By:
Brooke Patten, B.A. in History (Class of 2024), Christopher Newport University
Sheri Shuck-Hall, Ph.D., Professor of History, Christopher Newport University
Did you know that the distribution of American pharmaceuticals has been a developing industry since the colonial period? Yet we often overlook how various cultural groups influenced American medicine and why in 1906 the United States developed government standards and regulations of products to treat illness and disease. Until then, sellers of patent medicines, sometimes referred to as quack doctors, were able to provide pharmaceuticals that had dangerous and addictive side-effects. This exhibit examines how the American pharmaceutical industry developed from the colonial period to the early 20th century and its impact on the public. Featuring artifacts from the Isle of Wight County Museum in Smithfield, Virginia, we will explore the origins of pharmaceuticals in early American medicinal practices, the roles of doctors and pharmacists in the 19th century, and the hazards of unregulated patent medicines that led to U.S. legislative action to protect consumers.[1]
Early Influencers
A significant influence on colonial and early American medicine was the knowledge brought by European colonizers. Throughout the 17th century, many people believed in a popular scientific theory that miasmas – or poisonous air – harmed those close to it and caused diseases. The earliest references of this hypothesis could be traced all the way back to ancient Greece. Greek philosopher Hippocrates argued that a person’s environment, the proximity to certain waters, and overall geographic location all played a role in why someone fell ill. The miasma theory ultimately led most people to believe that their bodies became infected when miasmatic air entered their system and therefore needed to remove the toxins to be cured. Coincidentally, herbs that naturally increased the excretion of urine (diuretics) and feces (laxatives) appeared in many popular early medicines. Americans favored this reasonable understanding of disease through the late 19th century, gravitating towards pharmaceutical products that provided the quickest and simplest way to cure themselves.[2]
Europeans also acquired medicinal knowledge from Indigenous communities and incorporated native plants and herbs into prescribed remedies and treatments. Sassafras, which is native to the present-day eastern United States, was a popular herbal remedy throughout many tribes. The Lenape (the original inhabitants of Manhattan) used sassafras in spring as a cleansing tonic and its root to thin the blood. The Cherokee, Creek, Koasati, Iroquois, Delaware, Chippewa and others treated many ailments like bladder pain, coughing, bruising, and eye disorders with sassafras bark, roots, and leaves.[3] In the West, the Tewa (a linguistic group within the Pueblo people of modern-day New Mexico) traditionally used the juniper plant for a variety of medical benefits. It reduced pain and swelling, aided childbirth recovery, and functioned as a filling for teeth and as a diuretic. American colonists widely adopted the medical use of native sassafras and juniper (and countless others), and eventually medical manufacturers profited off this knowledge.[4]
Other influencers of American medicine were Black medical practitioners in the 18th century, known as herb doctors. Informal apprentices trained with elders as they learned and used plants to produce medicine based on family traditions and knowledge. For example, herb doctors used balmony (a white flowering plant native to North America) and bittersweet nightshade in a medical drink known as “bitters.” Black herb doctors prescribed it not only to cure and strengthen the body, but also to purify the blood. Black families handed down such practices and recipes over generations, which expanded the medical knowledge available to those enslaved in the South. In the American colonies, then, medical practitioners benefitted from the abundance of new medicinal plant life around them and learned from the neighboring Indigenous and enslaved African communities.[5]
Physicians vs. Pharmacists
In colonial America, doctors not only cared for sick patients, but also prepared medical remedies and sold them in “doctors’ shops”—the precursor to modern-day pharmacies.[6] Physicians who practiced in the colonial period could receive either formal or informal training in the field. Yet most colonial doctors lacked a licensed education; they instead established their medical knowledge based on family records and experience as an apprentice. Some of the informal medical experts were women in the communities as they were responsible for their family’s medical care, including managing births. Other practitioners earned respect through costly (often prohibitive) doctoral research at established universities in Great Britain or at the early American medical colleges.[7]
Men who could afford the expense attended the first medical school at the College of Philadelphia (now the University of Philadelphia), established in 1765. Schools that followed included Harvard Medical School (1782), Dartmouth Medical School (1797), the Medical Institution of Yale College (1810), and Columbia University’s College of Physicians and Surgeons (1814). By the early 19th century, a nationwide surge in scientific endeavors led to the growth of professional medical training at these institutions. As the United States was still in its early years, medical and healthcare advancements progressed slowly. Yet increased knowledge and professionalization from these universities lead to the eventual divide between physicians who diagnosed the ailments and the pharmacists who distributed the actual medicine.[8]
