Historiographic Overview
For students and teachers, this section provides examples of the secondary literature on this topic. In general, this essay serves as an overview of some of the issues relevant to this subject.
Quackery
Quackery might arguably be called an understudied subject, but it has not been ignored. Some scholars have made quacks and quackery a much more central component of their research projects. This essay will focus on pieces fairly representative of the work set in the eighteenth-century by three authors who have in particular spent considerable time on the subject of quackery. The authors and their works we discuss here include: James Harvey Young’s Toadstool Millionaires, William Helfand’s Quack, Quack, Quack (which we will review in more depth later, and Roy Porter’s Quacks. These books each cover the scene in slightly different ways, and together provide a sufficiently rich picture of eighteenth-century quackery.
Helfand
William Helfand, a pharmacist, spent years collecting posters, prints, and ephemera involving medicine, especially pharmacy in its commercial aspects, and is accepted as an expert on the subject. Quack, Quack, Quack, is a look at quacks from this perspective — it is the catalogue to an exhibit of historical materials featuring an introduction and contextualizing captions by Helfand. “A quack,” for Helfand, “is someone else” (Helfand, 11). Helfand begins the book identifying with those who in times past relied on marketing and innovative if not novel business practices. Given that history is often written from the point of view of increasingly powerful doctors, “Where were the losers?” Helfand asks (Helfand, 8). He ends, however, revealing his true judgment of quackery. Noting that quackery will continue, “despite what we do” (Helfand, 50), he implies that quacks are our enemies and that they persist despite our attempts to foil them.
In the introduction, Helfand does a good job of giving an overview of quackery (with an emphasis on America and England) over a large span of time, but is not always careful to provide a historical perspective. For instance, Helfand tells the reader not only that, “Quacks have been with us forever,” but, “the quacks and their nostrums will,” also, “be with us forever” (Helfand, 40, 50).
As to why quackery has persisted over such a long expanse of time, Helfand suggests a few reasons, including: that quacks often play upon the fears and hopes of their customers, quack nostrums might have simply been cheaper and more convenient (economically as well as in general) than more expensive medical care; and that the efficacy of regular medicine, even today, has limits.
Young
James Harvey Young, whom Helfand refers to as “the scholar of American quackery” (Helfand, 9), authored Toadstool Millionaires in 1961. He concludes the book with the 1906 passage of the Pure Food and Drugs Act by Congress, which should lead us to question his biases. In fact, the approach he takes in Toadstool Millionaires reflects his 40-year career as a “quackbusting” historian. The final passages of the epilogue are particularly pointed in their exhibition of Young’s dislike of quacks. Young’s open allegiance to the, “medical brilliance of our own day,” (Young, 262) should perhaps not surprise us, given that this book was researched and written before the social and cultural turns and the rise of post-modern influence in history, which cumulatively resulted in a turning of the focus of scholarship in the last three decades of the 20th century away from “great men” and more toward stories of women, common folk, and otherwise understudied or marginalized groups. Given Young’s clear agenda in roasting quacks, we should be careful in what we glean from his work.
The most important thing we can take from Toadstool Millionaires for our understanding of 18th-century American quackery is simply the framework and the basic details which Young provides. The book begins by briefly discussing regular and irregular medicine in England. As people came to America in the eighteenth century, however, the medical scene to which they arrived was different in important ways. Lack of credentialed doctors meant that the boundaries of practice and authority among various health practitioners — surgeons, apothecaries, doctors, and even lay and folk healers — were not as strong as in Britain. Quackery, therefore, was more important to the process of providing regular care in America and quacks in general drew less ire for it. Furthermore, until the Revolutionary War hindered trade, most patent medicines in America were being imported from Britain and were therefore not “home grown” nostrums. Thus, Young argues, with the exception of a handful isolated cases, American quackery and the selling of nostrums did not take on a vigor equal to that in Britain until after the Revolutionary War and the formation of the Union.
Porter
If we accept Young’s idea that 18th-century American regular and irregular medical practitioners were modeling themselves after those in Britain, we might wonder what Britain’s healthcare environment looked like. It is in this sense — showing us the state of affairs in Britain in which the American situation was based — that Roy Porter’s Quacks can be useful.
Quacks, an illustrated version of Porter’s 1989 book, Health for Sale, is a solid work of scholarship explicating the social and cultural phenomenon of quacks in the long-18th-century Britain. The most important aspect separating this book from the other works is Porter’s attention to the problems of defining exactly what a quack is. He rejects the notion that a scholar should pre-judge quacks, thus eschewing an essentialist definition of the term defaulting either to our present-day assumptions or the characterizations of their critics. By properly historicizing quacks, Porter argues, one can properly identify them according to their behavior. For Porter, this leads to seeing quacks in the context of their economic realities. From this perspective, a key characteristic that can help us in distinguish quacks from doctors is their lack of a clear and stable client base, a circumstance which necessitates appealing to strangers — the mass market — to garner customers. This opens the door to thinking about quacks, and healthcare more generally, in terms of markets and consumerism.
With respect to the study of America, however, the book ultimately should be seen as a beginning to further inquiry. The care with which Porter takes to compellingly complicate and synthesize eighteenth-century quackery in Britain does not do much to deepen our understanding of the knowledge and practices of American quackery. Quacks does, however, help us consider some of the ways we might learn more about quackery in America. It not only blueprints the state of medicine which served as a template for American (especially pre-Revolutionary) medical thought and practice, but also blueprints a conceptual framework for quackery’s future study.
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In closing, we regret that no recent monograph exists which sufficiently integrates the thought and practice of regular and irregular medicine in pre-Revolutionary America. Although the readings we have reviewed suggest that historians have not in large measure focused on eighteenth-century quackery in America, the reason why this is the case is not clear. Perhaps it is because the first half of the phrase, “American quackery” is as important as the second — maybe Young, in the end, was correct to suggest that distinctly American quackery was not a very visible, or even vigorous, activity in this time period. This conclusion does seem quite possible given the limited attention the topic is given in the existing literature. Nevertheless, the authors we have investigated do provide us with a basis for further inquiry into the role and prevalence of quackery. For even if we conclude that quackery was not a considerable part of Philadelphia’s Web of Healing, it may be just as important to analyze why this was the case.