In the November, 1979 issue of High Times, writer Richard Ashley investigated the shady world of patent medicines, from snake oil to science and back.
The Harrison Narcotics Act of 1914 gave doctors a legal monopoly on the distribution of opium, morphine, heroin and cocaine, the chief medical and recreational drugs then in use. Before the Harrison Act all drugs were legal, cheap and available to anyone who wanted to buy them. And until the last decade of the 19th century, it seemed that doctors would never acquire the prestige necessary to convince the country that they and they alone should control the distribution of their favorite drugs. Indeed, through most of the century doctors were generally regarded as ignorant and brutal charlatans.
The prevailing theory of disease was still that formulated by Galen, the second-century Greek physician who believed that disease results from an imbalance among the four “humors” (liquids) of the body—blood, phlegm, yellow bile and black bile. Galen cured people by removing the bad or worn-out humors through bloodletting and doses of herbs that induced sweating, vomiting and evacuation of the bowels and bladder. Paracelsus, the 16th-century physician and alchemist, made a significant modification of Galen’s therapeutic technique. Deciding that herbs didn’t induce enough sweat, vomit and waste, he replaced them with chemicals and minerals that did. It became an article of faith that the more awful medicine tasted and the more drastic its effects, the greater its therapeutic power. In his medical treatise, The Angel of Bethesda, written in 1722, Cotton Mather, the fiery Puritan preacher, devoted a chapter to the wondrous cures achieved through eating dung and urine. Mather was merely following established medical practice: disease was seen as an invader that only something at least as horrible as itself could drive out.
No challenge to this doctrine emerged in Western medicine until the early 19th century when the disastrous effects of traditional therapy finally convinced some influential French physicians that they should restrict themselves to helping nature itself bring about a cure. But such common sense didn’t impress the American docs. What captured their imaginations and held them in sway for several generations was the “heroic” therapy of Benjamin Rush, a signer of the Declaration of Independence and the leading American physician of the late 18th and early 19th centuries. Rush argued that “undue reliance upon the powers of nature in curing disease” would hinder the development of medicine and resolved to take whatever drastic measures seemed necessary to effect cures. “Desperate diseases require desperate remedies,” he proclaimed. And he practiced what he preached. He didn’t merely bleed his patients, he drained away 80 percent of their total blood supply; and, to rid the body of those worn-out humors bloodletting didn’t remove, he administered 15-grain doses of jalap (a powerful herbal purgative) three times a day till they were shitted out. Then to revive them from the ensuing swoon and “to keep up their strength,” he prescribed 30 grains (approximately two grams) of mercury per day. (Toxic levels of mercury are now measured in parts per million.) Some of his disciples thought nothing of administering 100 to 200 grains every hour around the clock, with the result that, before joining their ancestors, the patients of these poisoners frequently lost their jawbones and teeth.
The public might have endured the tortures of the Heroic School if they had also turned in some cures. But the doctors were no more effective treating pneumonia and tuberculosis, the prime killers of the day, than they were in controlling the periodic epidemics of malaria, yellow fever and cholera—and the state of medical education didn’t promise much hope for the future. The typical doctor picked up what little he knew during an apprenticeship to a man who followed the accepted doctrines. Medical-school graduates were even less likely to heal the sick. While the number of schools had grown from 4 in 1800 to 79 in 1875, the curricula remained unchanged. Students enrolled for a four-month course of lectures, returned the following year to hear them a second time, took a nominal examination and received their degree. At Harvard the examination consisted of five minutes of oral questioning from each of the nine faculty members. Approval from five of the nine was sufficient to pass.
Not surprisingly, the public turned away from the regular doctors and embraced anyone who promised relief on less frightening terms. Various schools of healing that rejected the use of mercury and other mineral drugs achieved popularity, but none grew as large or lasted as long as self-medication with patent medicines—so named because the makers of the earliest proprietary medicines obtained patents for their products. There were only a handful on the market in 1800; a century later there were at least 28,000 and maybe as many as 50,000.
