The year was 1792. George Washington was elected to a second term as the first president of the United States. But it would be more than 100 years before modern amenities like electricity and cars were available to American families. As hard as it is to imagine daily life then, it is nearly impossible to comprehend the practice of medicine and patient access to healthcare as we know it today.
But 1792 was also the year that Edward Stabler would come to the bustling port city of Alexandria, VA, to open his own apothecary, following his apprenticeship with his brother. Stabler’s apothecary would represent the pinnacle of healthcare in a new America.
Today, the Stabler-Leadbeater Apothecary Museum owned by the City of Alexandria, is just a few miles south of Surescripts headquarters. After changing hands and undergoing a few renovations since then, it remains a frozen-in-time 1850s era pharmacy that comes to life in the historical accountings shared by Callie Stapp, the museum’s curator, and Lauren Gleason, the assistant director of education and museum operations.
These experts explained what the role of a typical 18th century American pharmacist might encompass. Given the incredible advancements in medicine over the last two centuries, it may come as a surprise that the role of the pharmacist today is not really changing so much as it is returning to how it was practiced in George Washington’s lifetime –and in his neighborhood.
A typical day in a 1790s apothecary
Without requirements of formal education or certification, physicians and pharmacists of this time would enter the practice of medicine as an apprentice before striking out on their own.
Physicians would provide care for a patient’s physical health problems, like a broken bone or wound. Pharmacists of that time were akin to chemists, making medicines along with products like paint, dye, perfumes, cleaning products and pesticides, much like those that would have been available for purchase at the Stabler-Leadbeater Apothecary, according to Gleason.
“Anything that was an order for medicine was considered a prescription – even if you wrote it yourself.”
Assistant Director of Education and Museum Operation for the City of Alexandria
For an illness or health concern, “customers might come into the shop, they might send someone with a note that is an order or say ‘these are my symptoms’ to the pharmacist. The pharmacist was legally allowed to diagnose you and prescribe something to you,” said Gleason. “Or you might come in with the physician’s prescription, who you’d seen beforehand.”
Since the City of Alexandria acquired the museum and its contents, its curator, Callie Stapp, has poured over the meticulously detailed ledgers kept by Stabler and others while operating as the community’s pharmacy.
The ledgers, Stapp explains, show a variety of ways a patient might have interacted with a pharmacist to obtain medicine or a remedy. The person might have told the pharmacist what a doctor advised them to order, or just shared their symptoms asking for a recommendation, or asked for the same medicine that they received previously for an ongoing condition that the pharmacists would have noted and could look up in their ledger.
Gleason adds, “if they were a wealthy person they were probably going to go to the doctor. We know that sometimes even the wealthy people just directly requested things [medicines] from the pharmacy.”
George Washington’s care team and Edward Stabler’s Apothecary
At his Mount Vernon home in 1799, George Washington’s team of doctors were at his bedside when he passed away from a throat infection at age 67. Doctors James Craik, Gustavus Richard Brown and Elisha Dick treated Washington with remedies like bloodletting, applying blisters and mixtures of molasses, butter, vinegar and sage tea to soothe his throat and quell the infection.
The Stabler Apothecary is just a handful of miles north of Washington’s Mount Vernon home. Stapp notes that “Elisha Cullen Dick does place some orders here, so that’s very interesting [and] we know the Washington family is doing ordering, both George, the extended family after him, Martha, and we know his doctors are also ordering things [from The Stabler Apothecary].”
When none of his doctor’s remedies proved effective to treat Washington’s condition, Dr. Dick recommended that a tracheotomy be performed to improve his breathing. But Dr. Dick’s colleagues feared this still-experimental procedure – especially with such a prominent figure--so it was not performed.
It’s been debated since, but some believe the tracheotomy would have extended Washington’s life, begging the question: if all members of his care team were empowered equally, would the outcome have been different for George Washington that day?
Community has always been the center of patient care – even for George Washington
As a result of COVID-19 Pandemic, pharmacists are evolving yet again from filling prescriptions to a role that resembles the community pharmacists of George Washington’s day, providing patients with access to clinical care that may include limited testing and prescribing. Most importantly, pharmacists have the clinical expertise to manage care for patients facing chronic conditions and have earned the trust of their patients to serve alongside doctors as valued members of a care team.
George Washington’s care and the records of The Stabler Apothecary serve as a reminder that healthcare was not siloed in America’s early days. It required a team made up of pharmacists, who were often the first or only clinicians providing direct care to patients as well as doctors readily working together to deliver care in their communities. And the relationships shared between clinicians and patients were personal, helping patients trust those who cared for them.
“That's one of the things where in a small town like this, you [doctors and pharmacists] know who's ordering what”
Gleason added, “A pharmacist back then, must have been the kind of person that had such a great and incredible memory.”
In George Washington’s case, it was possible that his doctors would have stopped to purchase medicines for their own practices but could have had a conversation with Edward Stabler about what Washington would have ordered so his doctor could restock for him on his next trip to Mount Vernon, according to Stapp.
While the treatments and medicines have changed over time for the better, the evolving role of the pharmacist seems to be taking a page from early America's history, reminding us that everything old is new yet again.