Acknowledgments and history of the project

The Medicine and Madison Avenue Project was made possible through the encouragement of Lloyd Cotsen and the generous funding provided by the Ahmanson Foundation. The National Humanities Center has undertaken this project in collaboration with the Duke University Library and the State University of New York at Stony Brook.

In 2000, the National Humanities Center, through funding made available by the Ahmanson Foundation, initiated a grant program designed to encourage Fellows at the National Humanities Center to develop teaching materials based on their research projects. One of the recipients of that grant support was Nancy Tomes, who was the Burroughs Wellcome Fund Fellow in the History of Modern Medicine at the Center from 1999 to 2000. MMA represents an outgrowth of Tomes's book in progress, "The Making of the Modern Health Consumer, 1900-1940," which looks at the impact of modern consumer culture on American medicine and public health. The Ahmanson Foundation/National Humanities Center grant made possible Tomes's collaboration with Ellen Gartrell, Director of the John W. Hartman Center for Sales, Advertising, and Marketing History at Duke University, and the staff of the Digital Scriptorium, who maintained Duke's extensive collection of digitized primary source materials. Drawing on their experience in developingAd*Access and the Emergence of Advertising in America, Gartrell and her colleagues at Duke supplied the archival, administrative, and technical skills to bring MMA to life.

The following individuals worked together to create MMA:

• Nancy Tomes: Project Creator, SUNY at Stony Brook
• Amy Gangloff: Research Assistant, SUNY at Stony Brook
• Ellen Gartrell: Director, Hartman Center, Duke University Library
• Lynn Eaton: Project Leader, Duke University Library
• Paolo Mangiafico, Technical Advisor, Duke University Library
• Kristen Kramer, Project Manager, Duke University Library
• Ryan Denniston, Technical Assistant, Duke University Library
• Pablo Torres, Website Designer and Developer, Duke University Library

The following consultants provided invaluable advice on the design and implementation of the MMA Project:

• Robert C. Allen, Ph.D., Department of American Studies, University of North Carolina at Chapel Hill
• Peter W. English, M.D., Ph.D., Departments of Pediatrics and History, Duke University

Introduction to "Medicine and Madison Avenue"

Essay by Nancy Tomes, 2000

Since the 1980s, American consumers have been exposed to an increasing number of commercial messages linking health promotion with specific products and services. In the wake of a landmark Federal Trade Commission ruling that took effect in 1982, hospitals and physicians now advertise much more extensively. Since 1997, the Food and Drug Administration has loosened restrictions on direct-to-consumer advertising of prescription drugs. Policy makers, health professionals, and health consumers are now weighing the positive versus the negative effects of these far-reaching changes (Tomes 2000).

Medicine and Madison Avenue is designed to help users develop a deeper understanding of the issues involved in contemporary debates about health-related advertising. Although certain features of the current "health sell" are new, the underlying tensions surrounding the commercialization of medicine and health promotion have long historical roots. Many of our contemporary dilemmas concerning the advertising and marketing of health care products and services emerged in the first half of the twentieth century, as both modern medicine and modern advertising came to maturity. By looking at this more distant past, users will gain new perspectives on contemporary debates about the role of advertising as a form of consumer health information (Tomes 2001).

Since the turn of the last century, advertisements have become an increasingly significant source of knowledge about health promotion and disease prevention. To be sure, their influence has by no means been absolute or uncontested. Ads compete with many other sources of information about health, including television, radio, newspapers, and magazines. Because of their commercial orientation, they often arouse resistance and skepticism in their hearers. But due to their creativity and pervasiveness, advertisements are particularly effective in gaining public attention to specific health problems. Thus their role in shaping popular health beliefs and behaviors deserves special attention.

Studying historical advertisements can help today's health professionals to understand generational differences in health beliefs and behaviors. Today's senior citizens grew up in the 1920s and 1930s reading the kind of advertisements included in this database; likewise, the ads from the 1950s may linger on in the consciousness of the so-called baby boomers. Advertisements also provide a valuable record of the popularization of medical science. Since the early 1900s, they have been an influential (if not always entirely accurate) forum for explaining new discoveries about health and disease. For example, commercial messages played a key role in educating Americans about the role of germs in causing infectious diseases and the importance of vitamins in the diet (Tomes 1998; Apple, 1996).

