A long, long time ago in a public health era far, far away, there was a world where CVS or Walgreens storefronts weren’t on every corner and drug regulations were nonexistent. This was the time of apothecaries – those fascinating druggists who meticulously mixed herbs and minerals, adding a dash of animal fat here and a bit of earwax there, all with the intent of curing the ailments of their fellow man. Historically, the term “apothecary” referred to both the person who manufactured and dispensed medicines (lowercase “a” for our purposes), and the shop in which those medicines were sold (capitalized “A”). Though they remain staples of fantasy worlds like that of
Harry Potter, and twee boutiques frequently adopt the title, apothecaries were not mystical, magical beings or
peddlers of expensive (and often useless) oils, but highly valued and esteemed medical professionals.
As the nation’s first hospital, Pennsylvania Hospital (PAH) was also the first to have an associated Apothecary shop for patients, which curbed the need for apothecaries to act as both doctor and pharmacist, as was required in more rural areas of the colonies and later the new states. As the hospital expanded and the realm of American pharmacy evolved, so too did the role of the apothecary.
PAH was officially founded in 1751, but because the construction of the three sections of the Pine Building was almost entirely dependent on the contributions of wealthy philanthropists and unpaid laborers, nearly 50 years passed between the completion of the east wing and the other two sections. The center building was mostly completed in 1801 (the dome of the surgical amphitheatre upstairs was finished in 1804), and while its primary purpose was to join the east wing housing the physically ill and the west wing housing the mentally ill, the first floor – the Great Court – also provided residential and administrative spaces for employees and servants and a designated area for the Apothecary.
While this long-term space was not assigned for decades, the pharmaceutical needs of the hospital’s 150-180 patients still needed to be addressed. In 1764, PAH co-founder Thomas Bond wrote to the hospital’s Board of Managers requesting that an apothecary be appointed. According to the letter, which has been preserved in the Pennsylvania Hospital archives, Bond and his colleagues urged the managers to reach out to their contacts in England as it was “absolutely necessary that a person properly qualified ... should be procured as soon as you conveniently can.” These qualifications included that he “be so well skilled in the Affairs of Chymistry [sic], as to be able to manage a small Laboratory,” though they were clear to “obviate any fears of his having too great employment” by explaining that the candidate would not be required to diagnose illnesses or dress wounds like traditional one-man-band apothecaries.
The physicians’ request was fulfilled, and by the end of the eighteenth century, the hospital’s managers sought to expand the Apothecary even further to keep up with the increase in beds. An archived indenture contract from 1791 indicates that a man named William Gardiner was brought on board as an apothecary’s apprentice. Though some apothecaries attended medical school, most learned the trade through apprenticeships, as was customary of many career paths at the time. While Gardiner’s “Master” was expected to be an accomplished chemist, perhaps with experience pulling teeth or assisting with childbirth, the contract indicates that the rules of Gardiner’s indenture term were a bit more mundane: readily obey the apothecary and keep their secrets, faithfully use this experience to learn as much as possible about the “Trade or Mystery of an Apothecary,” and abstain from “Cards, Dice, or any unlawful Game” as well as “Ale-houses, Taverns, or Play-houses.”
In 1808, the Board of Managers once again received a letter from the hospital’s physicians, this time authored by Philip Syng Physick, the “father of American surgery,” and Benjamin Rush, the “father of American psychiatry” (and man with a penchant for bloodletting). The letter details that the surgeons required “the appointment of another apothecary” in addition to the man already employed due to the “late increase of patients.” Any subsequent correspondence no longer exists, but it’s likely their wish was granted given that the spacious Apothecary room had recently been completed – and that they had already done the groundwork for the managers by recommending John A. Gordon, a man of “talent, preparatory education, and character,” for the job.
As PAH’s footprint continued to grow, the hospital management decided to relocate the Apothecary to a newer building. It remained a strictly inpatient dispensary, though it eventually began serving employees as well. Of course by the early twentieth century, “apothecaries” were so out, and “pharmacies” were in, and ye olde mortar and pestle had been all but replaced by drugs produced en masse in factories. William Procter, Jr., a graduate of the Philadelphia College of Pharmacy and the "father of American pharmacy,” worried that the relevance of the meticulously trained, scientifically minded pharmacist was swiftly waning, and instead “he relapsed into a simple shopkeeper.”
