But the scarcity of physicians, especially in rural areas, left a medical gap that the apothecaries, trained through apprenticeship and many times more numerous, naturally moved to fill. In 1727 English law finally recognized and legalized the fact that for most people the apothecary-surgeon was the only available practitioner of medicine. In turn, the business of purveying drugs and compounding medicines passed from the apothecaries to the wholesale druggists and pharmaceutical chemists.
As it was transferred to America the trade of apothecary—it was neither a craft nor a profession in any strict sense—was probably much like that of the rural apothecary-surgeon of seventeenth-century England. The apothecary still made his living primarily from the provision of drugs and medical preparations; but he also performed amputations, dressed wounds, and subjected his patients to the normal medical treatments of the day.
ALL THAT THE LAW ALLOWS
Virginia was the only colony that tried to draw legislative boundaries around the various aspects of medical practice. The effort came in 1736 in the form of “an Act for Regulating the Fees and Accounts of the Practicers of Phisic.” On two grounds the act deserves to be quoted at some length. For one thing, it throws a good light on the state of medical practice at that time. For another, it affords undeniable parallels to some current problems in the cost of medicines and medical care, and to the role of government in serving the interests of the “consumer.”
An eighteenth-century operating chair, fully equipped with tilting back, padded adjustable supports, and straps to keep the patient from writhing away from the knife. Anesthesia was limited to strong doses of spirituous liquors; antisepsis was unknown. The illustration is taken from Denis Diderot’s famous encyclopedia of arts and sciences.
The first section of the act recited certain abuses, especially of the surgeons and apothecaries:
I. Whereas the practice of phisic in this colony, is most commonly taken up and followed, by surgeons, apothecaries, or such as have only served apprenticeships to those trades, who often prove very unskilful in the art of a phisician; and yet do demand excessive fees, and exact unreasonable prices for the medicines which they administer, and do too often, for the sake of making up long and expensive bills, load their patients with greater quantities thereof, than are necessary or useful, concealing all their compositions, as well to prevent the discovery of their practice, as of the true value of what they administer: which is become a grievance, dangerous and intolerable, as well to the poorer sort of people as others, & doth require the most effectual remedy that the nature of the thing will admit.
The second section then proceeded to emphasize the chief distinction between the apprentice-trained apothecary-surgeons and the university-educated physicians by allowing the latter to charge twice as much for their services as the former could. If the apothecaries and surgeons felt—as well they might have—that the difference in fees was an insult to them, it did not last long. The law was not renewed at the following session of the Assembly; perhaps its backers, the physicians, had seen their patients flock to the lower-priced practicers.
Although Virginia was the only colony to set medical fees by law, the practice of legislative price fixing in other areas of the economy was as common in colonial America as it was in England. In Virginia, to be specific, not only prices and quantities but in some cases even qualities of goods and services offered to the public by tavernkeepers, shoemakers, millers, and ferrymen were regulated by law. The economic philosophy and terminology of laissez faire were among the alien isms imported after 1776. During the colonial years, government rarely hesitated to act in the economic field where the need was felt.