"To delay for the sake of diagnosis is simply to waste valuable time. It is one of the errors of so-called scientific medicine, and should have nothing to do with the cure."
-- William Radam, 1890 
Any Americans got their first inkling of the germ theory of disease from patent medicine advertising. Always among the first by which the new is tried, nostrum promoters were quick to sense the dramatic implications inherent in the researches of Pasteur and Koch and their fellow-scientists. Even before most American physicians had become persuaded that bacilli could cause disease and that weakened bacilli introduced by inoculation could promote immunity , a rash of germ-eradicating nostrums had assailed the mass market. Among the first and boldest was a pink liquid called the Microbe Killer. It was made by William Radam, a Prussian who had emigrated to the vast state of Texas.
This contemporary of Pasteur -- and Radam was wont both to cite the French bacteriologist and to berate him for limited vision -- had once been a soldier in the Prussian army. His real occupation, however, was that of gardener. "Circumstances of my early life," he wrote, "placed me in close commune with Nature." Settling in Austin, Texas, Radam devoted himself to raising fruits and flowers. For nearly two decades he improved his thirty acres of soil and operated a nursery and seed-store. Then disaster closed in upon him. Radam for years had suffered with malaria, trying in vain the remedies prescribed by a whole host of physicians and proprietary advertisers. At length his condition worsened, complicated by sciatica and rheumatism. To physical suffering was added overwhelming grief, for two of Radam's children died. Desperate and despondent, the gardener set out to find his own cure .
Radam turned to nature to show him the path to truth. "All my early life," he wrote, "was passed amid flowers." Radam had been no mere dirt gardener. He had sought to keep himself informed of horticultural advances. "I was an earnest subscriber," he asserted, "to every floral magazine that came within my knowledge." In the pages of these periodicals Radam discovered clues that aided him with his experiments. He turned to medical journals too, but they proved no more helpful to his inquiry than physicians had been to his health. Indeed, he said, "whenever I took one up it diverted me from the line of my researches, disturbed the tenor of my investigations, and confused my ideas."
The medical journals, nonetheless, seem to have provided Radam with a key clue, the microbe. He became convinced that his body was filled with these minute but evil creatures. "When I drove to my seed-store," he wrote, "I knew that I could sit only on the edge of my buggy, because the microbes would not let me sit any other way, and when I stepped to the ground I knew that it took me several minutes before I could move, the microbes that produced sciatica and rheumatism being disturbed and so preventing me." The gardener was a living barometer. His "collection of microbes" could anticipate an imminent cold snap by two days, and "when the storm came, they would freeze, and force" him "to take refuge by a red-hot stove to get them quieted."
In his dire extremity, Radam was dazzled by the blinding light of revelation. Killing microbes in the human body, he decided, was the same as killing bugs on plants. With this latter task he had long been concerned. Radam recalled all the pest poisons he had read about. He thought back over all the chemicals he had used. He remembered offering a $1,000 prize for something that would destroy cabbage blight without hurting cabbages. Two military men had tried for it. They placed an old kerosene can over an ailing cabbage plant and ignited a spoonful of sulphur inside the can. The fumes did indeed kill the blight, "but the cabbage, too, was dead as a doornail." This experiment had failed but, thinking back upon it, Radam became persuaded that "if I could discover any thing that would kill blight, fungi, and microbes on plants without injuring them, I should also be in possession of something that would cure me."
Aided by his garden books and a small microscope, Radam set forth to save his life. He began to perform experiments on the diseases that afflicted grapes, strawberries, and geraniums, treat-ing them with poisons suggested by the Department of Agriculture, dosing them with drugs and medicines left over from his own vain quest for health. The gardener was horrified that so many of the chemicals prescribed by doctors for man's ills were lethal both to fungi and to plant. But he gathered a few hopeful hints from his toilsome greenhouse hours.
