J.B. Merrick Apothecary continues previous process of providing prescriptions
By David Schmidt
Special to Main Line Life
Head into J.B. Merrick Apothecary on Cricket Lane in Ardmore and you have stepped back into time. Pharmacists and owners Jay Pennypacker and Joe Annarelli, are providing a service which would be familiar to the original Main Line Quakers settlers.
Their apothecary shop sells prescription drugs and medical remedies. “We’re continuing the tradition stated by Mr. Merrick to be a prescription-only store. That’s why it’s called an apothecary instead of a pharmacy or drug store,” said Pennypacker, who bought the place when Merrick retired in 1969.
“We do sell some non-prescription items, but they are health-related,” he said. “We don’t have a soda fountain, or sell other products found in drug stores today. We’ve modeled ourselves after the European druggist shops.”
The shop’s a refreshing change from the huge chain pharmacies. They offer much more than medicine, the newer ones even having “drive-thru” areas to pick up prescriptions. Pennypacker clearly feels the heat of these monster stores, just as WalMart killed small town retail centers, these giant chains are changing how American’s get their medicines.
Going into Merrick’s is a charming step back into an earlier world. What’s most noticeable is how familiar they druggists are with their customers. Most are elderly, clearly customers for a long time. “Much of our clientele have been with us some time and are older,” Pennypacker said. “But it evens out, because the elderly take more medicine than younger people.”
Time has changed what pharmacists do, but one thing that hasn’t changed at Merrick is counseling their customers. “We’ve a lot of consultations. It’s out job to make sure they understand how to take the medicine and any side effects they might have,” he said. The chains are rushing to catch up with this credibility process, since it’s been mandated by law, but it’s been standard practice at Merrick’s since the store James B. Merrick opened the store in 1938.
He was one of the founding members of the American College of Apothecaries, a national organization. Actually there’s no technical difference between an apothecary and a pharmacist, both would have graduated from a pharmacy program. Both Pennypacker and Annarelli, for instance, graduated from the Philadelphia College of Pharmacy and Science, now known as the University of the Sciences in Philadelphia.
But it’s not just the giant pharmacies that are changing the tasks of druggists. “Historically there’s a big difference in the prescriptions we handle,” he said. “The knowledge is gone compared to what used to be taught in pharmacy schools. “Today the schools concentrate on drugs and their interactions. It’s what they refer to as being more clinical.”
Both men recognize that the schools are responding to the modern needs of medicine, which focuses on prepared pharmaceuticals. “We have pharmacy students intern for us and what we spent an entire semester studying, they get in a day,” he said. “We had a lot more knowledge of drugs and chemistry because we were expected to mix and make the medicines,” he said.
And that’s where their tie to history lies.
It’s only been in the 20th century that medicines were manufactured and marketed from pharmaceutical companies to patients. In American medical history, the apothecary played an important role. Early on the line between doctors and pharmacists was much more blurred. Doctors often prepared their own medicines, and even owned and ran apothecary shops.
Likewise, many people went to their apothecary for medical treatment. Often they were the only care providers. Then the idea was ‘any care’s better than no care.’ Even as the 18th century closed, many medical practitioners relied on a universal understanding of the four body humors (or fluids) to explain sickness.
The four body humors were: blood, phlegm, yellow bile and black bile. The prevailing understanding was that all diseases resulted from an excess of one of these fluids, and the cure was to ‘re-balance’ the humors through bloodletting and purging.
Virginia physician B.H. Hall made this clear, writing in 1803, “This state of [yellow] fever, called more loudly for the lancet than common; indeed I scarcely met with a case … when bleeding was not used.” Most apothecary shops shod those lancets, and probably bled people in communities where they were the closest thing to a surgeon.
In an article entitled From Quackery to Bacteriology: The Emergence of Modern Medicine in 19th Century America, Barbara Floyd proposes that after the turn of the 19th century the attitude towards science had fundamentally changed..
When they were a British colony, Americans participated in the Age of Reason. But with independence came a shift in attitude. America, being a rough-hewn unsophisticated pioneer nation hadn’t the time to concern themselves with advancing knowledge This was now the Age of Common Man. The country had little time and little use for the generation of men like Franklin and Jefferson who dominated the intellectual life of the country from 1750 to 1800 and who promoted scientific research.
Floyd quotes Alexis de Tocqueville who saw this in a larger context. He considered the combination of democracy and economic opportunity in the Jacksonian era placed an emphasis on profitable technology over basic science. As a consequence, medical science based upon empirical research, suffered.
She blames a philosophical movement which dominated American societyRomanticism as contributing to this stagnation. The theory came to America from Europe between 1812 and 1861 as a revolt against the Age of Reason.
Rather than rational empirical thought, Romanticism emphasized feeling, sensitivity, and the supernatural. According to her, as Romanticism mixed with Jacksonian democracy in the 1820s and 1830s, it developed many uniquely American traits, one of them being religious evangelicalism imploring the common man had to improve himself by purifying his body and soul, and the country would do the same.
The impact of this philosophy on medical care was significant. Physicians refer to that period is now known as the ‘heroic’ age of medicine. There were no anesthetics, antibiotics, and few surgical instruments, so surgical procedures were performed only under ‘heroic’ circumstances — to save a life.
