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The Apothecary's Cabinet 16Pp Apothecary’s Cabinet No. 1, Fall 2000 News and Notes from the American Institute of the History of Pharmacy Pharmacy in the American Century NE hundred years ago school diploma until New York in products, stationery, candy, over- people walked into drug 1910. the-counter remedies, surgical sup- O stores and asked “Doc” for Few women practiced phar- plies, and small, inexpensive “cures” for their ailments. Today, pa- macy a century ago. Pharmacy was items. In addition, stores in rural tients are again putting their faith in a business and therefore in the areas often carried paints and oils, pharmacists to be responsible for sphere of men. Most of the few as well as flavorings and canning proper drug use. A century ago, women pharmacists in 1900 supplies. armed with a handful of effective worked in hospitals. The prescription business drugs, pharmacists could do little but was a small part of the activities of ease discomfort. Today, pharmacists most stores, yet essential to pro- General Emporium control the distribution of hundreds vide the special ambiance of the of potent and effective medicines, One hundred years ago, the “drugstore.” Most prescriptions and desire to play a much larger role average drugstore was a general called for some compounding; the in the healthcare enterprise. emporium, containing the sort of manufacturing of ingredients had A century ago, almost all merchandise that we associate with passed on to large-scale companies pharmacists had received their community pharmacies today: a generation before. training via apprenticeship, some- Cosmetics, magazines, tobacco As much as prescription fill- times supplemented with a semes- ter or two of formal schooling. Af- ter working with a drugstore owner The American Institute of the History of Pharmacy is a unique for four or so years and studying a agency dedicated to the preservation of pharmacy’s heritage. few basic texts, a young man would take a state board examina- The Apothecary’s Cabinet is a new publication from AIHP that tion. Upon passing, this fellow takes a popular look at the history of pharmacy in its many fac- could place “R.Ph.” after his name. ets. We welcome your comments and submissions. No state required a pharmacy No. 1 1 Kriger’s drugstore in Baltimore (c. 1929) carried all the essen- tials: cigars, candy, toiletries, and a prescription department. ing, pharmacists were called upon to practice a fair the Great War, the profession changed its approach. bit of low level “doctoring,” selling cough medi- The leaders of pharmacy helped to push through cines, laxatives, pain relievers, and the like to cus- education requirements in states during the 1920s tomers. In a time when paper credentials (diplomas and 1930s. In addition, leaders pinned their hopes on and certificates) were less important, each pharmacy educational reform. By 1928, the colleges of phar- owner built his reputation on individual achieve- macy agreed to institute a mandatory 4-year B.S. ment. minimum for graduation. The Era of Academic Reform (1910-1965) Start of Compounding Decline In the midst of the Progressive Era (1900- When the students entered the four-year pro- 1920), the state of New York passed a law requiring grams they learned the art and science of compound- that all pharmacists registered after 1910 possess a ing, even though this skill was being taken over by pharmacy school diploma. The standard course at mass manufacturing. Beginning at the turn of the the time took two years. Initially, pharmacists op- century with new drugs like aspirin, pharmaceutical posed these laws. However, when educational re- companies introduced more synthetic, crystalline en- former Abraham Flexner in 1915 called pharmacy a tities. Easily compounded into tablets, these medi- non-profession and then the War Department refused cines supplanted older liquid mixtures of botanical to routinely commission pharmacists as officers in fluid extracts and tinctures. Just as manufacturing Apothecary’s Cabinet • No. 1 Editor: Gregory J. Higby Assistant Editor: Elaine Condouris Stroud Publisher: American Institute of the History of Pharmacy, located at the University of Wisconsin School of Pharmacy, Madison, Wisconsin 53706-1508 Phone (608) 262-5378, email [email protected]; www.aihp.org. THE AMERICAN INSTITUTE OF THE HISTORY OF PHARMACY is incorporated under Wisconsin statute 180 as a non-profit organization de- voted to advancing knowledge and understanding of the place of pharmacy in history. It publishes Pharmacy in History, Apothecary’s Cabinet, occa- sional monographs, and pamphlets; it fosters humanistic teaching in pharmaceutical education; confers awards for outstanding achievement in its field; sponsors historical meetings and exhibits; collects and preserves source materials; and serves as a center for research and information. PUBLICATION PRICES: Apothecary’s Cabinet is distributed free of charge to schools of pharmacy upon request. This and other publications of the AIHP may be obtained through membership ($50 per year for individuals, $100 for institutions); individual copies of Apothecary’s Cabinet are $2.00. 