Another of nature's purifying mechanisms, Radam believed, was lightning, which during a thunderstorm cleared the air. At such times, he asserted, "no fungi were formed, and I too felt better, breathing more easily and being more free from pain." Meat and milk kept longer, also, and plants were "more full of life." Radam asked himself the question: "What is air? Is it nothing more than oxygen, nitrogen, carbonic acid, ammonia, and water, with electricity pervading all? And if there be any thing more, what is it? and how can we make it?" The persistent gardener devised an apparatus which, he thought, might duplicate nature's beneficial action. It failed, but he tried again and again. "I must either succeed or die," he wrote, "so I put all my energies into it, and persevered." After a year of effort, he found what he was after, and he christened it the Microbe Killer.
The miraculous potion that flowed forth from Radam's experiments was, he held, a universal non-poisonous antiseptic. As the germs of decay in houses were destroyed by paint, in railroad ties by creosote, in meat by wood smoke, and in corpses by embalming fluid, so the microbes of decay in the living body were annihilated by his marvelous discovery. The concoction could be taken in such huge amounts that it would saturate all the tissues and permeate all the blood of the human frame, and this with safety to the person, with destruction to the microbes. The remedy was therefore sovereign: it could bring all disease under absolute control.
'What made Radam so sure was that he had tried his invention on himself and it had saved his life. He had drunk copious draughts. The microbes had fought back. His blood teemed with them, and he could feel them moving about in anguished protest against the action of the medicine. The battle almost destroyed the battleground. Radam felt weak and low. But on he went. The microbes gave grudging ground. In three months the gardener felt like a new man. In six the last microbe was dead and Radam was cured.
The physician had cured himself and, according to his theory, he could cure all men. Yet he wanted further proof. The Microbe Killer, Radam realized, might make the basis of a profitable business. But he had no medical training. In what was basically important, Radam felt, this made no difference: to cut down weeds, need a farmer be a botanist? Nonetheless, there were hazards. The doctors were tightly organized and jealous of competition from without their ranks. Radam knew he ran the risk of a charge of manslaughter should he give his helpful medicine to a patient who might die from the poisons being simultaneously administered by a regular physician. For the next stage of his tests, the gardener determined to find hopeless cases not under other treatment. He learned from his Negro workers of a man dying of consumption and of a woman suffering from a growth in her breast. Even yet, Radam was cautious. He did not prescribe his remedy for the woman, nor put a jug of it into the hands of a man who came to report her sad plight. Radam told him that if he wanted to take a gallon there was one in the next room. "The gallon soon disappeared," Radam recorded, "and I consoled myself with the thought that if the woman died I could conscientiously swear that I did not give her the water."
But the woman did not die, nor did the consumptive man. Both were restored to health. Other people heard the news. Many were mystified, finding it hard to believe that Radam, "a nurseryman and florist . . . a plain man, from a so-called backwoods country," could have made such a revolutionary discovery. But they begged tearfully for Microbe Killer to treat their ailments. Radam gave it to them. Cures mounted. Soon Radam was so busy making medicine that his gardens went to weeds. With some reluctance, for among his flowers Radam "felt like a father among his children," the medical pioneer determined to let both himself and the world profit by his discovery.
In 1886 Radam patented his invention, "a new and Improved Fumigating Composition for Preserving and Purifying Pur-poses." The text of his specifications was singularly silent about the medical purposes the gardener had in mind. He did avow that his invention would "kill all fungus, germs, parasites, and other matter producing fermentation or decay," but Radam stressed the value of this, not for preserving health, but for preserving fruits and meats. The patent revealed how he managed to ape nature's lightning. Inside a large closed tank the inventor built an oven. Into the bottom of the tank he poured water, and into the oven he placed a mixture of chemicals: four ounces of powdered sulphur, two ounces of nitrate of soda, an ounce of black oxide of manganese, an ounce of sandalwood, half an ounce of chloride of potash. The chemicals were burned, the products of their combustion mingling with the vapor of the heated water and being absorbed by the water remaining in the tank. When the combustion was over, the water was allowed to cool. Sediment and floating particles which had spilled over from the violent burning were removed. The water was drawn off and tinted a pale pink by the addition of wine. The sovereign remedy was ready for bottling .
Such a process of manufacture was so haphazard that no two Microbe Killer batches would contain the same proportion among the ingredients. Yet on one thing all future analysts were to agree, that the lion's share of Radam's remedy was water. A Department of Agriculture chemist was to place the percentage at 99.381. As for the rest -- what rest there was -- a doctor was shortly to suggest that a product identical with a batch of the Microbe Killer which he had analyzed might be produced for less than five cents a gallon by adding to a gallon of well water about an ounce of red wine, a dram of impure muriatic (hydrochloric) acid, and four drams of impure oil of vitriol (sulphuric acid). Such was Radam's man-made pink lightning .
