Selected Papers of William L. White www.williamwhitepapers.com Collected papers, interviews, video presentations, photos, and archival documents on the history of addiction treatment and recovery in America.

Citation: White, W. (2014). Patent Medicine and Addiction in America. Posted at www.williamwhitepaeprs.com.

Patent Medicine and Addiction in America

William L. White Emeritus Senior Research Consultant Chestnut Health Systems [email protected]

NOTE: The original 1,000+ page manuscript for Slaying the Dragon: The History of Addiction Treatment and Recovery in America had to be cut by more than half before its first publication in 1998. This is an edited excerpt that was deleted from the original manuscript.

During the 19th and early 20th most widely distributed to American centuries, both the traditional medical field consumers. and the patent medicine industry provided The story of patent medicines begins drugs with high addiction potential to early in American history. English patent medicate a wide variety of physical and medicines were imported into the colonies psychological discomforts. America’s legal regularly until the time of the Revolutionary drugs came from two institutional sources. War. Some English colonists arrived with The first, referred to as the “ethical” drug patents for particular medicines issued by companies, have traditionally manufactured, the King of England (Gilbert, 1989). These advertised, and distributed medicinal drugs patents allowed the holders, and no one only to doctors, hospitals, and pharmacies. else, to manufacture and sell particular As prescription laws became the rule, the medicines. The term “patent” comes from ethical companies were the primary sources the Latin word patere, meaning “to be open.” of prescription drugs in the United States. The patent process required that the The other branch of the rising contents of the remedy be made public--a pharmaceutical industry was made up of requirement that few of the drug companies “patent” drug companies, which were willing to meet (Haller, 1989, p. 520). manufactured, advertised, and sold what Most so-called "patent" medicines in today we would call “over-the-counter” drugs America were really "proprietary" medicines. directly to the American public. Few formulas for American-made medicines Psychoactive drugs--including alcohol, were patented. Their manufacturers did not opium, morphine and cocaine--appeared in own the formula for their contents, but the products of both ethical and patent instead owned a bottle shape and color, a companies, but it was through the patent product name, or a label design. The term companies that these substances were first patent medicine was usually applied to williamwhitepapers.com 1 products that shared two characteristics: 1)  Mother Bailey's Quieting Syrup their ingredients and formulas for their  Mrs. Winslow's Soothing Syrup preparation were kept secret, and 2) they  Allen’s Lung Balsam were advertised and sold directly to the  Dr. Coles Catarrh Cure public (Young, 1953). Patent medicines  Jayne’s Expectorant were also known as nostrums or secret  Hoopers Anodyne, the Infant's Friend remedies.  Dr. Grove's Anodyne for Infants