2 Apothecary’s Cabinet had gradually disappeared from pharmacies after the Pharmaceutical Survey Civil War, compounding began its slow decline in At the conclusion of the war, the leaders of pharmacy practice. pharmacy decided that some action was necessary to combat the low stature of the profession. Working Prohibition with the American Council on Education, the profes- If pharmacists in the 1920s were compounding sion united in a major self study called the Pharma- fewer prescriptions, they were making up more ceutical Survey, which began in 1946. Every major chocolate milkshakes and other soda fountain spe- aspect of pharmacy was studied. Considering the cialties. With the passage of national prohibition, the large numbers of educators involved, it is not sur- drugstore fountain replaced the tavern as the new, socially acceptable gathering place. Beverage alco- hol disappeared from legal commerce, except in pharmacies where, because it was official in the United States Pharmacopoeia, one could still get whisky by prescription. Students at the University of Wisconsin School of Pharmacy in 1915, as shown in this photo- graph, learned the proper manufacture of suppositories by compression. Depression When the Depression of the 1930s hit, the pharmacy business suffered but was less damaged than others. First of all, people still got sick and needed medicines. Second, drugstores had a stock of durable, low cost items, such as soap, cosmetics, and prising that academics received special scrutiny. The candy that customers desired to buy. Third, no mat- Survey concluded that the adoption of a standard 6- ter how bad things got, people still wanted their year, Doctor of Pharmacy curriculum would make cigarettes and cigars. And fourth, when prohibition pharmacy a true profession in the eyes of the public. was repealed in 1933, pharmacies had liquor to sell (and the reputation as legitimate outlets). 1950s Ironically, the call for more education came at World War II just the time when developments within the pharma- In 1941, the United States entered the conflict ceutical industry and the legislative realm would re- of World War Two. As was the case a generation be- duce the scope of practice. After World War Two, fore, the War Department decided not to commission American drug companies raced to produce new pharmacists as officers. Again they cited the low medicines in convenient dosage forms. Prescription professional status of pharmacists. It angered the volume rose dramatically and compounding all but leaders of the profession to see nurses routinely disappeared during the decade of the 1950s. commissioned as officers, even though they had less The role of the pharmacist was limited by cus- education than pharmacists. tom and law to dispensing only. The Durham- No. 1 3 Humphrey Amendment to the 1938 Food Drug and gained confidence in the ability of medical science to Cosmetic Act came into effect in 1952 and restricted find cures for disease. The pharmacy, which once the discretionary powers of the pharmacist through only offered palliation, now contained true remedies. its codification of the prescription drug legend and limits on refills. Furthermore, anti-substitution laws The Clinical Pharmacy Era (1965-1990) passed by most states restricted practice even more. Pharmacists were discouraged to counsel about Looking back we tend to romanticize the 1960s drugs. As the Code of Ethics for the American Phar- as a decade of rebellion. For pharmacy, important maceutical Association (1952) stated clearly: “The evolutionary steps were taken. In 1960, a pharmacist pharmacist does not discuss the therapeutic effects from Berryville, Virginia, Eugene V. White, pulled or composition of a prescription with a patient. out all the commercial fixtures from his drugstore When such questions are asked, he suggests that the and set up an office practice. Rather than selling qualified practitioner [physician or dentist] is the some traditional drugstore items as others had tried proper person with whom such matters should be in similar practices, White relied completely on pre- discussed.” scription business. Among his innovations was the During this period of count and pour pharmacy patient profile card. practice, educators debated the length of the profes- In the institutional area, a team of pharmacists sional curriculum. The chain store industry wanted lead by Don Francke surveyed hospital pharmacy in to keep the 4-year standard, mainly to keep labor the United States. The resulting book, Mirror to Hos- costs down. Reform minded leaders favored the 6- pital Pharmacy (1964), served as a jumping off point year program suggested by the Survey. A compro- for the new concept of “clinical pharmacy.” mise 5-year B.S. program was adopted to begin as White had shown that the setting of pharmacy the standard in 1960. practice need not be tied to a general emporium, and The 1950s were a boom era for community Mirror set out the mechanics of advanced control of pharmacy, especially for chains expanding into the drug use through unit packaging, pharmacy technicians, burgeoning suburbs.
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