Keys to the Medicine Chest
Meriwether Lewis's Drug Purchases in Philadelphia
by Gregory J. Higby, Ph.D., R.Ph., Executive Director
American Institute of the History of Pharmacy
University of Wisconsin—Madison
Whelan's invoice raises five questions:
- What sort of diseases did Lewis expect to face?
- What were the main therapeutic approaches he planned to use?
- What did druggists stock and where did these items come from?
- Do any of the items have special significance?
- Why were they purchased from Gillaspy & Strong instead of some better-known Philadelphia druggist?
Diseases — A quick glance at the list of medical supplies elicits an obvious response: First and foremost, Lewis expected to confront "ague" and "intermittent fever"—malaria—and similar indispositions. Fifteen pounds of powdered cinchona bark was about 1500 60-grain doses. This was a fortunate choice, although no one had yet discovered the connection between the insect and the disease.1 Most physicians at that time were certain that "intermittent fever" was transmitted by the foul air of a swamp, or lowlands in general.
Lewis also expected his men would contract venereal disease. Four of his drugs or medicines were indicated for gonorrhea or syphilis, including calomel, copaiba, and a pound of mercury ointment. Opium and its tincture (laudanum), of course, were added to alleviate pain and induce sleep. And a few pounds of various ointments were included to treat the inevitable wounds and abrasions. For soothing eyes irritated by dry, dusty winds, zinc sulfate and lead acetate were combined with water to make eye wash. The largest set of medicines involved the gastro-intestinal tract—the seat of most diseases of young men—laxatives including jalap and rhubarb, calomel and magnesia, and Rush's Pills.Therapeutics— The drugs, of course, reflect the therapeutic approach of the captains, which followed the prevailing viewpoint shared by orthodox physicians and laymen alike: Most diseases were caused by imbalances within the body. Whether these imbalances were humoral, chemical, or mechanical, the treatments were pretty much the same—remove the bad through bleeding, puking, sweating, or purging—and health would be restored. To accomplish this end, the drugs from the standard materia medica were utilized.2
Benjamin Rush was famous (or notorious) for his depletive regimens typified by bleeding and administering his anti-bilious pills of jalap and calomel, which supposedly stimulated the body to excrete excess bile, which was the cause of many ailments.3 Rush apparently provided Lewis with a set of medical instructions, which the captains largely ignored. They did, however, administer Rush's Pills freely to their men and dosed themselves with them as well.
Druggists — To purchase these drugs and medicines, there was no better place in 1803 than Philadelphia, the center of the young American pharmaceutical industry. As the nation's leading city of science, with its first medical school and hospital, it is not surprising that a pharmaceutical establishment arose there as well.4
More importantly, as the famed Quaker City, Philadelphia was home to a number of apothecaries and druggists who used their connections with other Friends back in England to build their pharmaceutical reputations and businesses. From the early 1700s on, members of the Society of Friends in Britain had entered the drug trade and flourished. By the time of the American Revolution, perhaps half of the drug manufacturing in England was controlled by Quakers.5 Their straightforward and honest approach to business worked well in the drug trade, which was traditionally hampered by shady practices such as adulteration and substitution.
Quaker druggists in the Philadelphia area had access to the best drugs, medicines, and spices from England. In addition, drawing on know-how shared by their English counterparts, American Quakers began the manufacturing of chemicals. In the 1780s the Marshalls of Philadelphia started to manufacture a few fine medicinal chemicals. In 1793, John Harrison, the son of a Philadelphia Quaker, was the first in the United States to produce large quantities of sulfuric acid. 6Core of the trade — In the early republic, druggists were the linchpins of American pharmacy. As wholesalers, they supplied drugs and medicines to general stores, physicians, farmers, plantations, ships, and apothecaries. Apothecary shops were retail establishments selling drugs, patent medicines (remedies with unspecified ingredients), books, flavorings, dyes, spices, and dietary specialties.