The first American patent for medicine was granted in 1796 to Samuel Lee, Jr., for his Bilious Pills (certain to cure not only biliousness, but “Yellow Fever, Jaundice, Dysentery, Dropsy, Worms and Female Complaints”). Three years later another Connecticut man, Dr. Samuel Lee, patented his Bilious Pills. The outraged Sam Lee, Jr., attacked the upstart Sam Lee in violent terms. Then he discovered from the patent application that Dr. Lee’s pills contained mercury and immediately took out advertisements announcing the presence of the Heroic School’s favorite drug in his rival’s products. “If people uncautiously purchase his pill for mine, I shall not be answerable for their effects,” he solemnly warned. Dr. Lee retorted that it wasn’t his pill that contained mercury, and the Lees waged war through the advertising pages for the next two decades. Both prospered mightily, and observing that the existing patent procedures didn’t afford any protection worth having, shrewd men ignored the patent office and instead copyrighted their labels and promotional materials.
Up until the patent-medicine era, advertising in America had been as dull as it was limited; it was usually even honest. There were only 20 daily newspapers in 1800 and the advertisements they carried generally ran to small notices listing the new goods available at the local stores. By 1860 there were 400 dailies, and an enormous number of small-town weeklies had sprung up. The patent-medicine men flooded these vehicles with giant-size ads featuring large illustrations of their products and hard-sell copy in bold type promising instant relief from a wide variety of ailments—at least one of which the average reader was almost certain to have. One brand cured “General Debility, Mental and Physical Depression, Imbecility, Determination of Blood to the Head, Confused Ideas, Hysteria, General Irritability, Restlessness or Sleeplessness at Night, Absence of Muscular Efficiency, Loss of Appetite, Dyspepsia, Emaciation, Low Spirits, Disorganization or Paralysis of the Organs of Generation, Palpitation of the Heart, And, in fact, all the concomitants of a Nervous and Debilitated state of the system.” The number and kind of symptoms were determined chiefly by the seller’s imagination and the space available on the label. Testimonials, real or faked, were also standard fare. Ditto dire warnings of the fate awaiting anyone foolhardy enough to forgo the recommended nostrum.
Medicine makers were not above graphically rendering the painful demise of a hapless babe and insinuating it was all the mother’s fault: “Oh, what a pity that Mrs. Vowels did not know about CASTORIA.” And few were reluctant to exploit even the most serious current events: “TO ARMS! TO ARMS!’’ exclaimed Holloway’s Pills during the Civil War, “THE CITIZEN Soldier will find a more deadly foe in the brackish, muddy waters and damp night air, than in the most determined enemy.” Fortunately, the manufacturer was able to assure distressed families from every part of the nation that Holloway’s Pills would “So purify the Blood and Strengthen the Stomach and Bowels that the Soldier can Endure these hardships and still be Strong and Healthy.” (Not if he took Holloway’s and similar concoctions. Dysentery, the “deadly foe” of Holloway’s ads, was the most common serious problem of the troops, and Holloway’s Pills contained a powerful purgative designed to accomplish what dysentery was already doing too well.)
These brazen hucksters didn’t confine their lies to the newspapers and magazines: they painted and postered every space they could reach. In the cities, hardly a wall remained free of nostrum ads. Even the curbstones were painted with appeals. Horse-drawn omnibuses carried the message and throwaways were pressed on pedestrians. Henry Helmbold had his pamphlet, The Patient’s Guide, a Treatise on Diseases of the Sexual Organs (or the Human Condition Saved from Wreck), stacked in public toilets and hotel lobbies to alert the thoughtful to the wonders his Extract of Buchu could work on “secret diseases” caused by “excesses in married life, early indiscretions, or self-abuse.” No one was spared and nothing was sacred. Gargantuan patent-medicine ads covered both sides of Niagara Falls, the Palisades of the Hudson River, and the Rockies and Sierras facing the route of the Union Pacific Railroad.
