"And they like to pay a little for a tonic and an evening's entertainment rather than pay a lot to a doctor who gives you no fun at all."
-- Victor Holmes, Salt of the Earth 
"Nothing in God's world is the matter with most of you but worms, worms, worms" 
Such a startling pronouncement, set in bold-faced type, might well give pause to any newspaper reader and urge the eye on down into the smaller print in search of whys and wherefores. How much more disturbing were the same words when heard rather than seen, delivered with pontifical assurance by the resonant voice of a commanding figure in a tall hat and cutaway coat, who gained in majesty through the flickering illumination of gasoline flares.
Patent medicine promoters, during the same years that they pioneered in print the many psychological lures that might sell their wares, often went out to meet their customers face to face. Because the effort of orating an appeal was more profitably expended on a group than on an individual, some enticement to attract a crowd was necessary. Exotic costume might help, but most itinerant vendors did not rest content with dressing themselves up. They added entertainment. They put on a show.
Colonial America had her mountebanks selling their wares, just as did Europe of the same day. They came to towns and villages especially at such times as fairs, when the native population was swollen by outsiders. They set up their platforms, performed their shows, delivered their harangues, sold their remedies, and went their ways. The tone of their entertainment sometimes offended ministers, and the quality of their medicines sometimes disturbed physicians. If the two groups could agree, as in Connecticut on the eve of the Revolution, restrictive legislation might be enacted. Medical declamations by mountebanks, the colonial assembly decided in 1773, as well as their "plays, tricks, juggling or unprofitable feats of uncommon dexterity and agility of body," had harmful social results. All this fostered "the corruption of manners, promoting of idleness, and the detriment of good order and religion," and also ensnared people into buying "unwholesome and oftentimes dangerous drugs." So mountebanks were outlawed .
But laws did not stop them. During the first half of the 19th century there were many men like William Avery Rockefeller who brought both entertainment and nostrums to backwoods towns. Rockefeller circulated through the Midwest and, according to legend, used his talents as marksman, ventriloquist, and hypnotist to attract the crowds to whom he sold his packaged herbs. (When William's son, John D., died in 1937, his physician reported that the aged millionaire had taken "several patented articles religiously, to aid his health.") 
The heyday of the medicine show came during the last two decades of the 19th century. Solo performers like Rockefeller continued to operate. But there was a tremendous expansion in the size and variety of the business. Nevada Ned, a big-time showman, summed up the colorful scene: "Here full evenings of drama, vaudeville, musical comedy, Wild West shows, minstrels, magic, burlesque, dog and pony circuses, not to mention Punch and Judy, pantomime, movies, menageries, bands, parades and pie-eating contests, have been thrown in with Ho-Ang-Nan, the great Chinese herb remedy, and med shows have played in opera houses, halls, storerooms, ball parks, show boats and tents, large and small, as well as doorways, street corners and fairs." 
So large and complex did the cast of characters become that
caste lines developed, from the prestigious performers in large
shows vending innocuous remedies like liniments down to the "jamb
workers," the sheer frauds, like the Duke and Dauphin encountered
by Huckleberry Finn .
The grandest spectacle of all was the Indian show born of the joint imaginations of a Connecticut Yankee and a Texan. The New Haven Irishman, John E. Healy, had been a Civil War drummer boy who took a liniment down to Savannah in Reconstruction days. Temporarily side-tracked with a troupe of non-therapeutic Irish minstrels, Healy had gotten back to medication in 1879 with a liver pad. This was his first venture with "Texas Charley" Bigelow, a farm boy who had served a med show apprenticeship with Doctor Yellowstone. The experience had given him long hair and beard and useful if suspect Indian medical lore. The liver pad did well, especially among the newly liberated Negroes of the South, who attributed to it conjuring powers. Healy and Bigelow, however, dreamed of even bigger things. In 1881, along with "Nevada Ned" Oliver, they formed the Kickapoo Indian Medicine Company to vend a remedy called Kickapoo Indian Sagwa. The original Sagwa, according to a legend in the business, was made of aloes and stale beer. Whatever it may have been, the formula through time did not stray far from herbs and alcohol. It was not the constituents but the promotion that brought this tonic fame. Healy and Bigelow began hiring Indians by the hundreds -- none of them Kickapoo -- to put on a show .
