The Apothecary in Eighteenth-Century Williamsburg Being an Account of his medical and chirurgical Services, as well as of his trade Practices as a Chymist
Being an Account of his medical and chirurgical Services, as well as of his trade Practices as a Chymist
Williamsburg Craft Series
Published by Colonial Williamsburg
in Eighteenth-Century Williamsburg
Of the first 225 men sent over fromLondon to settle at Jamestown in 1607 and1608, seven were practitioners of medicine—asit was then practiced: Walter Russell,Gent., was a “Doctour of Physicke,” whichis to say that he had studied at a university and earned adegree in medicine; Thomas Wotton, Will Wilkinson, andPost Ginnat were listed as surgeons—“chirurgeon” asit then appeared; Thomas Field and John Harford borethe label of apothecaries; and the seventh was “Tho:Cowper the Barber.”
Plainly, the Virginia Company of London, numberingseveral prominent medical men among its backers, wantedits adventurers to the New World to have the best ofmedical care. Unfortunately for about four of every fivesettlers in the first few years at Jamestown, the best wasnot enough to avert wholesale mortality from sickness,Indian arrows, and “meere famine.” That some of themedical men shared the fate of their patients seems likelyin the absence of later information about most of them.
Medical theories and practices at the beginning of theseventeenth century were largely those that had prevailedsince the time of Galen, a Greek physician who died abouttwo centuries after Christ. According to Galen, the fourelements of Aristotelian science—fire, water, air, and2earth—comprised the four major humors of the humanbody: blood, phlegm, yellow bile, and black bile. Bloodwas held to be moist and warm, phlegm was moist andcool, yellow bile dry and warm, and black bile dry and cold.
Sickness, in the theory of Galen, was caused by one ormore of these humors becoming impure or out of placeor out of balance. Treatment thus consisted of removingor diminishing the offending humor by purging, bleeding,vomiting, blistering, urinating, sweating, or salivating;on the other hand, a deficient humor was to be restoredby diet and drugs. Galen classed drugs according to theirwarm, cold, moist, or dry qualities. For instance, pepperwas a heating drug, good for chills, while cucumber wasa cool one, to be given in case of fever.
Galenism had been subjected to attack in the sixteenthcentury by Paracelsus and Vesalius, but its appeal waslogical and remained strong in seventeenth-century England.(In fact, some survivals can be found in twentieth-centuryfolk medicine.) Dr. Lawrence Bohun (or Boone), whocame over in 1610 and returned to England in 1611, spentsome of the year investigating medicinal sources in Virginia.He discovered a white clay—and shipped some to England—thathe claimed could absorb and expel poisons from thebody. Among vegetable remedies, Bohun experimentedwith sassafras and found “Galbanum mechoacon, otherwisecalled rubarbum alum, to be of service in cold moistbodies, for the purginge of fleame [phlegm] and superfluousmatter.”
WHAT IS AN APOTHECARY?
Already it will be evident that the practice of medicinein seventeenth-century England, and hence in the firstAmerican colonies, was not neatly confined to the licensedgraduates of accredited medical schools. Quite the contrary.In fact, Henry VIII had complained that all kindsof ignorant people got into the act, including “Smiths,Weavers, and Women.”
In the upper half of this woodcut from The Expert Doctor’s Dispensary, published inLondon in 1657, a learned physician is shown conducting a urinalysis. He simply holds theflask of liquid to the light for visual examination. Below, a customer presents what appearsto be a written prescription to be filled by the apothecary.
Two centuries of legal and parliamentary pulling andhauling, plus the consequence of some natural developments,left the situation in England somewhat stabilized—butnot necessarily logical. The barbers, chartered as aguild in 1462 and authorized to practice surgery, includedboth barbers and surgeons in growing disharmony untilthey were formally divorced in 1745.
The apothecaries—the word originally meant shopkeeper—joinedthe guild of grocers at one time but shortlybroke away to form their own guild in 1617. Meantime,the physicians, organized in the College of Physicians,obtained the right to keep watch on the apothecaries.
Physicians, who had to have as much as 14 years trainingand four degrees from Oxford or Cambridge, werenaturally not abundant. Being learned men, they wouldnot stoop to the indignity of such menial work as performingsurgical operations or compounding medicines. Theformer was the province of the surgeon or barber-surgeon,the latter was the specialty of the apothecary.
But the scarcity of physicians, especially in rural areas,left a medical gap that the apothecaries, trained throughapprenticeship and many times more numerous, naturallymoved to fill. In 1727 English law finally recognized andlegalized the fact that for most people the apothecary-surgeonwas the only available practitioner of medicine.In turn, the business of purveying drugs and compoundingmedicines passed from the apothecaries to the wholesaledruggists and pharmaceutical chemists.
As it was transferred to America the trade of apothecary—itwas neither a craft nor a profession in any strict sense—wasprobably much like that of the rural apothecary-surgeonof seventeenth-century England. The apothecarystill made his living primarily from the provision of drugsand medical preparations; but he also performed amputations,dressed wounds, and subjected his patients tothe normal medical treatments of the day.
ALL THAT THE LAW ALLOWS
Virginia was the only colony that tried to draw legislativeboundaries around the various aspects of medical practice.The effort came in 1736 in the form of “an Act for Regulatingthe Fees and Accounts of the Practicers of Phisic.”On two grounds the act deserves to be quoted at somelength. For one thing, it throws a good light on the stateof medical practice at that time. For another, it affordsundeniable parallels to some current problems in the costof medicines and medical care, and to the role of governmentin serving the interests of the “consumer.”
