Dr. Pierce also seized another enormous opportunity, and that was to satisfy the hunger Americans had for credible medical advice. Accordingly he published The People’s Common Sense Medical Adviser, a three-inch-thick tome covering everything from setting a broken bone to breaking bad habits. (One particularly vicious habit that worried Dr. P was that of ‘self-abuse’ or ‘solitary vice’, which apparently was running at epidemic levels in the late 19^th century. In my 1881 edition, the topic claims more than twenty pages—more than cancer.)

You may wonder, as I did, whether these ingredients have medicinal value, when examined with the benefit of 125 years’ worth of hindsight.

• Cinchona: the source of quinine, at the time the only treatment for malaria. Malaria was endemic in the United States in the 19^th century.
• Columbo or gentian: thought to be useful against gout, rabies, and jaundice. Now thought useless.
• Guaiac: still the base of guaifenesin, an expectorant found in most OTC cough medicines.
• Licorice: flavoring.
• Opium: the OG of narcotics. From opium are derived morphine, codeine, and heroin. 
• Podophyllin: still used for the treatment of genital warts. Why in heaven’s name this would be in a tonic escapes me.
• Glycerin: a carrier, sweetener, and humectant. Still widely used in pharmaceutical preparations.
• Alcohol: which needs no introduction.

Now wait a second—was that opium? Yup. Along with morphine and cocaine, opium was a part of many patent preparations (including both of Dr. Pierce’s best sellers)—but do recall that all of these substances were entirely legal then, and conveniently taxed at port of entry by the US government at 37.5% and 25%, respectively. If patent medicine purveyors made a bundle peddling poppies, so did the Feds.

It should also be noted that at the conclusion of the Civil War, quite literally hundreds of thousands of men returned from the field of battle with lifelong scars, mental and physical. Before oxycodone, fentanyl and other synthetic opioids, opium and its derivatives were the sole source of relief to anyone with chronic pain, cancer, and so on. And thus it was that the humble poppy not only fueled the Gilded Age patent-medicine business, but also laid the foundation for today’s Big Pharma.

Beginning in 1845, Mrs. Winslow’s Soothing Syrup was one of the first drugs marketed directly to consumers—specifically to sleep-deprived mothers for use on teething or colicky babies. Unfortunately each ‘soothing’ teaspoonful of syrup contained about twice the usual adult dose of morphine. As did Dr. Pierce’s best-sellers.

Mothers quickly found that these products were not the best choice for their children, but they didn’t mind the stuff themselves. After an alarming number had become either addicts or victims of overdose, in 1911 the American Medical Association lurched into action and denounced Winslow’s Syrup. (As far as I have been able to tell, they kept silence on Dr. Pierce’s products. He had by this time served a term in the US Congress, but of course that wouldn’t have anything to do with the AMA’s opinions. Just a fun fact.)

And these companies are all still with us today, and bigger than ever. Fancy that—outside of the drug business, how many companies have that kind of staying power? By comparison, not one of the original companies in the Dow-Jones Industrial Average index (begun in 1896) remains on the list today.

Things changed for patent-medicine makers in 1914, when the Harrison Narcotics Act made over-the-counter narcotics illegal. Since it did nothing to prevent medical professionals from prescribing them, this had the effect of shifting the target of pharmaceutical advertising from consumers to doctors. For a while, anyway. Today’s pharma companies are right back in the direct-to-consumer marketing business, creating demand for drugs you never thought you needed with their ubiquitous ‘Ask Your Doctor About’ ads, tchotchkes in doctors’ offices—and who doesn’t like free samples?

Then as now, advertising works: Study after study has shown that modern patients actually feel discouraged when they leave the doctor’s office without a prescription in hand. So while folk tend to chuckle a bit at Dr. Pierce and Mrs. Winslow, I think we might instead see them as pioneers: not only as drug developers but also as drug marketers.

With their slick ads, innovative packaging, and yard-long side-effect legal scrolls which, like old gas-station maps, simply cannot be refolded into their original compass once unfurled—modern drug makers are certainly dressed in finer feathers than their forebears were, but any other token of originality we may accord them is likely misplaced. As Dr. Pierce and Mrs. Winslow proved early on, the business of dispensing drugs was—and remains—a lot bigger, and much more scalable, than the business of practicing medicine.

Oh, and you may visit Dr. Pierce, if you like—he’s in Section One of Forest Lawn Cemetery and has a very distinctive monument.

You can find more articles like this here on Robert’s blog and also on his weekly column on Buffalo Rising. All images are property of the author.