Healy and Bigelow could traffic not only on the long-established connection between the red man's vigor and the white man's nostrum. They could also count upon the Easterner's awed curiosity about a bronze-skinned people he no longer knew at firsthand but was much aware of through reports of constant Indian fighting in the West.
The standard Kickapoo show traveled with half a dozen Indians and as many white performers. The show opened with the Indians sitting stoically in a half-circle, in front of a backdrop painted to reveal an Indian scene, the more realistic because of torchlight illumination. Nevada Ned, or some other "scout" wearing long hair and buckskins, introduced the Indians one by one, briefly describing their past heroism. Five of the redskins acknowledged their introduction with a mere grunt, but the sixth delivered an impassioned oration in his native tongue. As interpreted by the scout, the tale described the dramatic origin of the remedy which had saved countless Indian lives and which was about to be offered, after great sacrifice, to the white members of the audience. When the sales pitch was finished, half the Indian and white members of the company went out among the crowd to sell, while the remaining whites played musical instruments and the Indians beat their tom-toms and broke into wild war whoops. In such a noisy atmosphere, medicine and money changed hands.
Some seventy-five such Kickapoo shows might be touring the country at a time during the eighties. Now and then Healy and Bigelow promoted an even more majestic spectacle, a stationary show with up to a hundred performers. Nevada Ned presided over one such venture that played a whole season in New Jersey. A wagon train attacked by Indians was saved by cowboys who in turn were threatened by a prairie fire. The final outcome was the sale of up to $4,000 worth of Kickapoo Indian Sagwa every week. Among the show's spectators was numbered Buffalo Bill himself, but there is no record as to whether or not he bought a bottle.
The peer of Healy and Bigelow ventures, in commerce if not in showmanship, were the troupes traveling to boost the sale of Hamlin's Wizard Oil. John Austen Hamlin, the founding father, had been a magician pure and simple, according to legend, until he discovered that the take was greater when he used his prestidigitation to promote a liniment. Magic there was for sure in the name Wizard Oil, which he affixed to the remedy he vended. Moving from Cincinnati to Chicago during the Civil War, Hamlin built up his product to one of the best-known liniments in America. In doing so, he rather forsook magic for music .
Hamlin's emissaries sang for their sales. Touring the highways and byways of the country were numerous troupes, each made up of a lecturer, a driver, and a male quartet. The group traveled in a special wagon, pulled by a four- or six-horse team, into which was built a parlor organ. The wagon, in the torch-lit evening, became a stage, from which the quartet sang and played. A stylish sight they were, clad in silk top hats, frock coats, pinstriped trousers, and patent leather shoes-with spats. At times the assembled audience sang with them. One of Hamlin's stunts was the lavish distribution of pamphlets in which the words of such songs as "I'se Gettin' Up a 'Watermelon Party" and "Is Life Worth Living?" were interspersed with promises as to how Wizard Oil could grapple with asthma and neuralgia. These song books were carried into thousands of homes. During the week or more that a troupe stayed in a town, the members were busy during the day as well as at night. While the lecturer sought to place supplies of Hamlin's liniment with local drug-gists, the quartet displayed their talents for church and charity groups.
Hamlin, a man of substance in Chicago, fittingly spent some of his Magic Oil income, soon after the great fire, to build an opera house that bore his name.
There were other major entrepreneurs like Hamlin and the Healy-Bigelow team. There were also innumerable small-time free-lancers of all shades of repute. One of the better sort was Dr. C. M. Townsend with whom the young James Whitcomb Riley traveled for a season. The doctor was a kind and generous man with a gift for coining moral aphorisms. During the winter he prepared and packaged his Magic Oil, his King of Coughs, and his Cholera Balm, in Lima, Ohio, and in the spring set out with a covered wagon containing side seats for the members of his troupe. Nearing a town, they would arouse the population with blasts from a horn and then distribute broadsides. At the edge of town they formed a band and paraded through the main streets .
Dr. Townsend gave two "lectures" a day, one in the afternoon, the main speech at night. The versatile Riley did so many things that he was presented as the "Hoosier Wizard." He beat the bass drum, played the violin, sang ballads, gave poetic readings, and used his sketching talent to draw cartoons on blackboards affixed to the wagon while his employer extolled the merits of his remedies. "Last night at Winchester," the poet wrote, "I made a decided sensation by making a rebus of the well--known lines from Shakespeare --
'Why let pain your pleasures spoil,
For want of Townsend's Magic Oil?'"
