"Ponce de Leon, groping toward that dim fountain whence youth springs eternal, might believe that he had found his goal in the Peruna factory, the Liquozone 'labora-tory,' or the Vitae-Ore plant; his thousands of descendants in this century of enlightenment painfully drag themselves along poisoned trails, following a will-o'-the-wisp that dances above open graves."
-- Samuel Hopkins Adams 
The most famous series of articles in American patent medicine history began on October 7, 1905, in the pages of Collier's, The National Weekly. They were written by a free-lance journalist named Samuel Hopkins Adams, and his conclusions were succinctly rendered in the title he gave to the series, "The Great American Fraud." Adams did not say much that had not been said before in the long decades during which patent medicines had been criticized. But in the Collier's series he made a major campaign out of what had been an occasional skirmish, and he reached an audience not only vastly larger than had ever before heard nostrums castigated, but one enthusiastic about supporting reform.
Adams' "muckraking" journalism came during the Progressive period. The first major attack on patent medicines had been part of that earlier upsurge of reform sentiment associated with Jacksonian democracy. It had been led by perceptive physicians and pharmacists, who belabored Swaim's Panacea and saw hazards to American health in other packaged pills and potions. Denunciation of nostrums continued in the years that followed, as in the case of R. G. Eccles, that relentless foe of Radam's Microbe Killer, who was both doctor and druggist. He and his fellows in both professions could aim anti-nostrum weapons of improving accuracy, as medical science and pharmaceutical chemistry advanced. The target also kept expanding, as the volume of patent medicine production boomed and the blatancy of advertising increased during the last quarter of the 19th century. In view of these circumstances, although nostrums came in for a great deal of criticism, it is perhaps surprising that there was not more.
To be sure, the patent medicine evil remained an acceptable theme for an indignant oration before the annual meeting of the medical society, to be printed soon thereafter in the society's transactions. The reform-minded physician, however, became so obsessed with quackery within the profession that the trend was toward fewer speeches and articles on nostrums advertised direct to the lay public. As scientific standards developed, there was much concern that state licensing procedures did not reflect these advances so as to eliminate unskillful practitioners like the seventeen kinds of non-regular "doctors" imposing upon the residents of Indiana. Equally disturbing to competent medical men was the rise of the quack remedy promoted direct to physicians .
The old days of simple prescribing were fast passing as the manufacturing of medicines became a major American business, and physicians of the best intent had a hard time deciding what was good and what was spurious. In the 1870's they were confronted with a host of new products to assay. The "ethical" proprietary made its appearance, a non-secret packaged product, unpatented but sometimes bearing a distinctive copyrighted name, prepared in the laboratory of a reputable pharmaceutical manufacturer. These medicines were primarily elegant preparations of standard formula -- elixirs, pills, syrups -- aimed at performing essentially the same roles as the official preparations of the Pharmacopoeia. In the same decade new German synthetics came to America, chemical pain-killers and fever-reducers, the formulas of which were known. These drugs were patented and marketed under special arrangements with the German producers. The advertising for these new remedies might promise too much, but it was essentially honest. The serious trouble came when doctors, not well trained in the materia medica in any case, sought to keep the new ethicals apart from countless pseudo-ethicals which quickly appeared to imitate new pharmaceutical approaches and steal their thunder 
"Far more iniquitous [than the maker of ordinary patent medicines]," warned a Philadelphia physician in 1892, "and far more dangerous to society is the wily manufacturer that advertises 'to the profession only.' Whether he ostentatiously holds secret the composition of his nostrum, or whether with pretended frankness he describes it with an appellative that means nothing, or publishes a formula that cannot be carried out, his object is the same; he seeks to make the physician's the hand whereby he may reach pockets shut from the coarser methods of the Warners, the Pink-hams, and the Jaynes .. . . [A sick man] certainly deserves better [from his physician] than to be handed over to the mercies of 'antikamnia,' or 'Quickine,' or 'gleditschine,' or 'Freligh's tablets,' or 'Listerine,' or any other of the unholy crew." 
This rebuke by Solomon Solis Cohen to his muddled or careless colleagues was one of many attempts to keep the pseudo-ethicals off medical prescription pads. Vain efforts had already been made to curtail one of the worst features of these proprie-taries, the way in which their makers advertised in medical periodicals and, in some cases, influenced editorial policy. Even the Journal of the American Medical Association harbored suspect advertising. During the eighties and nineties, criticism of such a course led leaders of the Association to reform policy somewhat, but never altogether and not for long. Publishing deficits led to a relaxation of standards. A new promise as late as 1900 was not completely kept: the Association did require advertisers to supply formulas, but these lists of ingredients sometimes proved false. In 1905 JAMA did not have as many bad ads as many medical journals, but this is only faint praise. In the field as a whole, the situation was shocking. Out of some 250 medical journals, only a few could not be "bribed into defrauding their readers" by hearkening to the quack advertiser's demand that plugs appear disguised as articles or editorials. Some journals were "owned openly or covertly" by the men who marketed pseudo-ethical remedies .