Perhaps Procter’s fears would have been assuaged had he lived to see the evolution of the modern pharmacy. Sure, a pharmacist may play the part of “shopkeeper” for a moment when ringing out a few boxes of tissues and a pint of Ben & Jerry’s alongside a prescription, but this has always been the case. Apothecaries often sold household and personal items (soap, candles, tobacco), and that tradition continues at community drugstores and PAH’s Outpatient Pharmacy, located on the ground floor of the Preston building. Though the role has expanded and (thankfully) involves less trial-and-error experimentation, the apothecary/pharmacist remains just as essential to patient care as ever.
While PAH’s early physicians had to send eloquent pleas to the Board of Managers to keep up with the hospital’s apothecarial needs, today’s Outpatient Pharmacy team is made up of 15 staff members – pharmacists in both the pharmacy and physician practices, technicians, specialists, a discharge coordinator, and more.
In addition to providing specialty drug services and immunizations, over 72,000
prescriptions are filled annually, and that is sure to increase given the pharmacy’s
new extended hours. Spindly brass scales weighing out loose herbs and powders for custom elixirs may have gone by the wayside, but the pharmacy team is able to fulfill each patient’s unique needs by working alongside the hospital’s physicians and offering medicine counseling.
“The Outpatient Pharmacy team plays a vital role in patients’ safe and effective medication therapy by acting as the bridge between patients and their prescriptions,” said Suzanne Brown, MS, RPh, director of Pharmacy Services. “Between counseling, follow-up calls, therapy assessments, dose modifications, medication reconciliation, and lab ordering and monitoring, our comprehensive services ensure patients are comfortable with their often complex medication regimens.”
With the Outpatient Pharmacy taking care of patients’ and employees’ pharmaceutical needs, the original Apothecary space was renovated into an office utilized by longtime hospital administrator and president Robert Cathcart until his retirement in 1991. Homages to the past remain, though. The walls are lined with paintings of hospital notables, such as attending surgeon Thomas George Morton, MD, who dedicated nearly 40 years to the hospital; attending physician J.M. DaCosta, MD, whose mutton chops were apparently cool enough to be the subject of a Thomas Eakins painting; and of course, PAH’s pride and joy, Philip Syng Physick.
“The bones of the room are intact, but the shelving in the alcoves has been removed and replaced with portraits,” said Stacey C. Peeples, MA, curator and lead archivist of the hospital’s historic collections. “The chair rail was removed for a long time, but was replaced a few years ago when a closer examination of an old photograph clearly demonstrated there was in fact a chair rail around the room.”
A photo of the apothecary in its golden days remains on the wall, as well as a few original hospital documents, but the room has otherwise completely transformed over time. This is unsurprising, of course; PAH has always been a working hospital, not a museum. As more effective medications were developed, others were left to obscurity, and our predecessors couldn’t have guessed that we’d be willing to dole out some Benjamins for a few antique, decorative jars (not least because they may have personally known said Benjamin). No dusty vessels once filled with pastes and powders remain, and supply lists of the time were not kept. Today it’s just a roomy conference space with a planetarium clock and a lovely view of the hospital grounds, perfect for a mid-meeting daydream.
Nevertheless, it only takes a walk around those grounds to get a feel for what the Apothecary would have kept stocked. PAH’s Physic Garden is home to a wide variety of plants used medicinally in the eighteenth and nineteenth centuries, such as digitalis for heart issues, parsley for halitosis, chamomile and ginger for gastrointestinal problems, and even lamb’s ears, nature’s ready-made bandages. Other remedies likely contained ingredients like calamine, chalk, barks, witch hazel, and other botanicals – some with strange, exotic names and scents, and others that would likely be considered questionable today.
National Pharmacy Week is just around the corner (October 15–21), so whether you’re planning to pick up a prescription from PAH’s Outpatient Pharmacy, or you happen to swing by the pharmacy section at your grocery store, take a moment to consider just how far American medicines and the drugstores that provide them have come. And maybe offer your pharmacist a quick “thank you” for not offering leeches or earwax-based remedies over the counter.
If you’re interested in learning more about Pennsylvania Hospital’s history, call 215-829-3370 to arrange a tour of the historic Pine Building.