Bilious pills: the ‘take two aspirins’ of their era harmed more than they helped

Clinical

Chloe Hava

26 February 2000

Mark HW. Lewis and Clark expedition. World History Encyclopedia. 2024. Available from: https://www.worldhistory.org/Lewis_and_Clark_Expedition/
De Wolfe A. Lewis and Clark’s laxative emergency. Exploring Echoes. 2025. Available from: https://exploringechoes.substack.com/p/lewis-and-clarks-laxative-emergency
Higby GJ, Mussulman JA. Rush’s bilious pills: Rush’s thunderbolts. Discover Lewis & Clark. Available from: https://lewis-clark.org/sciences/medicine/rushs-bilious-pills/
National Park Service. Medicine on the Lewis and Clark expedition. 2023. Available from: https://www.nps.gov/articles/000/medicine-on-the-lewis-and-clark-expedition.htm
Harty C. Mercury laxatives: Lewis and Clark’s evidence. MedShun. 2024. Available from: https://medshun.com/article/what-evidence-is-there-of-lewis-and-clark-mercury-laxatives
Finn JD. Offbeat Oregon: Lewis and Clark blazed their trail with heavy-metal laxatives. Spokesman. 2025. Available from: https://redmondspokesman.com/2025/05/01/offbeat-oregon-lewis-and-clark-blazed-their-trail-with-heavy-metal-laxatives/
Connecticut History. First American medicine patent – today in history: April 30. CT Humanities. 2020. Available from: https://connecticuthistory.org/first-american-medicine-patent-today-in-history-april-30/
Patent Medicine. Early American patent medicines. Medical Discoveries. Available from: http://www.discoveriesinmedicine.com/Ni-Ra/Patent-Medicine.html
McIntire T. Bad medicine: sickening Civil War remedies. National Museum of Civil War Medicine. 2022. Available from: https://www.civilwarmed.org/bad-medicine/
Baldwin G (Firm). Baldwin’s bilious and liver pills: cures sickness, dizziness, shoulder pains, yellowness of the eyes, skin, brown or yellow coated tongue, bile, jaundice, constipation, piles, all liver troubles. Wellcome Collection; JSTOR. Available from: https://www.jstor.org/stable/community.36630781
Lai DG, Nelson HF. “There was death in the powder and he knew it”: dis/ability and tactics of resistance in the autobiography of Elizabeth Storie. Études écossaises. 2026. Available from: https://journals.openedition.org/etudesecossaises/4925
Storie E. The autobiography of Elizabeth Storie: a native of Glasgow, who was subjected to much injustice. R. Stobbs; 1859. p. 6–7. Available from: https://archive.org/details/autobiographyel00storgoog/page/n13/mode/2up
Dr Spiegel’s stomach and liver pills – a specific for bilious complaints. Bebout Family Medicine. Available from: https://www.beboutfamilymedicine.com/dr-spiegels-stomach-and-liver-pills-a-specific-for-bilious-complaints/
Olson DA. Mercury toxicity. In: Nelson SL, editor. Medscape. 2024. Available from: https://emedicine.medscape.com/article/1175560-overview
Cleveland Clinic. Mercury poisoning. Health Library. 2022. Available from: https://my.clevelandclinic.org/health/diseases/23420-mercury-poisoning

8.00 am	Set up and check in IVF work fluctuates – some days it’s minimal, other days it’s constant. I check what’s booked/expected, confirm any urgent needs, and make sure there’s space for IVF stock.
9.00 am	Ordering and supply planning Weekly ordering is done on Monday mornings and reviewed again on Wednesday because we can’t reliably order later in the week. This helps to protect continuity.
10:30 am	Dispensary coordination My dispensary manager leads ordering of IVF medicines, support materials and consumables. She also prepares syringe/needle packs for medicines that require separate consumable supply, so patients receive everything together.
12.00 pm	Clinic liaison Phone or email contact with IVF nurses occurs most days to clarify prescriptions, confirm timing and align supply with treatment cycles.
2.00 pm	Prescription collection Our courier collects prescriptions from fertility clinics weekly, as not all clinics use e-scripts. These are processed promptly to avoid delays that could affect treatment timing.
3.30 pm	Patient support IVF supply often includes practical support: ensuring patients have what they need for transport and storage, and that any supporting materials and consumables are ready alongside the medicines.
6.00 pm	Engagement and training Some evenings may include a Fertility Nurses of Australia meeting, or delivering training sessions for fertility clinics for IVF clinicians and nurses.
8.00 pm	Urgent supply Occasionally I’ll get an out-of-hours call from an IVF clinician to arrange emergency medicines supply, requiring rapid coordination to keep treatment on track.