If Radam's patent was vague on the relationship of his process to therapeutics, the same could not be said for his trade-mark, secured the next year. This symbol was reminiscent of the design which William Swaim had devised for his Panacea seven decades earlier. In both, a husky male wielded a mighty club, but Radam's hero was a 19th-century Hercules, clad not in shaggy pelt but in neat business suit. Instead of swinging at a multi-headed Hydra, this athlete wielded his gleaming bludgeon at a tall skeleton, its bony arms raised to ward off the inevitable blow. Thus would the Microbe Killer conquer death itself .
Radam began to advertise his "solution of gases." "My life at this period," he wrote, "became very exciting, very different from the peaceful times I had among my flowers." Demands from the ailing, reading testimonials of Radam's early patients, grew so great that he was hard put to keep up the supply. The medical profession was critical, but during the early boom their verbal attacks seemed only to publicize the Microbe Killer more. Radam took pleasure in the rumor that some of his most severe critics from within the medical profession were surreptitiously using his medicine themselves. "I killed nobody," Radam explained, "and of course any man may cure another with water if he likes." 
What exasperated the gardener more than criticism were efforts
to steal his lightning. Eight or ten presumptuous souls sought
to trespass on Radam's prerogative as the sole maker of the sole
universal destroyer of all microbes. The first had the audacity
to paint an advertisement on Radam's own fence. All the old tricks
were used. His jugs were simulated; his wrappers, circulars, and
advertising were copied; his price was undercut. Driven to distraction,
Radam went to court. "I soon discovered," he wrote,
"the joy and delight which lawyers feel when they are engaged
in plucking a fat goose." Radam learned something about geese
from the experience. He found that it helped to pluck them if
he used in his promotion judiciously selected quotations from
a judge's decision, even though that decision had been against
him, both in the original court and on appeal. Radam was lucky
that there was advertising value in his suits against competitors.
He got nothing else. In one case he did win a verdict against
a rival Microbe Destroyer, but the damages amounted to only a
single cent and in the Texas Supreme Court the decision was reversed
Notwithstanding his troubles, by 1890 the ex-gardener from Texas was really in clover. He had seventeen widely scattered factories producing gallon jugs of Microbe Killer, which now was manufactured in three strengths. He owned a store on Broadway where an agent stood ready to offer a free glass of the remedy to any passerby who wandered in. He had exchanged his Austin acres for a mansion on Fifth Avenue overlooking Central Park. There William Radam sat, according to the frontispiece of a treatise he published in 1890, a stocky, bearded man with frock coat, striped pants, and a heavy watch chain, peering through a compound microscope at the bacilli he had conquered .
Microbes and the Microbe Killer contained many other plates besides the portrait of the author. Most of them, Radarn asserted, were so far as he knew the first photographs ever reproduced of bacteria. 'Whatever their authenticity, they were enough to give the average layman a nasty shock. Evil-looking dots and blobs, they bore such titles as "Microbes in a Stale Egg," "Fungus on a Ripe Strawberry," and the germs of cancer, piles, and uterine catarrh.
Any John Doe with an ache or pain who looked at the magnified portraits of these terrifying little monsters, even if he could not read Radam's equally disturbing prose, might well consider three dollars a jug for Microbe Killer an overwhelming bargain. For the literate, Radam's volume, which was loaned by his agents to all corners, had other facets of fascination no less grim.
The microbes so vividly pictured in the plates, so the text explained, abounded everywhere. A baby drew them in with his first breath, even if he had not already inherited them from his mother. The sea was full of them. They ran rampant in barns and museums. They congregated in homes. They crowded into hospitals. A quarter of a million of the tiny demons could cluster on an inch of surface. There was absolutely no escape .
Slowly and laboriously the titans of natural science, like Pasteur, had learned that a few diseases were caused by bacteria. But these inquirers had been halting and shortsighted. They had been more intent on theories than on facts. They had been more concerned with classifications than with cures. It had been left for a simple gardener to discover the full truth.