Most small-scale medicine shows were neither so moral nor so literary. Bad liquor flowed like water. One lecturer took swigs of the alcohol in which were preserved the repulsive tapeworms. Drug addiction was not infrequent. Performers were people with skill too limited to make the big time, or with temperaments, habits, or pasts which doomed them to dreary, ill-paid, nomadic lives. Most of the "doctors," for that matter, died broke. Expensive habits, poor management, a run of bad luck, drained off the proceeds. Not that each individual sale did not yield a hand-some dividend. Few of the small operators were as conservative as the O. Henry pitchman who "respected his profession, and was satisfied with 300 per cent. profit." The sky was the limit. The operators filled salve boxes with axle grease. They mixed powdered herbs in hotel bathtubs. They colored and flavored and bottled water. "Water," explained the brooding "doctor" in a Jim Tully story, "is the great healer-three-fourths of the earth's surface is water." 
Whatever medicine was sold, and whatever attractions were used to lure the citizenry, the sales pitch was always sandwiched in between entertainment. It would not do to begin selling at once, for the audience would feel themselves short-changed. A proper mood needed creating. This mood was not one thing. It might be awe at expert marksmanship. It might be delight at black-face comedy. It might be the slightly naughty shock of seeing a magician pull lingerie from grandpa's pocket., The mood was something that beguiled a crowd, drove from their minds extraneous concerns, and focused attention upon a novel and entrancing spectacle. Thus they were made receptive. Even with such a build-up, no medicine man was cocky enough to count on holding his audience during the sales pitch without the promise of more free entertainment to come. The after-piece was a fixed part of every show.
When the pitchman took over, he did not begin by mention-ing medicine. Showmen there were, indeed, like Doctor Silver Dollar, who haughtily denied they were what they really were. When a village editor referred to Dollar's Famous Carnival of Health as a "medicine show," the doctor disdainfully replied: "You sully us. We deal in no back lots and gutter water." Most pursuers of the profession did not go to this extreme. But they might deny that they were selling medicine -- they were giving it away and using the small mandatory contribution to finance a missionary journey. Or they might deny that they were selling medicine -- rather, it was healthful minerals extracted from Nature's purest water. If it was medicine and if they were selling it, the price was "introductory" and seldom half as high as the figure printed on the label .
Any talk of medicine and money was gradually and gingerly approached. Skilled haranguer that he was, the pitchman had a big job to do first. He had to scare the living daylights out of the people in his audience. However hale and hearty they might feel, he must make them sick and frightened enough to buy his sovereign remedy. The variety of fright was infinite. The false symptom was a popular approach. For example:
"Do you ever feel like it is almost impossible to get up in the morning? You eat well and sleep well, but you hate to get up. You hate work. Do you ever feel that way? ... Well, folks, you may not know it, but that's the first sign of gallopin' consumption!" 
Or again: "You laughing, happy audience; you mother, you father, you young man, woman and child, every one of you -- within you are the seeds of death! Is it cancer? Is it consumption? Is it perhaps some unknown malady?" 
Often was cited the horrible example: "Kidney trouble sneaks up on you like a snake in the grass. Like a thief in the night. It spares neither rich nor poor. The Archbishop of Canterbury was descending the steps of that great English cathedral when he fell down like an ox smitten in the shambles, stone dead! They held an autopsy; there was nothing wrong with his stomach, heart, or lungs. But gentlemen, when they turned him over and looked at his kidneys . . . gentlemen, they looked just like a rotten tomato." 
In addition to the power of his personal magnetism, the travel-ing "doctor" had another advantage over his rival who advertised in the press. The medicine showman could contribute to the atmosphere of panic by means of horrendous exhibits. The massive hookworm -- bought by the bucketful from local slaughterhouses -- was indeed a shocker. Curled up in alcohol in large glass jars, the sobering creatures mutely performed for months. There were showmen specializing in making the hookworm the root of all evil, who performed clandestine feats of legerdemain that let them later exhibit worms in public and tell the names of local dignitaries who had allegedly harbored them .
