Comic valentines first appeared in Great Britain and North America in the middle of the nineteenth century. They were usually sent anonymously, and were often poorly printed on cheap paper with insulting verses that attacked all trades, professions, and offensive habits such as smoking. Not surprisingly, the health professionals--doctors, pharmacists, dentists, nurses, and their colleagues--came in for their share of abuse, as the example of the quack doctor shows. William H. Helfand, from The Picture of Health: Images of Medicine and Pharmacy from the William H. Helfand Collection (1991), p. 132.