"My proposition is simple," Radam told his readers, "but it comes from study and observation of Nature. I have found that all disease may be concentrated under one head. It may assume different forms in different persons. It may be known, for instance, as fever in one, pneumonia in another, diphtheria in a third, cholera or diarrhoea in a fourth, and so on. But the differences which give rise to the necessity for using such names are merely details. There is, in truth, but one disease .... And just as there is actually but one disease, so there is but one cause of disease, and that may be limited in the common acceptation of the one word 'decay.' But what is decay? The visible result of fermentation. And what is fermentation. The phenomena produced in organic matter by the action of microbes."
To a person who was sick, it made no difference whatever which infinitesimal body had laid him low. The farmer did not worry about the name of the weed which was choking his corn. "A microbe is a microbe" -- this was William Radam's basic theme. It was a fundamental fact of blessed promise, for "The same treatment affects them, the same curative agent kills them, whatever their form or whatever be the effects which they produce."
In the light of this gospel, how futile, how brutal, the procedures of regular medicine! What will the physician do when a new patient is admitted to the hospital? "He will stop at the bedside of that patient, and although the poor fellow may be too sick to rise or turn, he will spend half an hour pounding and thumping him, listening to his heart and lungs, and going through a tedious ceremony, simply to try to diagnose some minute points which have nothing whatever to do with the cure or with the mode of treatment that the disease calls for. It looks scientific. It tends to surround the doctor's calling with a halo of mystery. It deceives the patient and the public. It keeps them in ignorance. Diagnosing disease is simply blindfolding the public."
But after diagnosis comes something much worse: the pouring of poisons down the patient's gullet, the chopping him apart with knives. "The instruments of the surgeon," Radam charged, "are the means of destroying more lives in our hospitals and col-leges than are the weapons of all our desperadoes and lawbreakers."
Don't send for a doctor, the ex-gardener warned his readers: to delay for diagnosis is to waste valuable time. "Suffice it to know that there is trouble of any kind, and the microbe killer will reach it."
It must be the Microbe Killer. For patent medicines were as dangerous as doctors. Countless blood-purifiers went forth onto the market accompanied by glowing claims, but not one of them could destroy a single micro-organism. Yet gullible people bought them in huge amounts. Truth to tell, Radam confided to his readers, "The public likes to be humbugged." Both in the country and in the city, thousands of men and women had fallen victim to well-worded promises and had even borrowed money to buy worthless nostrums. "This city of New York abounds with men," Radam reported (in straight-faced goose-plucking prose), "who live entirely, and live well, on the money they squeeze out of the pockets of individuals who are silly enough to trust them." This was sad but it was true. "People should not be led away by every charlatan who jumps up before them and talks; but as long as the world lasts there will probably be fools in it, and fools are a godsend to rogues."
In the pages of Radam's red-bound volume, there sounds an antiphony between the grim and the glad. The author did not play the gloomy strain for too many measures at a time. Quickly he trumpeted the note of cheer. He gave case histories of mar-velous recoveries. He expatiated on the Microbe Killer's harmlessness. He argued that drinking the sovereign water for the prevention of disease was better than being forced to take it as a cure. He boasted that a severe yellow fever epidemic in Key West could have been stopped short if the Collector of Customs, to whom Radam had hurried two free gallons, had seen fit to use the remedy. He bragged that the Microbe Killer could have saved the German Emperor's life had not jealous physicians intercepted seven letters which his former subject had sent to Frederick containing the good news about the healing potion.
A certain amount of blind or selfish opposition to any new discovery is always to be expected. The Kaiser's doctors, the Texas doctors, did not bother him, Radam asserted, with their indifference or criticism. Gratuitous condemnation was a different thing. At that a man had a right to be incensed. In the closing pages of Microbes and the Microbe Killer, Radam expressed his sense of outrage at a "most uncalled-for act of injustice." A physician and pharmacist named R. G. Eccles, on the staff of the Long Island College Hospital, had published an analysis of the Microbe Killer in a drug trade journal that was ridiculous and false. Instead of testing Radam's remedy as a self-respecting doctor should, by noting its effects upon human beings, Eccles had contented himself with sitting down in his own laboratory and examining it. He had boldly charged that Radam was putting sulphuric and hydrochloric acids into his medicine. Now Radam was willing to "cordially endorse" the judgment Eccles had expressed that these acids were poisonous. But the former gardener stoutly denied putting them into his remedy. Indeed, he had gone before a notary public and sworn a solemn oath: "I have never bought nor used one dollar's worth of sulphuric or muriatic acid to make my Microbe Killer." 
