From Physick to Pharmacology

Five Hundred Years of British Drug Retailing

Louise Hill Curth, Louise Hill Curth

• Editorial: Routledge
• Año: 2017
• ISBN:
  9781351935388
• Edición: 1
• Categoría: Geschichte
• Categoría: Weltgeschichte

From Physick to Pharmacology addresses the important, albeit neglected history of the distribution and sale of medicinal drugs in England from the sixteenth to the twenty-first century. The social history of early medicine and the evolution of British retailing are two areas that have attracted considerable attention from academics in recent years. That said, little work has been done either by medical or business historians on the actual retailing of drugs. This book merges the two themes by examining the growth in the retailing of medicinal drugs since late-medieval times. The six academics contributing essays include both medical and business historians who provide an informed and stimulating perspective on the subject. After an introduction setting out the context of drug retailing and surveying the current literature, the volume is arranged in a broadly chronological order, beginning with Patrick Wallis's study of apothecaries and other medical retailers in early modern London. The next chapter, by Louise Hill Curth, looks at the way the distribution network expanded to encompass a range of other retail outlets to sell new, branded, pre-packaged proprietary drugs. Steven King then examines various other ways in which medicines were sold in the eighteenth century, with a focus on itinerant traders. This is followed by pieces from Hilary Marland on the rise of chemists and druggists in the nineteenth century, and Stuart Anderson on twentieth-century community pharmacists. The final essay, by Judy Slinn, examines the marketing and consumption of prescription drugs from the middle of that century until the present day. Taken together, these essays provide a fascinating insight into the changes and continuities of five centuries of drug retailing in England.

Chapter 1
Introduction: Perspectives on the Evolution of the Retailing of Pharmaceuticals

Louise Hill Curth

A drug is defined as a chemical substance that is taken to prevent or cure disease or to otherwise enhance physical or mental welfare … [which] implies a cultural rationale.¹

Disease is not a human invention, but a biological process which has been created and fostered by the way humans have chosen to live. It is thought that as nomadic hunters and gatherers began to settle permanently in one place, a range of pathogens once limited exclusively to animals transferred to humans. A large number of ‘zoonoses’, or diseases naturally transmitted between species, probably came from domesticated animals such as dogs and cattle, which manifested themselves as diseases like measles, smallpox or tuberculosis. The early settled populations also became prone to deficiency diseases, most notably anaemia caused by insufficient iron, and parasitic infections caused by the faecal contamination of water. As populations continued to grow, so too did the types and numbers of pathogens.²

Although patterns of disease have changed, and will always continue to do so, every culture and society has its own theories about what constitutes ‘health’ and ‘illness’ and how to achieve, sustain or cure these bodily states. There are also ongoing debates as to how these terms should even be defined. Many modern health professionals tend to view ‘health’ as a unitary rather than a multidimensional or relative concept.³ Jacalyn Duffin, however, has suggested that the terms ‘illness’ and ‘disease’ are actually two different things. The former relates to what are generally referred to as ‘symptoms’ or the subjective problems experienced by an individual. ‘Disease’, on the other hand, describes the way in which these are perceived by society.⁴ This definition, however, can be taken further. For example, symptoms may be experienced, described and classified quite differently between groups of people. Furthermore, many diseases have mutated over the centuries, resulting in either related or new types of illnesses. What is defined as ‘disease’ in some societies may not be recognized as sickness in others, and many different types of medical structures of beliefs and practices have developed as a result.⁵

However, despite the many differences, all societies share the drive to produce, maintain or restore such a state of health, generally with the aid of various types of often dangerous, potent organic and inorganic ingredients which fall under the rough heading of ‘drugs’.⁶ The types of ingredients that are used, their relationship with other treatments and even the way that they are expected to work are also closely linked to the society and culture in which they are used. Although herbal remedies are found in most societies, both the types and quantity of ingredients can differ greatly. Tobacco, for example, was considered to be an ‘antidote against all venome and pestilential diseases’ during the seventeenth century. Today, it is seen as a ‘public danger’ from which governments must protect their citizens.⁷

Many differences are also evident in the usage of synthetically made medicines. Antibiotics are widely and enthusiastically consumed in Western Europe in the form of prescriptions and as ingredients in ‘over-the-counter’ medicines. They are also ingested via the food chain, with large amounts being used to promote growth and prevent infections in animal husbandry and fish farms. As a result, new strains of diseases resistant to antibiotics have developed.⁸ There are also many differences between the types and quantities of drugs prescribed within Western countries. For example, in the early 1980s some German doctors were prescribing six to seven times the amount of digitalis-related drugs as those in France and England.⁹ There are also differences in the physical attributes of products, with varying preferences for tablets capsules, liquids, transdermal patches or intravenous administration which require different dosages according to factors such as sex, age and weight.¹⁰

Modern studies on the history of drugs tend to fall into one of four camps, none of which focus specifically on the way in which medicines are sold. The first includes general studies which discuss the murky division between licit and illicit drugs, such as narcotics and stimulants.¹¹ These are followed by histories of specific pharmaceutical companies or monographs on specific types of drugs, such as opioids, hallucinogenics or alcohol.¹² The final category includes collections of essays which cover a range of often loosely related ‘drug’ themes.¹³

