Medicine cabinets are amazing spaces. They can contain a multitude of pills, pastes, syrups, and wrappings that we know we can reach for to manage many types of pain, ailments, and illnesses ourselves. They can provide a window into a person's well-being—really? you've never peeked after washing your hands?—and tell us what works for them. Such forays can give us a basis for making decisions about similar conditions. After all, medicine cabinets house a collection of expertise—all packaged in a way to make them identifiable and trustworthy so that in the absence of a physician, we're confident of receiving treatment within the promised parameters of healing.
Between 24-hour pharmacies (1) and Web MD, at any given moment we have access to patented non-prescription, or over-the-counter (OTC), medications, and medical information that we are free to weigh and use at our own discretion. We might take this for granted as we reach for that bottle of antacids or pain relievers or cough syrup, but the establishment of non-prescription patented medication represents a significant movement toward access to standardized health remedies. And as discussions about access to health care rage around us in the United States, OTC medication has become for many a primary means of treating ailments. The standard of care in our medicine cabinets is increasingly for many a measure of health
Packaging a Cure
In the video game Assassin's Creed when you're in need of medical attention you have the option of visiting a medical stand and purchasing medicine vials meant to completely cure your ailments, whatever they might be. While no such miracle cure really exists, the medical experience in the game isn't all that far from the reality of health care for much of history. While medical professionals were required to have training, the standard of practice varied—particularly in the 17th-, 18th-, and early 19th-centuries when medical care was dispensed by physicians, doctors, barber-surgeons, and apothecaries.
The advent of the Scientific Revolution and the following Age of Enlightenment saw an explosion of cross pollination between the sciences that allowed doctors to treat illnesses and injuries with greater success. However, during this period and up to the early 19th-century, the odds of a single patient receiving successful treatment from a physician were 50-50 (2). Methods of treatments varied in accordance to superstition, astrology, and religion. For example, the doctrine of signatures maintained that God had provided a natural cure for every illness—as was evidenced by the resemblance some herbs bear to various parts of the body (i.e., liverwort could cure ailments relating to the liver). And ideas about balance were rampant; the prevalence of the theory of humours—that there were four fluids in the body (black bile, yellow bile, phlegm, and blood) that needed to be in balance for good health—encouraged the practice of bloodletting.
In this context, physicians sought to distinguish themselves by patenting their cures, which meant serving them in specific bottles and with particular labels. The more famous of these include Godfrey's Cordial, Dalby's Carminative, Bateman's Drops, Turlington's Balsam of Life, Steer's Opodeldoc, British Oil, Daffy's Elixir, and Balsam of Honey (2). But patents weren't enough to cement these cures as trustworthy in the minds of the purchasing public. But the longstanding success of these medications was also in part due to their reproducibility. They were easily counterfeited, right down to their packaging—but they were chosen to be counterfeited because they worked. So in a sense, they became public property. You wouldn't be too far off in thinking of these early counterfeits as generic brand medications. The public trust in the formulas allowed drove the market for patented (and counterfeited) cures in more rural areas where obtaining medical care was a challenge. These formulas in their tell-tale bottles and wrappings placed medical treatment conveniently within reach of many people.
The Essence of Peppermint: A Case Study
The Essence of Peppermint [pdf] provides a useful case study in considering the factors of success, trust, and counterfeiting in creating a standard of care via patented medication.
Essence of Peppermint is a simple mixture of peppermint oil, water, and alcohol. The addition of peppermint water functioned as a means of enhancing the flavor of treatments like Castor oil. It was also used to alleviate nausea, stomach pains, reduce gas, and relieve headaches, toothaches, and rheumatic ailments (3). In 1762, John Jupiter, a chemist and Westminster-based apothecary, obtained a royal patent that would allow him to prepare and sell essence of peppermint for fourteen years. This patent acted as a stamp of approval in his marketing efforts:
ESSENCE OF PEPPER-MINT By his Majesty's Royal Letters Patent, Is now well known to give speedy relief to cholicky and gouty pains in the stomach and bowels, in the sea sickness, in Teachings from other causes, and in all disorders arising from wind; multitudes of infants as well as others, are daily relieved from its grateful, cordial, and stomatic effects, which are not equaled by any other medicine.
Prepared and sold by J. Juniper, chemist and apothecary, in Dean Street, near Gerrard street, Soho. in stopper bottles 3s and vials Is each, and is by him appointed to be sold by Mr. Oldham, chemist, in the Hay-market; Mr. Churchill, chemist, in the Stand; Mess. Vernor and Charter, booksellers Ludgate-hill; Mr. Wilkie, St. Paul's Church yard, at the Rainbow coffee house, Cornhill; by Mr. Grey, chemist, in Bishopgate street without, near Spital-square; and Mr. Biddle near Whitechapel-bars (The Gazetteer and New Daily Advertiser 1767:3). (4)
Five years later, Jupiter would introduce an embossed vial with the words "King's Patent" and a specific wrapping, which when combined with the green colored cure contained within established the Essence of Peppermint as a recognizable cure.