While apothecary and pharmacy are often used interchangeably, the separation of both from professional medical experts started in the early 18th century. The colonial apothecary owner was someone involved and knowledgeable in both the pharmaceutical and medical fields, with responsibilities ranging from prescribing treatments to administering them. However, as exclusiveness of the medical field developed, colonial legislative acts eventually solidified the pharmaceutical industry as a subfield of medicine. For example, an early Virginia law from 1736 separated the physician from “any apothecary making up the prescription of another.”[9] Later on, the establishment of the American Pharmaceutical Association in 1852 led to further professionalization and standardization of pharmacists, which became the preferred title. Yet the medical industry headed for a revolution full of hidden dangers with industrialization and deregulation.[10]
“Palatable Poison” for the People
After the American Revolution, a populist movement rejected elitist, traditional physicians and even pharmacists—both associated with British colonialism—in favor of do-it-yourself medicine that was reminiscent of the frontier mentality. By the 1840s, U.S. manufacturers began producing their own medicinal products to match this growing trend. Companies secured trademarks of their concoctions, protecting their brands. These goods, known as patent medicines, often included opium, cocaine, and nightshade. Manufacturers avoided the full disclosure of the ingredients in their products (and therefore were not officially patented). Patent medicines appeared in newspaper advertisements, featuring drugs and special remedies to heal even the worst ailments without a doctor’s prescription. The medical profession warned against these claims, but many Americans ignored them. Congress instead supported a free market without government control in the hopes of encouraging innovation and entrepreneurship.[11]
Until 1906, there were no federal regulations protecting the health and safety of Americans regarding the food and medical products that citizens purchased. Americans subsequently fell prey to the deceptions and exaggerations of patent medicines because of the shortage of healthcare options. Many communities, especially in more rural areas, lacked a doctor within a safe distance, and even more people could not afford a doctor’s visit, let alone the additional medication needed. This desperate lower-class population hoped to find cheap and convenient remedies for their painful ailments, leading them towards the potentially dangerous, untested concoctions. The public purchased patent medicines at local shops and even on the streets from travelling salesmen. Profiting on pain, unscrupulous companies built and expanded the market full of questionable and sometimes toxic products.[12]
Opium was a popular additive of patent medicines. As early as 1753, Scottish doctor and surgeon George Young published A Treatise on Opium, which observed the effects of opium on over thirty-five ailments. He argued that the drug was far more effective than many had previously thought when given in larger doses. Though Dr. Young prefaced his work by mentioning that his research might increase the demand and consumption of the drug, he nonetheless felt it necessary to share his knowledge on opium’s productive uses. After the United States began the formal importation of opium in the early 19th century, the availability and popularity of the drug began to flood the American market, along with its addictive consequences. Despite opium’s effectiveness on pain relief, millions of people became addicted and abused the drug. Patent medicines offered elixirs or pills containing opium without a prescription, so Americans consumed these drugs without knowing how deadly they could be over time.[13]
Cocaine was another popular drug in patent medicines, but its consumption began long before its use as a popular anesthetic in the late 1800’s. For generations, Indigenous peoples of South America had used the coca leaf to lessen the effects of living in high altitudes and to stimulate the mind, much like caffeine does today. Medical observations of cocaine’s benefits had been circulating since the mid-19th century. During the age of patent medicines, cocaine was a popular additive, advertised to produce “strength, vigor, and new life into all parts of the system.”[14] The most commercially successful cocaine tonic was Vin Mariani, a mix of red wine and cocaine. It claimed to treat many maladies, including the following: “malaria, fever, chills, nervous disability, mental and physical depression, and consumption.”[15] Other companies soon followed with their own concoctions, including the now world-renowned Coca-Cola. Its original recipe contained cocaine (omitted in the early 1900s) and rose in popularity as a tonic to increase energy and even as a cure for opium or coffee addictions. Yet the addictive nature of the drug was not immediately apparent to consumers.[16]
Commonly known in America as deadly nightshade, belladonna also found its way into patent medicines. Nightshade consumption had its origins since antiquity as a hallucinogenic. In colonial America, nightshade had associations with witchcraft. As the name suggests, deadly nightshade harbors a toxicity fatal to humans in a large enough quantity. Those who ingested too much belladonna medicinal elixirs experienced dry throat and hazy vision, followed by restlessness, hallucinations, and convulsions. Those who died of belladonna overdose appeared to suffer from asphyxia and heart failure. Yet these dangerous side effects did little to stop the population from consuming belladonna by using lesser amounts as medicine. The limited medical science available left many illnesses unidentified, so patent medicine bottles often advertised a wide range of remedies; the grossly exaggerated claims to cure many ailments increased sales. Despite its potentially threatening effect, belladonna was sold in bottles like the one below for the purpose of treating constipation, muscle pain, whooping cough, epilepsy, and asthma.[17]
