From Care to Capitalism
Throughout the seventeenth and early eighteenth centuries, women were entrusted with the health of their families. In this capacity, women sometimes administered opium to help family members manage pain and nervousness. During the early 1800s, as the United States began to develop its medical infrastructure, demand for opium increased and became a staple in nearly every physician’s bag. These physicians were usually white, middle-class men who built their practices by attending to white women of comparable social standing. Unlike men, who were expected to endure their afflictions without pain medication, white women were generally regarded as delicate and were therefore encouraged to seek medical care.
This assumption, combined with the limited understanding of many physical and psychological conditions in the nineteenth century, contributed to frequent misdiagnoses. Physicians mistakenly attributed unrelated complaints of debilitation, chronic pain, and psychological distress to uterine disease. Sexual taboos aimed at preserving white women’s purity often hindered the research needed to investigate these complaints and physicians turned to opiates for symptomatic relief. By 1900, middle- and upper-class white women made up nearly two-thirds of people with opiate use disorders. While many historians attribute this to professional overprescription, there was another significant agent of addiction: the patent medicine industry.
Over the course of the nineteenth century, American pharmacy moved away from its apothecary model, and pharmaceutical companies and entrepreneurs came to produce most medicinal preparations in the form of patent medicines. The term “patent medicine” itself originated in seventeenth-century England, where the crown issued patents granting inventors a monopoly over a specific formula. Over time, it was adopted for similar mass-produced preparations in the United States. This term helped sellers evoke a sense of official endorsement, although manufacturers usually only registered a trade name with the U.S. Patent Office and not a list of ingredients. Most patent medicines contained opium and alcohol, which manufacturers were not required to disclose before the 1906 Pure Food and Drug Act, and could be purchased in stores or by mail-order without a prescription.
Patent medicine companies realized that accessible products with specific names and purposes would appeal to middle-class white women, who were conditioned to see themselves as perpetually unwell but often misdiagnosed by physicians. As a result, women’s health became a specific industry branch, and patent medicine companies were able to advertise their unique products without restriction. Unrestricted advertising abilities gave companies an additional advantage over physicians, as commercialism was considered unscrupulous by members of the medical profession. Companies eagerly exploited this advantage, and medical misogyny, in nationwide campaigns that promoted addictive nostrums for women.