With the scientific community doing little to improve medicine, the public rebelled. Heroic medical treatment was shunned and lay health reformers and practitioners, filled with the democratic spirit, rushed in with “theories” of their own. Treatments used water, electricity, manipulation of animal magnetism, and vegetable compounds. Many of the quackery theories took on qualities of social reform and religious revivalism to become movements of their own.
Unfortunately there was little the medical community could do to improve the public’s confidence in them. In the early 1800s many medcical situations simply weren’t understood and there was little that could be done.
Birth, for instance, wasn’t a reason to visit a hospital babies were born at home, perhaps with the assistance of a midwife. Experienced ones saved a lot of lives both mother and child. But if things went wrong, they were helpless, but no more than physicians. There was a very high rate of infant mortality, and dying in childbirth was a major cause of death.
Surgeons found much of their business in removing limbs. The concept of cutting into a body to remove anything other than a bullet was considered correctly more deadly than leaving things in God’s hands. In the case of bullets, surgeons figured they couldn’t make things worse, and might help, if the wound didn’t putrefy — or get infected — which normally happened. Remember, then there was absolutely no tie between cleanliness and health Germs hadn’t been ‘invented,’ yet.
Even the Civil War was slow to help, although it confirmed the profession of nursing care and removed the final barrier to women serving in this capacity. Some understanding of the need for cleanliness developed, unfortunately thanks to the number of infected amputations which physicians and nurses cared for. Most died, but it was the only existing treatment for major trauma and gunshot wounds suffered in battle.
But out of this horror came new theories of bacteriology which slowly produced fundamental changes in medical practice. By the end of the century scientific advances began to catch up with the medical needs of the public. Medical training adapted to this growing knowledge base.
During the 1800s things began to get more organized. “The Philadelphia College of Pharmacy began in 1821,” said Pennypacker. “Before pharmacists became a profession, a lot of physicians provided their own medicines and dispensed them, even into the 20th century,” he said.
“Many physicians considered pharmacists as competitors and it stayed that way for many years,” he said. Now, professions have moved so far apart they’re now all members of the ‘team’ that provides medical care.
Throughout the 1800s, druggists provided the best medicines they could. Medical treatment was expensive and individuals frequently diagnosed their own problems and compounded medications using domestic medical books and the apothecary supplied ingredients. Vinegar of roses for headaches was one such home remedy. Individuals could purchase the rose petals, steep them in vinegar, and apply the preparation topically.
Surprisingly, some of the ingredients are the basis for modern medications. They included chalk for heartburn, calamine for skin irritations, and cinchona bark for fevers. Later it was discovered that cinchona bark contains quinine for malaria and quinidine for cardiac conditions.
But others weren’t as notable. Early examples of apothecary ‘cures’ are the foxglove flower … a heart remedy; the periwinkle flower … first used as an astringent or tonic, and the may apple … then dried, ground into a powder and used as a laxative. The foxglove flower is used to treat heart disease. Extracts from the periwinkle flower and may apple are now used to treat cancer.
Early medicines were prepared from roots, seeds, barks and minerals and administered as brewed teas, syrups, suspensions and emulsions, fine powders for pills or ointments. Few, if any, medicines then actually cured what ailed people, most were to alleviate symptoms and pain, probably the primary role of medicine.
For example, a tincture was probably 20 percent alcohol-based and many patent medicines contained opium and morphine. They were the only substances which reduced pain, in spite of their dangers. Tens of thousands of veterans of every 19th and 20th century war spent the remainder of their lives addicted to the pain medicine which had probably saved their lives.
It was the search for a safe way to relieve pain that resulted in the first wonder drug. In 1897 Bayer chemist Felix Hoffmann developed a stable form of this natural compound found naturally in willow tree bark or meadow grasses which could be safely used by most people, without side effects. Acetylsalicylic acid, sold by Bayer under the trade name “Aspirin,” was the first reliable and effective such pain killer.
This encouraged others to look to the chemistry lab for new medicines. These wonder drugs were often a substance not made from ‘natural’ materials, but created in a laboratory from a chemical compound. While revolutionary in its day, this has become standard. Today, just 25 percent of the medicines listed in the United States Pharmacopoeia come from herbs.
By the turn of the 20th century pharmaceuticals had found a new role in medicine and pharmacy and drug stores moved to providing medicines as orders by physicians. But this wasn’t a matter of handing out pills. “Everything was handmade. You would roll your own pills and mix your own lotions and syrups. Nothing was pre-made,” Pennypacker said.
Most drug stores still have displays which include the tools of those pharmacists: the mortar and pestle, and rows of darkened glass containers with strange Latin names the ingredients of those pills and poultices.
Progress continued throughout the first half of the century, with drug stores becoming a treasured part of American society. As in the movie It’s a Wonderful Life, the drug store was where you got medicine, and where you either worked as a soda jerk, or stopped by for ice cream.
But druggists still weren’t just salesmen. “Even in the 1950s there was still some mixing and making, even though there were a lot more drugs,” he said. In fact, Pennypacker still manufactures some medicines. “We have a few circumstances where we still prepare medications,” he said. “Neonatal medicine is one area. For babies that tiny, there aren’t many prepared medicines,” he said.
For Annarelli and Pennypacker it’s not just about selling people things and that’s why they own an apothecary shop instead of working for CVS or Eckerts. “This is what we’ve chosen to do and what this business is all about interacting with people and helping them,” he said.