Rebecca J. Keck

With the exception of Lydia Pinkham, Keck appears to be the only woman in 19th century America to have earned substantial wealth on her own behalf through the sale of patent medicine.[11] Like Pinkham, Keck began her career because of family bankruptcy caused by the Panic of 1873. But unlike Pinkham, Keck not only considered herself a practicing physician, but became the top executive of her business, which she ran with the assistance of her two oldest daughters, Belle Alexander and Charlotte Dorn, while her husband played only a peripheral role and her only son contributed even less to the operations.

It is difficult to know Keck's exact income, but she was able to purchase her infirmary in 1879 for $12,000 in cash,[12] and at the time of her death, her life insurance payout of $15,520 was one of the largest made in the United States for the week of May 17, 1905.[13]

While unpopular with members of the medical establishment in Iowa and Illinois, Keck enjoyed glowing front page editorial endorsements from newspapers in the cities where she practiced. Some newspapers ran her illustrated, full-column advertisements on the front page under the heading, "Mrs. Dr. Keck's Column." The Decatur Review[14] declared on November 15, 1883, "We have a marked example among us of success in medicine, in the person of Mrs. Dr. Keck, well-known in the West," while the Bloomington Pantagraph declared on August 30, 1883 that Mrs. Dr. Keck "absorbs considerable public attention and is a subject for congratulation among the women of America…a forcible illustration of the ability of women to succeed" in "avenues of professional or public life." The Quincy Whig said she was "one of our longest established and best known physicians,"[15] while the Evening Peorian referred to her "celebrity as a physician and good name as a citizen."[16] The Peoria National Democrat declared, "her success is unprecedented…she is capable of doing the work of five ordinary women."

Members of the medical establishment disagreed. The secretary of the Illinois State Board of Health, Dr. John Rauch, was quoted in the Chicago Tribune as saying that Keck was "foul and damnable in every way,"[17] and other members of county medical associations held similar opinions. Dr. James Clarke of Fairfield wrote that the sale of her catarrh cures "made the doctor wealthy, even if it did not cure her patients."[5] Regular doctors universally dismissed her as a quack, and her name was excluded from the physicians and surgeons listing in the Davenport business directories every year after 1878, although Keck continued to describe herself as a specialist and physician in the regular alphabetical listings and bought the entire back cover of the 1882 edition to advertise her infirmary.

The state of Illinois passed the Medical Practices Act in 1877 in an effort to regulate the medical profession in the state.[18] This Illinois law was a landmark in health law in the United States, leading the way towards improved standards for medical licensing and medical education in the country.[19] The act defined requirements for a physician's license that excluded thousands of untrained physicians from the state during the first year after it was passed.[20] Popular opposition to this measure was strong, with some citizens arguing that the law was "an opening wedge for socialized medicine" in the state.[21]

After the passing of the Medical Practices Act, Keck continued treating her patients in Illinois and quickly emerged as an opponent to the state's legal reform effort. As opposed the new governmental regulations, Keck became engaged in a highly publicized, adversarial relationship with the secretary of the new Illinois State Board of Health, Dr. John H. Rauch, that lasted for at least a decade.[17] When local doctors tried to prevent Keck from practicing in McLean County, Illinois in early 1878, the Bloomington Daily Leader called her case the first test of the new legislation, "the beginning of a long and tedious litigation" between the "regulars" and the "irregulars."[22] The lasting stigma of this discourse may have contributed to her fading from public view after her death, and her career remains little known today.

Criminal charges of practicing medicine without a license were brought against Keck in at least five different counties in Illinois between 1878 and 1889, against which she was defended by her lawyer W. S. McCoy.[23] During this time, Keck continued her business in McLean, Logan, Champaign, Peoria and Adams counties in Illinois for twenty years.[24] Medical legislation in Iowa had even less effect on her business, and she opened Mrs. Dr. Keck's Infirmary for All Chronic Diseases in Davenport in 1879,[12] practicing with uninterrupted financial success there and in Cedar Rapids, Dubuque and rural communities in Iowa until she retired in 1900.[25]

Over the years, Keck grew increasingly boastful of her ability to cure many types of chronic diseases, including tuberculosis, an obviously impossible task in an era before the bacillus that caused the disease had been identified. Patients wrote to Keck when they were cured of chronic lung infections, piles, eczema, general debility, deafness and a host of other issues, and she published their testimonial letters in her advertisements.,[26][27]

Fraudulent testimonial letters were a common feature of 19th century patent medicine advertising.[28] Nevertheless, United States Census records from 1880 show that many of the individuals whose testimonials appeared in Keck's advertisements were real people.[4] However, in over a thousand ads that survive to be studied today, less than a hundred individuals are named, and there is no way to verify the facts presented about their illnesses, particularly the accuracy of the diagnoses, and there is no way to verify the percentage of Keck's patients who were cured by her treatments.

Standard allopathic medical practice during the 1870s and 1880s often involved "heroic" treatments with harsh, mineral medications containing lead, mercury (calomel) and arsenic, as well as toxic vegetable compounds containing strychnine, castor oil (derived from ricin), belladonna and other poisonous substances.[29] Clumsy, unsanitary surgical procedures were also common, so it is possible that Keck's herbal tonics and nursing advice may have been better for her patients than the regular doctors' remedies in some cases.

While a number of unlicensed physicians were sued for medical malpractice in Davenport during the years she practiced, no such accusation against Keck appears in the public record.[30]

The only parties who sued Keck during her career were male doctors with medical degrees who sought either to prevent her from obtaining a medical license or to prevent her from practicing medicine without one. No evidence that she harmed a patient was ever produced in any of these cases.