With so much to straighten out in the front room of their own house, physicians of critical bent paid less attention to the old-fashioned type of patent medicine aimed direct at the consumer. Only "sporadic attempts have been made from time to time, by medical associations and medical journals," wrote the editor of JAMA in 1900, to expose patent medicines, and "but little progress has been made in checking the evils. . . . In fact, but little light has so far been shed on the subject." That little light, so far as the lay public was concerned, had been hid under a bushel, for the criticism was printed in the pages of medical journals which laymen rarely if ever saw .
The same was true of drug periodicals. 'What condemnation of patent medicines there was in the late 19th century did not meet the eyes of steady nostrum buyers. When criticism came before the gaze of the druggist, it forced him to face up to an old dilemma. As a man of science, he must admit grave evils in the nostrum trade. As a merchant, he found the sale of proprietary remedies bulking large in his gross income. It was not impossible to find plausible ways of resolving this pressure. One oft-repeated argument held that there were good patent medicines and bad patent medicines and a druggist should confine his stock to bottles of the former. The view was also ventured that the public was bound to buy quack stuff, and if pharmacists stopped selling it less competent merchants, like grocers, would .
Despite vested interests and inertia, a valiant corps of pharma-cists continued the attack. They appealed to their colleagues not only with humanitarian arguments but through a more careful analysis of self-interest. "Do we not recognize," a Chicago druggist asked, on the floor of the 1893 American Pharmaceutical Association convention, "that this [patent medicine] industry is one of our greatest enemies, and that there are millions of dollars' worth sold all over the country, thus diverting money which rightly belongs to the retail drug trade, in the way of prescriptions and regular drugs?" 
How stupid can pharmacists be? another druggist asked a decade later. "They give away valuable window display space to show goods which are making their sworn enemies rich; they hang the pictures and tack signs of their biggest rivals in the most conspicuous place in their stores; they plaster their windows with transparencies and give place on the sidewalk to all kinds of signs and bicycle racks, to the end that a quack living in a distant city, a doctor who is too sick to practice, or a 'retired missionary' who is too strong to work, may wax opulent." 
Year after year patent medicine quackery was debated on the floor of American Pharmaceutical Association meetings. Strong resolutions were passed condemning nostrum evils, and pleas were issued for remedial legislation. A handful of drug trade journals also kept up a constant attack. One of the most vigorous, the Druggists Circular and Chemical Gazette, looked backward from 1905 and expressed satisfaction over its career of "active and uncompromising opposition to fraud and sham in the drug business." Not only had it met the Microbe Killer head on. It had revealed that the advertising photograph of the alleged discoverer of a purported brain tonic was really the picture of a notable German musician. There had been many other blasts at quackery .
Yet at times even the most devoted crusader was overwhelmed with a sense of despair. "Of what avail," a pharmacist had queried in 1883, "are teachers of science, and schools of learning, and the lives devoted to the study and application of materia medica, and the bringing to light of the hidden resources of nature, for the alleviation and cure of human maladies, when such cabalistic signs as St. X, 1860, can be made to invest rum with wonderful healing properties, or a bearded man in a pine forest, kneeling beside an open book and alembic, effect the wonderful transformation of turpentine into an 'elixir of life'?" 
Pharmacists and physicians who continued to fight patent medicines, despite such occasional discouragement, were joined in the late 19th century by a new brand of scientist. The same chemistry that developed the German pain-killing drugs had widespread applications to the food which Americans were eating. The Civil War had launched a boom in canned and packaged foods. Greater remoteness of producer from consumer, with complicated processing in between, coupled with new chemical techniques, provided temptations which many manufacturers were unable to resist. Chemicals were employed to heighten color, to modify flavor, to soften texture, to deter spoilage, indeed, to transform ingredients like apples and hayseeds into concoctions labeled strawberry jam. Farmers in agrarian states were aroused at the use of chemistry to deodorize rotten eggs and to revive rancid butter. What chemists had learned to disguise, the farmers began to realize, chemists could learn to detect. On state payrolls, there began to appear agricultural chemists, men who sometimes went to Germany to improve their techniques, whose task was to discover and publicize the tricks of shady processors. In 1884, seeking strength through collaboration, the state men banded together into an Association of Official Agri-cultural Chemists. These scientists began to turn out official reports by the dozen, exposing the fraud in food. Some of them did not confine their energies to investigating the things which people ate. Any crookedness involving chemistry interested them, and no more fertile field for probing existed than that of patent medicines. From Connecticut to North Dakota state chem-ists began to test tonics for alcohol, soothing syrups for morphine, headache powders for acetaniide. In their official pamphlets they published the results of their analyses, tearing the mask of secrecy from scores of nostrums and exposing the brazen falsity of label claims .
