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Vol. LVIII, No. 7
April 7, 2006

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Commodification Meets Black Cohosh
NLM Seminar Focuses on 19th-Century Patent Medicine

In the late 19th century, when many women had little or no access to medical care, Lydia E. Pinkham's "Vegetable Compound" became one of the world's most popular medicines.

This was before big pharma's direct-to-consumer marketing. Before hormone replacement. Before aspirin. Even bathtubs were a luxury.

Pinkham converted her home remedy for menstrual and menopausal symptoms into a major business — the first widely successful U.S. company run by a woman. She pioneered direct advertising to women, and made a fortune.

Lydia Pinkham’s “Vegetable Compound,” a patent medicine marketed directly to women, was widely sold in the late 19th century. To make the trade relationship seem direct and personal, Pinkham’s advertising cards featured appealing images of herself and her grandchildren. (Image courtesy of NLM)  

"She was an ideal example of commodification [commercial product-creation]," explained the University of Delaware's Prof. Susan Strasser in a recent NLM seminar sponsored by the History of Medicine Division.

She traced the elixir's beginnings to 1875 in Pinkham's Lynn, Mass., home, where Pinkham and her family received local women seeking help for "female maladies." Pinkham, a generous neighbor, would offer the gift of her homemade medicine.

Until her sons had an idea. "Lydia was giving her remedy away," said Strasser. "She gave it away and gave it away until her sons said, 'Let's sell this.'" With the U.S. in a depression and her husband bankrupt, they had little to lose.

Pinkham made her medicines and composed accompanying pamphlets, while her sons handled distribution. As the business took off, Pinkham wrote countless letters responding to women seeking health advice. "Soon, the business was incorporated and its products sold worldwide. There was an extremely rapid dissemination of trademark," said Strasser, whose specialty is American consumer culture.

Pinkham's compound was 18 percent ethyl alcohol — 36 proof. "Alcohol was used as a solvent, extraction medium and preservative," Strasser explained. "Other ingredients were liferoot, unicorn root, pleurisy root, fenugreek and black cohosh."

Many physicians then prescribed proprietary medicine for dysmenorrhea, for symptoms of menopause and even for conditions as serious as prolapsed uterus, since many women could not afford the cost of surgery. "Pinkham was well versed in herbal remedies," said Strasser. "Local healers without medical education were essential to all communities before the 20th century." Some herbal lore, she noted, had been inherited from Native Americans, who used black cohosh for gynecological disorders.

The Pinkham Company's special talent was in new marketing techniques: selling directly to women. Lydia Pinkham's own likeness, as well as that of her grandchildren, appeared on product labels and her advertising relied on testimonials. "In its commodification, the advertising used a model of old-fashioned social relations. The trademark image made women believe that the trade relationship would be direct and personal," said Strasser. At first, Lydia handled the correspondence herself, but soon there was too much for her, and the company hired as many as 30 women to handle letters. Even decades after her death, the staff continued to sign Pinkham's name until the practice was exposed. The business was sold in 1968.

Did her herbal methods produce or extend any new knowledge that was folded back into conventional medical education and treatments? "No," Strasser replied. "There was a huge backlash against proprietary medicine among regular physicians."

Was Pinkham a forerunner of modern direct-to-consumer marketing? "Pinkham and her family were market leaders," said Strasser.

What of current medical use of black cohosh, formerly one of Pinkham's ingredients? Although some studies suggest the substance may help relieve menopausal symptoms, other study results do not. NCCAM is currently funding research to determine whether black cohosh (Cimicifuga racemosa) reduces the frequency and intensity of hot flashes and other menopausal symptoms. No studies have been published on long-term safety in humans.

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