 Dr. Moffett's Teething Compound Opium, Cocaine, and Alcohol as Patent  Perkin's Diarrhea Mixture Medicines  McMunn's Elixir of Opium Patent medicines containing alcohol  Ayer's Cherry Pectoral and other drugs came in many forms. They  Professor Hoff's Consumption Cure came in their natural form, such as gum  Dr. Fowler's Strawberry and Peppermint opium. They came in tinctures--drugs Mixture dissolved in alcohol--such as the Laudanum.  Gooch's Mexican Consumption Cure They came in syrups like Mother Bailey’s  Kendal Black Drop Quieting Syrup, concentrated solutions of  Perry Davis’ Vegetable Pain Killer water and sugar which often contained alcohol and opium. They came as cordials, So many American patent medicines were aromatic liqueurs that contained opium or loaded with opium, cocaine, or alcohol that cocaine, as did Coca Cordial. There were Anstie, in his 1865 text on stimulants and also balsams (ointments filled with other narcotics, referred to them as the "inebriant drugs that were absorbed through the skin), medicines" (Anstie, 1865, p. 85) anodynes (pain-relieving agents), and powdered forms of opium and cocaine. Source and Availability Some products also were mixed with tobacco for smoking. The resin-heavy form Most of the opium that formed the of opium specifically prepared for smoking basis for American narcotic medicines was was not available in the U.S. until the mid- imported. During the 19th century some 1800s. producers tried to cultivate poppies in the Although opium was available in United States--particularly in the South, but crude form during the 18th century, it was not American opium production could never until the 19th century that a patent medicine compete with the prices of opium imported industry arose, with opiate-filled elixirs and from countries such as Turkey. nostrums as the centerpiece of its offerings. Beginning in the mid-19th century, The industry used crude opium and patent medicines filled with alcohol, opiates, morphine, as well as another narcotic and cocaine were available from doctors, alkaloid—codeine--isolated by the French drugstores (without a prescription), grocery Chemist Robiquet in 1832. stores, mail-order houses, and traveling During the 18th and early 19th peddlers who went from town to town selling centuries, a number of patent medicines their chemical wares. In his containing opium or opium derivatives autobiographical account of addiction, became quite popular, including: William Cobbe wrote about buying opiates in drug stores "which sell the poison as  Dovers Powder (ipecac and opium indifferently as they sell toilet soap" (Cobbe, powder) 1895, p. 127).  Laudanum Drug products could be ordered in  Paregoric Elixir (camphorated tincture of secret and delivered with discretion, in what opium) may have been the first appearance of the  Godfrey's Cordial "brown-paper wrapping." In advertising, the testimonials to these products called out to williamwhitepapers.com 2 those seeking physical and emotional vulnerability and told it readers how to comfort. The fancy bottles, with their protect themselves or self-treat those government patent and copyright stamps, diseases--with patent medicines. which really applied only to the bottle or the The patent medicine industry reached its label, gave the impression of official peak level of profit and visibility between government endorsement. 1870 and 1930. Its growth was explosive. David Musto’s exploration of the role The value of the "proprietary medicine" of the physician in the spread of addiction industry, as it called itself, rose from suggests that addiction was a harmful side- $3,500,000 in 1859 to $74,500,000 in 1903 effect of 19th-century medicine. Musto (Young, 1961). During this period, the described three patterns of iatrogenic traveling medicine show and the patent (physician-caused) addiction: 1) an medicine catalogue served as forms of inadvertent role in prescribing a new product entertainment and the primary source of like heroin, which was not yet known to be health care for many Americans. Medicine addictive; 2) a negligent role prescribing shows performed by the Kickapoo Indian narcotics out of fear the patient would simply Medicine Company or Hamlin’s Wizard Oil seek a new doctor if refused; and 3) an Company mixed the sale of patent intentional role in helped an alcoholic medicines, which were universally referred become addicted to morphine on the to as "snake oil," with the high drama of grounds that morphine was believed to be minstrels, bands, animal shows, contests, less harmful than alcohol (Musto, 1985). burlesque, comedy, and Wild West shows. The cultural perception of opiates The patent medicine almanac was a contributed to their widespread availability. mixture of calendar, advice column, and Taking an opium-based medicine, for stories, all mixed with testimonials to the example, was viewed during the nineteenth miraculous powers of the sponsor's century as taking an aspirin might be viewed particular potion. During the last quarter of today. It was a part of everyday life, seen as the 19th century, the manufacturer of an ordinary form of relief for physical Hostetter's Stomach Bitters (which was discomfort and pain. The average citizen did more than 80-proof alcohol) distributed not come to consider opium a dangerous between 10 and 13 million copies of each and potentially addictive drug until the late edition of its yearly almanac. The ever- nineteenth century. Before then, opium-, present patent medicine almanac in the local morphine- and cocaine-laced products were toilet served two purposes, one of which was widely available and aggressively advertising (Young, 1961). advertised. The best evidence of the growth in American opiate use can be found in the The Growth of the Patent Medicine annual figures for importation of opium, Industry figures kept quite carefully for tax purposes. The volume of crude opium and smoking The patent medicine industry grew in opium imported into the United States rose a mutually dependent relationship with from 450,925 pounds during the 1840s to another phenomenon: the development of more than 6 million pounds during the American newspapers. The patent medicine 1890s. During this period the annual per- industry needed the newspaper’s power of capita opium use rose from 12 grains in 1840 promotion, and the newspaper industry to 52 grains in 1890 (Musto, 1973; Mark, needed the advertising income from the 1975; Rankin, 1976). patent medicine makers. The American patent medicine industry boomed in the mid User Profile to late nineteenth century, at a time fears were rising of such dreaded diseases as In 1928, Charles Terry and Mildred typhoid, yellow fever, and cholera. Pellens took a survey of what was then Newspapers spread the word of public known about American opiate use for the williamwhitepapers.com 3 Committee on Drug Addiction of the Bureau another. She finally recovered after her stay of Social Hygiene. This classic work, The at a Brooklyn Convent in 1914 (Jonnes, Opium Problem, summarized all available 1996, p. 18). surveys on opium use that had been taken Tropical diseases and the tricks of the in the second half of the 19th century and the patent medicine industry are not the only early 20th century. Terry and Pellens came explanations offered for the vulnerability of to the conclusion that most opiate users in women to narcotic addiction. Early addiction this period were white, middle-aged women specialists linked the increased use of drugs from among the most educated and honored in women to their physical and psychological members of society. At the turn of the character, often noting that women were century, addicts were likely to be found, not more susceptible to drug use because of in the Northern urban ghettoes, but in the their more highly refined nervous systems. rural South. Opiate