Dr. Eccles had also penned a "funny sermon" on microbes, Radam asserted, which proved only that he had misinterpreted Microbe Killer advertising and needed to read Radam's book. The whole attack, in fact, was "wanton and unwarranted," and probably never would have occurred at all had Radam seen fit to purchase advertising space in the Druggists Circular and Chemical Gazette.
Despite some sharp words, there was in Radam's reply to the critique a tone of lofty indulgence, a holier-than-thou air he really did not feel. The attack was in earnest, the blow was telling, and the ex-gardener was turning again to lawyers to get them to help him launch a libel suit.
Eccles had called a spade a spade. Radam, said the doctor, was a "misguided crank" intent on "out-quacking the worst quacks of this or any other age," by engaging in "the business of universal poisoning" while earning profits of 6,000 per cent. Sulphuric acid ruined the teeth, enfeebled the digestion, and injured the kidneys. Radam did not even use pure ingredients, for analysis revealed traces of chemicals denoting the cheapest commercial grades. Radam's theories, said Eccles, were fantastic. To maintain that microbes caused all diseases was "downright humbuggery." To suggest that a fungus was an animal was to mistake a locomotive for a cabbage. To use "microbe" as a word for one common thing-here Eccles was preaching his "funny sermon"-was like asserting that lions, tigers, dogs, horses, hyenas, rabbits, deer, and camels were identical because each was a "beast." Anything potent enough to kill all these animals was pretty sure to kill a human being in the bargain. "A universal microbe killer," Eccles insisted, "would necessarily be a universal life destroyer." But Radam's Microbe Killer could not cure anything. His hyperbolic claims were "simply laughable." 
As Eccles and Radam had traded verbal blows, so they were to exchange court suits. The master of the Microbe Killer had not postponed until the pages of his treatise a public reply to the Brooklyn physician's charges. Radam had defended himself in newspaper advertising and brochure. At times he came very close to losing his temper in print, accusing "those little parasites" of "slandering" him "by falsely putting forward poisonous formulas as mine" and "by attempts at blackmail." He challenged Eccles to give him fifty incurable patients for three months, and -- except for those who were too far gone, like rotten potatoes, or too drugged down -- the ex-gardener promised to cure them all. As he got set to hail Eccles into a Manhattan court for libeling the Microbe Killer, so Eccles prepared to return the compliment in Brooklyn for the language Radam used in countercharging. The Brooklyn case came first to trial. The doctor sought $20,000 damages because Radam had called him a charlatan and a quack. The maker of the Microbe Killer went to great pains to defend himself. He employed as chemical expert a man soon to manage the Farben interests in America. He secured as attorney the eloquent agnostic, Robert Ingersoll. And he presented a case that caught Eccles completely by surprise .
Up to this point, Radam had stoutly denied that the Microbe Killer formula published in the Druggists Circular during 1889 was even close to a good guess. There was neither sulphuric nor hydrochloric acid in his healing potion, he had said, both of which, indeed -- in this he had concurred with Eccles -- were poisons. In the Brooklyn court Radam spun round. His own expert witness presented an analysis that differed from that of Eccles only in details. Radam vigorously insisted that both the Microbe Killer and the formula Eccles had printed were of tremendous therapeutic value. He lauded his own originality in finding a method of putting the two acids into a remedy of such demonstrated blessing to mankind.
Dr. Eccles was startled but not routed by Radam's amazing about-face. Presenting to the jury medical evidence concerning the risk of imbibing the acids over long periods, the lawyers for the Brooklyn physician also cross-examined Radam. They got him to admit himself to be "the most learned and profound of living American naturalists." Then they plied him with questions on the elementary facts of botany. The ex-gardener could not define an anther. He could not place potatoes, calla lilies, or poppies in their proper botanical orders. When asked to explain his ignorance, Radam blithely asserted that since discovering his Microbe Killer he had forgotten these inconsequential facts. Now all he knew about was the cause and cure of all disease.
