The Uncomfortable Alliance Between Physician, Apothecary and “Patent” Medicine Manufacturers
“Patent” medicines came to be in the early 17th century in Europe. They evolved over the following 100 years and made their way to America. While the initial medicines in the 18th century were indeed patented, near the end of that century, the expense and disclosure of ingredients required in patents were being rethought. Manufacturers suddenly began to regard their formulas as being held secret and they now used registered trademarks as protection. From Thomas’ all the way to William’s time at Harvard, patent medicines grew in acceptance and availability. But, up until the early 19th century, these nostrums were hard to come by; expensive and often less trusted than the home remedies.
Initially, patent medicines like, Daffy’s Elixir, Bateman’s Pectoral Drops, Turlington’s Balsam of Life and Dr. Benjamin Godfrey’s Cordial, were shipped to the colonies from England. The first American-made patent medicines, like everything else in those days, were poor counterfeit efforts of their British cousins. Like tea, taxes more than anything else, caused the local manufacture, to find a way to circumvent additional costs. After the Declaration of Independence and the War of Independence, the local manufacture of medicinal nostrums and later patent medicines in America, began in earnest.
The new country was ripe for the growth of these remedies. Soon the patent medicine industry was one of the largest and most profitable in the colonies. Poor health, along with the sorry record of physicians and their apothecary’s formulations, lack of education and superstition, fueled this large and rapid growth. As manufacturers prospered, they looked for increasing means to gain more customers. The Almanac and Newspaper industry provided the answer. As every new discovery in science occurred, patent medicine advertising reflected the technological answer. As electricity and electrical motors began to make their way into the common world, electrical devices, magnetic belts, electrified nostrums—all these became the cure for many ills.
Even before the War for Independence, American apothecaries were imitating the old English patent medicine brands. By the end of the war, Americans were importing empty vials and filling them with their own versions of the name-brand elixirs; sometimes even importing actual printed wrappers to perfect the counterfeit. As was the custom of the day, most of these patent medicines were purported to cure just about anything and everything. The colonial customers had no idea that the products they were purchasing were not the originals. The principal ingredient in all of these medicines was alcohol. Since they actually had little to no medicinal value, the results were exactly the same.
In 1796, Samuel Lee Jr. of Windham, Connecticut secured the first American patent. Lee’s “Bilious Pills” which were purported to fend off biliousness, yellow fever, jaundice, dysentery, dropsy, worms, and female complaints. When confronted with a counterfeit version from another Samuel H.P. Lee, also from Connecticut, the original Mr. Lee Jr. not only sued, but waged his war against the charlatan using a rising star of the day: newspapers! Mr. Lee Jr. noticed that the articles they posted against each other created a demand so great that by 1810 Bilious Pills were in all territories, even south to Georgia and in the newly acquired territories to the west of the Mississippi. Numerous and aspiring promoters, having taken a page out of the Lees’ books had entered the war against biliousness.
In the 19th century, the adage oft quoted that the “cure was often much worse than the malady” rang particularly true for the American public. The science and ethics of medicine was based on very unsure educational roots. This period has often been called medicine’s “heroic” age. Patent medicines and extreme bleeding and purging were the remedies of the day for most illnesses. However, not many sick men and women wanted to be that heroic. Many charlatans and unethical practitioners appealed to these “cowards” with promises of mild medications. Nostrum manufacturers like Samuel Lee Jr. boasted that there was no harsh mercury in their formulas. Samuel Thompson, a purveyor of the day, wrote, “Physicians learn nothing of the nature of the medicines they prescribe except how much poison could be given without causing death.”
Suspicion of regular physicians due to their “heroic” therapies grew deeper with the rise of Jacksonian democracy. The rise in the anti-intellectualism of the day imbued the citizenry with a belief they had an innate common sense that was superior to trained experts. Lemuel Shattuck in 1850, in a pioneering report on public health in Massachusetts wrote, “Anyone, male or female, learned or ignorant, an honest man or a knave, can assume the name of physician, and “practice” upon anyone, to cure or kill as either may happen without accountability. It’s a free country!” Into this willing world, the patent medicine manufacturer strode confidently, preaching to his dutiful choir that his, and only his remedies, would set them free from all manner of afflictions.
