and uncertainty in the preparation of medicines has been felt with peculiar weight. The character of medical preparation is liable to vary in every state and city of the union. The physician is exposed, unknowing, to the administration to his patients of medicines different from those which his judgment has prescribed."

It is of interest that Spalding had been an early pupil of Dartmouth Medical School's founder, Dr. Nathan Smith, and later served as Smith's assistant at Dartmouth. He had clearly been well trained. "This evil," Spalding trumpeted in 1818, "is due primarily to a lack of cooperation by many physicians in the great country!" His suggestion that a national pharmacopoeia be formed "under the authority of and by the conjoint labors of the profession throughout the union" was received with almost universal approval. And so, at long last, one came to be.

The statement made regarding the objective of a national pharmacopoeia was to the point: "The value of our materia medica is of great variance. Some embody principles of highest quality and usefulness. Others are laden with pretensions not proved. It is our responsibility to select among substances of medical power those best understood and established and to form from them preparations in which their powers can be exerted to greatest advantage. To these must be affirmed convenient and definite names."

Word went out to all medical societies, medical schools, and colleges with the information that the United States had been divided into four grand divisions: Northern, Middle, Southern, and Western. Delegates were to be elected from each division's medical bodies. Deliberations by each division over a pharmacopoeia were to be commenced at once, approved at a preliminary convention, and considered at a General Convention "in the city of Washington on the first of January 1820." From all this disparate information, a national pharmacopoeia was to be distilled, and "the elixir of reason and common sense was to be made universally available to all medical bodies, apothecaries, and pharmacists in the United States and its territories."

Easy to say, enormously difficult to do! A roll call of some of the names on the conventioneers' name tags is of interest: from Vermont came Drs. Selah Gridley

and Erastus Torrey; from New Hampshire Drs. Reuben Mussey, Ebenezer Learned, Mathias Spalding, and John Batchelder; from Massachusetts Drs. John Warren and others; from Brown University Dr. William Ingalls; and from Connecticut Drs. William Tolley and Eli Ives. Lyman Spalding's old Dartmouth mentor, Dr. Nathan Smith also attended, as one of the representatives of Yale Medical College, to which he had by then moved.

Despite an unexpected period of mild weather that rendered the rough roads of the time almost impassable, the General Convention did indeed meet in Washington as scheduled. Dr. Samuel Mitchell of New York was appointed president and Dr. Thomas Hewson of Philadelphia took office as secretary.

It is almost disrespectful to relegate the mountain of taxonomic toil which then ensued to a few lean sentences. Bulky "essays" produced by the members of the four divisional conventions, "having undergone deliberate examinations," were united into one work. The title The Pharmacopoeia of the United States of America was adopted by noisy acclaim and the precious pages were handed over to a committee charged with seeing to its publication. "We have now thrown our weight into the whole process formerly dominated by the English," cheered the exhausted conventioneers. They then resolved that a second General Convention be held "in the present location" in 1830. Each division was to elect by ballot three delegates to see to the revision and augmentation of the book.

The first national pharmacopoeia was duly published as 1820 came to a close. It was not judged perfect by all, but it became a bestseller and in most parts of the union almost exclusively regulated the preparation of medicines. And the General Convention of 1830 would catch the errors, duplications, and omissions occasioned by the magnitude of the undertaking of 1820.

The promised General Convention of 1830 was held in Washington on January 4. In order to broaden the horizons of the conclave, the surgeons general of the Army and the Navy plus three members of Congress who were physicians were invited to join the elected delegates.

The gathering was charged with taking an enlightened look at the 1820 book and

instituting such revisions as were deemed necessary. A committee was duly appointed to see to that task. But, aghast at the stacks of paper and vociferous testimonials with which it had been entrusted, the committee went into executive session and chickened out, stating: "Several important modifications are mandatory which require a more particular examination than your committee can possibly give them; therefore, your committee recommends that the exacting challenge be referred to a 'Committee of Revision' which shall prepare for the press a revised edition of the Pharmacopoeia and make the necessary arrangements for publication."

During the ensuing Washington winter, they debated ointments, tinctures, infusions, confections, extracts, pills, syrups, tonics, spirits, medicinal waters, and cerates (this last a compound of active ingredients in a base of lard or white wax). There were 400 preparations in the 1820 edition (including, as it happens, two pertinent to the article "Wild Greens" in the Spring 2006 issue of Dartmouth Medicine—Helleborus foetidus, or "bearsfoot," and Helleborus niger, or "black hellebore"). By the time the 1830 edition was ready for press, the number of preparations had increased to 720 (and, again pertinent to the article "Wild Greens," veratrum was indexed by name—V. album and V. viride).

The Convention was called again and again. In the 1880 edition of the Pharmacopoeia, there were 1,161 "prescriptions"; 240 items had been added (including American and Indian cannabis, as well as the extract and tincture of V. viride) and 200 deleted.

The changes through the years also included an increasing number of pages devoted to tables of reagents, specific chemical characteristics of some botanicals, methods of preparation, and indications for use-all hints of the coming revolution in the worlds of medicine and pharmaceuticals.

In fact, as I write, sitting before me are both a copy of the first Pharmacopoeia of the United States—the one published in 1820—and the latest edition of the Physicians' Desk Reference, a pharmacological resource that contains some 10,000 citations for the multitude of preparations available to today's doctors in humankind's ceaseless struggle to attain and sustain optimum health.