Not all the criticism of patent medicines after the Civil War was written by natural scientists. There were lay critics, too, as there had been in antebellum days. To find this condemnation of nostrums, the newspapers were hardly the place to look, at least not until the 20th century. Rural newspapers, crammed to the margins with remedy ads, were so completely devoid of criticism that William Allen White's anti-nostrum Emporia Gazette was a startling exception. City papers continued to rely on the caveat emptor policy, taking what ads were offered and letting the reader exercise his own due diligence. When there was criticism, it was often temporary or half-hearted or both, a one-shot campaign against an unusually notorious quack whose cousins might be advertising in adjacent columns. Some papers did hold to something like consistency in excluding remedies for venereal disease and sex weakness, while accepting tuberculosis and cancer cures. Still, with all their caution, enough editors were sufficiently independent-minded to cause medicine proprietors sleepless nights, especially after nostrum control bills began to appear in state legislatures. If the press had been considered as indisputably safe, patent medicine advertisers would have had no need to develop ways of making criticism costly .
What the nostrum manufacturers had invented to protect themselves was a "red clause" in advertising contracts. Frank J. Cheney, whose company made Hall's Catarrh Cure, boasted to his fellow members at a Proprietary Association meeting that the clause was "pretty near a sure thing." "It is mutually agreed," the red type in the advertising contract read, "that this Contract is void, if any law is enacted by your State restricting or prohibiting the manufacture or sale of proprietary medicines." Cheney told his colleagues how he had used the contract in Illinois to call the tune for newspapers when a tax on proprietaries was threatened by the legislature. These words to the wise were sufficient, and "muzzle-clauses" proliferated .
As the 19th century changed into the 20th, the press became bolder. On many papers the advertising exclusion policy toughened up considerably, and some publishers publicly flaunted the "red clause" which had hitherto held them in restraint. These newspapers, it is true, represented a minority of the American press: of all the gazettes which Massachusetts boasted, only the Springfield Republican had courage enough to report a lively debate in the state legislature over a nostrum-labeling bill. But this journal, the Chicago Tribune, the St. Louis Star, the New York Post, the New Orleans Item, the Seattle Post-Intelligencer, and a respectable group of other papers, down to and including the Telegram (circulation 500) published in Marine, Illinois, put public service ahead of advertising revenue and fought patent medicine abuses .
Some magazines also had spoken out in opposition to medical quackery. Orange Judd's American Agriculturist, begun in 1859, had excluded objectionable nostrum advertising and had set aside a special page on which to expose frauds. Wilmer Atkinson's Farm Journal, started in 1877, had adhered to the policy described in the circular announcing the first issue, that it would accept no "quack medical advertisement at any price." Popular Science Monthly took a perennial interest in quackery and through the years printed a series of able attacks. Even the staid Atlantic Monthly in 1867 published Dr. S. Weir Mitchell's The Autobiography of a Quack, a novel which revealed the shabbiness of the fake remedy game so vividly that it was reprinted in the Century when the anti-nostrum movement had heated up .
It was during the 1890's that the Ladies' Home Journal first got interested in patent medicines. Cyrus H. K. Curtis, the pub-lisher, came to the decision that proprietary ads must go, and, when the treasurer protested, the taciturn New Englander withered him with a look. In full agreement with his publisher and father-in-law was editor Edward Bok. He kept the Journal columns clean and occasionally wrote a harsh word about nos-trums, particularly the bitters of high alcoholic content. Many of Bok's feminine readers were ardent members of the revived temperance crusade, and WCTU leaders, more sophisticated than they once had been, were now well aware that Hostetter's Bitters and Peruna might provide an unwitting or a secret tipple. Through pamphlets, speeches, and propaganda in the schools, they battled the demon rum disguised as medicine. Bok gave them a helping hand .