The Brooklyn jury were not persuaded that this was true. They awarded Dr. Eccles the sum of $6,000.
Radam appealed the verdict and then in Manhattan sought revenge. The lawyers for the Microbe Killer -- Ingersoll had been replaced -- outpointed the attorneys for Eccles and the Druggists Circular. They kept their learned American naturalist off the witness stand. They prevented the Brooklyn physician from presenting to the jury a well-rounded case. The matter hung on a legal technicality. The defense pleadings had been drawn up in general terms, asserting that Dr. Eccles' article was true in every particular, without stating in detail each point. Radam's lawyers cited precedent wherein a decision regarding libel had been reversed because the pleadings had been so drawn. The judge agreed. He forbade the defense to prove that the state-ments in the Brooklyn doctor's article were justifiable because true, and he charged the jury to bring in a decision against Eccles and the drug magazine. The members of the jury deliberated on the sum to be awarded Radam. Ten wanted to give him six cents, but two held out for a larger amount, in order to take back from Dr. Eccles part of the money he had been given in Brooklyn. The compromise sum was $500 .
For the moment Radam was $5,500 short on the exchange, but
he did not care. "I am gratified," he said, "for
it is a complete vindication of the unjust charges and libelous
attack on the microbe killer." His witnesses had tried to
show that the attack by Eccles had hurt his business. Now he sought
to use the verdict to recoup his losses. In newspaper and pamphlet
proclaimed that the therapeutic value of the Microbe Killer had
been proved in court. He cited the judge. He quoted testimony
from his many witnesses -- a sewing machine executive, the inventor
of a typewriter, a Baptist clergyman, a music teacher, the president
of the Mount Holly and Bedford Railroad. All told the same tale:
how they had undergone years of suffering caused by catarrh, or
consumption, or ulcerated legs; how they had found the Microbe
Killer and been cured. On the average, according to the court
testimony, cures had required from fifteen to thirty gallons of
the potent potion, at a cost of three dollars the jug .
At the time of the trial, Radam sent a warning to Dr. Eccles Refrain from any further attacks upon the Microbe Killer, the ex-gardener threatened, or you will be "challenged to mortal combat." But the Brooklyn physician weighed the issue and took the risk. He reported in detail the outcome of the trial and continued to label Radam as an utter humbug. Yet no duel ever took place. 'What, after all, had Radam to gain? He had one court victory to publicize, and in time a court of appeal reversed his Brooklyn defeat. 'Why worry about a few more vitriolic paragraphs in a drug trade journal? 
For, after all, who read the Druggists Circular and Chemical
Gazette? The masses of mankind were learning about the miracle
which bacteriologists were indeed beginning to work through the
pages of newspapers, the same papers in which William Radam was
advertising. How many men and women, among the millions who saw
the dramatic news stories and the astounding advertisements, could
differentiate between the credentials of microbe-hunter Pasteur
and those of microbe-hunter Radam?
The inability of the general public to discriminate between a French scientist and a Texas quack is one important factor that helps to explain a disturbing paradox: the age in which major discoveries were made for the first time explaining much disease in a genuinely scientific way was the very age in which patent medicines reached their apogee. The period in which the medi-cal profession acquired the knowledge to demonstrate beyond question the folly of quackery was the very period in which the nostrum business achieved the largest sales and the most unscru-pulous promotion America had yet seen.
Behind the paradox lie many factors besides man's continuing credulity. One is the complexity of the medical problems. It was to take time for the separate details of the new medical knowledge to be comprehended, evaluated, coordinated, and applied. The old killers were still the big killers in 1900. Influenza and pneu-monia headed the list, for which there were no "well-defined and generally accepted plan of treatment." Tuberculosis was second. Serums could not prevent the white plague (though many had already been tried), nor could drugs cure it. The best thing to do was to avoid infection, but the public was indifferent and anti--spitting ordinances went largely unenforced .