8.00 am	Set up and check in IVF work fluctuates – some days it’s minimal, other days it’s constant. I check what’s booked/expected, confirm any urgent needs, and make sure there’s space for IVF stock.
9.00 am	Ordering and supply planning Weekly ordering is done on Monday mornings and reviewed again on Wednesday because we can’t reliably order later in the week. This helps to protect continuity.
10:30 am	Dispensary coordination My dispensary manager leads ordering of IVF medicines, support materials and consumables. She also prepares syringe/needle packs for medicines that require separate consumable supply, so patients receive everything together.
12.00 pm	Clinic liaison Phone or email contact with IVF nurses occurs most days to clarify prescriptions, confirm timing and align supply with treatment cycles.
2.00 pm	Prescription collection Our courier collects prescriptions from fertility clinics weekly, as not all clinics use e-scripts. These are processed promptly to avoid delays that could affect treatment timing.
3.30 pm	Patient support IVF supply often includes practical support: ensuring patients have what they need for transport and storage, and that any supporting materials and consumables are ready alongside the medicines.
6.00 pm	Engagement and training Some evenings may include a Fertility Nurses of Australia meeting, or delivering training sessions for fertility clinics for IVF clinicians and nurses.
8.00 pm	Urgent supply Occasionally I’ll get an out-of-hours call from an IVF clinician to arrange emergency medicines supply, requiring rapid coordination to keep treatment on track.

8.00 am	Set up and check in IVF work fluctuates – some days it’s minimal, other days it’s constant. I check what’s booked/expected, confirm any urgent needs, and make sure there’s space for IVF stock.
9.00 am	Ordering and supply planning Weekly ordering is done on Monday mornings and reviewed again on Wednesday because we can’t reliably order later in the week. This helps to protect continuity.
10:30 am	Dispensary coordination My dispensary manager leads ordering of IVF medicines, support materials and consumables. She also prepares syringe/needle packs for medicines that require separate consumable supply, so patients receive everything together.
12.00 pm	Clinic liaison Phone or email contact with IVF nurses occurs most days to clarify prescriptions, confirm timing and align supply with treatment cycles.
2.00 pm	Prescription collection Our courier collects prescriptions from fertility clinics weekly, as not all clinics use e-scripts. These are processed promptly to avoid delays that could affect treatment timing.
3.30 pm	Patient support IVF supply often includes practical support: ensuring patients have what they need for transport and storage, and that any supporting materials and consumables are ready alongside the medicines.
6.00 pm	Engagement and training Some evenings may include a Fertility Nurses of Australia meeting, or delivering training sessions for fertility clinics for IVF clinicians and nurses.
8.00 pm	Urgent supply Occasionally I’ll get an out-of-hours call from an IVF clinician to arrange emergency medicines supply, requiring rapid coordination to keep treatment on track.