Just about every household in the country stocked one or more patent medicines, and while experience must have convinced many regular buyers that their favorite remedy cured none of the diseases listed on the label, they were nonetheless convinced that it had sterling qualities. At least 600 patent preparations contained opiates in sizable amounts; an undetermined but large number featured cocaine in concentrations ranging from moderate to 99.5 percent pure; and thousands were heavily fortified with alcohol, which was perhaps the favorite of recreational users. Alcohol, though still America’s favorite drug, was the first to come under legislative attack. Maine prohibited the sale of alcoholic beverages in 1851. Within ten years most of the northeastern states had followed suit and by the early 1870s the Prohibition Party fielded a presidential candidate. Communities all across the nation began voting out devil rum, and while enforcement was sporadic, reputable citizens, particularly those whose livelihood depended on the goodwill of their neighbors, couldn’t afford to be caught. So they resorted to the patent medicines most suitable for quenching the Big Thirst. Hostetter’s Bitters was a 78-proof drink flavored with herbs, but under the law it wasn’t an alcoholic beverage—it was a medicine that could be openly bought and sold in the driest of towns. The various brands of bitters became the briskest-selling numbers in the proprietary market.
And what was the medical profession doing while patent-medicine sales increased 20-fold between 1859 and 1903? Until the 1890s, very little. The American Medical Association was formed in 1847 but the only significant change in medical practice since the heyday of the Heroic School was the arrival of opium as a cure-all rivaling mercury. Opiate consumption increased 351 percent between 1860 and 1911. The patent-medicine industry blamed the accompanying rise in addiction on overprescribing doctors, and the doctors blamed it on self-medication with opiate-based nostrums.
Then, in the early 1890s, American doctors became convinced that the germ theory of disease, which Europe had accepted 30 years earlier, was correct. Johns Hopkins opened as a research center in 1893 and dozens of smaller research facilities were created over the next few years. By 1900 medicine was a respectable profession, but doctors still had trouble weaning the public from patent medicines. Even their own medical journals, including the Journal of the American Medical Association, were filled with patent-medicine advertising, and thinly disguised patent-medicine endorsements appeared in their editorials and articles. All efforts to end this self-defeating policy foundered on a simple economic fact: patent medicine advertising provided the bulk of medical-journal income.
But the medicine makers soon had to face an enemy far more powerful than the doctors. Collier’s magazine hired the muckraking genius S.H. Adams to write an exposé of the industry. The first installment of “The Great American Fraud” appeared in October 1905, and its first paragraph rendered the verdict:
Gullible Americans will spend this year some seventy-five millions of dollars the whole sale not the retail value of the goods in the purchase of patent medicines. In consideration of this sum it will swallow huge quantities of alcohol, an appalling amount of opiates and narcotics, a wide assortment of varied drugs ranging from powerful and dangerous heart depressants to insidious liver stimulants: and, far in excess of all other ingredients, undiluted fraud. For fraud, exploited by the skillfulest of advertising bunco men, is the basis of the trade. Should the newspapers, the magazines, and the medical journals refuse their pages to this class of advertisements, the patent medicine business in five years would be as scandalously historic as the South Sea Bubble.. ..
Publication of the Adams articles coincided with the first consideration by the new Congress of the Pure Foods and Drugs Act. The Proprietary Association, the trade group formed by drug manufacturers in 1881, lobbied hard to kill the act, warning that it “would practically destroy the sale of proprietary remedies in the United States” and plunge the country into an economic depression. But the evidence Adams had marshaled to back up his charges was too strong to ignore, and Congress passed the act in 1906.
Actually, the new rules affecting patent medicines were quite mild, merely requiring that certain “dangerous drugs” be listed on the labels of any preparation containing them. And the president of the Proprietary Association viewed the outcome in a realistic light when he assured his colleagues that “people generally will reason… that preparations which come up to the requirements of a congressional enactment must be all right, or, certainly, that they are not harmful or dangerous.” And, sure enough, the Pure Foods and Drugs Act strengthened rather than weakened the industry. Just as people now say, “If it weren’t safe, they wouldn’t sell it to you without a prescription,” people then believed the act guaranteed the safety of patent medicines. Only the small medical firms failed to benefit from the new legislation. Already having a hard time competing against the giants—the cost of launching a new product had risen from $50,000 in 1880 to $250,000 by 1900—the added costs of doing business under government regulation led many of them to close their doors. The big companies got bigger and bigger. By 1970 five firms—American Home Products, Bristol-Myers, Miles Laboratories, Sterling Drug, and Warner-Lambert—accounted for 45 percent of all proprietary-remedy sales.