Of course, health-related advertisements long predate the twentieth century (For more on this earlier history, see Emergence of Advertising in America (EAA)). But for a variety of reasons, advertising became an increasingly important form of health information and persuasion around the turn of the last century. Its growing influence reflected the revolution in mass media that started in the last century. The so-called print revolution of the mid-to-late 1800s greatly cheapened the cost of paper manufacture and printing. The number of weekly and daily newspapers climbed dramatically; in 1910, at the peak of the print media's boom, newspaper publishers produced approximately 2,200 English-language dailies and 14,000 weeklies (Sloan and Startt 1999, p. 282). During the same time period, the number of magazines published also grew dramatically. Between 1890 and 1905, magazine circulation in the United States tripled, to over 65,000 million, or three magazines for every four people (Schneirov, 1994, p. 5).

This media revolution was financed by advertising. Publishers could lower the newsstand and subscription prices for newspapers and magazines because manufacturers were willing to pay to advertise in their pages. With the maturing of the industrial revolution, American manufacturers faced increasing outputs and declining prices. In order to make a profit, they had to expand the sales of their goods. Professional advertising flourished as companies eager to promote their goods and products paid to have agencies place advertisements in the pages of daily newspapers and mass circulation magazines (Pope 1983, Strasser 1989).

Starting in the late 1800s, both the design and placement of advertisements became the work of professional advertising agencies (For more on the early history of advertising, see Emergence of Advertising in America (EAA) and Ad*Access). At first these agencies simply bought space for advertisements in different print outlets. But soon agencies started to develop the advertisements themselves. Ads began to develop beyond simple text-dominated announcements of a good's availability and merits to more complex visual statements. The look of ads changed dramatically as technological improvements in lithography and other forms of reproduction made it possible to reproduce line drawings and later photographs. The work of producing an ad became increasingly complex. Agencies competed to win clients by developing the most impressive advertising campaign. This process involved a creative team who studied the product and its potential buyers and developed a selling "platform" or concept; copy writers and illustrators who translated that selling concept into an attractive combination of words and images; and a marketing team who planned to introduce the new campaign with suitable promotions, such as coupons and contests. Ad agencies grew up in Chicago, New York, and Philadelphia. Since many of the largest agencies were located on Madison Avenue in New York City, the term "Madison Avenue" became a colloquial (albeit geographically misleading) term for modern advertising as a whole (A list of works on the history of advertising is included in Suggestions for Classroom Use).

From the outset, advertising professionals realized that appeals to health constituted a lucrative way to promote many products. Indeed, the patent medicine industry's spectacular successes in using new forms of advertising to promote sales helped to create the modern advertising industry. But starting in the late 1800s, advertising agencies sought to become more professional by repudiating the "snake oil" tactics of the patent medicine entrepreneurs (See Lears 1994). In place of the inflated claims used to promote patent remedies, they sought to make their advertising appeals more consistent with modern scientific methods and discoveries. The J. Walter Thompson Company became particularly well known for its use of scientific arguments in advertising. JWT account executives read medical journals to discover the latest findings about disease and conducted market research to discern popular health beliefs and fears. This new breed of health advertisement capitalized on the growing prestige of science and medicine during the early 1900s. The achievements of a new kind of laboratory-based science in the late nineteenth century greatly enhanced the authority of the medical profession. The experimental proof of the germ theory of disease led to dramatic changes in surgery and public health. New understandings of hormones, glandular function, and vitamins transformed conceptions of physiology and nutrition. Starting in the Progressive era (1890s to 1910s), American science and medicine enjoyed an unprecedented era of prestige (Starr 1982). Reflecting that prestige, advertisements began to include the symbols of modern medical science: white-gowned doctors and nurses, graphs and charts, microscopes and petri dishes filled with disease germs.

The scientific claims made in historic advertisements reflect the state of medical knowledge in their times, not our own. Their veracity has to be evaluated in the context of scientific thinking at that time. Most mainstream manufacturers sought to stay with the general framework of accepted medical knowledge, knowing that if they did not, they were likely to get negative publicity and regulatory scrutiny. Various "watchdog" groups emerged in the early 1900s, both inside and outside the advertising industry, seeking to restrain unrealistic claims for health-related products (See Timeline). The Food and Drug Administration and the Federal Trade Commission had some power to enforce restraint in advertising claims. See Fleischmann's Yeast/ FTCcase documents:

• Letter of complaint and reply
• FTC complaint against the Fleischman Company
• FTC in the matter of the Fleischman Company and Standard Brands Inc.
• FTC, Interview with Hubert Prior (Rudy) Vallee
• FTC, Interview with Mabel Kinneer

The American Medical Association also sought to expose fraudulent advertising appeals. But many companies continued to "puff" their products as much as the law would allow.