The essays which form From Physick to Pharmacology examine the way in which the nature of British drugs changed over the course of five hundred years. At the broadest level, they illustrate basic medical theories and the ways in which they changed over the centuries from a holistic to a biomedical model. These essays also help to illustrate the evolution of drug production and distribution. Perhaps most importantly, however, they illustrate the five main, albeit overlapping, phases in the development of English pharmaceuticals.¹⁴ The first can be called ‘kitchen physick’, which refers to most remedies being prepared within the home from ‘natural’ ingredients. This is followed by the mercurial rise of commercialized remedies in the eighteenth century, fuelled by more intensive nation-wide advertising that played on the fears of a hypochondriacal public. The third phase covers an era of rapid population growth and urbanization in the long nineteenth century (roughly 1780–1900), when the number of fixed shops specializing in the distribution of drugs expanded even faster than the rapid growth of the medical profession, and brought with it concerns over the safety of some of the preparations provided. Stage four includes the rise of pathology and microbiology in the late nineteenth and early twentieth centuries, with the final phase concentrating on the era of the giant multinational pharmaceutical companies since the inter-war years. This picture deliberately simplifies the pattern of distribution of medical remedies. Throughout, the most central characteristic has been the immense variety of the channels through which ‘patients’ have received and acquired ‘drugs’, and the equally complex strategies of diagnosis and treatment, with self-medication consistently being the most common variety. In some ways the boundaries between these phases are impossible to draw with any precision. Thus, regulation of the sale of drugs begins in our third phase, but really gathered momentum in the fourth. The integration of scientific research into the production of medicines is a characteristic of the fourth stage, but reaches its high point in the big multinational companies of our fifth stage. These categories and boundaries are presented here to try to give a structure to a long period in the development of the production and distribution of medicines. They can no doubt be improved upon.

Naturally enough, this range and complexity of treatment strategies, of medical practitioners and of production and distribution provides a major challenge to the historian. There are, for example, many more levels of complexity and differentiation than are customary in other branches of retail history. While the contributors are necessarily modest about the ability of their researches to uncover the full intricacy and extent of the supply of drugs in their era, this volume breaks new ground in the history of drug retailing. That said, a single volume cannot, of course, hope to serve as a general guide to the topic. It can, however, aim to illustrate the common thread of the relationship between medicinal beliefs, treatments and society.

The first phase, kitchen physick, derived much of its force from classical learning, based on the idea that health and illness were ‘organic’ or constitutional in the sense of deriving from inner processes, rather than invasive external pathogens. It therefore followed that since all parts of the person were inter-linked, the right frame of mind, composure, control of the passions and suitable lifestyle could either help to prevent or help to cure illness.¹⁵ In this period, the notions of health and disease were linked to Galenic-astrological principles which held that diseases were caused by humoral imbalances, linked to an individual’s personal habits or from various environmental effects. Although God was seen as the ultimate source of health or illness, at the same time it was thought that the deity encouraged humankind to make efforts to protect or restore their health with the ‘herbes, fruites, rootes, seedes, plantes, gums, precious stones, beasts, foules [and] Fishes’ provided for these purposes.¹⁶ In fact, the tradition of using medicinal herbs dates back to Mesopotamian and Egyptian times, a variety of common plants were used for medicinal purposes during the Hittite Empire, which flourished between 1380 and 1200 BC.¹⁷ At the beginning of the early modern period, herbs and other plants were still the foundation of both preventative and remedial medicine.

Although the term ‘medical marketplace’ can be used to describe later phases covered by this collection, there are doubts about its usefulness in this first phase. Both Margaret Pelling and Andrew Wear have pointed to the limited extent of ‘commercial’ transactions involving health care and the substantial number of healers who either bartered their services or offered them at no cost, and the even greater extent of domestic health care taking place in the patient’s own home.¹⁸ Two contributions to this volume relate to this period. As Patrick Wallis discusses in Chapter 2, in early modern England, medical potions produced within the household were supplemented by those produced by apothecaries or other merchants. Most were based on easily accessible plants and other organic materials and were often combined with a growing number of imported ingredients.¹⁹ Provincial wholesalers known as druggists also supplied such materials to various types of merchants who all sold a range of goods.²⁰

The core texts in use in the early modern period were based on the Greek ‘pharmacon’. Strictly defined, this refers to drugs, potions or magical potions, but in the broadest sense refers to the sum of all knowledge pertaining to drugs. This tradition had been built upon by later writers, and as Patrick Wallis shows, there was interest in the early modern period to help standardize remedies which were attributed to ancient writers such as Galen or Avicenna, as well as to the thirteenth-century medical writer Mesue, and then to produce vernacular texts. In England, Nicholas Culpeper translated the Latin Pharmacoepia, ‘that book by which all Apothecaries are strictly commanded to make all their Physick with’ in order to provide his countrymen with ‘the liberty of the subject’.²¹

This phase also saw the appearance of pre-made, pre-packaged proprietary nostrums, which were sold in a variety of retail outlets, alongside the more traditional remedies. Although apothecaries had been prescribing, compounding and administering medicines for centuries, the Company of Physicians attempted to stop such activities in the late seventeenth century. Their efforts to halt this competition resulted in what became known as the ‘Rose Case’, begun by a patient complaint to the Company of Physicians during the winter of 1669–70. Although the College attempted to prosecute Rose for practising medicine, an appeal from the Society of Apothecaries resulted in a judgment in favour of Rose from the House of Lords which resulted in apothecaries being given the legal right to practise medicine.²²

As Louise Hill Curth shows in Chapter 3, this case gave a green light to growth in the manufacture and distribution of branded, commercially promoted proprietary medicines, which were marketed very vigorously in the contemporary mass media. The development of proprietary medicines had a profound effect on the ‘dosing habits’ of English consumers.²³ Pre-packaged branded drugs were a novel concept for a people who had spent centuries either preparing potions at home or having them made to order. In a sense, the producers had to ‘create’ a demand. Anyone could patent a medicine as long as it was ...