The simplicity of the formula, however, ensured that it would not remain proprietary. Jupiter's marketing efforts took medication beyond the shores of Great Britain. With the promise of relieving sea sickness, these small vials traveled to North America, where they were essentially removed from his association by virtue of distance. With time, the distinctive bottles, complete with the King's Patent embossing, and their wrappings were produced in the United States, further removing Jupiter from the manufacture and sale of the Essence of Peppermint. The small variations that resulted in the packaging—i.e., font types and sizes—didn't dilute the popularity of the medicine. The similarities were enough to help maintain the brand and help establish subsequent versions of Essence of Peppermint as a standard that could be trusted.
This particular presentation for Essence of Peppermint lasted for 120 years. The vials consistent physical appearance in the archaeological record has allowed them to be tracked to various military and trade contexts, suggesting that they were purchased for personal use as well as gifts (5). For example:
At both Fort Beausejour/Cumberland in New Brunswick and Fort Coteau-du-Lac in Quebec, there were long periods of time when these posts were manned by only a small detachment of men which would not likely have included a regimental medical person. Under such circumstances an easily administered, simple remedy like Essence of Peppermint may well have been a logical type of drug or medicine to have with the detachment.
In the late 18th-century and into the 19th-century, essence of peppermint was also specifically listed among the medicines carried by trading companies such as Hudson Bay Company, the Northwest Company, and the American Fur Company suggesting that Essence of Peppermint was widely known and a popular sale item. Its popularity may have also extended its medicinal properties beyond its originally advertised purpose.
OTC as a Primary Means of Care
The United States is home to roughly 312 million people. And 50 million of those people are without health insurance. A very public and accessible story about the lack of health insurance and the reliance of OTC medications comes from marine biologist and science writer Kevin Zelnio, whose son was hospitalized earlier this year with pneumonia. Zelnio discusses a reliance on patented OTC medicines and a shift in behaviors to help keep his family healthy:
That was until my eldest started kindergarten this Fall. Now he is frequently at home for a few days with colds or mild flus. Still it’s nothing that popsicles, Dimetapp and a bunch of TLC can’t take care of. I work from home as a consultant and writer, so it didn’t bother me too much if and when I get infected, plus I am there to help my family when they fall ill.
But recently my mindset has become affected by our position. I tell my kids not to do things that I certainly enjoyed doing as a kid, like don’t climb high on trees, run a little slower on the trail, watch out for roots and stones! It’s not just the usual parental concern either. I’m consciously thinking “oh my god, I cannot afford to fix them if they get broke!”.
Zelnio's story has a happy ending: his son makes a full recovery ... and he moves his family to Sweden.
But Zelnio is not alone in his reliance on OTC medications. Jonathan Cohn's Sick documents the stories of Americans who are increasingly unable to pay for prescription drugs and regular check-ups. Stories like that of the Maldonados—who lost their health insurance and then found that Medicaid was unable to cover their medications and so began rationing their prescriptions—are common throughout the book. They rarely have happy endings: Ernesto Maldonado dies of a heart attack because he cuts a blood thinning medication. Reduced access to health care and prescription medications often forces people to seek alternative care. For these people, the means to self treat may not necessarily represent a cure, but it does present a degree of power. However, that sense of power may be a false one.
Patent medication placed remedies within reach for people who had no knowledge of how to prepare medicines or lacked access to the necessary plants and other ingredients to produce the remedies themselves. And it is is often to these means that people return to when medical care is just beyond their reach. But in the event of serious illnesses, it's unlikely that OTC medications will be enough.
How likely are you to turn to your medicine cabinet before seeking professional medical attention? Where do you get medical information when you need it—your mom, friends, the Internet? And how do you weigh when the contents of your medicine cabinet aren't enough?
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Cohn, Jonathan. 2007. Sick: The Untold Story of America's Health Care Crisis—And the People Who Pay the Price. New York: Harper Perennial.
Johns, OR (1981). Essence of Peppermint, a History of the Medicine and Its Bottle. Historical Archaeology, 15 (2), 1-57 PMID: 11632091
Miles, Ann (1998). Science, Nature, and Tradition: The Mass-Marketing of Natural Medicine in Urban Ecuador. Medical Anthropology Quarterly, 12 (2), 206-25 PMID: 9627923
1. In New York City, at least. | 2. Jones 1981: 2. | 3. Jones 1981: 4. | 4. Jones 1981: 7. | 5. Jones 1981: 26-31.
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