addiction by Blacks Explanations like these continued well into during the 19th century was rare. Most the 20th century (Towns, 1915). opiate addiction started in response to The patent medicine industry also physical illnesses and physician-provided targeted children, and medicines for children drugs. The limited access of Blacks to were as likely to contain opiates as were medical services, although it contributed to those designed for their mothers. Some poor health and shorter life expectancies, opium- and cocaine-laced patent medicines protected them from physician-caused were promoted specifically for use with opiate addiction. babies. Dr. J.C. Fahey's Pepsin Anodyne Opiate addiction was particularly claimed to "pacify the most fretful child." widespread in areas of the South where Promising that the product contained "no opium-laced medicines were commonly laudanum or injurious article," the Fahey used to treat malaria and a wide variety of preparation contained both chloral hydrate intestinal and tropical diseases. Women like and morphine (Holbrook, 1959, p. 51) Louisa May Alcott suffered from such Opiate-laced preparations in products diseases and to the subsequent soothing like Mrs. Winslow's Soothing Syrup, effects of opium and morphine. Alcott used Godfrey's Cordial, Children's Comfort, opium and morphine to ease the enduring Mother Bailey's Quieting Syrup, Steedman’s pain that came from her treatment with the Teething Powders, Atkinson’s Infants’ highly toxic, mercury-laden calomel (Palmer Preservative, Paregoric Elixar, and Hoopers and Horowitz, 1982). Anodyne ("The Infant's Friend") were so The patent medicine industry also popular for calming infants and children that supplied a large number of opium-, cocaine- warnings began to appear about their deadly , and alcohol-laced products for “women’s possibilities. When the caps were left off ailments.” Some of these products were products like Laudanum or other alcohol- emblazoned with the words “Woman’s based opiate preparations, the alcohol Friend.” Advertising copy from the patent evaporated. This left a potent narcotic medicine era used similar tactics to promote preparation in the bottom of the bottle that these products to women. This begins a could prove fatal to a baby who was given saga in which addiction among women is even a “normal” dose. And products like simultaneously promoted and hidden within Dover’s Powder used a heavy sulphate of the culture. The stories of addicted women potassa that could sink to the bottom of the appeared rarely, in the form of fiction and bottle, leaving the dangerously potent opium drama, as in Harper Lee’s story of a at the top, where it could easily be poured off woman’s morphine addiction in To Kill a for the child’s medication (Pollard, 1858; Mockingbird, or in Eugene O’Neill’s account Haller, 1989). of his mother's morphine addiction in Long Babies also were born dependent Day's Journey into Night. (O’Neill’s mother upon opiates after their mothers’ sustained made many attempts to cure her morphine use of opiate-laced medicines during addiction, in one private sanitarium after pregnancy. In his study of the history of williamwhitepapers.com 4 addiction among American women, Stephen Alcoholics were also known to be Kandall notes the first report of “congenital vulnerable to opiate addiction in biographical addiction” in America: F.B. Earle’s 1888 accounts and in clinical books of the day. In report of an infant’s death three days after 1895, William Cobbe reported that “double being born to an opium-addicted mother and multiple addiction slaves are prone to (Kandall, 1996, p. 51). That same year, switch off from one drug to another of their Hubbard reported the case of a mother drugs, in the vain hope of finally banishing all secretly addicted to morphine. After her first from their lives” (Cobbe, 1895, p. 154). In child died of morphine withdrawal only days 1896, the American Textbook of Applied after delivery, she regularly dosed her Therapeutics noted the alcoholic’s tendency second child with Laudanum, to keep from to develop morphinism after the ravages of losing this child to withdrawal. Mother and the body from alcohol demanded a "stronger child continued their secret addiction until and speedier narcotic" (Quoted in Terry and both were successfully treated by Hubbard-- Pellens, 1928, p. 105). This was confirmed beginning when the child was seven years by Crothers in his 1902 treatise on old (Hubbard, 1881) morphinism, in which he described how In 1894, the prominent pediatrician "broken down alcoholics" used morphine Dr. Louis Fischer warned that nursing by injections to relieve the physical and addicted mothers--and the practice of emotional pain of their latest binge quieting children with soothing syrups and (Crothers, 1902, 30). In 1893, the noted teething cordials--were creating life- addiction expert J.B. Mattison coined the threatening addictions in infant children term “multiple inebriety” to describe doctors (Fischer, 1894). Dr. J.B. Mattison, who were addicted to rum, morphine, and America’s foremost 19th-century authority cocaine (Mattison, 1893). on narcotic addiction, regularly voiced his conviction that morphinism in babies and Pressure for Reform children was far more widespread than people believed and that this condition As the public was exposed to stories played a hidden role in infant mortality of the respectability of those who were falling (Mattison, 1896). victim to addiction--the socially affluent, the Women and children were not the highly educated, and religious and medical only groups who were over-represented leaders--and of the danger that these among 19th-century drug casualties. substances presented to children and youth, Nineteenth-century medical literature they began to demand stricter controls. The contains regular references to the controls took two early forms: the passage occupational vulnerability to addiction of of state prescription laws (or laws requiring nurses, doctors, and doctors’ spouses. In an that pharmacists sell drugs only for 1883 article on opium addiction among “legitimate” purposes) and the passage of physicians, Dr. J.B. Mattison blamed this the federal Pure Food and Drug Act of 1906, vulnerability on their access to the drug, their which required that products containing intimate knowledge of the hypodermic, and alcohol, opium, and cocaine be so labeled. the weary days and sleepless nights in the typical physician’s life (Mattison, 1883). References Mattison also introduced into the medical literature the confessional account of a Anstie, F. (1865). Stimulants and narcotics: morphine-addicted doctor whose story Their mutual relations. Philadelphia: showed how easy it was for a physician to Lindsay and Blakiston (NY: Arno Press become addicted to narcotics (Mattison, Reprint, 1981). 1883). In 1899, Dr. T.D. Crothers estimated that 10 percent of American physicians were Cobbe, W. (1895). Doctor Judas: A addicted to narcotic drugs (Crothers, 1899, portrayal of the opium habit. Chicago: S.C. 784-786). williamwhitepapers.com 5 Griggs and Company: (NY: Arno Press, 1981). Mattison, J. (1893). The Modern and Crothers, T.D. (1893). The disease of Humane Treatment of the Morphine inebriety from alcohol, opium and other Disease. Medical Record, 44:804-806 narcotic drugs: Its etiology, pathology, (December 23). treatment and medico-legal relations. NY: E.B. Treat, Publisher. Musto, D. (1985). Iatrogenic addiction: The problem, its definition and history. Bulletin of Crothers, T.D. (1902). The drug habits and the New York Academy of Medicine, 61, 2nd their treatment. Chicago: G.P. Englehard & Series, October: 694-705. Company. Musto, D. (1973). The American Disease: Fischer, L. (1874). The opium habit in Origins of Narcotic Controls, New Haven: children. Medical Record, 45, 197-199. Yale University Press.

