Patent medicines and secret remedies
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b5415 (Published 14 December 2009) Cite this as: BMJ 2009;339:b5415
- Jeffrey K Aronson, clinical pharmacologist
- jeffrey.aronson{at}clinpharm.ox.ac.uk
Patent means open (box 1), but patent medicines have traditionally contained secret ingredients. The Oxford English Dictionary defines a patent medicine as “a proprietary medicine manufactured under patent and available without prescription.” However, the term and its current definition are historically misleading. From the start, the hallmarks of patent medicines were that they were advertised direct to the public and sold over the counter. They were rarely patented because it was advantageous to be secretive about ingredients that were often ineffective and even hazardous. If a product had a patent it was generally because the remedy was effective—Epsom salts, marketed by Nehemiah Grew in the late 17th century, contained magnesium sulphate as a purgative.
Box 1: Etymologies
Patent comes from the hypothetical Indo-European root PET, to spread or open out. Petals spread out; patellas, spatulas, and spades look like open dishes; space is an open area; and paella is cooked in an open pan. According to the Oxford English Dictionary, letters patent (Latin litterae patentes) were originally open letters from a monarch or government, intended “to record a contract, authorize or command an action, or confer a privilege, right, office, title, or property”; the term then came to mean documents that grant “for a set period the sole right to make, use, or sell some process, invention, or commodity.” It was subsequently shortened to patent.
Quacks, originally quacksalvers, supposedly quacked or boasted about their salves; a mountebank was a man who would mount a soapbox (Italian: montare in banco) to shout his wares at a fair; charlatans were wont to prattle (Italian: ciarlare) about their medicines1
Patent medicines could be purveyed by physicians and apothecaries or by unqualified quacks, mountebanks, and charlatans (boxes 1 and 2). Historian Roy Porter suggested that between 1600 and 1850 there were more similarities than differences between quacks (“less cheats than zealots”) and regular practitioners,2 an assertion that is borne out by the history of patent medicines.
Box 2: History of apothecaries
Apothecaries were originally members of the grocers’ livery company. However, during the late 16th and early 17th centuries, under the leadership of Francis Bacon and the Huguenot refugees Gideon de Laune and Théodore Turquet de Mayerne, they sought to secede. Eventually, the Worshipful Society of Apothecaries of London was incorporated by royal charter of James I on 6 December 1617, although it continued to be allied to the Society of Grocers. The grocers stocked perishable goods, the apothecaries non-perishable ones, including spices, sweetmeats, preserves, and medicines.
Apothecaries purveyed and compounded drugs, dispensed physicians’ prescriptions, and charged for medicines. Physicians employed apothecaries or used them as required and charged for consultation and advice. The decision of the House of Lords in 1704 in the case that the College of Physicians brought against an apothecary called William Rose, accusing him of administering medicines without licence from the college, without the direction of any physician, and without taking or demanding any fee for his advice, established that apothecaries could independently prescribe and dispense medicines. The college’s monopoly was broken.3 In 1711, the Worshipful Society of Apothecaries was established as a separate livery company.
Sales of patent medicines burgeoned during the 18th century. They were often named after their inventor (Swaim’s Panacea, Turlington’s Balsam of Life); after a famous, but often conveniently dead, practitioner (Dr Boerhaave’s red pills, Dr Radcliffe’s drops), or after the place of origin (Epsom salts, California vinegar bitters). The name might include the source of the medicine (Clark Stanley’s snake oil liniment) or its supposed indication (Dr D Jayne’s expectorant, Mayr’s wonderful stomach remedy). Exoticism could be an advantage (Indian panacea, Green Mountain magic pain remover).
Advertisements for such products, promoting (?) their value in wide ranges of conditions, indeed often for all conditions, might be accompanied by recommendations from patrons—Dr Scott’s bilious pills had benefited “the Dukes of Devonshire, Northumberland and Wellington, the Marquesses of Salisbury, Angelsea, and Hastings, the Earls of Pembroke, Essex and Oxford and the Bishops of London, Exeter and Gloucester.”4 Testimonials from grateful patients were also cited— an advertisement for Lydia Pinkham’s vegetable compound for women stated, “Lydia Pinkham’s private letters from ladies in all parts of the world average one hundred per day.”5
Secret remedies yesterday
Regular practitioners have always been critical of patent medicines. In 1790, for example, James Adair, a Scottish physician, published a scathing indictment.6 “Many persons have been destroyed by quack drugs,” he wrote, “but dead men tell no tales.” He and others pointed out that quack medicines contained conventional treatments (such as opium and ipecacuanha in Dover’s powder), poisons (such as hemlock), or nothing of value whatsoever.
However, during the second half of the 19th century, with the rise of the chemicals industry and the consequent beginnings of drug companies, such as Hoechst and Bayer in Germany and Burroughs–Wellcome in the UK,7 the criticism became more intense and evidence based. Pharmacology (the word dates from the start of the 18th century8) was becoming scientific.