Man still suffered grievously from diseases commonly trans-mitted by water, milk, and food. Gastrointestinal ailments ranked third in the mortality table. Summer diarrhea was ubiquitous, especially hard on infants and children. No serum had yet suc-ceeded in preventing typhoid fever, and cities like Cleveland and Pittsburgh had major outbreaks early in the new century .
In due time medical science and its practitioners were to ac-quire a prestige among the general public which they never enjoyed during the 19th century. But in the closing third of that century, many Americans continued skeptical of regular doctors, and with some reason. Despite improvements that were under way, most American physicians, in their knowledge and dedication, were no Pasteurs. At the worst, the situation was very bad. One "doctor" acquired his diploma by marrying the widow of a colleague and putting his own name on the dead doctor's diploma. Another got licensed by showing a Chinese napkin to a county clerk and saying it was a diploma from a Chinese medical school. Countless more attended shoddy proprietary schools that were little more than diploma mills. Even at Harvard, the head of the medical school explained in 1870, written examinations could not be given because "a majority of the students cannot write well enough." 
Many American physicians, during the years in which the germ theory was being established by European research, had not yet adopted the last major medical doctrine to pass westward across the Atlantic. Dr. Oliver Wendell Holmes and others had brought home the French attack on "heroic" medication, and, although therapeutic nihilism won many converts, its triumph was not complete. One problem was the medicine-taking habit instilled by long usage in the American people. People wanted to take something and many doctors prescribed to fill the demand. The correspondence of a busy village doctor in Illinois, who practiced from the mid-1850's into the nineties, is typical. He received many letters, penciled by humble people, filled with bad grammar, wretched spelling, and fervent pleas to send more medicine. One woman tersely revealed an oft-repeated cycle from home remedy to nostrum to physician -- evidence that the promises in patent medicine advertising often fell short. "I am troubled with worms," she wrote. "2 months ago I took turpentine[.] A week after I took A whole bottle of virmifuge[.] still no relief. I am worried all but to death so please fix something so I will get relief." 
Insofar as therapeutic nihilism did take hold with the medical profession, its reign helped the nostrum promoter. Indeed, here was a situation in which the patent medicine man could have it both ways. The excesses of heroic medication had driven people to nostrums. Now the excess of caution in prescribing on the part of doctors who adhered to nihilistic tenets worried people who had the medicine habit and tempted them to resort to proprietary brands.
The impact of nihilism in high places had another effect. It weakened the emphasis in medical education upon pharmacology and the materia medica. Doctors trained in even the best schools got scant grounding in therapeutics. "If surgery were taught in the same dilettante way that materia medica is in too many of our medical colleges," one physician noted, "surgical cases would be to a great extent in the hands of the instrument makers, who would be instructing the surgeon through their commercial travelers as the medicine houses are attempting to do with the general practitioner." The lack of adequate training regarding drugs made doctors easy prey for a clever new dodge developed by the manufacturer of patent medicines, by which pseudo-science assumed not only the mantle of science, but also its coat, pants, shirt, tie, and drawers .
Nostrum makers began to simulate the methods by which medical and pharmaceutical science kept the profession informed of new developments. Articles appeared in medical periodicals -- some journals created for the purpose and others fairly reputable but careless in editorial policy-reporting exciting new therapeutic advances. The names of the new remedies were not blatantly suspect, like Radam's Microbe Killer, but had a scientific lilt -- Syrup of the Hypophosphites, Extract of Pinus Canadensis, Lithiated Hydrangea. Formulas were given and also were printed upon the package, but frequently "in such a way," so noted an organ of the American Pharmaceutical Association, "that no pharmacist can put it up." Besides citing a formula, these journal articles described complicated chemical procedures relating to the process of manufacture and numerous details from exhaustive clinical tests. All this was drafted with consummate skill: the phraseology was properly esoteric, the illustrations im-pressive, and the great good news in the conclusion presented with dignified restraint .
After the journal article -- sometimes without one -- came the reprint. It was mailed to the desk of the busy doctor, who was informed that this latest advance of science was being presented to the medical profession as a prescription item to be employed or not as doctors saw fit. Soon there appeared in the waiting room of the physician a detailman, equipped with more literature and free samples, who looked the same and talked as knowingly as did the agents of reputable pharmaceutical manufacturers presenting their "ethical specialties."
