From Physick to Pharmacology: Five Hundred Years of British Drug Retailing (review)

From Physick to Pharmacology, Five Hundred years of British Drug Retailing is a welcome supplement to a growing body of work on the origins and development of British drug manufacture. However, Louise Hill Curth’s main concern is not manufacturing, or scientific development, but rather how a wide variety of drugs were bought, sold, concocted, advertised and otherwise used in Britain over the last five centuries.

The book is divided into seven chapters, corresponding to five key phases in British drug retailing, each concentrating on a salient feature of Britain’s developing medical market: almanacs in early modern London, the emergence of proprietary medicine, dispensing doctors, state support through the poor laws and regulation, then finally the highly sophisticated forms of medical retailing we have today. The first phase can be termed “Kitchen physick,” remedies prepared in the home from natural ingredients. The next period sees rapid commercialization in the eighteenth century, particularly of proprietary medicine, which fed an increasingly hypochondriac public. This was followed by the growth of urbanization in the long nineteenth century with chemist shops specializing in distribution of a wide range of medicaments. The new “Poor Law” (1834) extended the opportunities for dispensing medicine, directly through poor law hospitals and indirectly through the growth of friendly societies. This development coincides with the rapid professionalization of medicine in the nineteenth century. The fourth stage saw the rise of pathology and microbiology at the turn of the twentieth century, while the final phase witnessed the rise of giant pharmaceutical firms from the 1920s onwards, but particularly after the therapeutic revolution of the 1940s.

Perhaps the most striking feature of the essays is the continuity of drug consumption in Britain. As Nye Bevan, founder of the National Health Service, complained in 1949, “a cascade of medicine was pouring down British throats.” Since early modern times, self-medication and pill ingestion has been marked features of Britain’s medical landscape. The key point about the drug market is that it was by no means the exclusive preserve of the wealthy. Self-medication was often the only type of treatment poorer people could afford. Patrick Wallis’s excellent article on apothecaries suggests that the purchase of dugs was widespread in early modern London, despite the College of Physician’s determination to impose a monopoly on medical advice. The college’s failure to prevent apothecaries poaching on the preserve in the “Rose case” (1670) paved the way for the rise of a unique eighteenth century phenomenon, the proprietary medicine. Almanacs made advertising such medicines a viable proposition. Louise Hill Curth neatly shows how common almanacs were and how effective a form of advertising they could be with some medicines, such as Daffy’s Elixir, lasting well into the twentieth century.

Steven King and Hilary Maitland are concerned with the availability of drugs nationwide. King provides a useful study of two districts, urbanizing Lancashire and the more rural Northamptonshire. He suggests that middle class people had little difficulty in obtaining medicines despite the problems of distance and poor communication, while the old “Poor Law” always provided medical services, knowledge, and drugs available to the bottom of society. Government involvement in the regulation of chemists and pharmacists in the nineteenth century increased professionalism, and Hilary Marland suggests one result of this was the change from small independent shops to large chains. At mid-century, most pharmacists ran one or possibly two premises; by its end, chains such as “Boots Chemists” were common. State regulation and product standardization, the socalled “ethical drugs” made this development not only possible, but desirable.

The final articles by Stuart Anderson and Judy Slinn chart the emergence of science-based, mass produced proprietary medicines and the modern pharmaceutical industry. Several important developments aided this process: greater diagnostic skill, the invention of radical therapeutic remedies, and the growing involvement of the state. Modern pathology and microbiology revolutionized our understanding of disease and...