The Journal's random attacks on nostrums turned into a vigor-ous campaign in 1904. The change of tempo owed much to a chance error. In an editorial condemning "The 'Patent-Medicine' Curse," Bok listed the ingredients of various nostrums, citing a document issued by the Massachusetts State Board of Health. One of the remedies was Doctor Pierce's Favorite Prescription, and it contained, said Bok, relying on his source, alcohol, opium, and digitalis. The company promptly launched a $200,000 libel suit, asserting that the medicine contained none of these. The editor found he had made a careless and costly mistake. The Massachusetts analysis he had depended upon was a quarter of a century out of date; new analyses run by chemists hired for the purpose confirmed the Pierce contention. So did a visit to the manufacturing plant. Bok printed a retraction, prepared for the trial, and stepped up his denunciation of the patent medicine business .
The Journal editor hoped that he might be able to find an old bottle of Pierce's remedy, perhaps in some isolated rural store, which would contain alcohol, opium, and digitalis. To make this hunt he needed an able and trustworthy man, and Bok hired a young Harvard-trained journalist and lawyer named Mark Sullivan. Despite a diligent search, the Journal's sleuth could find no such bottle as his employer needed for the trial. The woman's magazine lost its suit, and the jury awarded Pierce $16,000. In the meantime Bok had given Sullivan other undercover tasks to do, and, shadowed by detectives, he probed into the workings of the patent medicine business. Using assumed names, Sullivan advertised in the papers of various cities as if seeking to hire men skilled in different branches of the industry. Then he interviewed those who struck at his bait, the chemists, the experts in direct mail selling, the advertising specialists. Eager for better jobs, these men bragged about their own ability, revealing to Sullivan the tricks of the trade, confiding the formulas. He learned that letters written by ailing men and women in response to advertise-ments were sold, after the company had fully exploited them, to other proprietors. These pathetic and confidential missives ended up in huge bundles, packaged according to disease, and brokers sold or rented the letters for several dollars a thousand. Sullivan bought some packages and had them photographed. Another photograph became more celebrated. Sullivan soon learned that, although advertising showing Lydia Pinkham's maternal face might be read as suggesting that she would answer letters of inquiry from suffering women, the venerable lady had long been dead. Accompanied by a friend who owned a camera, he set out on a tour of the Pine Grove Cemetery near Lynn, Massachusetts, and found the imposing tombstone inscribed with the date of Mrs. Pinkham's passing, May 17, 1883. The picture soon appeared in the pages of the Journal .
It was Sullivan who found out about the "red clause" in advertising contracts. As a result of some delicate maneuvering, he secured a copy of the minutes of the Proprietary Association meeting at which Cheney had made his boastful speech. With this clue, Sullivan tracked down and photographed similar "muzzle-clauses" in the contracts of several major medicine adver-tisers. He also obtained pictures of letters written by proprietors to newspapers when danger loomed, and he secured direct quotations from Dr. Pierce's son praising the newspaper publishers' association for help in defeating inimical bills .
All of this sensational information Sullivan drafted into an article which he called "The Patent Medicine Conspiracy Against the Freedom of the Press." Bok liked it but felt it too "legalistic" and long for the Ladies' Home Journal and offered it to Norman Hapgood, the sober, scholarly editor of Collier's. Hapgood took it and Sullivan's article appeared in the magazine during November 1905. At the time that it was printed Collier's was in the midst of the most earnest campaign ever waged against patent medicines by an American magazine .
The crusade had started with a jest. William Jennings Bryan had been belaboring corporations in the pages of his personal organ, the Commoner, a paper which contained full-page adver-tisements for Liquozone, a nostrum promising to cure everything from dandruff to dysentery. Hapgood chided Bryan editorially, asking if it were not inconsistent for him to attack the immorality of corporations and at the same time countenance such an absolute therapeutic monopoly. Bryan did not appreciate the joke and wrote a letter of injured innocence. Liquozone's proprietor did not appreciate the joke and sent his lawyer to talk with Hapgood. "In a short time," the editor later wrote, "we were launched into a field we occupied for years." 
The more Hapgood looked into the matter, the more he was affronted by the fraud and effrontery of the patent medicine business. Collier's own hands were not clean, as Bryan had pointed out. The magazine was running advertising for such remedies as Vapo-Cresolene, which promised to cure whooping cough and diphtheria, and Buffalo Lithia Water, which posses-sed a "Marvelous Efficiency in Gout, Rheumatism, [and] Gastrointestinal Dyspepsia" lauded by no less a figure than the Physician in Ordinary to the Pope. Such ads Hapgood ordered expunged from his magazine, and he set out to find a reporter capable of digging out the facts and writing a hard-hitting full-scale exposure of medical quackery. The man he found was Samuel Hopkins Adams. The choice was one of the shrewdest in the annals of journalism .
