity of science.”46 Even so, Silliman was known as a talented showman who loved dazzling demonstrations. In the 1840s, he grew particularly fond of the oxyhydrogen blowpipe, an early kind of blowtorch that he used to create pyrotechnic displays. His assistant claimed these displays provided “no lull or intermission” and were a “constant appeal to the delighted senses.”47 Popular science came in a variety of forms with no clear separation—except perhaps in the minds of the performers and their critics—between good and bad science, regular and irregular, or high and low culture.48 And with intense competition for audiences among itinerants and scholars, lectures and presentations became more lively and creative out of necessity.49
Medical shows and lectures thrived by mixing science with wonder and surprise to educate, heal, and hopefully, sell. The shows established a healer’s authority and authenticity because audiences could literally see with their own eyes the miraculous cures that were possible. Patent-medicine sellers followed in this tradition, often putting on elaborate productions that had little overtly to do with healing but provided tremendous entertainment. Some dressed as wizards or shamans and told dramatic tales of how they discovered their remedy, a practice common among irregulars of all types. Self-improvement and American progress also figured into the displays, as sellers made sure to demonstrate how their remedies would lead to a better, more perfect world. Patent medicine shows tended to perform a night or two and then move on quickly, hitting the road before customers had a chance to discover that their much touted and hoped for remedy might be no remedy at all.50
While it’s tempting to label the tactics and theatrics of itinerant medicine sellers as quackery, many took their lecturing and doctoring seriously. Charles Came was a self-taught scientist and medicine man who toured upstate New York in the 1840s and 1850s selling patent medicines and offering electrical healing demonstrations. Posters announcing his arrival in town included a long list of diseases he could cure, including liver disease, paralysis, bronchitis, ulcers, and rheumatism. His lectures were accompanied by music from mechanical organs, magic lantern projections, and slides for presentations on everything from astronomy and phrenology to the Bible, architecture, and fungi. He also had a telegraph that audience members could use to send messages to each other. Vases on both sides of the stage shot flames into the air. Such promotions and theatrics make Came appear easily categorized as an out-and-out charlatan: that is, until he opened his mouth to speak. During his lectures, Came spoke about the promise of electricity to heal, but he also demonstrated Galileo’s insights on the speed of falling bodies using a pneumatic device containing a feather and a coin inside a vacuum. He carried an orrery, a device showing the relative positions and motions of bodies in the solar system that he used to teach about astronomy. Came’s appearances were like a tour through a science museum. He also stayed in towns longer.51
Unlike the itinerant healers who offered quick fixes before leaving town, Came carefully tended to his patients, often hanging around for several days to treat certain cases as required. In 1850, he traveled to Michigan to care for his sister after several local doctors had tried and failed to heal her mysterious illness. His success in treating her, likely with a combination of patent medicines and electricity, won him more patients. After treating several others, he reported that the townspeople would “not hear about my going home,” though he did eventually break free. Came also used his remedy on himself and his family, a sign that he believed in and took his own medications seriously. He wrote home often advising on remedies for his children. He also sent home money. And with the few cents he charged men—even less for women and children—to attend his lectures and demonstrations, his was not the lucrative scam that regular doctors would accuse itinerants like Came of running.52
Life on the road was hard. Like Samuel Thomson in his early years, Came spent months away from his family, traveling constantly to eke out a living. Competition for audiences and buyers was fierce. Women sellers often had an easier time because they faced little competition: there were few women doctors and even fewer treatments for female-specific ailments. Even so, nothing about performing on the road was easy for men or women: itinerancy made for a life of endless uncertainty and exhaustion. Many healers simply preferred a fixed address and the comforts of home that a regular medical practice often afforded.53
Although patent-medicine advertisements and shows encouraged self-diagnoses, many also cultivated direct relationships with their clients. Pinkham’s ads urged women readers to write to her for advice. She promised to personally answer each one at no cost to the writer. Her kind and sympathetic face provided a personal touch that made readers feel comfortable seeking her advice and trusting in her response. Appealing to Victorian modesty, Pinkham promised that only women would ever read or even touch the letters. Encouraging women to write her also pulled potential customers away from regular doctors. One ad asked, “Do you want a strange man to hear all about your particular diseases?” Soon, dozens of letters arrived each week. By 1909, Pinkham’s ads claimed that the company files contained “over one million one hundred thousand letters from women seeking health.”54
True to her word, Pinkham answered each one, though she was forced to hire a correspondence department to take her dictation as the letters increased in frequency. Many sought her advice on problems that had plagued them for years with no answer in sight. “Dear Mrs. Pinkham, I have been afflicted with a malady that my physician frankly tells me he has never met with before and I write to ask you the cause and what the cure [is],” wrote one woman. She went on to describe a mouth infection that had turned her gums and cheeks white and left her face and throat swollen and painful. Her lower back was in “constant pain,” her urethra enlarged and painful, and her general condition utterly fatigued. Pinkham knew just the problem. “You have taken virulent poisons in the form of medicine that has caused disease of the mucous membranes,” she wrote. From the symptoms, Pinkham declared that the woman suffered from mercury poisoning that resulted from overdosing with calomel. Heavy doses of calomel had resulted in similar cases of mercury poisoning throughout the nineteenth century. That this woman’s doctor could not identify her symptoms underscores the difficulties women faced in getting proper medical care; many doctors did not recognize or know how to treat women’s complaints, and some doctors also shied away from full examinations for fear of offending female modesty. Pinkham advised the woman to bathe with hot water, eat fibrous foods, drink warm broths, take walks, and to get plenty of fresh air. Of course she also recommended a course of her Vegetable Compound but instructed her to take it in dry form as the alcoholic version would aggravate her symptoms.55 It was straightforward advice that made sense to her patients as well as promoting the health hygiene common to hydropaths. It probably even helped her.
The Reinhardts also offered advice to patients through the mail from their Milwaukee offices, though perhaps of a more dubious quality. Readers of their Home Private Medical Advisor were urged to write for advice on all aspects of love and sexuality to save themselves from the tremendous pain that might result from mistakes. Sexual diseases offered a particularly ripe platform for healers like the Reinhardts to ply their services. While some sexual dysfunction was real, most of the cures offered by people like the Reinhardts embodied the specific anxieties of the Victorian age about the body and pleasure. Sexuality was seen as both a benevolent power and a source of misfortune and danger for nineteenth-century men and women. Many believed that sensual desires could easily become insatiable and lead to moral degradation and suffering, a belief callously played up by both quacks and moral reformers at public expense. Sexuality, so the story went, had to be controlled and directed to achieve its benevolent effects. Into this arena marched the Reinhardts, eager to “treat” and bill those they diagnosed as being on the perilous path to sexual excess and downfall.56
Diagnostic forms included in their home manual asked about common, nonspecific symptoms such as headaches and dizziness as well as subjective questions about the “strength of manly power,” and a man’s bashfulness around women. These forms also asked about previous experience wearing an electric belt, providing the suggestion for a treatment that figured prominently in the Reinhardts’ arsenal. With this information, the Reinhardts offered a free diagnosis and suggested a course of treatment that was not free, of course, but was, so they claimed, guaranteed to work.57
Regular medicine found much to hate in healers like Lydia Pinkham, Charles Came, and Willis and Wallis Reinhardt. Financially, patent-medicine sellers presented a formidable challenge to regular medicine. Although they called 1906 a lean year, the Reinhardt brothers pulled in $34,357.40 in business from 485 patients, at an average price of $71 per person (more than $1,500 in today’s dollars).58 The money that patent-medicine sellers spent on advertising assured them a wide audience and the potential for profit far in excess of a regular doctor confined to one town or city. Patent sellers also had vocal and powerful supporters. Newspaper publishers actively defended patent-medicine sellers because their livelihood depended, in large measure, on their ads, which made regular doctors’ efforts to stop patent medicines more challenging. In Wisconsin, the Reinhardts paid the Wisconsin Newspaper Association to lobby against state efforts to pass medical licensing laws. They also urged newspaper editors to oppose any bills that attempted to restrict medical advertising on the grounds that these laws violated the freedom of the press.59
To regulars, advertising by any means smacked squarely of quackery. The American Medical Association’s 1847 code of ethics specifically prohibited advertising and condemned propriety patents. “It is derogatory to the dignity of the profession to resort to public advertisements, or private cards, or handbills, inviting the attention of individuals affected with particular diseases,” read the statute. “To boast of cures and remedies, to adduce certificates of skill and success, or to perform any other similar acts. These are the ordinary practices of empirics, and are highly reprehensible in a regular physician.”60 The only legitimate way for regulars to publicize themselves in the eyes of the AMA was through presentations of scientific papers at local medical societies, teaching in medical schools, or working in clinics. Of course, many regular doctors used other means, including making public presentations, to win patients. In his commencement address before the 1867 graduating class of the Medical College of Georgia, Dr. Henry H. Tucker reminded students that “the man who goes about seeking patients proves, by that very fact, that patients do not seek him, and that is the very best evidence that he is not worth seeking.”61 The AMA also drew a sharp distinction between ethical remedies made of known ingredients advertised only to doctors and unethical patent remedies that bypassed doctors in a cloak of secrecy to go directly to the consumer. The distinction was impossible for the AMA to enforce with its limited resources, and many regular doctors prescribed patent remedies despite ignorance of their contents. By 1902, patent medicines and machine-made tablets accounted for 20 to 25 percent of all prescriptions at apothecaries in New York, a number likely similar in states across the country.62
But to druggist R. V. Pierce of Buffalo, New York, the “holy horror” that regulars expressed toward the “advertising doctor,” “liberally bestowing upon him the epithet of quack” was ridiculous. He, instead, suggested that the difference between regulars and patent-medicine sellers was more a matter of style than substance. The doctor “announces himself a graduate, talks learnedly and gives notice to the public in some way that he is ready to serve them,” wrote Pierce. “He may make a great display in style, manner, dress, pretensions, writing for the newspapers, exhibiting literary pedantry, referring to the superior facilities afforded by some particular school or society to which he belongs.” All of these, declared Pierce, “are but modes of advertising professional wares; in short, are artful, though not refined tricks, resorted to for private announcement.”63 Pierce’s sarcastic appraisal of medical advertising may have had a personal motive, as regular doctors routinely attacked pharmacies that carried propriety remedies. Many druggists claimed they could not live on the sale of prescriptions alone and that they had little control over the products that consumers came asking for by name. They also pointed out that many of those patent medicines, including Radway’s Ready Relief and Holman’s Liver Pad, came with the endorsement of regular doctors right on the label.64 Others, like Dr. James’s Fever Powders and Dr. Hooper’s Female Pills, were the branded remedies of regular doctors.65
Pinkham also sought the endorsement of regular doctors even as she ridiculed them for the inefficacy of their therapies for women’s troubles. While many patent medicines used patient testimonials as promotion, many of Pinkham’s female customers were reluctant to appear in advertisements for embarrassing female problems. Druggists, on the other hand, did so willingly, happy for the free advertising. A few regular doctors did as well, including Dr. John S. Carter of Erie, Pennsylvania, who declared that he “shall continue to prescribe your Vegetable Compound.” The endorsement of a doctor, or even someone pretending to be one, gave patent medicines an air of authenticity and efficacy. Customers may have lost patience with regular therapies, but they still gravitated toward products with a professional seal of approval.66
Some regulars not only affixed their name to some labels but accepted money from patent-medicine sellers themselves. Even as the American Medical Association condemned advertising as unethical and immoral (and those who placed such ads as far worse), the organization’s periodical, the Journal of the American Medical Association, featured pages of ads for patent medicines, which it, like the penny press, depended on for revenue.67 The hypocrisy of such an act was not lost on all regular doctors. A paper presented before the Pennsylvania State Medical Society in 1894 charged the AMA with promoting quackery by allowing patent-medicine ads to appear under its imprimatur. It certainly was not the only regular medical journal to run such advertisements. The American Lancet, another medical journal, responded to the accusations by essentially pointing a finger at the other journals and crying “but they do it too!” “It is hardly to be expected that the association will advise that the journal be deprived of an income of $8000 yearly, by refusing advertisements which its rival weeklies accept,” declared the American Lancet. The paper went on to assert that reputable doctors, “by long and severe training,” have learned to “distinguish between the true and false in all medical matters” and asked what all that training was good for if it did not “enable him to detect the falsehood?”68
Even worse, many regulars ran their own advertisements in newspapers and magazines. In 1866, the Boston Medical and Surgical Journal lamented that many doctors had gone far beyond the bounds of professional decorum that allowed for a simple announcement of a change of address or notice of the resumption of practice. “Now we find the newspapers of this city every day containing the advertisements of members of our body which can in no way be distinguished from those of some professional quacks,” the Journal moaned. “Not satisfied, moreover, with seeking notoriety by special and extra puffs in the columns of the daily journals, disgraceful exhibitions of machinery and written promises to cure are conspicuously presented to the gaze of the passerby in office windows, pamphlets containing accounts of wonderfully successful cases are published for public distribution, and self-laudatory circulars are issued for the medical reader.”69 In a crowded medical field, in a profession that did not always pay well, regulars had to do something to stand out from the crowd. But how to do it while maintaining the dignified image demanded of them by medical societies and by the fledgling profession itself posed a seemingly irresolvable conundrum.
Regulars also condemned patent-medicine sellers for their inferior or nonexistent medical education. “In almost every instance they are prepared by men who “know little of medicines beyond their names,” and nothing of the physiology or diseases of the system,” proclaimed Dr. Hunter in the New York Daily Times. “How few [patients], indeed, look beyond the advertisement by which they are induced to purchase the nostrum, to inquire into the professional character of its assumed discoverer! Did they do so, they would be somewhat startled to find that, in almost every instance, his medical education is scarcely superior to their own.”70 While it was likely true that nearly all patent-medicine sellers had no formal medical training, the same could also be said of many regular doctors, who were self-taught or learned through an apprenticeship. In the absence of licensing laws, medicine was a field open to nearly everyone. Lydia Pinkham came from a long line of female healers who practiced medicine on family, friends, and neighbors. Her success in applying herbal remedies earned her respect and standing as a healer long before she even considered turning her home practice into a business. To those who considered them ignorant of medical practice, most patent sellers took the same line as other irregular healers, arguing that experience trumped education and book learning every time.71
Dr. Hunter’s attack suggested, too, as many other regulars would also claim, that patients were partly to blame for blindly accepting the claims of patent medicines. But Americans had long tended to their own health with only the occasional intervention of a doctor. Self-dosing was both a habit of choice and necessity. Patent medicines easily meshed with American notions of self-reliance, common sense, and self-confidence in dealing with most health problems. This culture would begin to change a bit by the end of the nineteenth century. Americans became more urban and thus closer to trained medical care, and they grew more accustomed to relying on the specialized skills and knowledge of experts, but even so, the affordability of many patent medicines and the high value placed on the cure allowed patent medicines to thrive into the twentieth century.72
Patent medicines easily swallowed and exploited new scientific ideas without the agony and divisiveness that plagued other irregular systems. The germ theory of disease proved no deterrent to patent sellers, who began marketing germ whackers like William Radam’s Microbe Killer. Another seller marketed the Pillow Inhaler, a pillow filled with medicines said to destroy germs while the patient slept. Each new scientific discovery or therapeutic advancement seemed to find a place in patent medicine. Without an underlying theory or a national network of practitioners, patent-medicine makers could adapt far more seamlessly to the changing medical landscape and latest health fads than other irregular healing systems. Patent medicines took advantage of medicine’s theoretical prospects and thrived on its persistent weaknesses in daily therapeutic care.73
All of this is to say that despite the excoriating rhetoric of regular medicine, patent-medicine makers were not all charlatans preying on the innocent and gullible. Nor did their business tactics by necessity mark them as unethical and dangerous. Regular doctors had a complicated relationship with advertising, alcohol as medicine, and self-promotion. For centuries, regular doctors had gathered ingredients and mixed and prepared most of their own remedies, so ready-made and easily purchased patent medicines represented direct competition and a formidable financial challenge to regulars. Everyone advertised in some way, but patent-medicine sellers tended to take better advantage of these new avenues for reaching their audience than regular medicine. Prosperity took many different paths and forms in nineteenth-century medicine. Some healers opted for the individualism of an independent business while others found a home in the collective security of an established trade in a culture that sanctioned a wide range of medical practices. Healers like the Reinhardts surely did operate a quackish and exploitative business, but the case seems far less clear for Charles Came and Lydia Pinkham.74
The commercial climate of the nineteenth century encouraged people to believe that health, like nearly everything else, was a tangible good that money could buy. In some ways, regulars helped to foster the market for patent medicines by encouraging patients to trust in their pills and tonics that, just like patent medicines, often contained opiates and alcohol as primary ingredients. At an average cost of a penny a pill, patent medicines seemed like a good value for the money and cost far less than a visit to the doctor. These remedies also suggested speed and convenience, factors as appealing today as they ever were in the past. Impatient about illness, Americans still treat themselves more than they seek professional medical care, and usually without consulting or even informing their doctor. For the sick, whether a remedy was bought at the pharmacy on a doctor’s prescription or from a traveling medicine man likely made little difference in the nineteenth century’s hit-or-miss climate of relief and cure. In the absence of therapies with proven effectiveness, patent medicines made sense.75
Consumer confidence determined, in large measure, the success of the remedy. Many customers swore by the effectiveness of particular medicines and took them regularly. Patent-medicine makers used advertising to develop direct relationships with their users. They identified problems and provided the solution. Repeat sales were critical, and some remedies served satisfied customers for decades. Wistar’s Balsam of Wild Cherry for coughs and consumption, for instance, “which has effected some of the most astonishing cures ever recorded in the history of Medicine,” was on the market for more than one hundred years. Some products still around today began life as patent medicines. Angostura bitters, Coca-Cola, Dr. Pepper, tonic water, and Hires Root Beer were all once patent medicines. They also appealed to temperance advocates, a growing market in the late nineteenth century. Early recipes for root beer, for instance, often called for sassafras, a root with a potent flavor noted since at least the early nineteenth century for its medicinal use as a cleansing tonic, laxative, and blood purifier. Hires marketed its root beer as a cure-all, claiming that it was “soothing to the nerves, vitalizing to the blood, refreshing to the brain.” Dr. Pepper was also sold as a remedy for a variety of health problems, including impotence, as it was said to restore “vim, vigor, and vitality.” A treatment for headaches and depression, Coca-Cola got its name from two of its medicinal ingredients, kola nuts and coca leaves, the raw source of cocaine. Just how much cocaine was in the original 1885 formula is unknown, but by 1902, the drink contained as little as one four hundredth of a grain per ounce of syrup. Coca-Cola was hardly alone among patent medicines for its use of cocaine, as the drug’s harmful effects were not generally known; the drink became cocaine-free in 1929. Many other products that date from the heyday of patent medicines are still used for medical purposes but have altered ingredients and toned down the spectacular health claims in the ensuing decades. These include Geritol, Doan’s, Phillips’ Milk of Magnesia, and Luden Brothers Cough Drops.76
Manufacturers of patent medicines reversed the standard production process of the era. Rather than collect and fill orders, patent-medicine makers made a product and created demand through psychological lures and vivid advertising; it was a new way of doing business that pioneered the modern systems of manufacturing, advertising, and distribution.77
The host of contemporary publications condemning patent-medicine sellers as ignorant and inept contributed to the rise of the modern conception of consumer protection. Sensational exposés in the nation’s newspapers and magazines along with the cries of regular doctors whipped up government and public concern about the contents and practices of patent medicines. The American Medical Association lobbied for legislation affirming its belief that drug decisions should be left to regular doctors alone. In 1905, the AMA began requiring drug companies that advertised in its journals to prove that the drug worked as it was claimed to do. Progressive Era legislators, however, while expressing faith in science to reveal the truth, also strongly believed that people must be given information in order to make their own decisions. The same idea motivated the muckraking journalism of Upton Sinclair against the meatpacking industry and Samuel Hopkins Adams’s “The Great American Fraud,” a multipart exposé of patent medicines: the right of the public to know. While Adams’s work, along with the two-volume Nostrums and Quackery, a compilation of articles from the Journal of the American Medical Association, named names of patent sellers and assigned blame fearlessly and bluntly, neither succeeded in shutting down patent medicine. The first federal drug regulation, the 1906 Pure Food and Drug Act, prohibited false or misleading drug labels and required sellers to list the presence and amount of dangerous ingredients, including alcohol and cocaine, but not every ingredient. The act did not prohibit false therapeutic claims, and though subsequent legislation attempted to do so, proving an intent to defraud or harm on the part of the manufacturer turned out to be virtually impossible. In short, the law allowed patent-medicine makers to determine what their labels said for the most part but demanded that whatever they said about the ingredients at least be true. It was up to the public to read the label and assume responsibility for its choices: in other words, buyer beware.78
The Reinhardts’ business ended with their expulsion from the medical field in Wisconsin. Although they boasted hundreds of happy patients, not every case turned out well. Once patients ran out of money, the Reinhardts proclaimed them cured and turned them away if they tried to come back. If a patient got an attorney to enforce his claim, the Reinhardts nearly always settled out of court and returned some of the money. One man, after paying more than five hundred dollars for treatment of his “sexual weakness,” told the Reinhardts that he “had paid them sufficient money to be cured” as they were treating him “for all diseases that human flesh is heir to.” The Reinhardts locked the door and told the man he could not leave until he paid them an additional hundred dollars for treatment. He gave them everything he had, eighty dollars, so they would release him and stop all further treatment.79 This and other cases led the state to restrain the Reinhardts on civil and criminal charges. The charges did not stick, but in 1908, the Milwaukee County district attorney reached a settlement with the brothers that forbade them from running or participating in any medical business in Wisconsin ever again.80 It was a decision hailed in the pages of the Journal of the American Medical Association, which commended the Wisconsin Board of Medical Examiners for its persistence in finally securing the closure of the Wisconsin Medical Institute.81
Lydia Pinkham’s Vegetable Compound, on the other hand, is still on the market. Though Pinkham herself died in 1883, her company carried on. The remedy that saved her family from financial ruin in the 1870s created a fortune that her descendants, unfortunately, fought bitterly over for decades into the twentieth century. But the product, if not the original formula, survived, and Pinkham’s face still graces packages of her eponymous remedies, still giving comfort, if not care, to those in pain. Other patent medicines are still available in the twenty-first century. Proprietary remedies touting proven formulas for weight loss, energy, stamina, and immune health abound in health food and vitamin stores and in the pages of popular magazines.
The Pure Food and Drug Act of 1906 and subsequent regulations helped to constrain some makers and curbed the use of narcotics, cocaine, and alcohol, but it also pushed some toward medical devices, which were more lightly regulated. Electrical belts, brushes, and vests proved particularly popular in the early twentieth century. Williams’ Electric Batteries, an electric box with different applicators attached, claimed to help rheumatism, neuralgia, and nervousness while also affording “constant amusement in the home circle.”82 The government also placed restrictions on drug advertising to consumers through most of the twentieth century, but in 1997, the Food and Drug Administration issued new guidelines that allowed for direct-to-consumer advertising as long as the drug maker provided information about risks and benefits—the long list of side effects that zip by in small print and speed reading on television and radio. Drug makers once again have a direct and independent relationship with consumers just as they did in Lydia Pinkham’s day. Federal laws now regulate the extravagant claims and harmful ingredients of the past, but the Reinhardts’ “sexual weakness,” rebranded erectile dysfunction, and other ailments are now treatable in pill form (in this case, Viagra and Levitra) by regulars. Though many of these remedies still require a prescription, patients ask for remedies by name, and doctors often have trouble denying their requests, particularly with a payment structure based on patient satisfaction.83
Patent medicines made many promises to their users, the most potent of which may have been their claim to treat seemingly intractable problems. Holes in medical knowledge provided opportunities to medical entrepreneurs and reformers alike in the late nineteenth century, and into one of these gaping holes stepped the osteopaths and chiropractors.