The late 19th century patent medicine industry ranged from large companies that were deliberately dishonest about their treatments’ success, to small entrepreneurs attempting to scam vulnerable, uneducated people in need of a quick cure. Despite the sometimes comedic or exaggerated advertisements, these medications were often far cheaper and easier to procure than possibly safer, more effective alternatives from a traditional doctor or apothecary. How could so many Americans be duped so easily? With much of the science surrounding medicine still left to be discovered and accepted by the public, unscrupulous businesses continued to profit from deceiving their customers in an unrestricted market.[18]
The Death of Patent Medicines
While England spearheaded research towards a better understanding of how and why people contracted diseases, the American medical community lagged. Many American students attended European medical schools because they were well-established with good reputations compared to their American counterparts, where there were “few laboratories, little decent equipment, and no funds for hiring capable assistants.”[19] Coinciding with the American Civil War (1861-1865), the number of international graduates declined – lowering American access to current medical knowledge. During the mid-19th century, European medical experts contributed to the germ theory, whereby germs (microorganisms) caused illness or disease. Yet the germ theory held little credibility to the American people until the end of the century. Instead, patent medicine manufacturers and sellers made a fortune on citizens’ desperation and subsequently prevented advancements in medical knowledge.[20]
Beginning in the 1870s, the longstanding skepticism about the germ theory had finally declined in the United States and Europe. New research conducted on diseases by influential scientists who studied bacteria like Louis Pasteur transformed the perceptions on how to treat illnesses. Manufacturers started to mass produce anti-toxins for diseases, including diphtheria and tetanus. Coinciding with these changes, Johns Hopkins University opened in 1876 and was the first American college that ran its research based on the established European model. The nation slowly expanded its medical research capabilities compared to previous decades. By the turn of the century, there was a national initiative led by reformers—labeled as Progressives—who focused on ending corruption and improving medical research and knowledge so that American citizens could make more informed decisions rather than trusting quack doctors and their untested, cure-all elixirs.[21]
Despite patent medicine companies rallying against national legislation to regulate products, Progressives like Dr. Harvey Wiley, a chief chemist who led the U.S. Bureau of Chemistry (later named the Food and Drug Administration in 1931) and other reformers pushed to end quack medicine. President Theodore Roosevelt signed into law the Pure Food and Drug Act in 1906 (also known as Dr. Wiley’s law). It demanded that manufacturers label medicines with dangerous ingredients such as opium, morphine, chloroform, alcohol, and cocaine, and it prevented manufacturers from displaying false statements regarding their products. This regulatory law ultimately decreased the sales of patent medicines. Though medical scams and patent medicines still exist in the United States today and prey on those who lack access to proper healthcare or life-saving medicines even in the 21st century, the numbers have greatly decreased.[22]
Learning from the Past
It would be easy to focus on the absurdity of advertisements for quack medicines. Yet to do so would overlook the larger problem. The popularity of dangerous patent medicines demonstrated the need for proper healthcare. A large population of American citizens lacked the resources or funding to afford traditional, educated physicians and treatment, which still plagues many American communities today. Instead, these people obtained the limited medical knowledge available to them and the popular remedies within their society and culture, regardless of their sometimes-dangerous perceptions and side-effects. If you wish to see more of these medicines for yourself, consider a visit the Isle of Wight County Museum in Smithfield, Virginia where you can place yourself in an early American country store and learn more about the popular brands and ingredients in pharmaceuticals.[23] See https://www.historicisleofwight.com/ for more details on events and exhibits.
Acknowledgements
We would like to give a special thanks to CNU history alumna Rachel Popp, curator of the Isle of Wight County Museum, who not only inspired and helped guide this project, but also allowed Brooke to access their artifacts, special collections, and galleries. We would also like to thank Dr. Sara Black, Assistant Professor of History at Christopher Newport University and author of Drugging France: Mind-Altering Medicine in the Long Nineteenth Century, who kindly provided her expertise by peer-reviewing this exhibit.
About the Author
Brooke Patten is a history major and political science and leadership minor at Christopher Newport University (Class of 2024). Brooke completed this exhibit as a service-learning project for the Isle of Wight County Museum in partnership with the CNU Public History Center. In addition to volunteering at many non-profits, she is currently working as an intern at the Mariners’ Museum Library and hopes to pursue a career in archives and special collections.
Notes
[1] J. Worth Estes, “The Pharmacology of Nineteenth-Century Patent Medicines.” Pharmacy in History 30, no. 1 (1988): 3.
[2] Marianna Karamanou, George Panayiotakopoulos, Gregory Tsoucalas, Antonis A. Kousoulis, and George Androutsos, “From Miasmas to Germs: A Historical Approach to Theories of Infectious Disease Transmission” Infez Med 20, no. 1 (2012): 58; Phyllis Allen Richmond, “American Attitudes Toward the Germ Theory of Disease (1860-1880)” Journal of the History of Medicine and Allied Sciences 9, no. 4 (1954): 439.