Adams was no doctor, although he was not unfamiliar with matters medical. As an undergraduate at Hamilton College, he had pursued for a time a course in premedical studies. Journal-ism won him away from science, but Adams did not abandon his interest in disease and health. After graduating, he became a reporter, spending nine years perfecting his craft on the staff of one of the nation's distinguished newspapers, the New York Sun. He became adept at crime reporting and covered the major sensational cases of robbery and murder. Sleuthing techniques here developed were later to stand Adams in good stead. In 1900 he left the Sun to enter the employ of that driving temperamental genius of the journalistic world, S.S. McClure. Adams first edited the syndicate that distributed stories and articles to newspapers, and later served as advertising manager for the McClure publishing house .
While Adams was associated with these enterprises, McClure's Magazine suddenly became the most exciting periodical in America. On its staff were topflight reporters like Lincoln Steffens, Ida Tarbell, and Ray Stannard Baker. They began to write articles asserting that the American dream had been blighted. Big business had grown so huge, these journalists stated, that it had crushed American freedom, ruining small busi-ness, thwarting freedom of speech, and subverting all branches of government. Charges like these had been made before, but seldom so explicitly and never with such a wealth of circumstantial detail. McClure's authors were not content with generalities. They named names, mentioned places, and cited dates. There was already a reform spirit astir in America, here and there, when McClure's writers began to write. With their exposure articles they fanned local fires into a searing national flame. They were joined in this task by other writers on other magazines, for the booming circulation figures of McClure's led to widespread imitation. Never before had so many Americans, especially the great middle class, bought so many magazines. Never had the magazines treated the evils of society with such a combination of exact description and moral passion. Never -- unless the abolition crusade is excepted -- had exposure literature played such a compelling role. The leadership of American thought, said the philosopher William James, was leaving the universities and entering the ten-cent magazines .
In 1904, a year after the McClure authors had brought "muckraking" journalism to fever heat, Samuel Hopkins Adams resigned his post as advertising manager in order to write. No longer on the regular payroll, he continued to receive McClure's checks, since his important early articles appeared in the magazine shoulder to shoulder with pieces by Steffens, Baker, and Miss Tarbell. With them Adams shared a dedication to factual accuracy and a zeal for improving the lot of mankind, both of which marked his discussions of certain aspects of the public health. For Adams had turned to his continuing interest in medi-cal science for themes, writing on tuberculosis, yellow fever, typhoid fever, and surgical techniques. These subjects, good as they were, lacked one essential ingredient of the full-blown "muckraking" essay: the human evil-doer. Such a sinister figure was by no means absent from the medical scene. So Adams turned to patent medicines.
Ray Stannard Baker, as Adams recalled it, first suggested to him that he prepare a series on American nostrums. The idea struck him most favorably. He had done some thinking but no research when he was approached by Norman Hapgood. Adams owed first loyalty to McClure, who could have published the series, but for some unaccountable reason -- his staff could never predict his reactions -- McClure was lukewarm to the idea. Hap-good, however, was in earnest. Adams signed a contract and set to work.
The build-up for the Adams series lasted from April to October. Week after week, in editorial, jingle, and picture, Collier's whacked away at the nostrum menace. E.W. Kemble drew a "DEATH'S LABORATORY" cartoon, depicting a skull with patent medicine bottles for teeth. Hapgood wrote an article bemoaning the fact that America's most reputable newspapers opened their pages to disreputable ads, and he surrounded his words with a pictorial border linking patent medicine appeals with the mastheads of papers from which they had been clipped. The rhymster, Wallace Irwin, like countless other Americans, perused an advertisement and discovered to his horror
- That mushrooms were growing all over my liver,
- That something was loose in my heart,
- That due to my spleen all my nerves had turned green
- And my lungs were not doing their part.
- I wrote Dr. Sharko and got as an answer,
- "The wart on your thumb is incipient cancer .
Adams, in the meantime, was hard at work. He was gathering and studying examples of nostrum advertising. He was buying the medicines advertised, transporting the bottles to his Hamilton chemistry professor or experts at a pharmaceutical laboratory, and requesting them to find out what was inside. He was getting counsel from state agricultural chemists and consulting editors of pharmaceutical journals. With a list of curative claims and a list of ingredients, he was asking experts in medical research if the former could possibly derive from a dose of the latter. Adams was doing lots of leg work. He was selecting choice testimonials and then seeking to find the testators and get their stories at first hand. Nor was the busy journalist diffident about approaching nostrum princes themselves. One of the leading proprietaries of the day, a remedy so influential that babies were named for it , was Peruna. The maker of this much-vaunted tonic was a genial old German named Samuel D. Hartman, a trained physician. Adams journeyed to Columbus, Ohio, to talk with Hartman and was accorded a friendly reception. The medicine man told the reporter everything, even after being warned that the planned article was bound to be critical .
