About the Medicine & Madison Avenue Collection
- Acknowledgments and history of the project
- Project scope and overview
- Introduction to "Medicine and Madison Avenue"
- Building the MMA database
- About the advertising collections at Duke
- About the "Competitive Advertisements Collection," the source of images for Medicine and Madison Avenue
- Preservation of advertisements
Disclaimer: This site includes historical materials that may contain negative stereotypes or language reflecting the culture or language of a particular period or place. These items are presented as part of the historical record.
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 teaaching 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 maintain Duke's extensive collection of digitized primary source materials. Drawing on their experience in developing Ad*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 have 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
Project scope and overview
MMA is one of three databases on the history of advertising currently available through Duke Library's Digital Scriptorium. MMA can be used on its own, but users will benefit by looking at its contents in conjunction with the other two databases: Ad*Access and the Emergence of Advertising in America(EAA). MMA's focus is on the changing views of medicine, health, and disease reflected in product advertisements. The following essay, written by Nancy Tomes, provides an overview of the project. References in parentheses are to books and articles listed at the end of the essay. A more complete bibliography is provided in Suggestions for Classroom Use.
Introduction to "Medicine and Madison Avenue"
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/ FTC case documents:
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.
-- 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, and
-- FTC, Interview with Mabel Kinneer.
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:
Yet men too were concerned about their health, and ad campaigns often included gender specific appeals for their products. See for example the ads:
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...
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).
Building the MMA database
The advertisements in the MMA database are drawn from the J. Walter Thompson Company's archives. They were selected from the company's Competitive Advertisement files and client files. In choosing among the thousands of advertising images in those files, we particularly looked for:
--ads for commonly used over-the-counter drugs (cold and flu remedies, pain killers);
--ads that appealed to health promotion or disease prevention as a motivation for product purchase;
--ads featuring representations of doctors, nurses, and other health experts;
--ads invoking scientific knowledge generally (graphs, diagrams of the body, statistics).
We made an effort to include both newspaper and magazine advertisements. (On the differences between the two kinds of ads, see JWT Newsletters, Apr. 15, 1926: "Some pros and cons concerning the adapting of magazine advertisements for newspapers.") When considering a range of magazine ads, we usually picked the more visually complex and interesting examples. For example, if we had a choice between a black and white line drawing and a full color illustration, we chose the latter.
Once advertisements were selected for inclusion, we had to seek permission to reprint images published after 1923. Some companies did not grant us permission to include their products' images. For more information about what kinds of material are included - or absent from - MMA, see the Frequently Asked Questions.
About the advertising collections at Duke
Duke University's Hartman Center for Sales, Advertising & Marketing History has been active in building research collections in its topic fields since 1992. The Hartman Center now ranks as one of the most extensive resources for studying advertising history in the U.S. Its collections, acquired to preserve documentation that stimulates interest in and study of historical marketing topics, include the archives of advertising agencies and trade organizations, as well as the papers of industry executives and private collectors.
The most extensive collections are those of the J. Walter Thompson Company, a major international advertising agency founded in 1864, and the Archives of the Outdoor Advertising Association of America (OAAA), the trade organization for the billboard and other out-of-home advertising industry. Other ad agency records held here include those of DMB&B, Wells Rich Greene, and Charles W. Hoyt Company. The OAAA Archives are complemented by many individual collections relating to outdoor advertising, including the papers of the R.C. Maxwell Company and files of commercial artists Howard Scott and Garrett Orr. Other individuals' papers in the Hartman Center include papers of executives Kensinger Jones, Edgar Hatcher, and transit advertising salesman John Hogan. Specialized collections include the Wayne P. Ellis Collection of Kodakiana, the Nicole Di Bona Peterson Collection of Advertising Cookbooks, the Mobius Advertising Awards Collection, and the McGraw- Hill Marketing Information Center files. Many other medium and smaller sized archival collections and a growing collection of books and periodicals complement these holdings.