A pitchman who battled against catarrh planted one of the company in his audiences to step up when an appeal was made to test the potency of the salve on sale. "My friend, have you catarrh?" the doctor would inquire. "Yes, sir," the shill replied in a snuffly voice. "Please put a small application of this salve in each nostril," the doctor directed. The shill did as he was bade. Finally the pitchman handed the sufferer a spotless handkerchief. "Now blow your nose hard," he said. The noise could be heard hundreds of feet away. What the audience did not know as they were shown the revolting result was that the doctor's anonymous assistant had earlier stuffed a nostril with stiff custard .
This sort of "proof" showmen often resorted to. It was a common stunt to flatter an audience by remarking on their intelligent faces. Most crowds, the showman would say, looked much less bright. The present company could not be persuaded by mere words, he was well aware, so he would present an irrefutable demonstration. This might require calling the huskiest man from the crowd to take the tuberculosis test, which consisted of blowing through a straw into a sensitive diagnostic fluid (limewater). Of course, the fluid turned milky, and of course the cloudiness denoted raging consumption. The healing potency of the doctor's remedy could also be scientifically proved. A few drops (of vinegar) dispelled the cloud and restored the water to its pristine clarity .
Other demonstrations relating to body chemistry were equally persuasive, and the site of their internal occurrence might be graphically portrayed by means of anatomical models and charts which showmen carried. It was effective, when orating about the dire afflictions which might assail the lungs, the liver, and the bowels, to point to pictures of these organs printed in gaudy reds and purples. Diamond Dick displayed a series of such charts -- the muscles, the veins and arteries, the skeleton, the inward organs, even the nerves shining in silver within a dark human frame. Another pitchman used an "Alas, poor Yorick" routine. He came forth holding in one hand an inhalator and in the other a skull. Nervous laughter swept his audience. "This isn't a joke, friends," the showman said. "It is far from a joke. This is the skull of a man who died from catarrh. He wouldn't have died if he'd had one of these inhalators. Put it in your nose and it goes where you can't get with anything else . . . . Spinal meningitis germs enter the nasal passages. Science says that over fifty disease germs, many of them deadly, enter the nose and mouth. Here's something that won't make them feel so good, but will make you feel a lot better." 
Quick cures were sometimes wrought before the very eyes of an audience. Liniment could relieve deafness (if due partially to impacted wax) when the showman, in addition to inserting the potent fluid, performed some sleight-of-hand with an earspoon. Snake oil could vanquish arthritis of the elbow if, during its vigorous application, the victim's arm was numbed by pressing tightly against the back of a chair. Stunts of this sort were not devoid of risk. On one occasion a showman had made a man's rheumatism temporarily disappear by vigorous rubbing. But the pain returned, and the dissatisfied customer came back with a gun. The frightened doctor fled the town on foot. Out in the country, he heard dogs baying in the distance. Fearful of a posse, the showman climbed a tree. Soon two hounds ran by chasing a rabbit. Safe but completely unstrung, the pitchman gave up his profession .
From time to time, of course, there were skeptics who had to be dealt with. Most pitchmen were quick thinkers endowed with a brazen manner, and they had a store of stock remarks to deal with various untoward situations. It was deemed wise to heap a scornful scolding on the first member of the audience who sought to wander off after the spiel began. The rest of the crowd, fearful of being made so embarrassingly conspicuous, generally stood rooted to their spots. Sarcasm was also employed to silence the smart aleck who voiced his doubt. Many pitchmen sought to ward off hostility from one quarter by praising the local disciples of Aesculapius and suggesting that the nostrum for sale had the blessing of reputable medicine. One street-corner sharper, indeed, posed as a virtual agent for the American Medical Association. But there had to be a certain ambivalence regarding orthodox medicine, for with showmen as with newspaper-advertisers, their remedies had to succeed where regular doctors failed. Surgeons especially were belabored. The operating doctor was a lower form of creature than a butcher, quick to engage in such a dastardly adventure as to "cut open your umbilicus and take out your tweedium." 
Fantastic tales to explain a remedy's healing potency often formed part of a showman's speech, varied to fit the flavor of the show. Many were the medical secrets that had been lured from the Indians by devious stratagems. God's hand was frequently at work, for there were medicine shows that traveled in the name of religion. Pitchmen in somber Quaker garb vended remedies with much thee-ing and thou-ing. The Shakers also were in the field, similarly clad -- and this sect really did exercise some supervision over the quality of the herbal mixtures vended. The Oriental theme was also popular. One "professor" spent his first evening in a new town saying not a word. Swathed in robes, he sat silent as a statue, staring straight ahead, while two aides, one on either side, pounded away at kettledrums. Phosphorescent banners bore his name and a weird mixture of unintelligible letters and symbols. The scene was illumined by green fire .