Not all remedy proprietors took such a charitable view of Adams' researches, and he found that his goings and comings were being followed by a private detective. Suddenly events took a nasty turn. One weekend Adams was invited to a house party in Connecticut. In the station in New York, he met the wife of a close friend, also on the guest list, and they rode together on the train. Soon thereafter it was brought to his attention that this episode had been observed and that the story of his train trip with another man's wife might be made public in an unfavorable way if he was so injudicious as to continue his investigations .
The suggestion of blackmail made Adams' blood boil, yet he was worried, for he shrank from any course that might bring embarrassment to the lady. As luck would have it, Adams was well acquainted with the mayor of the city where the nostrum proprietor lived whom Adams believed to be chiefly responsible for the threat. Hastening west, Adams told the mayor his plight. The city official knew just the facts which the journalist required. Not long before, the mayor reported, the nostrum maker had been surprised in a roadhouse room with another man's wife. When detectives had knocked on the door, the startled medicine proprietor had jumped from a window and broken his leg.
Adams cautiously let it be known that he was privy to this tale. Not only did he hear no more of the threat, but the detectives were immediately withdrawn.
Safely past this contretemps, Adams returned to his researches with a new zest. "A character inherited from a line of insurgent theologians," noted a Collier's colleague, "gave him firm conviction in his beliefs." And Adams "gloried in combat." In this respect appearances were perhaps deceptive, for the reporter looked younger than his thirty-four years and his face, rather than being pugnacious, was relaxed and pleasant, with soft contours and rounded features. His hair was cut long and parted just to the right, and he wore a high stiff collar and flowing cravat. Adams' amiable, indeed aesthetic, appearance may have fooled the patent medicine tribe into thinking him a less than worthy foe. No such miscalculations were made after October 7, 1905 .
On that date Collier's carried the first chapter of "The Great American Fraud." Adams' vigorous words appeared under a page-wide illustration showing a hooded skull in front of patent medicine bottles exuding noxious vapors. Sinewy serpents, so often the nostrum maker's symbol of evil, had now turned coat and slithered among the vials .
"Gullible America," Adams began, "will spend this year some seventy-five millions of dollars in the purchase of patent medi-cines. In consideration of this sum it will swallow huge quantities of alcohol, an appalling amount of opiates and narcotics, a wide assortment of varied drugs ranging from powerful and dangerous heart depressants to insidious liver stimulants; and, far in excess of all other ingredients, undiluted fraud. For fraud, exploited by the skilfulest of advertising bunco men, is the basis of the trade. Should the newspapers, the magazines, and the medical journals refuse their pages to this class of advertisements, the patent medicine business in five years would be as scandalously historic as the South Sea Bubble, and the nation would be the richer not only in lives and money, but in drunkards and drug-fiends saved."
After this sweeping introduction, Adams got down to cases.
He rebuked Pond's Extract for "trading on the public alarm"
by running an advertisement boldly headed "MENINGITIS"
while New York was suffering an epidemic. Next to his criticism
was a reproduction of the offending ad. Adams described how proprietary
manufacturers inserted into their advertising contracts with newspapers
the restraining clause printed in red ink. Beside Adams' words
was a picture of a contract which had been offered by the Cheney
Medicine Company to the Emporia Gazette. Adams explained
that patent medicine testimonials were gathered from gullible
ignoramuses or secured through various pressures from people in
public life. He told the tale of the visit to the advertising
manager of a Chicago newspaper by an agent for Paine's Celery
Compound. The agent showed the manager a full-page advertisement
with blank spaces in the center.
"We want some good, strong testimonials to fill out with," he said.
"You can get all of those you want, can't you?" asked the news-paper manager.
"Can you?" returned the agent. "Show me four or five strong ones from local politicians and you can get the ad."
"The Nostrum Evil," as Adams entitled his initial article, con-tained other generalizations buttressed by specific instances. It was, indeed, a sort of broad preview of what he intended to treat in more detail in the articles to follow.
Adams followed his first general attack on nostrums with the exposure of Peruna, about which he had warned its friendly proprietor at the beginning of their conversation. The article opened with a quotation from a public health official .
