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

Published in an economic history series, this collection of essays examines the development of supply mechanisms and of patterns of consumption of pharmaceuticals in Britain from the sixteenth to the end of the twentieth century. Taking such a long view, the book is good at highlighting major historical changes in this area, from the widespread use of homemade remedies in the early modern period via the boom of proprietary medicines and the chemist shop's nostrums in the eighteenth and nineteenth centuries, to today's large-scale consumption of branded and patented drugs produced by an international pharmaceutical industry.

Focusing on early modern London, Patrick Wallis, in the first of the six essays of this volume, describes a complex market for drugs, in which the local apothecaries played an important role, not only as retailers but also as manufacturers of medicines and as medical advisors. While, as Wallis shows, the distribution of apothecaries in the city matched the locations of their wealthier clientele, the cost of medicines varied greatly, and the poor could gain access to them through financial support from guilds, their parish, or charitable sources. