Marketplace of the Marvelous (33 page)

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.
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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).
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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.
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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.”
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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.”
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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.
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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.”
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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.
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Others, like Dr. James's Fever Powders and Dr. Hooper's Female Pills, were the branded remedies of regular doctors.
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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.
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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.
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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?”
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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.”
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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.”
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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.
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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.
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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.
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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.
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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.
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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.
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