[3] Rebecca Tannenbaum, Health and Wellness in Colonial America, (Greenwood, 2012), 156.
[4] Rebecca Tannenbaum, Health and Wellness in Colonial America, (Greenwood, 2012), 156; United States Department of Agriculture, “Sassafras Plant Guide: Nature Resources Conservation Service,” National Plant Data Center https://plants.usda.gov/DocumentLibrary/plantguide/pdf/pg_saal5.pdf; Plants as Medicine: Lenape Healing Traditions Continue Today | Columbia School of Nursing, Columbia University Irving Medical Center, 20 April 2021; Wilfred William Robbins, Harrington, John Peabody, and Barbara Freire-Marreco, “Ethnobotany of the Tewa Indians,” Bureau of American Ethnology Bulletin. 55 (1916): 1–124; Tannenbaum, Health and Wellness in Colonial America, 156.
[5] Tannenbaum, Health and Wellness in Colonial America, 158.
[6] Bob Zebroski, A Brief History of Pharmacy: Humanity’s Search for Wellness (New York: Routledge, 2016), 114.
[7] Ibid.; Tannenbaum, Health and Wellness in Colonial America, 21-22.
[8] Wyndham B. Blanton, Medicine in Virginia in The Eighteenth Century (Richmond: Garrett and Massie, Incorporated, 1931), 437.
[9] Gregory J. Higby, “Professionalism and the Nineteenth-Century American Pharmacist,” Pharmacy in History 28, no. 3 (1986): 117.
[10] Higby, “Professionalism and the Nineteenth-Century American Pharmacist,” 117; Tannenbaum, Health and Wellness in Colonial America, 161.
[11] Zebroski, A Brief History of Pharmacy, 138; Arthur Joseph Cramp, Nostrums and Quackery: Articles on the Nostrum Evil and Quackery (Chicago: Press of American Medical Association, 1912), 9.
Volume 1 of Nostrums and Quackery, American Medical Association
[12] Norman Gevitz, “Domestic Medical Guides and the Drug Trade in Nineteenth-Century America,” Pharmacy in History 32, no. 2 (1990): 51.
[13] Jacques M. Downs, “American Merchants and the China Opium Trade, 1800-1840.” The Business History Review 42, no. 4 (1968): 421; George Young, A Treatise on Opium: Founded upon Practical Observations (A. Millar, 1753), v-vii; Zebroski, A Brief History of Pharmacy, 108-109.
[14] Estes, “The Pharmacology of Nineteenth-Century Patent Medicines,” 4.; Henry Kraemer, Fred B Kilmer, and Johnson & Johnson, Belladonna: A Study of Its History Action and Uses in Medicine (New York: Johnson & Johnson, 1893), 13.
[15] Estes, “The Pharmacology of Nineteenth-Century Patent Medicines,” 12-13.
[16] Estes, “The Pharmacology of Nineteenth-Century Patent Medicines,” 4.
[17] Jurgen Leo Müller, “Love Potions and the Ointment of Witches: Historical Aspects of the Nightshade Alkaloids,” Journal of Toxicology: Clinical Toxicology, 36:6, (1998), 617-627, DOI: 10.3109/15563659809028060; Kraemer, et al. Belladonna: A Study of Its History Action and Uses in Medicine, 38; Estes, “The Pharmacology of Nineteenth-Century Patent Medicines,” 38.
[18] Despite our current medical advancements and state-of-the-art technologies to treat illness and disease, during the pandemic in 2020, the drug hydroxychloroquine became a sought-after remedy to Covid-19. Medical experts warned against its consumption due to its harmful side-effects, but some Americans ignored the dangers and suffered deadly consequences. https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/hydroxychloroquine-treatment-covid-19/art-20555331; Estes, “The Pharmacology of Nineteenth-Century Patent Medicines,” 3-18
[19] Richmond, “American Attitudes Toward the Germ Theory of Disease (1860-1880),” 438.
[20] Steven M. Opal, “A Brief History of Microbiology and Immunology,” Vaccines: A biography (2010): 31-56; Richmond, “American Attitudes Toward the Germ Theory of Disease (1860-1880),” 437.
[21] Richmond, “American Attitudes Toward the Germ Theory of Disease (1860-1880),” 438; Zebroski, A Brief History of Pharmacy, 188; J. M. Cavaillon and S. Legout, “Louis Pasteur: Between Myth and Reality” Biomolecules 12:4 (2022), 596. https://doi.org/10.3390/biom12040596
[22] Estes, “The Pharmacology of Nineteenth-Century Patent Medicines,” 3; Zebroski, A Brief History of Pharmacy, 212.
[23] Estes, “The Pharmacology of Nineteenth-Century Patent Medicines,” 4.