No one knew where he really came from or where he trained. Even after his death in 1901, his origins remained open to debate. Charles Rice arrived at Bellevue Hospital as a patient in 1865 and lived on the grounds of the large complex until his death almost 36 years later. In the intervening years, he oversaw the largest pharmacy operation in America and led both the reformation of the United States Pharmacopeia (USP) and the creation of the National Formulary (NF).
A Drug Service Pioneer
Only a few public hospitals existed in the United States until well after the Civil War, and even fewer had professionally trained pharmacists on staff. Consequently, hospital-trained physicians in America had little understanding of or appreciation for pharmacists and pharmacy, unlike those who trained in many European hospitals. In 1904, Martin Wilbert, a hospital pharmacist and historian, wrote, “How woefully deficient and unsatisfactory the drug service in many of our hospitals must be becomes evident when we realize that in this great country, with hundreds of institutions, we have had but one solitary instance of a hospital pharmacist who has become widely known through his professional and scientific work. I refer to Charles Rice of Bellevue Hospital, New York.”
Bellevue Hospital traced its beginnings to a six-bed infirmary, established in 1736 in New York City’s almshouse. Serving at times as a jail as well as a pest-house for patients infected with communicable diseases, by the beginning of the Civil War, Bellevue Hospital had established its own medical college. In 1867, Bellevue opened one of the very first outpatient departments—the Bureau of Medical and Surgical Relief for the Out of Door Poor. Rice, who had begun working in the hospital’s drug department, was named the outpatient facility’s first director. In 1885, he was named chemist and superintendent of the General Drug Department and later, chemist of the Department of Public Charities and Corrections.
By this time, Rice had assumed responsibility not only for Bellevue Hospital but for all of the medical institutions of the city and county: eight hospitals, four branches of the New York City Lunatic Asylum, the almshouse and workhouse, the penitentiary, the Tombs prison, four district prisons containing approximately 17,000 prisoners, and four large dispensaries treating 60,000 patients annually.
The earliest centralized formulary of the municipal hospitals of New York was issued in 1868. Entitled Formulae of Mixtures, Pills and Other Preparations at Bellevue & Charity Hospitals, the 14-page pocket-sized book had no authorship attribution, although it is likely that Rice was involved; the five subsequent editions identified Rice as the author. The 59 formulae of the first edition included expectorants, laxatives and tonics. Separate instructions included the handling of poisons and rules regarding the quantity of medicines to be prescribed and sent to the floor:
- No mixture, the dose of which is a teaspoonful, shall be ordered or sent in larger quantities than 2 oz.
- No mixture, the dose of which is a tablespoonful, shall be ordered or sent in larger quantities than 4 oz.
- If the bulk of a mixture above
2 oz. or 4 oz. respectively consists of water, it may be supplied in reasonable quantities.
- All other medicines shall be prescribed or sent only in quantities
sufficient to last 24 hours.
Charles Rice reportedly began each day by testing the milk that was delivered to all of the city hospitals before going to his office. Once at work, he continued those efforts by being responsible for food products that were purchased for use at Bellevue. But as a pharmacist, he really shone by personally overseeing the requisitions for medical and surgical supplies prepared by pharmacists—not only at Bellevue but at other institutions in the system. His efforts to work for the public good were noteworthy at a time when it was said his was the only department that had not suffered through the influence of political intrigue at one time or another.
Expert on Drug Adulteration
Rice’s work at Bellevue and his personal friendship with Edward Robinson Squibb made him familiar with the problems and extent of pharmaceutical product adulteration. In 1880, he was named the chair of the USP Committee of Revision, a post he filled until his death in 1901. As chair, Rice quickly moved to organize an expanded and widely dispersed committee to “address the needs of professional practice, mass manufacturing and developing regulations against drug adulteration.”
He advocated the incorporation of average doses into product monographs to provide useful information to the compounder. Rice also had an interest in providing pharmacists with tested formulas that the pharmacist could compound rather than depend on mass-produced products. He led the New York effort to prepare a formulary composed of unofficial formulas; many had been deleted from the previous issue of USP. This effort led to the first publication of the NF in 1888. Rice’s efforts in the development of modern compendial works on the identification and production of standardized medicines were formalized when the USP
and NF were established as the official
standards under the 1906 Pure Food and Drug Act, legislation that mandated the federal inspection of meat products and forbade the manufacture, sale or transportation of adulterated food products and
dangerous patent medicines.
Charles Rice spent his life at Bellevue as a pharmacist ensuring that the right medicine was available for patients for both the hospital and the nation.
Anderson L, Higby GJ. The spirit of voluntarism: a legacy of commitment and contribution. The United States Pharmacopoeia 1820-1995. Rockville, MD: United States Pharmacopoeial Convention; 1995.
Worthen DB. Charles Rice (1841-1901): Creator of the Modern Scientific Pharmacopoeia and Father of the National Formulary. J Am Pharm Assoc. 2004;44:521-523.