In America, concern about adulterated and misbranded foods and drugs culminated in the publication of 11 articles by Samuel Hopkins Adams in Collier’s Weekly in 1905, titled “The Great American Fraud,” in which he exposed many of the false claims made about patent medicines. This led directly to the 1906 Pure Food and Drugs Act. Doctors, supported by the American Medical Association, then published robust criticisms of the purveyors of patent medicines. They were met by a riposte in the form of a pamphlet, published by the Proprietary Association.9 The Proprietary Association collected newspaper reports of adverse events, including deaths that had been attributed to various medicines, and claimed that patent medicines were less dangerous than other medicines. Something of the flavour of this report emerges from the data on whiskey and alcohol (84 cases, 61 deaths) and Cannabis indica (one case, no deaths).
In the UK, patent medicines had been specifically excluded from the Pharmacy Act of 1868 and the Sale of Food and Drugs Act of 1875, and their contents could therefore be kept secret.10 11 Many of them, such as Battley’s sedative solution, Daffy’s elixir, and Godfrey’s cordial, contained opium, and their sales increased. In the 1880s, therefore, doctors, supported by Ernest Hart, editor of the British Medical Journal, started to campaign against this abuse.
A Patent Medicine Bill in 1884, which would have controlled these products, failed because of pressure from the Society of Chemists and Druggists. Undaunted, the campaigners used as a test case Dr Collis Browne’s chlorodyne, which contained chloroform, morphia, tincture of Indian hemp, and prussic acid and was responsible for a large number of cases of poisoning. The chairman of the parliamentary bills committee of the British Medical Association sent a memorandum to the Pharmaceutical Society, the Society of Apothecaries, and the General Medical Council, attacking patent medicines in general and chlorodyne in particular. Questions were asked in the House of Commons in 1891, to no avail. However, the parliamentary bills committee then persuaded the Treasury’s solicitor to prosecute the manufacturers of chlorodyne. The magistrate defined a patent medicine as one that was issued with a government patent. Chlorodyne, having no such patent, therefore came under the 1868 Pharmacy Act. What had once been secret became open. The manufacturers were fined for marketing a scheduled poison. Other similar patent medicines were thus brought under the act and controlled. Some manufacturers removed opioids from their products. Sales fell.
However, patent medicines continued to be sold, and the campaign continued. In the 1900s, the BMJ published a series of articles under the general title “The Composition of Certain Secret Remedies,” dealing with drugs used to treat epilepsy,12 headache,13 kidney diseases,14 and other conditions. In 1906 it started to reprint similar articles from the Deutsche Medizinische Wochenschrift.15
In 1909, the BMA gathered the articles into a single volume, Secret Remedies.16 Public interest was enormous, fuelled perhaps by H G Wells’s 1909 novel Tono-Bungay (“slightly injurious rubbish at one-and-three half-pence a bottle”). Secret Remedies sold 62 000 copies by June 1910.12 A second collection was published in 1912.17 The entries listed the ingredients in each product, details of the “claims and exuberant boasts” made by their manufacturers, and the prices charged. Comparisons with the actual costs showed how large the manufacturers’ profits were. The table summarises some of the entries, whimsically chosen from the two volumes.
Examples of secret remedies16 17
Although a select parliamentary committee was subsequently appointed to investigate patent medicines, it published its report on 4 August 1914, when public attention was focused not on Dr Boschee’s German Syrup, but on Germany itself; its recommendations were not pursued.18
Secret remedies today
Two Latin tags summarise the success of patent medicines, even today. The first, omne ignotum pro magnifico (ignorance makes everything look superb), was quoted in the preface to the first volume of Secret Remedies. The second, populus vult decipi (the public wants to be deceived), appeared as the legend to an early 17th century engraving by the Dutch artist Jan van de Velde, showing eager customers clustering around a quack and his wares. In 2007, American adults spent $12bn consulting practitioners of complementary and alternative medicine and $22bn buying their products.19
Although the ingredients of UK patent medicines are now stated on packets, the information will mean little to most consumers, and important information may in any case not be available. For example, an aqueous extract of kava kava has been used in Oceania as a recreational medicine for hundreds of years. It was reportedly safe (although Louis Lewin’s report of its effects in his 1924 account, Phantastica, raised some doubts about that20). Nevertheless, when a lipid extract of kava was marketed as an anxiolytic in the West, reports of hepatotoxicity appeared. There is now evidence that both types of extract are hepatotoxic.21 The hepatotoxic ingredient is not known.
The two volumes of Secret Remedies constituted a landmark publication in the control of over the counter medicines. Their story has modern resonances. Nostrums are still available over the counter. Perhaps another edition of Secret Remedies is needed.
Notes
Cite this as: BMJ 2009;339:b5415
Footnotes
This article is based on JKA’s Gideon de Laune Lecture, given to the Society of Apothecaries in 2008.
Competing interests: JKA is president of the British Pharmacological Society, a member of a NICE technology appraisal committee, and a member of the formulary committees of the British National Formulary and the British National Formulary for Children. The views expressed here are not necessarily shared by those organisations.
Provenance and peer review: Commissioned; not externally peer reviewed.