There certainly must exist an old English proverb warning, “He who carries coals to Newcastle runs grave risk of being burned.” I must admit that I have felt uncomfortably warm of late in contemplating my presentation before this seminar, in which laetrile should constitute a principal ingredient of my remarks. Some of you have devoted weeks of your lives to concern over this unorthodox cancer treatment and have played major roles in helping the Commissioner prepare his decision on laetrile’s status at the end of the rulemaking procedure called for by the 10th Circuit Court. This decision, published in the Federal Register on August 5, 1977 seems to me the most thorough, broad-gauged, and insightful analysis of a highly touted but ineffective product, the mode of its promotion, and the psychology of its acceptance that I have ever read.
What then, in the company of you experts, can I say that will not seem oppressively like res adjudicata or déja vu? So as to gain what I hope may be a fresh perspective, let me try to differentiate between what might be called endemic and epidemic quackery, essaying some historical epidemiology to point to factors present when epidemics occur. Endemic quackery has existed in the world, to quote Voltaire, since the first knave met the first fool. As long as some diseases remain unconquered and death marks the certain terminus of our earthly pilgrimage, and as long as an ethical medical profession abstains from promising the impossible, the unscrupulous will boldly cater to our often desperate hopes. Therefore, a certain basic level of quackery, I take for granted, has existed in all places and at all times and is destined to continue. Occasionally, as one scans the past, he can detect an outburst of quackish energy that I should like to designate as an epidemic. Sometimes a single promotion achieves such a status. At other times the epidemic level consists of a congeries of separate ventures. Before getting to laetrile, let me discuss briefly one epidemic promotion and one epidemic period from the American past.
In 1796, 180 years before the Medical Device Amendments of 1976, the federal government took perhaps its initial action regarding a medical device. In that year the government granted the first patent issued under the Constitution in the area of health to a Connecticut physician for “Improving Pain, Etc., by Metallic Points.” Elisha Perkins’ famous “tractors” furnished the new nation’s first example of a health quackery epidemic.
Always in such single-promotion epidemics, it seems to me, an ingenious promoter, or group of promoters, shrewdly devises and/or luckily falls upon an approach that meshes with remarkable pertinence into key elements of the prevailing social climate. In Perkins’ case these elements were fascination with electricity and cultural nationalism.
A small-town country doctor probably trained by apprenticeship to his father, Perkins discovered that he could ease pains in various parts of his patients’ bodies by drawing the blade of his penknife across the skin above the hurting parts and that he could relieve headaches by the ministration of a lacquered iron comb. He also observed that sometimes muscles contracted suddenly when touched during surgery by his knife. Knowing about Franklin and Mesmer, reading an account of Galvani’s experiments, Perkins did what many would-be innovators before and since have done, he compressed what he had heard and observed into a simple theory. Almost all painful conditions, he concluded, especially gout, pleurisy, rheumatism, violent insanity, “inflammatory tumors,” and yellow fever, resulted from a surcharge of an electric fluid that accumulated in the bodily parts. This could be released by drawing a metal point across the afflicted surface, always moving from the center toward the extremities, thus ending pain and working a cure. Asserting in his letters the necessity and propriety of making money from his discovery- Perkins bad a family of ten children to support–, this Yankee from the Nutmeg state shifted his therapeutic instrument from simple knife and comb to specially fabricated devices, a pair of small pointed metal “tractors,” called so because they pulled out pain. Made in a furnace in Perkins’ home, the two tractors were composed of secret alloys, one gold in color, the other silver. In time, forgetting the knife and comb, Perkins insisted that only his patented points would work. Perhaps he became genuinely persuaded such was the case. In the history of quackery many schemers have become converts to the gospel of their own oratory. Perkins sold his tractors for $25 a pair, in his day a princely sum.
Electricity was much in the air in the 18th century, and to posit an electrical cause for most diseases and a sort of miniature lightning rod cure struck the popular mind as both exciting and plausible. At least one testimonial, from a leading figure in the American Philosophical Society, compared Perkins’ achievement favorably with Franklin’s famous experiment and disparaged critics of Perkinism as similar to the English philosophers who had attacked the Philadelphia sage.
This linkage with Franklin underlined the proud fact that Perkins’ purported breakthrough was an American discovery. In the aftermath of a successful Revolution, cultural nationalism blazed brightly in the new nation. Dr. Benjamin Rush, a signer of the Declaration of Independence and now the most distinguished physician in the land, argued that there existed in the United States twenty times more intellect and a hundred times more knowledge than there had been in the American colonies before the war. Could it not be, Perkins’ champions queried jubilantly, that a nation which had provided the perfect example of freedom to the world might not also, through the metallic tractors, provide the means to universal health?
Perkins’ shrewd decision to get his tractors patented fit in neatly with this patriotic theme. In truth, patenting was still a very simple practice requiring no proof of an invention’s utility, but a patent could easily appear to be a symbol of governmental backing, even the consummate testimonial to healing potency. Perkins took immediate steps to bolster this sentiment among potential customers. At the very time the state medical society in Connecticut was ousting him for having “gleaned up” his tractors “from the miserable remains of animal magnetism,” Perkins labored to find distinguished buyers in Philadelphia, the nation’s capital. And he succeeded. Several members of the Congress acquired a pair. So did the Chief Justice of the Supreme Court, who wrote a letter praising the tractors to future Chief Justice Marshall. And a pair of the metallic points seems to have been bought by President Washington himself. With the three branches of the government thus leading the way, Americans engaged in a frenzy of “galvanizing trumpery.”
As these events demonstrate, Perkins had first-rank promotional talents. Prior to the tractors, he had added to his medical fees income secured from trading mules. His vigorous, magnetic personality certainly had much to do with both his therapeutic and his marketing successes. His series of testimonial pamphlets shows that Perkins worked as effectively in print as in face-to-face encounter. He gave tractors to some clergymen, along with a certificate saying they had bought them. And, despite their high cost, the metallic points sold well. An account suggests that people sold horses and carriages in order to buy them, and in one case a Southern plantation.
Perkins countered the opposition of his erstwhile fellows in the Connecticut medical society as the unorthodox almost always do. He accused them of blindness and greed. And he pointed out that some physicians supported his discovery, despite “menaces” from the stodgy establishment.
Besides electrical wonder and cultural nationalism, a third factor in the climate of the 1790s may have aided Perkinism to reach epidemic proportions. This was fear of yellow fever. That dread disease appeared again and again during the decade, including devastating attacks on Northern cities. In the Philadelphia epidemic of 1793 Perkins himself had lost a daughter, son-in-law, and two grandchildren. So a special poignancy marks his inclusion of yellow fever among the ailments amenable to tractor treatment. And the surest proof that Perkins placed great faith in the efficacy of his patented points comes from his going to New York in 1799 when that city lay prostrate in the grip of yellow fever to treat the ill by plying his device. He could not save himself. He contracted the fever end died of it.
Perkins’ death ended the American boom. A British craze, perhaps even more frenetic, engineered by one of Perkins’ sons, vanished when a provincial physician demonstrated that he could get just as enthusiastic patient response by using wooden tractors painted gold and silver as he could secure wielding the authentic patented points.
Some writers, admitting Perkins’ desire for money and his convenient forgetfulness about penknife and comb while later stressing that only the twenty-five dollar tractors possessed therapeutic efficacy, nonetheless wonder if it is appropriate to term him a quack. As his way of death demonstrates, they argue, he believed in his product, and therefore could not be a fraud. Does quackery require fraudulency? Does one “knowingly” have to sin or err in these matters to run afoul of the moral or statutory laws? Yes, said Congress in the 1912 Sherley Amendment. But I prefer