The History and Evolution of Healthcare in America

Imagine...

It is the early evening, the night of October 31, 1633. The night airs are settling around you as oil lamps and candles begin to cast faint flickering light through the salt glass windows. The cool dark fog envelops you in a disquieting silent shroud. On foot, you rapidly make your way down the dark cobblestone streets of Gravesend, in Northwest Kent England. Sticking to the shadows, you search for a specific tavern where you can take refuge. You have heard that the barkeep can assist you in finding safe haven. The early fog that is rolling in is cold and dank.

Your broadcloth clothing is damp, and the chill seeping into your bones is unbearable. You don’t feel well. You never really feel well! The nails in your hobnail boots click and clack, as you creep down the edges of the dark streets. As strangers approach, you slip into the side alleys. The shivers grip you, not just from the cold, but you also feel that the rumble of your belly will give you away. You pray this is not the first sign of consumption, dropsy, or the cholera that was gripping your homeland when you left. As you made your way from Belgium to England across Europe, you have left each and every town as disease and pestilence entered them, devastating the populations. Each time you found a home in a town and commenced to develop some skill, the plague, or fever began to rip the town apart, along with your hope to learn a trade and make a living. The only business that thrived was that of the undertaker. Having no aspiration for that line of work, and each time fearing you would succumb as well, you fled west-always farther west.

You are tired, cold, hungry and also scared as you come upon the sign above a doorway down the street. Marked by a tilting tombstone, the sign of “The Gravedigger’s Refuge” is a welcome sight: it is what you have spent the last cold and clammy hours searching for. As you enter the establishment you worry that though so close to salvation, your poor command of the English language and Belgian accent will betray you. Your simple goal is to escape this life for the promise of the new world, yet at this very moment your more pressing goal is to find a warm hearth, nutrition and a place to rest.

“Eay Yo” calls the portly man behind the bar, “what’s yer pleasure be?” You notice that his waistcoat is bursting and the few hairs on his head are askew. But despite the corpulent appearance, there is a dangerous air to this man. On your guard you respond, “A simple draught and some palaver ‘el do.” As you sit to make your drink you inquire as to how a man can find some “bed for the night and fair and safe work for the future.” “S’ yer trade mate?” asks the barman. “Carpenter” say’s you. The code you were told to use has worked out and the Barkeep comes from behind the bar - pulls up a stool and leans in. You pull back as his breath makes you nervous, for you have heard that vapors cause disease, and the vapors from his mouth are a foul stench for sure! “So, you’s a papist? I wouldn’t have reckoned that from yer accent but then again I ain’t been far” he begins. “I knows ya needs fast and complete passage, and yer lucks good mate as there is two ships leaving tomorrow morning. You reports to the Master of the ones called the Dove and tells him your name is Thomas Loker. Tells him you’s good with maul, trunnel and caulk and he will be sure to take you as carpenter’s mate.” He continues on while you listen. “Now yer bed and yer drink is 6 pence apiece, but the palaver is eight shilling. And mind you, you’ll need give me another eight for the Master if’n you expect to get the job. That’s all there is and get there early as I ain’t the only bookie in Gravesend.” Startled by the fees, but mindful of your need to leave, you dig in your purse and pay out 16 shillings 12 pence and wonder if you will need more for the master to secure the job. When you get to your bed you see that your bedmate is a frail man with a hacking cough. You find more comfort on the floor and make your bed there for the night...

New Medicines Selling the Cures

John Stith Pemberton was born in 1831 in Knoxville, Georgia. Like his uncle, Lieutenant General John C. Pemberton, the famous commander of the defense of Vicksburg, Mississippi, he too was a good son of the south, having enlisted in the Confederate army where he was wounded in the Battle of Columbus, Georgia in April, 1865. Like many wounded soldiers of the day, he rapidly became addicted to morphine. He tried various concoctions of coca, and coca wines to no satisfaction. Desperate to find a curative, he began to formulate his own version of one which contained alcohol, coca, kola nut and Damiana - a relatively small shrub native to Central America. The Damiana plant produces small, aromatic flowers coupled with a strong spicy aroma, one that had traditionally been used in tea for its “relaxing” effects. In April 1885, Pemberton’s French Wine Coca hit the market and became an immediate success.

Pemberton’s “potion,” contained a high percentage of alcohol, significant caffeine, 8.46 milligrams of cocaine per ounce of liquid, and a pleasing taste. He marketed his elixir to “scientists, scholars, poets, divines, lawyers, physicians, and others devoted to extreme mental exertion.” Like most “patent” medicines, the beverage was advertised as a cure for nerve trouble, dyspepsia, mental and physical exhaustion, gastric irritability, wasting diseases, constipation, headache, neurasthenia and impotence. It also was recommended as a cure for morphine addiction. In one of his more colorful advertisements, playing to the wide-spread public concern about drug addiction, depression, and alcoholism among veterans and “neurasthenia” among “highly-strung” Southern women, Pemberton said his medicinal concoction was “particularly beneficial for ladies, and all those whose sedentary employment caused nervous prostration, irregularities of the stomach, bowels and kidneys, and those who needed a nerve tonic and a pure, delightful diffusible stimulant.”

Unfortunately, later that year, Atlanta and Fulton County passed temperance laws which made the sales of his magical elixir – because its alcohol content - illegal. Pemberton responded by reformulating his “brew,” substituting carbonic acid (soda water) to replace the alcohol, and keep the other ingredients in solution. Having satisfied the chemical requirements of the laws, he then needed a new name. This moniker came from Frank Mason Robinson, the secretary and bookkeeper for the Pemberton Chemical Company. Renamed Coca-Cola, the new formula was introduced in May 1886, at the Jacobs Pharmacy in Atlanta. Delivered as syrup and mixed via a soda delivery system (the forerunner of the modern soda fountain), Jacobs sold 25 gallons its first year. The next year, sales topped 1049 gallons. In 1888, Asa G. Chandler, along with several other investors, bought the rights to Dr. Pemberton’s formula for $2,300. It was Chandler’s aggressive marketing that brought real success to Coca-Cola, making him and his investors many, many millions of dollars and allowing him to establish the Central Bank and Trust Company.

Although in 1894 Coca-Cola was sold in bottles for the first time, it was the distribution of it through pharmacies that accounted for much of the early sales. It pioneered the development of the soda fountain and people enjoyed visiting these establishments and ordering the “fresh” drink. As concern of patent medicines grew over time, pharmacy soda fountains gradually transformed from providing therapeutic medicines to simple beverages then called “soft” drinks (meaning not habit forming). The transition to soda fountains was largely complete when Samuel Hopkins Adams ran his series of articles condemning patent medicines in Colliers Weekly in 1905. His articles were both stunning and highly influential.