In addition to drugs and medicines, druggists sold surgical supplies, spices, containers, chemicals (including dyes and inks), and medicine chests. The sale of surgical supplies is not surprising, considering that druggists provided most drugs and medicines to physicians for their own dispensing in those days. Few physicians wrote out prescriptions, instead relying on themselves or their apprentices to compound and dispense medicines. Spices were commonly dealt by druggists because they came in through the same importers along the same trade routes as drugs.
Druggists used so many containers in their repackaging and making of basic preparations that they soon became noted as general sources themselves for vials, bottles, and jars.7
Medicine chests—both empty and filled—were staples of the druggists' trade from the late 18th century through much of the 19th century. Druggists (and later large apothecary shops) made them up in various sizes for physicians, farmers, and ship captains. Surviving "Directions" booklets some druggists provided for their medicine chests indicate that Lewis's list was typical for the times.8
1. Erwin H. Ackerknecht, "Malaria in the Upper Mississippi Valley, 1760-1900," Supplement 4, Bulletin of the History of Medicine (1945), 20-22, 54-55. Cf. Bruce C. Paton, Lewis & Clark: Doctors in the Wilderness (Golden, Co.: Fulcrum, 2001): 49-50. Paton considers (and rejects) the idea that the Corps spread malaria in the Missouri valley themselves. In expectation of insect problems, Lewis purchased mosquito curtains. See David J. Peck, Or Perish in the Attempt (Helena, MT: Farcountry Press, 2002), 51.
2. J. Worth Estes, "Patterns of Drug Usage in Colonial America," in Robert I. Goler and Pascal James Imperato, eds., Early American Medicine: A Symposium (New York City: Frances Tavern Museum, 1987) 29-37.
3. Alex Berman, "The Heroic Approach in 19th Century Therapeutics," Bulletin of the American Society of Hospital Pharmacists, 11 (1954): 321-327.
4. Glenn Sonnedecker, ed., Kremers and Urdang's History of Pharmacy, 4th ed. (Philadelphia: Lippincott, 1976): 189-193, 326-327; Joseph W. England, ed., The First Century of the Philadelphia College of Pharmacy, 1821-1921 (Philadelphia: College of Pharmacy, 1922). See also chapter five, "Drugs and Chemicals," in Edwin T. Freedley, A Treatise on the Principal Trades and Manufactures of the United States (Philadelphia: Edward Young, 1856): 149-181.
5. Roy Porter, "The Origins of the English Pharmaceutical Industry," Bulletin of the Society of Social History of Medicine, No. 41 (1987): 64-65. For a fuller discussion see Roy Porter and Dorothy Porter, "The Rise of the English Drugs Industry: The Role of Thomas Corbyn," Medical History, 33 (1989): 277-295.
6. Williams Haynes, American Chemical Industry, 6 vols. (New York: Van Nostrand, 1954), 1:177-178, 187-188. See also, George Urdang, "The Influence of the Quakers on Philadelphia Institutions," American Journal of Pharmacy, 118 (1946): 81-88; also Desmond Chapman-Huston and Ernest C. Cripps, Through a City Archway: The Story of Allen and Hanburys (London: John Murray, 1954): 37-42.
7. Gregory J. Higby, In Service to American Pharmacy: The Professional Life of William Procter, Jr. (Tuscaloosa: University of Alabama Press, 1992), 4-7.
8. [Henry Phelps], Directions for the Medicine Chest,... (Salem: Thomas Cushing, 1804), 1-18. Edward S. Lang, Medicine Chests: with Suitable Directions,...(Salem: Thomas C. Cushing ). For information on naval medicine at the time of Lewis and Clark see J. Worth Estes, "Naval Medicine in the Age of Sail: The Voyage of the New York, 1802-1803," Bulletin of the History of Medicine, 56 (1982): 238-253. See also, J. K. Crellin, "Domestic Medicine Chests: Microcosms of 18th and 19th Century Medical Practice," Pharmacy in History, 21 (1979): 122-131.