The truth was that the first prescription which the doctor wrote out directing a druggist to provide any given patient with a bottle of Fellows' Syrup of Hypophosphites was apt to be the last. When the sufferer looked at the printing on the carton, the 'label, and the pamphlets which came with his prescribed remedy, he\found enough medical counsel, in vigorous, down-to-earth, and Trghtening language, to let him dispense with a doctor. The patient 'txok this course with a feeling of security, for it had been a doctor who had pointed the way. As late as 1915 Fellows' proprietary syrup was not spending a cent in advertising direct to the public, but ninety per cent of its sales were over the counter without a prescription .
The nostrum makers were using doctors to get at their patients. Surveying his mail for 1899, a medical professor at Yale found that 424 circulars concerning medicine and its uses had come to his desk. Only fifty-four of them, he said, could he designate as "respectable." But the unrespectable were accomplishing what their promoters had hoped to achieve. Some ninety per cent of American doctors, another critic estimated sadly, were prescribing proprietary preparations .
Patent medicines of secret composition advertised direct to
the public, an observer suggested, might be likened unto "the
wolf in his own clothing." The Microbe Killer was of this
kind, though even Radam put advertisements in medical journals.
On the other hand, proprietary pharmaceutical specialties made
up of old drugs claiming to be new, promoted only to doctors although
labeled so that a patient could dose himself, were "the wolf
in sheep's clothing." Both sorts fooled many American sheep,
some of them possessing medical degrees .
Agile quacks managed to profit from yet another development of modern medicine. Specialization among physicians was slow in coming, partly because in earlier days only the charlatan had confined his practice to one part of the body. It was one of this breed, an eye doctor, whom the physician-novelist S. Weir Mitchell had met in the lobby of a small-town hotel. Made curious by advertising which claimed that the charlatan could restore sight to the blind by removing the eye, scraping its back, and restoring it to the socket, Dr. Mitchell, incognito, accosted the man. "May I ask," he said, "what anesthetic you used?"
"I can hardly explain that to you," the quack replied, "you wouldn't understand; but I can tell you that it's shaped something like a spoon." 
The same French school that taught therapeutic nihilism shifted the emphasis away from the sick man as a single entity and stressed a necessary concern with the pathology of individual parts. To this type of medical inquiry, specialization in medical practice was a natural sequel. The trend went on most rapidly in the ever-larger cities where there were enough cases of any given malady or malfunction to keep a specialist busy. Medical specialization permitted improved treatment, but it was more expensive, and inherent in the point of view was a possible hazard to diagnostic judgment .
Specialists sometimes tended to forget that illness can be more than the sum of a patient's diseased organs. The crowded bustling cities where specialists held sway were the very sort of environment to produce or aggravate psychosomatic disorders. Many a man with localized pains got no satisfaction from the seemingly mechanical ministrations of brusque specialists. He turned elsewhere. Either he resorted to a quack who at least would listen sympathetically to his complaints, or he perused the long list of symptoms in nostrum advertising and prescribed for himself. The desire to be cured, not piece-meal but all at once, is natural and strong. William Radam could find a sympathetic audience to hear his attack on specialization in medicine and the concept it implied, "that nobody can cure all ailments." 
There was another facet still. A bottle of tonic seemed cheaper than a visit to an internist or an orthopedist or a gynecologist with all his fancy equipment. Many patients who were willing to admit that specialization meant better medical care objected to the cost. As the 19th century came to a close, the medical profession was rising in public esteem as to its science, but it was falling with respect to its economic practices. Nor would the nostrum promoters let the American public forget this growing grievance. In almost every tirade against the regulars, the patent medicine men raised anew the old, old cry of greed, greed, greed .
With all the difficulties that still beset the science and art of medicine as the 19th century waned, there never before had been so firm a foundation in science on which to build a critique of quackery. William Radam could make and sell his Microbe Killer, but Dr. Eccles could attack him with sounder medical and chemical understanding than earlier critics had possessed. One thing that might be helpful would be to get Dr. Eccles' message to the same public who were reading Mr. Radam's advertising. During the first decade of the 20th century giant strides were to be taken in this direction.