8.00 am	Set up and check in IVF work fluctuates – some days it’s minimal, other days it’s constant. I check what’s booked/expected, confirm any urgent needs, and make sure there’s space for IVF stock.
9.00 am	Ordering and supply planning Weekly ordering is done on Monday mornings and reviewed again on Wednesday because we can’t reliably order later in the week. This helps to protect continuity.
10:30 am	Dispensary coordination My dispensary manager leads ordering of IVF medicines, support materials and consumables. She also prepares syringe/needle packs for medicines that require separate consumable supply, so patients receive everything together.
12.00 pm	Clinic liaison Phone or email contact with IVF nurses occurs most days to clarify prescriptions, confirm timing and align supply with treatment cycles.
2.00 pm	Prescription collection Our courier collects prescriptions from fertility clinics weekly, as not all clinics use e-scripts. These are processed promptly to avoid delays that could affect treatment timing.
3.30 pm	Patient support IVF supply often includes practical support: ensuring patients have what they need for transport and storage, and that any supporting materials and consumables are ready alongside the medicines.
6.00 pm	Engagement and training Some evenings may include a Fertility Nurses of Australia meeting, or delivering training sessions for fertility clinics for IVF clinicians and nurses.
8.00 pm	Urgent supply Occasionally I’ll get an out-of-hours call from an IVF clinician to arrange emergency medicines supply, requiring rapid coordination to keep treatment on track.

Knocking on doors

A workforce running on goodwill

The cost of saying no

Let pharmacists do what they are trained to do

Reform that matches need with value

How did you specialise in assisted reproductive therapy?

What does the role entail?

How do you help patients navigate their medicines regimen?

How do you manage medicines storage, cold-chain and supply?

How do you collaborate with fertility clinics, prescribers and nurses?

What advice do you have for ECPs keen on specialising in this area?

A Day in the life of Morag Horton, community pharmacy owner, Adelaide, South Australia

Compliance is key

Dispensing psychedelics safely

Managing patient enquiries

How does the nasal spray differ from EpiPen?

Can it be placed in a resuscitation kit?

Who is the nasal spray best suited to?

What should pharmacists know about its use?

Who is most likely to experience adverse effects?

Who might find it hard to use the nasal spray?

Could adrenaline nasal spray (neffy) be downscheduled?

How much does it cost?

Will the nasal spray be PBS listed?

Where can I find more information?

Bridging the gap when CBT is delayed

Checking duration against intention

Monitoring efficacy and tolerability

Knocking on doors

A workforce running on goodwill

The cost of saying no

Let pharmacists do what they are trained to do

Reform that matches need with value

How did you specialise in assisted reproductive therapy?

What does the role entail?

How do you help patients navigate their medicines regimen?

How do you manage medicines storage, cold-chain and supply?

How do you collaborate with fertility clinics, prescribers and nurses?

What advice do you have for ECPs keen on specialising in this area?

A Day in the life of Morag Horton, community pharmacy owner, Adelaide, South Australia

Compliance is key

Dispensing psychedelics safely

Managing patient enquiries

How does the nasal spray differ from EpiPen?

Can it be placed in a resuscitation kit?

Who is the nasal spray best suited to?

What should pharmacists know about its use?

Who is most likely to experience adverse effects?

Who might find it hard to use the nasal spray?

Could adrenaline nasal spray (neffy) be downscheduled?

How much does it cost?

Will the nasal spray be PBS listed?

Where can I find more information?

Bridging the gap when CBT is delayed

Checking duration against intention

Monitoring efficacy and tolerability

Knocking on doors

A workforce running on goodwill

The cost of saying no

Let pharmacists do what they are trained to do

Reform that matches need with value

How did you specialise in assisted reproductive therapy?

What does the role entail?

How do you help patients navigate their medicines regimen?

How do you manage medicines storage, cold-chain and supply?

How do you collaborate with fertility clinics, prescribers and nurses?

What advice do you have for ECPs keen on specialising in this area?

A Day in the life of Morag Horton, community pharmacy owner, Adelaide, South Australia

Compliance is key

Dispensing psychedelics safely

Managing patient enquiries

How does the nasal spray differ from EpiPen?

Can it be placed in a resuscitation kit?

Who is the nasal spray best suited to?

What should pharmacists know about its use?

Who is most likely to experience adverse effects?

Who might find it hard to use the nasal spray?

Could adrenaline nasal spray (neffy) be downscheduled?

How much does it cost?

Will the nasal spray be PBS listed?