Advertising campaigns succeeded in large part because they appealed to a long tradition of popular interest in personal health and hygiene. Since colonial times, Americans have experimented with self medication and diet regimens to maximize their personal well being and counteract the stresses of everyday life. The rapid social and economic changes at the turn of the twentieth century only increased the appeal of health products and services. Building on the growing prestige of scientific medicine, ambitious public health crusades and school health programs made Americans increasingly health conscious. Voluntary health societies warned about the dangers of many diseases, including tuberculosis, syphilis, and cancer. Their work in publicizing the warning signals of dangerous disease helped lay the foundation for more aggressive marketing of over the counter drugs. Advertisements played up the dangers of the common cold as a precursor to more deadly respiratory infections; they also identified common symptoms such as constipation, indigestion, and nervousness, as potential warning signs of serious illness.

The health sell by no means eclipsed other advertising strategies. Health arguments were often combined with representations of product use as a route to career success, personal popularity, and romance. Listerine, for example, had multiple selling platforms. Campaigns centered on germs and cold prevention would be scheduled for fall and winter months, that is, the traditional cold and flu season; at other times, Listerine ads emphasized its use as an aid to romance, popularity, and job success.

When reading historic advertisements, modern viewers need to keep in mind that, then as now, readers' responses to health-related ads varied greatly. Marketing surveys in the interwar period suggest that many Americans simply tuned out advertising messages. Others may have responded to advertisers' arguments with amusement or skepticism. Still others, probably a minority of the whole, believed what they read and acted upon the advertiser's message. Thus it is impossible to generalize about the impact that advertising had on individual consumers. At the same time, advertising seemed to "work," in the sense that sales of over-the-counter drugs and other health-related products grew steadily throughout this period. Even during the Great Depression, Americans spent about $350 million a year on patent medicines, roughly three to four bottles per person (Jackson 1970, p. 21). Both product manufacturers and advertising professionals believed that money invested in advertising was well spent.

Advertisers pitched many health products to women for two reasons: first, they knew that married women with families did the vast majority of shopping for the entire household, and second, they believed women were more concerned about health issues than were men. Advertising campaigns cast mothers as "deputy doctors" responsible for the health of their husband and children. What might be termed the "mommy sell" -- if you want to keep your child safe from dread disease, buy our product -- was extremely popular throughout the period. See the following ads:

• Child's cold may be flu
• Mother! Your child's cough...
• Ask your doctor, your grocer, your husband
• To puzzled fathers of rather young children
• If your baby catches cold

Yet men too were concerned about their health, and ad campaigns often included gender specific appeals for their products. See for example the ads:

• The job hunter with two strikes against him
• Do you ever wish you were single again?
• Street car colds!...

Because they were designed to sell products, advertising campaigns inevitably aimed at more affluent Americans, that is, people with the extra income to spend on items other than food and shelter. The lifestyles and habits represented in interwar advertisements did not represent an accurate sample of American families. During the depths of the Great Depression, advertisements continued to feature middle and upper class families (Marchand 1985). Figures recognizable as working class or ethnic Americans rarely appear in the advertisements in the MMA database. African Americans do not appear except as maids or servants until the 1950s, and then only in advertisements placed in Ebony and Jet. See for example the ads New Vicks double-buffered cold tablets... and You can not brush bad breath away...

References

Apple, Rima D. Vitamania: Vitamins in American Culture (New Brunswick, 1996).
Jackson, Charles O. Food and Drug Legislation in the New Deal (Princeton, 1970).
Lears, Jackson. Fables of Abundance: A Cultural History of Advertising in America (New York, 1994).
Marchand, Roland. Advertising the American Dream (Berkeley, 1985).
Pope, Daniel. The Making of Modern Advertising (New York, 1983).
Sloan, William D. and Startt, James D., ed. The Media in America: A History 4th ed. (Northport, Ala., 1999).
Starr, Paul. The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of A Vast Industry (New York, 1982).
Strasser, Susan. Satisfaction Guaranteed: The Making of the American Mass Market (Washington, D.C., 1989).
Tomes, Nancy. The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, Mass., 1998).
______. 2000 "Madison Avenue Medicine," Ideas vol. 7, no. 1, 4-17.
______. 2001 "Merchants of Health: Medicine and Consumer Culture in the United States, 1900-1940," Journal of American History (forthcoming, Sept. 2001).