As patent medicines expanded across the nation they became the first products based on national advertising and marketing campaigns. American newspapers owe much of their growth to the rise and largess of the patent medicine manufacturers. By the middle of the 19th century, many of the newspapers owed their existence both directly (as many were started by the manufacturers as nostrum sell sheets) or indirectly, as over 80 percent of most newspaper revenues came from the patent medicine industry. It was reported to a congressional committee in 1849 that at least one “pill man” was spending in excess of $100,000 per year advertising his purgative. The provision for free delivery of newspapers by the US post office in the early 1800s is directly attributable to the power and influence of these salesmen.
Apothecaries, did not weather the storm well. During this period, the classic compounding apothecary soon became replaced with druggists. While many of the new druggists were trained as apothecaries, many more no longer were. Unlike the old apothecary who ground and mixed their medications in accordance with strict published formulas, many druggists were content to sell the patent medicine elixirs, sodas and powders. The public was beating paths to their doors. Soon all Apothecaries, except those in hospitals or in physician owned board and care homes, were plying these —-dubious nostrums.
New Medicines- Selling the Cures
John Stith Pemberton was born in 1831 in Knoxville, Georgia. Like his uncle, Lieutenant General John C. Pemberton, the famous commander of the defense of Vicksburg, Mississippi, he too was a good son of the south, having enlisted in the Confederate army where he was wounded in the Battle of Columbus, Georgia in April, 1865. Like many wounded soldiers of the day, he rapidly became addicted to morphine. He tried various concoctions of coca, and coca wines to no satisfaction. Desperate to find a curative, he began to formulate his own version of one which contained alcohol, coca, kola nut and Damiana – a relatively small shrub native to Central America. The Damiana plant produces small, aromatic flowers coupled with a strong spicy aroma, one that had traditionally been used in tea for its “relaxing” effects. In April 1885, Pemberton’s French Wine Coca hit the market and became an immediate success.
Pemberton’s “potion,” contained a high percentage of alcohol, significant caffeine, 8.46 milligrams of cocaine per ounce of liquid, and a pleasing taste. He marketed his elixir to “scientists, scholars, poets, divines, lawyers, physicians, and others devoted to extreme mental exertion.” Like most “patent” medicines, the beverage was advertised as a cure for nerve trouble, dyspepsia, mental and physical exhaustion, gastric irritability, wasting diseases, constipation, headache, neurasthenia and impotence. It also was recommended as a cure for morphine addiction. In one of his more colorful advertisements, playing to the wide-spread public concern about drug addiction, depression, and alcoholism among veterans and “neurasthenia” among “highly-strung” Southern women, Pemberton said his medicinal concoction was “particularly beneficial for ladies, and all those whose sedentary employment caused nervous prostration, irregularities of the stomach, bowels and kidneys, and those who needed a nerve tonic and a pure, delightful diffusible stimulant.”
Unfortunately, later that year, Atlanta and Fulton County passed temperance laws which made the sales of his magical elixir – because its alcohol content – illegal. Pemberton responded by reformulating his “brew,” substituting carbonic acid (soda water) to replace the alcohol, and keep the other ingredients in solution. Having satisfied the chemical requirements of the laws, he then needed a new name. This moniker came from Frank Mason Robinson, the secretary and bookkeeper for the Pemberton Chemical Company. Renamed Coca-Cola, the new formula was introduced in May 1886, at the Jacobs Pharmacy in Atlanta. Delivered as syrup and mixed via a soda delivery system (the forerunner of the modern soda fountain), Jacobs sold 25 gallons its first year. The next year, sales topped 1049 gallons. In 1888, Asa G. Chandler, along with several other investors, bought the rights to Dr. Pemberton’s formula for $2,300. It was Chandler’s aggressive marketing that brought real success to Coca-Cola, making him and his investors many, many millions of dollars and allowing him to establish the Central Bank and Trust Company.