An eighteenth-century operating chair, fully equipped with tilting back, paddedadjustable supports, and straps to keep the patient from writhing away from theknife. Anesthesia was limited to strong doses of spirituous liquors; antisepsis wasunknown. The illustration is taken from Denis Diderot’s famous encyclopedia ofarts and sciences.
The first section of the act recited certain abuses, especiallyof the surgeons and apothecaries:
I. Whereas the practice of phisic in this colony, is mostcommonly taken up and followed, by surgeons, apothecaries,or such as have only served apprenticeships tothose trades, who often prove very unskilful in the artof a phisician; and yet do demand excessive fees, andexact unreasonable prices for the medicines which they6administer, and do too often, for the sake of makingup long and expensive bills, load their patients withgreater quantities thereof, than are necessary or useful,concealing all their compositions, as well to prevent thediscovery of their practice, as of the true value of whatthey administer: which is become a grievance, dangerousand intolerable, as well to the poorer sort of people asothers, & doth require the most effectual remedy thatthe nature of the thing will admit.
The second section then proceeded to emphasize thechief distinction between the apprentice-trained apothecary-surgeonsand the university-educated physicians by allowingthe latter to charge twice as much for their servicesas the former could. If the apothecaries and surgeonsfelt—as well they might have—that the difference in feeswas an insult to them, it did not last long. The law wasnot renewed at the following session of the Assembly;perhaps its backers, the physicians, had seen theirpatients flock to the lower-priced practicers.
Although Virginia was the only colony to set medicalfees by law, the practice of legislative price fixing in otherareas of the economy was as common in colonial America asit was in England. In Virginia, to be specific, not onlyprices and quantities but in some cases even qualitiesof goods and services offered to the public by tavernkeepers,shoemakers, millers, and ferrymen were regulated by law.The economic philosophy and terminology of laissez fairewere among the alien isms imported after 1776. Duringthe colonial years, government rarely hesitated to act inthe economic field where the need was felt.
From this particular Virginia law of 1736 it would appearthat some if not all medical charges had gotten well outof line—the correct line, of course, being what the peopleand their elected representatives thought was reasonable:
II. BE it therefore enacted, ...
That from and after the passing of thisact, no practicer in phisic, in any action or7suit whatsoever, hereafter to be commencedin any court of record in this colony, shallrecover, for visiting any sick person, morethan the rates hereafter mentioned: thatis to say,
Surgeons and apothecaries, who haveserved an apprenticeship to those trades,shall be allowed,
£ s d For every visit, and prescription, in town, or within five miles 00 5 00 For every mile, above five, and under ten 00 1 00 For a visit, of ten miles 00 10 00 And for every mile, above ten 00 00 06 With an allowance for all ferriages in their journeys. To Surgeons, For a simple fracture, and the cure thereof 02 00 00 For a compound fracture, and the cure thereof 04 00 00
But those persons who have studied phisicin any university, and taken any degreetherein, shall be allowed,
For every visit, and prescription, in any town, or within five miles 00 10 00 If above five miles, for every mile more, under ten 00 1 00 For a visit, if not above ten miles 1 00 00 And for every mile, above ten 00 1 00 With an allowance of ferriages, as before.
Lest it appear that all Williamsburg “practicers” madea habit of charging excessive fees, the generous treatmentan earlier doctor gave at least one of his patients must beset down. George Hume, a Scottish merchant who cameto Virginia about 1722 and soon caught all the prevalentills, found the place “only good for doctors and ministerswho have very good encouragem’nt here.” One ofthe “common distempers” that afflicted Hume was dysentery,then called the flux. He was laid so low that Dr.8John Brown all but despaired of his life. Hume’s gratitudefor being cured was doubtless enhanced by the fact—carefullyreported to his Scottish relatives—that “ye Dr.took nothing for my druggs.”
The third section of the act, specifying exactly whatthe “practicer of phisic” should set forth in his bill, bearsif least a faint augury of modern food-and-drug labelinglegislation:
III. And to the end the true value of the medicines administeredby any practicer in phisic, may be betterknown, and judged of, Be it further enacted, by theauthority aforesaid, That whenever any pills, bolus,portion, draught, electuary, decoction, or any medicines,in any form whatsoever, shall be administeredto any sick person, the person administering the sameshall, at the same time, deliver in his bill, expressingevery particular thing made up therein; or if the medicineadministered, be a simple, or compound, directedin the dispensatories, the true name thereof shall beexpressed in the same bill, together with the quantitiesand prices, in both cases. And in failure thereof, suchpracticer, or any apothecary, making up the prescriptionof another, shall be nonsuited, in any action or suithereafter commenced, which shall be grounded uponsuch bill or bills: Nor shall any book, or account, ofany practicer in phisic, or any apothecary, be permittedto be given in evidence, before a court; unless thearticles therein contained, be charged according tothe directions of this act.
This final section reveals that some differentiation betweenthe branches of the medical profession had alreadybegun in America. The tip-off is the phrase that imposeson “any apothecary making up the prescription of another”the same requirements as on physicians who make up theirown prescriptions.
THE DOCTORS OF WILLIAMSBURG
If competition tends to keep prices low, fees charged inand around the capital city in the early eighteenth centuryshould have been at the rock bottom level. GovernorGooch in 1729 reported to London that Williamsburgabounded in physicians. The same year young AdamCunningham gave up his brief effort to establish himselfin practice as a doctor:
Another illustration from the Diderot encyclopedia shows the operation of trepanninga skull and