"Let us," the man had suggested to Adams, "buy in large quantities the cheapest Italian vermouth, poor gin, and bitters. We will mix them in the proportion of three of vermouth to two of gin with a dash of bitters, dilute and bottle them by the short quart, label them 'Smith's Revivifier and Blood-Purifier; dose, one wineglass ful before each meal'; advertise them to cure erysipelas, bunions, dyspepsia, heat rash, fever and ague, and consumption; and to prevent loss of hair, small-pox, old age, sunstroke, and near-sightedness, and make our everlasting fortunes selling them to the temperance trade."
"That sounds to me," Adams had replied, "very much like a cocktail."
"So it is," the health official noted. "But it's just as much a medicine as Peruna and not as bad a drink."
Peruna's alcoholic content, Adams discovered, ran about 28 per cent, and a dollar bottle of the remedy cost its manufacturer -- including the bottle -- between fifteen and eighteen cents. As a medicine Peruna was promoted to cure nothing but catarrh, but catarrh in Dr. Hartman's pathology was a term encompassing appendicitis, consumption, mumps, and female complaints. Adams reported on Peruna "alcoholics" he had met, at least one of them a member in good standing in the WCTU, and he repro-duced an Office of Indian Affairs order to Indian agents prohibit-ing the sale of Dr. Hartman's product as an intoxicant "too tempting and effective." Among the many Peruna testimonials written by men in high places, Adams was particularly fond of the assertion by a North Carolina Congressman: "My secretary has as bad a case of catarrh as I ever saw, and since he has taken one bottle of Peruna he seems like a different man."
Next in the series came Liquozone, the nostrum which had started Collier's on the muckraking trail. Like numerous other remedies, it trafficked on the public's wariness of bacilli, and paraded as a universal antiseptic. Like Radam's Microbe Killer, Liquozone was 99 per cent water, though devoid of red wine. The one per cent was made up of sulphuric and sulphurous acids, with occasionally a trace of hydrochloric or hydrobromic acid. The risks a sick man ran in relying on Liquozone were those of neglect; proper medical treatment was not initiated. This was a serious charge to bring against the fake antiseptics, but it was still not so brutally fiendish a crime as that of which "The Subtle Poisons" were guilty .
These were, Adams believed, "the most dangerous of all
quack medicines." They were less transparent in their quackery
than Peruna and Liquozone, so even highly intelligent people fell
prey. Not only did they pose an immediate danger; they also created
"enslaving appetites." What were these insidious poisons?
They fell mainly into two classes, Adams said. One was made up
of catarrh powders that contained cocaine and soothing syrups
that contained opium. Medicines of this sort might threaten sudden
death, but, almost worse, they led innocent victims into narcotic
addiction. It was a "shameful trade," Adams asserted,
"that stupefies helpless babies, and makes criminals of our
young men and harlots of our young women." The second class
-- nostrums loaded with acetanilide -- were nearly as dangerous.
These too were habit forming and sometimes, because of a personal
susceptibility or through an overdose, led to death. The names
and addresses of twenty-two such victims Adams listed in a box
accompanying his article. The symptoms of still-living victims
of acetanilide were also grim. Adams quoted a medical report:
"Stomach increasingly irritable; skin a grayish or light
purplish hue; palpitation and slight enlargement of the heart;
great prostration, with pains in the region of the heart; blood
discolored to a chocolate hue." And yet Orangeine, one of
the acetanilide mixtures in widest use, claimed that it would
strengthen the heart and improve the blood. "Thus far in
the patent medicine field," wrote Adams, "I have not
encountered so direct and specific an inversion of the true facts."
The same statement, however, he might have applied to much of the advertising written by proprietors who were "Preying on the Incurables." "There are being exploited in this country today," Adams stated, "more than one hundred cures for diseases that are absolutely beyond the reach of drugs. They are owned by men who know them to be swindles, and who in private conversation will almost always evade the direct statement that their nostrums will 'cure' consumption, epilepsy, heart disease, and ailments of that nature." From two New York Sunday papers of the same date Adams clipped nearly a score of ads categorically promising to cure cancer, consumption, and fits, and reproduced these false promises in "A Fraud's Gallery." He reported the ingredients which some of these purported remedies contained, drugs like chloroform, opium, alcohol, and hashish, which could well hasten the course of the diseases they promised to eradicate. Adams concluded his discussion in somber mood: "Every man who trades in this market, whether he pockets the profits of the maker, the purveyor, or the advertiser, takes toll of blood. He may not deceive himself here, for here the patent medicine business is nakedest, most cold-hearted. Relentless greed sets the trap, and death is partner in the enterprise." 