Although in 1894 Coca-Cola was sold in bottles for the first time, it was the distribution of it through pharmacies that accounted for much of the early sales. It pioneered the development of the soda fountain and people enjoyed visiting these establishments and ordering the “fresh” drink. As concern of patent medicines grew over time, pharmacy soda fountains gradually transformed from providing therapeutic medicines to simple beverages then called “soft” drinks (meaning not habit forming). The transition to soda fountains was largely complete when Samuel Hopkins Adams ran his series of articles condemning patent medicines in Colliers Weekly in 1905. His articles were both stunning and highly influential.
Pemberton’s nostrum was not the first, nor was it the last, medicinal agent of the time to remain the most popular. It did, however, share a number of characteristics with all the other major sellers. It provided little medicinal value, it was addictive, and it had an extremely high profit margin. Since most medicinal treatments of the day provided little therapeutic value, expectation of the user were often exceedingly low. Almost all patent medicines claimed to cure all. The public often did not seek out the physicians of the day, preferring instead to treat themselves. When somebody found that a particular remedy did not cure them of one of the illnesses from which they thought they were suffering, they simply assumed they had some other disease. Due to the predominance of cocaine, morphine, and alcohol in these elixirs, users became rapidly addicted to them, and soon, the symptoms began to follow the dosage not precede it. Suddenly, America was getting hooked.
In 1872 the year of Judge Loker’s birth, some of the best-selling brands of these incredible “mixtures” included;
- Mrs. Winslow’s Soothing Syrup (1849). This liquid claimed to “likely sooth any human or animal,” and to effectively quiet restless infants and small children. It was widely marketed in the UK and the USA. The company used newspaper advertisements to promote their products, including recipe books, calendars, and trading cards. (Primary ingredients, morphine sulphate (65 mg per fluid ounce), sodium carbonate, spirits foeniculi, and aqua ammonia)
- Hall’s Catarrh Cure (1870) – marketed as a cure for Catarrh – better known today as bronchitis. The manufacturer of this nostrum, Frank J. Cheney, was the largest advertiser of patent medicines. He also became one of the principals of the Proprietary Association and the creator of the infamous “Red Clause” product. (Primary ingredients, alcohol, potassium iodide, sugar and small amounts of vegetable extracts)
- Lydia Pinkham’s Vegetable Compound for Women (1875) – Marketed as a women’s tonic to relieve menstrual cramps (primary ingredient – Alcohol)
- Peruna (1890’s) – marketed as another cure for catarrh. Dr. S. B. Hartman expanded his definition of catarrh to include catarrh of the kidneys, catarrh of the lungs; of the stomach, bowels, spleen and just about any other organ one could think of. Peruna was soon one of the most prevalent nostrums and the main curative enjoyed by a good many of the temperance supporters of the day. (Its primary ingredient: 28 percent grain alcohol)
- Catarrhal & Asthma Powders (1890’s) – Various brands like Birney’s Catarrhal Powder, Dr. Cloe’s Catarrhal Cure, Dr. Gray’s, and Crown powders also cured catarrh and asthma – although most patrons of these products had given up their claim of curing the ailments early on in their use. (Primary ingredient, from 270 to 1250 mg./oz. of cocaine)
During this era there were a large number of different classes of patent medicines available to people to self-dose without any prescription or requirement for a doctor’s prescription. In 1856, the number of patent medicines listed in New York alone was 500; by 1857 it had grown to over 1500. By the early 1900s, there were an estimated 28,000 patent medicines advertised, marketed, and publicized across the U.S. Some have estimated the number exceeded 40,000 by 1919.
Coca-Cola was not the only patent medicine to survive today as a consumer product. Some druggists, frustrated with the high cost of Chandler’s syrups, decided to manufacture their own nostrums. Charles Alderton, a pharmacist at Morrison’s Old Corner Drugstore in Waco, Texas, created Dr. Pepper. Others quickly came up with formulas and advertised their health benefits. Hires Root Beer claimed to purify the blood and make the cheeks rosy. Jamaican Ginger Beer, later known as Ginger Ale, alleged to ease a sour stomach.
Some of the largest pharmaceutical companies today got their start, either in the patent medicine game, or as suppliers of products to the nostrum industry.