On-line access is available to detailed descriptions, or collection guides, of these and the hundreds of other manuscript collections held by the David M. Rubenstein Rare Book & Manuscript Library. This resource, the Archival Collection Guides page, allows browsing and searching of the collection guides. This page also includes links to additional collections and resources here at Duke University. For more information, see questions 8 and 9 on the Frequently Asked Questions page.
About the "Competitive Advertisements Collection," the source of images for Medicine and Madison Avenue
The majority of images in MMA are from the "Competitive Advertisements Collection" (Pre-1955 files) within the J. Walter Thompson Company Archives. The "Competitive Advertisements Collection" was created at JWT as an in-house resource over the period of many decades. Like other advertising agencies, the J. Walter Thompson Company had employees who clipped advertisements from magazines and newspapers and filed them according to the type of product or service advertised. Then the files could be used for reference by agency staff. Evidently the primary purpose was to provide ready access to the current and earlier work of competing advertisers, hence the title of the collection. The clipping at JWT seems to have begun in the early 1910s and continues to this day. Although many agencies have created similar "tearsheet" files, the very large JWT "Competitive Advertisements Collection" is one of the few that has been preserved over so many decades.
The JWT "Competitive Advertisements Collection" as a whole fills many hundreds of cartons. In the earlier years (the "Pre-1955 Files" from which many of the ads in MMA are drawn), the clipped ads were arranged by categories with subject headings such as "Coughs and Cold," "Laxatives," "Cigarettes," and so forth. From 1956 on, the clippings are arranged by alphanumeric codes by the PIB (Publishers Information Bureau) scheme. So, for example, in these more recent files, the category D121is for Dental Supplies and Mouthwash, D211 is for Pain Relievers, Sedatives and Sleeping Preparations, and G111 is for Cigarettes.
Because the Competitive Advertisements Collection seems to have been created for a particular purpose, and because it was a working file from which agency staff used to be able to borrow items or whole folders, the collection is not a complete record of all advertisements printed in American magazines and newspapers. Some subject categories are much more fully represented than others, and sometimes files for specific years or products went missing long before the collection came to Duke in 1987 as a part of the massive J. Walter Thompson Company Archives.
Preservation of advertisements
One of the reasons for creating MMA is the difficulty that researchers and students have in locating large collections of older print advertisements. As mentioned above, a fairly small number of institutions in the U.S. focus on collecting advertising materials for permanent preservation and study. Many libraries do own collections of the thousands of magazines or newspapers that contain ads, but several conditions may make research access difficult. Some libraries keep only recent issues or recent years; others may preserve older periodicals and newspapers only on microfilm, which can be difficult to use and which prevents users from viewing images in color. Newspapers present a special problem because the acidic paper on which they are printed is so fragile. Newspaper ads produced on cheap newsprint made of wood pulp tend to become very brittle, even after a fairly short period of time. Here at Duke, we felt forced to close the pre-1955 portion of the "Competitive Advertisements Collection" because so many of the newspaper ads were too fragile to handle without their disintegrating.
Even when magazines or newspapers are available to researchers, searching through months or years of issues looking for ads about specific products or product categories can be labor-intensive and fatiguing. The "Competitive Advertisements Collection" has the advantage that the ads have been sorted by product type. Research becomes much easier for the on-site user. And preparation of an electronic version of the material grouped by type also becomes more practical.
Part of the process of creating MMA involved carefully sorting through the files of the "Competitive Advertisements Collection." The sorting allowed verification that ads were filed in the proper categories, permitted the removal of duplicates from the scanning process, and provided a good opportunity to unfold many items and place them in proper acid-free folders and boxes for the first time. So one result of the project will be better storage of the original paper items. By scanning the ads, we hope to increase use of them without physically wearing them out. Users who visit Duke University may use those previously-closed portions of the collection that now have received better physical care. We hope to extend that proper housing - and maybe scanning, too - to more of the collection as resources permit.
Bibliography for further reading
A bibliography has been created containing suggestions for further reading on the history of medicine, disease, health-related beliefs and behaviors, and advertising from the period 1910 to 1960.