Copyright and Citation

Most of the advertisements used in the MMA Project were published after 1923. Therefore, the majority of advertisements are not in the public domain. All the ads may be viewed and printed out by anyone for research, teaching, private study, or general interest. For any other uses see below for permission requirements.

Copyright Information

Research, Teaching, Private Study, General Interest User Information:

The advertisements on this website have been made available for use in research, teaching, and private study. For these purposes under Fair Use, you may reproduce (print, make photocopies, or download) materials from this website without prior permission, on the condition that you provide proper attribution of the source in all copies. Although we don't require you to contact us in advance for these purposes, we do appreciate hearing from teachers, students, and researchers who are using our resources in interesting ways (send e-mail to the Hartman Center at hartman-center@duke.edu).

Commercial, Broadcast, Mirroring, etc. User Information:

For other uses of materials from this website - i.e. commercial products, publication, broadcast, mirroring, and anything else that doesn't fall under "Fair Use" - we require that:

For other uses of materials from this web site - i.e. commercial products, publication, broadcast, mirroring, and anything else that doesn't fall under "fair use" - we require that:

1. Users must obtain permission from the current copyright holder.
   Individuals wishing to publish or broadcast any advertisement included on this website must assume all responsibility for identifying and satisfying any claimants of copyright, trademarks, or service marks.
   
2. Users must also obtain permission from the John W. Hartman Center for Sales, Advertising & Marketing History to reproduce materials held in its archive that are featured on this website.
   A letter granting permission from the current copyright holder must be submitted along with the request to the Hartman Center.

Contact the company that owns the product(s) contained in the advertisements you would like to use. You must provide written permission from these companies before the Hartman Center can provide permission to use an advertisement for a purpose which does not fall under "fair use." Please read on for more information.

The Hartman Center charges fees to cover the cost of reproduction of items in its collections. Requests that require extensive research or preparation by Center staff may require an hourly charge, negotiated in advance. In addition, requests to publish, broadcast, or otherwise disseminate ads may be subject to a commercial use fee. Please contact the Hartman Center Reference Archivist for more information and a fee schedule.

The Fine Print

The John W. Hartman Center for Sales, Advertising & Marketing History can provide high quality reproductions of items from MMA, with permission in advance from the copyright holder(s). We will make such copies for commercial uses, publication, broadcast, etc. uses only with prior permission.

Users may make a single copy in print or digital form of images or other material from the MMA site. These copies may be used only for use in research, teaching, or private study. They may not be made for or donated to other repositories. They may not be further reproduced without permission.

The recipient agrees to give proper acknowledgement to the Duke University David M. Rubenstein Rare Book & Manuscript Library, and further agrees to secure written permission in advance from the rights owner to publish or broadcast any item, in whole or in part, from the MMA on-line collection. Persons wishing to broadcast or publish this material must assume all responsibility for identifying and satisfying any claimants of copyright, trademark or service marks.

The recipient agrees to indemnify and hold harmless Duke University, its officers, employees and agents from and against all suits, claims, actions and expenses arising out of the use of reproductions provided by the David M. Rubenstein Rare Book & Manuscript Library. Duke University claims no rights to the advertising images included in MMA beyond ownership of the physical items.

How to cite materials from the MMA Project

When using advertisements from the MMA Project, please acknowledge their source by clearly stating the name of the project, the advertisement number, the collection name, and the name of the library. Also include the URL of the project page. Three examples are noted below:

For an advertisement:

Medicine and Madison Avenue - Ad #MM0065
John W. Hartman Center for Sales, Advertising & Marketing History
Duke University David M. Rubenstein Rare Book & Manuscript Library
https://repository.duke.edu/dc/mma (date user accessed the source)

For a supplementary document:

Medicine and Madison Avenue - Supplementary Document #MM1147
John W. Hartman Center for Sales, Advertising & Marketing History
Duke University David M. Rubenstein Rare Book & Manuscript Library
https://repository.duke.edu/dc/mma (date user accessed the source)

For a background article:

Nancy Tomes, "Suggestions for Classroom Use: Student Guide," Medicine and Madison Avenue,
John W. Hartman Center for Sales, Advertising & Marketing History
Duke University David M. Rubenstein Rare Book & Manuscript Library
https://repository.duke.edu/dc/mma (date user accessed the source)

Certain advertisements have additional copyright citation information required by the copyright holder. This information is included on the individual advertisement pages directly under the image. The user is responsible for including this information in all citations for those advertisements.

It is not required, but we appreciate hearing from people who are using the advertisements in interesting ways (send e-mail to the Hartman Center at hartman-center@duke.edu).