Gilbert, S. (1989). Medical fakes and frauds. Palmer, C. and Horowitz, Eds. (1982). NY: Chelsea House Publications. Shaman Woman, Mainline Lady. NY: William Morrow. Haller, J. (1989). A short history of the quack’s Materia Medica. New York State Pollard, T. (1858). Use of Opium in Children. Journal of Medicine, 89, 520-525. Atlanta Medical and Surgical Journal, 4:129- 134. Holbrook, S. (1959). The golden age of quackery. NY: Macmillan Co. Rankin, J. (1976). Politics of Alcohol and Drug Use. Addictions, Spring, pp. 37-57. Hubbard, F. (1881). The opium habit and alcoholism. NY: A.S. Barnes & Co. (NY: Terry, C. E. and M. Pellens (1928). The Arno Press Reprint, 1981). Opium Problem, Montclair, New Jersey: Patterson Smith. Jonnes, J. (1996). Hep-cats, narcs, and pipe dreams. NY: Scribner. Towns, C. (1915, 1920). Habits that Handicap: The Menace of Opium, Alcohol, Kandall, S. (1996). Substance and shadow: Tobacco, and the Remedy. NY: Funk & Women and addiction in the United States. Wagnalls Company. Cambridge, MA: Harvard University Press. Young, J. (1953). Patent Medicines: The Mark, G. (1975). Racial, Economic and Early Post-Frontier Phase. Journal of the Political Factors in the Development of Illinois State Historical Society, 46: 254-64. America's First Drug Laws. Issues in Criminology, 10(1).49-72. Young, J. (1961). The Toadstool Millionaires: A Social History of Patent Mattison, J. (1896). Morphinism in the Medicines in America before Federal Young. Atlantic Medical Weekly, 5:165-167 Regulation. Princeton, New Jersey: (March 14). Princeton University Press.

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Mattison, J. (1883). Opium addicts among medical men. Medical Record, 23:621-623. williamwhitepapers.com 6