In February 1906 Samuel Hopkins Adams concluded his series on "The Great American Fraud." He set to work immediately on another series, directing his detailed facts, his wit, and his scorn against the advertising doctors with their fake clinics and institutes. Editor Hapgood, in the meantime, kept up the pressure in his editorial columns, through his own barbed words, letters from grateful readers, and promises from newspapers which, with blinders removed, were joining the anti-nostrum crusade. Opposition evoked by the Collier's campaign also was quoted. The magazine was "A Yellow Weekly," said a Philadelphia editor, and its survey of the medical scene "a hideous and ghastly caricature." Medicine makers themselves felt aggrieved. One company threatened to sue Collier's for $50,000. The magazine did not court the suit, Hapgood replied, although it did not fear it. "The mere threat . . . will furnish the Proprietary Association of America with material for press notices: 'Another worthy medical firm grossly libeled!' 
Adams, indeed, avoided the embarrassment and Collier's the expense which had afflicted Bok and the Ladies' Home Journal as a result of carelessness. No statement was printed about a nostrum in Adams' articles, unless the ingredients were listed on the label, without a chemical analysis being made. Some 264 medicines, doctors, and firms were mentioned in the ten articles which Adams wrote. Four months after the last one had appeared, Hapgood asserted, the only damage suffered had been two personal protests "filed" with the magazine and two libel suits still on the docket .
By no means all the medicine men who smarted under the Collier's lash protested to the magazine. They had other channels through which to express their anger: the receptive pages of friendly papers, certain drug and medical journals, anonymous pamphlets. One of the latter termed Bok guilty of "gross misrepresentation" and called Hapgood "ignorant or ... malicious." These men, the pamphleteer charged, "want a sensation. . . . They could not make a sensation if they merely told 'the truth and nothing but the truth.' So they simply prevaricate -- affirmatively and negatively -- directly and indirectly -- by implication and by suppression and in every other way which serves their purpose; and they have the presumption to ask reputable publishers of this country to follow their lead!" 
This pamphlet and others like it also included harsh words aimed at physicians who condemned proprietary medicines. Collier's had been pleased to cite praise received from doctors for the Adams series, although Hapgood believed, just as Bok did, that the medical profession had been tardy in assuming its full measure of responsibility in the fight against medical quackery. "So far," Hapgood editorialized, ". . . the Medical Societies have done little but pass resolutions." It was a sentiment with which even the Journal of the American Medical Association reluctantly agreed. Nonetheless, the remedy proprietors were not wrong in fearing both doctors and journalists and in seeing a connection between the two. During the same months that the muckraking of nostrums was at high tide, the medical profession was assuming a much more aggressive role. The American Medical Association began a campaign that would at long last eliminate suspect advertising from its Journal. To provide a clear basis for separating proprietaries of value from those of disreputable stamp, a Council on Pharmacy and Chemistry was created. Its members, skilled physicians, pharmacists, and chemists, set about analyzing the ingredients in proprietary products and studying their techniques of promotion. The results, good or bad, not only determined the Journal's advertising policy but also appeared in the news pages for all who wished to read .
Nor did the Association limit its scrutiny to nostrums adver-tised directly to doctors. As proof of their wider concern with quackery, the American Medical Association reprinted Adams' vigorous articles in a booklet which was sold for a nominal price. In time nearly 500,000 copies of The Great American Fraud were bought by disturbed Americans. Doctors were also engaging in deliberate and effective pressure to achieve the goal which Collier's and the Ladies' Home Journal most desired, the action which the nostrum makers most opposed: national legislation regulating the patent medicine trade .
The manufacturers of proprietary remedies were right. There was a plot against them. It included not only muckraking writers and doctors, not only pharmacists and chemists. There was also a governmental contingent. State legislators were seeing the light and feeling the pressure. Members of the national House and Senate were growing increasingly concerned. In the executive branch, President Theodore Roosevelt had said a few words, and down the chain of command, in the Department of Agriculture, was a man who had said a great many more: Harvey Washington Wiley, chief of the Bureau of Chemistry. Wiley had long been pleading for a national law. While gathering material for "The Great American Fraud," Samuel Hopkins Adams had sought help from many sources, one of them Wiley's laboratory . To the red-brick building in Washington also had gone many other men and women desiring to tell the American people why laws were necessary if nostrum abuses were to be restrained.
The manufacturers of proprietary remedies were right. There was a conspiracy against them. And so many American citizens were becoming party to it that the outlook at long last was favorable that a protective measure might be passed.