The Business of Medicine

The relationship between doctors and pharmaceutical manufacturers sometimes raises concerns about the undue influence of companies on the medical choices made by doctors. Dr Claire Jones’ research on 19th and early 20th century trade catalogues in the Burroughs, Wellcome & Co. archives reveals a more complex relationship between commercial and medical interests.

Anecdotes of doctors welcoming regular visits from their friendly sales representative and of the pushy sales representative attempting to convince medics of the benefits of its products over expensive dinners or rounds on the local golf course are familiar to us in 21st century Britain. Yet, my new book The Medical Trade Catalogue in Britain, 1870-1914, on one of the first manifestations of printed advertising aimed at doctors in a book-like format, reveals that doctors have long been subjected to company promotional practices and that, perhaps more importantly, commercial interests have long been part and parcel of the practice of medicine.

Trade price list, Burroughs Wellcome & Co, December 1895. Wellcome Library ref. no. WF/M/PB/32/01/13.

Both pharmaceutical companies and medical instrument makers began to develop catalogues from the late eighteenth century. This new form of printed media, containing product descriptions, illustrations and prices within a medical reference book-like exterior, allowed manufacturers to promote their wares to doctors away from their showroom during a period of medical professionalization.

By the late nineteenth century, catalogues and other increasingly sophisticated printed and non-printed forms of promotion, such as advertisements in new specialist medical periodicals, free product samples, travelling exhibits and sales representatives, formed part of systematic company attempts to develop sustainable relationships with doctors across the world.

Burroughs, Wellcome & Co. catalogues

The catalogues and associated marketing material of Burroughs, Wellcome & Co. Ltd, which form part of the company’s extensive archive at the Wellcome Library, have been particularly useful for this research. The company, established by pharmacist Henry Wellcome in partnership with Silas Burroughs in 1880 and on which the Library and the Wellcome Trust was founded, became one of the world’s leading pharmaceutical companies and its success was in no small part a result of its innovative and aggressive promotional strategies and output.

The company produced and distributed more catalogues than any other during the late nineteenth and early twentieth centuries: while most companies produced a new edition every two to three years, Burroughs, Wellcome & Co. produced up to four new editions per year. Between 1890 and 1914, the company produced over fifty catalogue editions aimed at doctors and pharmacists, as well as numerous editions translated into over twenty languages demonstrating its international reach (for example, WF/M/PB/32/01/01 – WF/M/PB/32/01/34).

Advertisement for Burroughs Wellcome showing various situations in which a Tabloid medicine chest would be useful. Colour process-print. Wellcome Image ref. no. L0072858.

The catalogues and associated marketing material also reveals that the company were pioneers of medical branding and trademarks. ‘Tabloid’ and ‘Soloid’ branded medicinal preparations promoted inside colourful eye-catching catalogue designs, for example, aimed to ensure that doctors were quick to recall the company’s products during patient consultations.

The role of the doctor

However, my research into the catalogues of this period also reveals that markets for pharmaceuticals and for medical instruments were not only driven by companies but were also steered by demand from doctors. Doctors were active and willing contributors to both medical catalogues and to the medical industry as a whole; they worked in partnership with companies like Burroughs, Wellcome & Co. in order to test and develop new products and expressed their satisfaction with the final result by providing these companies with endorsements and reviews for publication.

Part of the company’s success in appealing to doctors lay in its ability to distance its manufactures and associated advertising from those produced by the many and often disreputable patent medicine vendors which operated throughout the nineteenth and twentieth centuries. The company appealed to the profession through the ‘ethical’ advertising of what it described as ‘ethical’ pharmaceuticals; this ‘ethical’ advertising took the form of catalogues.

Far from raising ethical concerns about patient care, such practitioner contributions to industry were celebrated by the medical profession and were viewed as crucial for the development of a progressive form of medical science, new to this period and based on laboratory testing, standardization and mass production. In effect, doctors were selling their product designs to each other and by extension, to the general public.

Burroughs Wellcome price list, 1885-1891. Wellcome Image ref. no. L0032232.

The profession’s approval of practitioner involvement in the development of medical products is evident from Burroughs, Wellcome & Co.’s catalogues but combined with the company’s archival sources, they provide an unparalleled glimpse into the working relationships between medical companies and doctors. The company’s numerous private letter books, in particular, reveal that it had correspondence with many doctors all over the country and that doctors were in fact often the ones that approached them.

One such surgeon clearly visible in the Burroughs Wellcome company records but also in collected papers on surgery (MS.1728) and amongst the papers of physiologist Sir Edward Sharpey-Schafer (PP/ESS/B.29/11) is John Ward Cousins (1834-1921). Cousins, a surgeon in Plymouth and at St Bartholomew’s, London, spent much of his professional career inventing medical tools and approaching suitable companies with ideas and designs for production, sale and promotion.

Interestingly, Henry Wellcome turned down Cousins’ offer to exclusively produce his designs for new probes, finger protectors, a mouth gag and antiseptic protective inhaler in early 1904 claiming that he could not do the designs justice (WF/E/01/01/07). Instead, Wellcome relinquished any potential profit for the apparent good of medical science as a whole by suggesting Cousins approach some of its competitors. While it is difficult to establish which competitor (if any) adopted any of these specific designs, the catalogues of both Maw, Son & Sons and Arnold & Sons certainly suggest their adoption, production and promotion by specialist instrument makers.

It is clear then that the close relationships between doctors and medical companies have a long history. Historically, these relationships were not always supply-driven and were not always considered ethically dubious. In fact, these relationships and their outputs were celebrated for their contributions to medical science. Yet, my research in this area only really scratches the surface. With help from libraries and archives, such as the Wellcome, we can hope to uncover a more complex picture of commercial medicine in the past and its relevance to medicine today. This picture must go beyond the simple demonization of companies and reveal the extent to which doctors were intimately involved in the production and promotion of pharmaceuticals and instruments.

Author: Dr Claire Jones is Director of the Museum of the History of Science, Technology and Medicine, University of Leeds.