ersey, 1949, p. 39.

Complex Formulas and Distinctive Packages

Indeed, the status of medical knowledge, medical need, and medical
ethics in the 18th century permitted patent medicines to fit quite
comfortably into the environment. As to what actually caused diseases,
man knew little more than had the ancient Greeks. There were many
theories, however, and the speculations of the learned often sound as
quaint in retrospect as do the cocky assertions of the quack bills.
Pamphlet warfare among physicians about their conflicting theories
achieved an acrimony not surpassed by the competing advertisers of
Stoughton's Elixir. The aristocratic practitioners of England, the
London College of Physicians, refused to expand their ranks even at a
time when there were in the city more than 1,300 serious cases of
illness a day to every member of the College. The masses had to
look elsewhere, and turned to apothecaries, surgeons, quacks, and
self-treatment.[51] The lines were drawn even less sharply in colonial
America, and there was no group to resemble the London College in
prestige and authority. Medical laissez-faire prevailed. "Practitioners
are laureated gratis with a title feather of Doctor," wrote a New
Englander in 1690. "Potecaries, surgeons & midwifes are dignified
acc[ording] to successe."[52] Such an atmosphere gave free rein to
self-dosage, either with an herbal mixture found in the pages of a
home-remedy book or with Daffy's Elixir.

[51] Fielding H. Garrison, _An introduction to the history of
medicine_, Philadelphia, 1924, pp. 405-408; and Richard H.
Shryock. _The development of modern medicine_, New York, 1947,
pp. 51-54.

[52] Kittredge, _op. cit._ (footnote 25).

In the 18th century, drugs were still prescribed that dated back to the
dawn of medicine. There were Theriac or Mithridatum, Hiera Picra (or
Holy Bitters), and Terra Sigillata. Newer botanicals from the Orient
and the New World, as well as the "chymicals" reputedly introduced by
Paracelsus, found their way into these ancient formulas. Since the
precise action of individual drugs in relation to given ailments was
but hazily known, there was a tendency to blanket assorted
possibilities by mixing numerous ingredients into the same formula. The
formularies of the Middle Ages encouraged this so-called
"polypharmacy." For example the _Antidotarium Nicolai_, written about
A.D. 1100 at Salerno, described 38 ingredients in Confe