The wonders of the Oriental healing art were relied upon by one of the noted women who plied the medicine trade in the early 20th century. Violet McNeal, in her autobiography, Four White Horses and a Brass Band, describes her debut as Princess Lotus Blossom. Wearing a mandarin coat and Chinese skullcap, she told her street-corner crowd the sad "story of peril, of overwhelming danger, of a dread and mysterious ailment which threatened to wipe from the face of the earth the great people of the Chinese nation." This dire disaster was loss of male vitality. "To the horror of all who were aware of this impending tragedy, it seemed inevitable that this mighty race might perish. Its life force was gone. Its manhood no longer possessed the strength for perpetuation of the strain which had existed throughout history." .
The Emperor, faced with the crisis, proclaimed that he would give a princely fortune to anyone who found a means of restoring Chinese vitality. Many famous physicians and scientists tried and failed. One astute sage, He Tuck Chaw by name, while exploring a volcanic region encountered a variety of turtle, the Kup Ki See, in which the golden-striped male was outnumbered by the female 1,000 to 1. What was the secret of this incredible vitality? He Tuck Chaw pushed his researches with vigor and hope. At last he discovered that the male turtle differed from the female in possessing a small pouch, the Quali Quah pouch, at the base of the brain. "He removed the pouches. . . , dried and powdered them, and gave tiny portions to the Chinese people. The reaction was both swift and effective." The nation was saved.
Princess Lotus Blossom, of course, had come into possession of the secret. "There is, gentlemen," she told her listeners, "a sufficient quantity of this same substance in these Vital Sparks I am going to offer tonight to restore you to health, virility, and happiness."
The Vital Sparks had really been no closer to a turtle than had the Princess to China. She and her husband had made them by pouring buckshot candy into a hotel bureau drawer, dampening it, and rolling it around in powdered aloes. This was what made "old men young and young men stronger."
After the pitchman had terrified his hearers and given the romantic credentials of his remedy, the moment came for selling. Sales went best amid noise, turbulence, and confusion. Nevada Ned's Indians whooped and his musicians played. Most showmen sought for a similar atmosphere. The beating of drums and blaring of horns produced a frenzied accompaniment for the pitchman's continued harangue, rendered in a bull-like roar. Members of the troupe ran madly here and there among the audience, sometimes turning cartwheels to add to the excitement. Getting one bottle of medicine from the doctor, each minion would hurry out and sell it, shouting "S-o-o-o-l-d!" or "Another bottle gone!" or "More medicine, Doctor!" as he pocketed the money and ran back to get another bottle. A sort of mob hypnotism swept spectators into the buying mood. Sometimes they bought and later went away, leaving the medicine behind .
Restrictive legislation-federal, state, and local-was to put serious restraints on the free-wheeling medicine showmen in the 20th century. As rural areas became less culturally isolated, the shows lost some of their appeal. Moving pictures and, in time, the radio offered competitive amusements that took some of the fresh zest away. Though the medium continued, it did not possess the glamor and the daring of late 19th century ventures sponsored by Healy and Bigelow and their imaginative rivals .
Seldom did an outsider get on the inside of the medicine show. On those rare cases when he did, he may well have been as astounded as was the fictional pedagogue in a novel of Harry Leon Wilson. Fleeing the routine of his campus and the dreariness of his home, Professor Copplestone winds up as an "Indian" in a flea-bitten show vending Aga-Jac Bitters among the farming folk of Iowa. At the first night's performance the yokels are carried away by the professor's medley of Greek iambics which passes for an aboriginal tongue. But they are not more impressed by Copplestone's contribution than is he by theirs. At the end of the evening, the professor's partner, a rogue named Sooner Jackson, counts out the money .
"Forty-two iron men," he cries, "only thirty-two
of which are profit, however, because those bottles cost money.
Therefore, old bean. . . , you are sixteen plunks ... to the mustard.
Not bad for a start, eh?"
"I, for one, consider it excellent," the amazed professor replies, and he muses to himself: "Indeed, reckoning time and energy invested, it was so far in excess of my ordinary stipend that I felt my previous years had been frittered away."