Lloyd Dobyns: Hi, welcome to Colonial Williamsburg: Past & Present on history.org. This is "Behind the Scenes" where you meet the people who work here. That's my job. I'm Lloyd Dobyns, and mostly I ask questions.

An 18th-century apothecary might serve his community as surgeon, pharmacist, and general practitioner. Susan Pryor, a medical historian, is here with me now to talk about the trade and Colonial Williamsburg apothecaries.

There was one, wasn't there?

Susan Pryor: There were eight, actually, in 1774 in Williamsburg.

Lloyd: You're in the apothecary shop, you've opened up in the morning, what are you going to see?

Susan: First and foremost, and apothecary is a combination doctor, druggist, dentist, surgeon, sometimes midwife. The apothecary store is just that; it's a store where imported ingredients for medicines and those medications will be sold. You'll also find a variety of grocery items as well. Anything that can come over from Europe via trade with London can be sold in an apothecary run by a doctor. 

Lloyd: So apothecaries would hand mix?

Susan: Yes. Everything is manufactured by the doctor. Most of the drugs were liquid, they could take a number of days or even weeks to complete. Solid forms of medicine could be completed within a couple of days.

What made the apothecary different was that the ingredients were unique. They were mineral, metal, chemical, botanical. They were things that people did not have in their herb gardens. The herb garden was the first thing used by individuals for healthcare. Then the doctor was stepped to.

Lloyd: Did the stuff that was mixed up in the apothecary shop work?

Susan: Very often. Much of it is still in use today, synthetic formulas today. Digitalis was a new medicine coming out of England in 1774, although I don't think it was in use in the colonies until the '80s, 1780s. Sincona bark, what is today quinine, was available. Intermittent fever, which was the original term for malaria, was a huge problem here. Senna, the common laxative which is still in use today, was sold in the 18th century. Ipecac, what we give our kids when they get into something poisonous – much of it had effectiveness. But it is treatment, as opposed to cure.

Lloyd: I mean at least you can be, there is a treatment for it.

Susan: There is a treatment, yeah.

Lloyd: You could go to the apothecary and get the treatment.

Susan: And hopefully you were strong enough to fight off the infection.

Lloyd: Well, you can't have everything.

Susan: That's right.

Lloyd: When do we start thinking about cure or prevention, rather than treatment?

Susan: Cures are going to come along more in the 20th century, especially with bacterial infections once we get antibiotics. Viruses can be treated. Even today, antiviral medications are kind of a new thing that will go a little further. Prevention, more after the germ theory is developed -- first proposed in 1878, but early 20th century before it's accepted – so the idea of knowing what to prevent is another century in the future from where I work.

Lloyd: If you don't know what you're preventing, it's very unlikely you can prevent it.

Susan: The closest thing you'd come would be smallpox inoculation. That's technically not a prevention, because you have to get sick with smallpox in a mild case before you can prevent a serious case.
 
Lloyd: Germ theory -- originally, germs were seeds, right? You planted a germ of something and it grew.

Susan: That's the normal definition of the word "germ" in this context. Animalculae will be the term describing what we know of as germs today. That's the term used by Leeuwenhoek in the 1630s when he's looking at his new microscope and he sees those little things squiggling around in there. He actually sees germs, he just doesn't know what he's looking at. They will pretty much be ignored until the 19th century as technology improves to kind of point the finger at the germ as being the cause of disease.

Lloyd: You don't have a hope of preventing disease at the apothecary shop.

Susan: Other than recommending that people should eat proper food, get proper amounts of rest and exercise – that's general healthcare. Preventing chickenpox, smallpox, colds, flu – not really. Not in the way we might say today "wash your hands with soap and water frequently to prevent the spread of germs."

Lloyd: In the apothecary shop, you have 100 people walk in who don't feel well, or feel something is wrong. Of the 100 people, let's say none has a serious disease. How many can you help, sort of on average?

Susan: Well it's going to depend on a lot of factors. Specifics on what they have, number one. Probably most of them, at least a little bit. There's one awkward thing there, the patient would not come to the apothecary shop, because it's a store. The doctor would travel to the patient. So of the 100 random patients, depending on what the problem was, there is effective treatment for most things.

Lloyd: How about headache?

Susan: What you'll see are treatments for migraines recommended. Coffee would be recommended. The patient should stay away from the light and stay away from sounds and smells, just like they would be recommended to do today.

Your basic tension headache, something aromatic to apply and anoint into the head. Lavender oil, rose oil – kind of early aromatherapy. You'll also see what we today might call allergy headaches, sinus headaches. But the concept of allergy wasn't around at the time, so they're not equating it with pollen count. A sinus headache could be treated with camphor as an inhalant to open up the sinus passages, similar to the camphor-based drugs we still use today.

Lloyd: So actually, a lot of the things that we are still using were developed then, or were in common use.

Susan: Yeah. We've taken it a little further. We've synthesized, we've removed superfluous ingredients, retaining active ingredients. We've made some modifications. But yes, very many of them are just further developments of, in most cases, professional drugs. In some cases, folk remedies.

Lloyd: Are folk remedies that effective?

Susan:  Depends. In some cases, yes. In other cases, no. That's not to say they're harmful, ether, necessarily. They're not necessarily active. There were many of them. People made up their own. Many folk remedies stayed within the households and families. Everybody learned how to use the herbal things in different ways.

Some were able to increase their knowledge through books. Others had to retain the memory of what was being used. In most cases, what you're using are common garden herbs. They’re things that are being used in cooking. There's not necessarily a health risk to them, but there's also not necessarily a valid benefit to them, either.

Lloyd: A health benefit. In the general population of Williamsburg, was smallpox a big deal?

Susan: It's a big epidemic problem. Came through about every 20 years.

Lloyd: Oh really? Sort of a cyclical thing?

Susan: Because it had to hit a new population base each generation. Once you get it and live, you're healthy. You're not susceptible. So once it runs through a population and uses up all its viable hosts, it has to go elsewhere until there is a new set of viable hosts again.

Lloyd: What other diseases or fevers were ordinary, or common, or everyday?

Susan: The intermittent fever – the malaria – is what we would consider an endemic condition. It's always present. It’s an incurable condition, so it can flare up at any time. It does have spike seasons: spring and fall.

Measles will kind of follow the smallpox route, being more epidemic – chicken pox and mumps, as well. The childhood illnesses that we have today were around in the 18th century – colds and flu. Tapeworm is listed quite frequently, very often in the late summer. Dysentery, diphtheria. Respiratory problems in the winter, things like that.

Lloyd: Were there treatments?

Susan: Depends on the symptoms. This is all involving each specific symptom. Pneumonia, for example, because there is often congestion in the chest, garlic syrup would be used. Helps if you like garlic.

For all of the diseases that produced a mark – chickenpox, measles, smallpox – calamine would be applied. Not only to help the itching, but to help dry up the pockmarks. The difference with the smallpox is that each of those marks is going to scar permanently, whereas with the chicken pox or the measles, they do fade away unless they are repeatedly scratched at.

Lloyd: You said that something came in summer and winter. Why summer and winter?

Susan: It's hard to say. It's just like today. For us, we always have cold and flu season in the winter. Your respiratory conditions are going to come through. You see pneumonias. Influenza is a term, a description of disease. Tapeworm is listed in the records very often at the end of August, early September. One way to get tapeworm is eating meat – not just beef, but meat – that's not been cooked correctly. Also there are worms, intestinal worms, from consuming unripe fruit. So there could be something to that.

One of the doctors in the city kept a seasonal log from 1745 to '81. It's a wonderful document because it does give you the cyclical nature of those conditions that were present here in the city.