The Pure Foods and Drugs Act was also an indirect boon to the doctors. For, while it didn’t give them the control they wanted over opium, morphine, heroin and cocaine —the principal analgesic and recreational drugs then in use—the exposure of patent-medicine frauds made the public much more inclined to believe what physicians said about the dangers of self-medication. Led by Dr. Hamilton Wright, acting as opium commissioner, organized medicine played it for all it was worth. The AMA distributed 500,000 copies of “The Great American Fraud.” Wright campaigned like a presidential candidate, warning that the availability of habit-forming drugs threatened the American way of life. The drug habit, he wrote in 1910, ‘‘had steadily spread to a large part of our outlaw population and into the higher ranks of society.” As a result, ‘‘millions of ordinary citizens were victims of the drug habit.” Addiction to the opiates and cocaine, Wright assured the country, was a disease curable by medical treatment. He had in his hand the ‘‘infallible cure” developed by Charles Towns. But, of course, as long as habit-forming drugs were available to anyone who wanted them, there wasn’t a chance of ending addiction and saving the country from disaster. The drug problem could only be eliminated by giving the medical profession control over ‘‘dangerous drugs.”
The doctors couldn’t cure addiction then any more than they can now. The Towns method proved as useless as the previous ‘‘infallible” cures. But Wright and his colleagues believed in it just as doctors believed in the methadone ‘‘cure” a few generations later. Congress believed, too, and passed the Harrison Narcotics Act of 1914, giving physicians control over the distribution of their favorite drugs and saddling the rest of us with a futile war against their nonmedical use. Physicians control and administer the drug-treatment and -research programs. They decide what drugs should be controlled, who should be classed as abusers and how they should be treated.
The Harrison Act also brought the long war between the physicians and the patent-medicine makers to a close. Granted recognition as society’s authorized healers, the physicians were the obvious victors. But the patent-medicine makers can hardly be considered losers. Indeed, the old rivals have neatly divided the legitimate drug market: for serious problems, the doctors’ prescription drugs; for everyday problems, the proprietary firms’ over-the-counter drugs. The medical profession occasionally condemns the volume and content of proprietary advertising, but the economic incentive for serious warfare has disappeared. Physicians have more power and patients than they can handle and over-the-counter sales increase every year. At the height of the preregulation era, annual retail sales were estimated at $150 million. They are now around $7 billion.
Prescription-drug sales have fared even better. In 1921 they accounted for only 14 percent of the total drug market; now their share exceeds 75 percent. But this has not adversely affected the position of the proprietary-drug manufacturers. The once clear division between patent-medicine companies and prescription-drug companies has disappeared—and with it the adversary relationship that often made both factions look bad in public. They still appear completely separate, and the so-called ethical drug houses present a carefully groomed image of scientific responsibility designed to reinforce this appearance. But the major proprietary companies are, in fact, the major producers of prescription drugs. For example, American Home Products, which gives us Anacin and Preparation H, owns Wyeth and Ayerst Laboratories, the makers of Equanil and Antabuse. And Winthrop Laboratories, which gives us Demerol, is a subsidiary of Sterling Drug, the makers of Vanquish (“for headaches”) and Cope (“for nervous tension”).
All in all, both the medical profession and the patent-medicine manufacturers are vastly more powerful than they were before the drug wars began. Both sides won, and neither has changed its basic mode of operation. As in the past, members of the Proprietary Association create tens of thousands of protected items from a couple hundred common ingredients, cloak marketing chicanery in an aura of scientific responsibility, and transform minor complaints into ailments demanding immediate treatment. And, as in the past, physicians regard disease as an invader that must be destroyed whatever the cost. Indeed, the Heroic School would have no difficulty understanding current medical practice. Massive doses of chemicals are still the vogue, as any cancer or psychiatric patient can testify. The only obvious loser of the drug wars is the patient.
Check out a sampling of old-timey patent-medicine ads below.