Book Review

Charlatan: America's Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam

N Engl J Med 2008; 359:438-439July 24, 2008

Article

Charlatan: America's Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam
By Pope Brock. 324 pp., illustrated. New York, Crown, 2008. $24.95. ISBN: 978-0-307-33988-1

In Gaetano Donizetti's opera L'Elisir d'Amore (The Elixir of Love), the itinerant Dr. Dulcamara peddles a “marvelous elixir that awakens love,” and in a vocally demanding patter song proclaims that his “superhuman elixir can, in a moment, not only cure the ills of love, but make the penniless rich.” Donizetti's audience surely knew — perhaps some from their own experience — that the origin of the character's name, the plant Solanum dulcamara (commonly called woody nightshade or bittersweet), is an herbal remedy for impotence.

The doctor's elixir stands in a long line of concoctions meant to arouse the male member — ginkgo, Spanish fly, rhinoceros horn, yohimbine, and boiled alligator testicles are among the recommended treatments. Newer remedies show up in television commercials that must presume a huge market for the relief of erectile dysfunction. Indeed, the National Institute of Diabetes and Digestive and Kidney Diseases reports that up to 30 million men in America have erectile dysfunction. In 1999 alone, according to data from the National Ambulatory Medical Care Survey, 2.6 million men asked a physician about Viagra during an office visit. The drug was introduced with enormous hype in 1998, but by 2002 worldwide sales had reached only $2 billion, perhaps because no pill for erectile dysfunction could live up to Pfizer's advance notices.

Whether erectile dysfunction is on the rise is not clear, but its frequency seems no different from what it was when John R. Brinkley, the Dr. Dulcamara of Charlatan, Pope Brock's witty book, offered to enhance virility by transplanting goat testicles into the scrotum. After attending Bennett Eclectic Medical College in Chicago for 3 years (from 1908 to 1911), Brinkley skipped from town to town, offering colored-water enemas, passing bad checks, and running from sheriffs. In 1917, he set up shop in Milford, Kansas (population 2000 at the time), and carried out his first goat-testicle transplant at the suggestion of a depressed farmer — “No pep. I'm a flat tire.” Word-of-mouth praise for the success of the operation launched Brinkley's career as a medical magician.

Headline from the New York Times, August 15, 1920.

Brinkley was not alone, however. In the mid-19th century, Charles Édouard Brown-Séquard, of the eponymous syndrome and a professor at Harvard Medical School, championed an extract of animal testicles to prolong life. On June 12, 1920, Serge Voronoff, a Russian surgeon working in France, made headlines by performing the first monkey-to-man testicle transplant, and on August 15, 1920, the New York Times reported that Frank Lydston, a professor of surgery at the University of Illinois, had transplanted a testicle from an executed felon into his own abdominal wall, and then proceeded to transplant testicles from other cadavers into a lineup of eager recipients. Brinkley was not far behind — in the summer of 1920, he, Voronoff, and Lydston appeared in Chicago to show what transplanted testicles could do for men. Brinkley, known as the Ponce de León of Kansas, performed more than 30 goat-gland transplants (including some transplants of goat ovaries into women) in that season of impotence.

Brinkley rose up from dirt-poor Beta, North Carolina, to become the director of the Brinkley Institute of Health, a nationally known radio personality and promoter of country music, a candidate for governor of Kansas (he lost), and the owner of 12 Cadillacs parked on a 16-acre estate in Del Rio, Texas, that rivaled the palace of Versailles. Ultimately, Brinkley was brought down by Morris Fishbein, editor of the Journal of the American Medical Association from 1924 to 1950 and an avowed enemy of quacks. Pursued relentlessly by Fishbein, Brinkley filed a losing lawsuit against him for libel. Pursued by creditors, disgruntled patients, and the Internal Revenue Service, Brinkley declared bankruptcy in 1941. He died a year later in San Antonio, Texas, and was buried under a large monument in Memphis, Tennessee, the city where he had met his wife, Minnie.

Brinkley's story has been told before — he is even the subject of a video documentary (The Goat Gland Doctor). Brock's account, told in short, pungent chapters, runs from the hilarious to the incredible. The nearly 20 pages of notes included at the end of the book make the implausible plausible. Anyone who doesn't laugh out loud while reading Charlatan can't see what fools we mortals be.

Robert S. Schwartz, M.D.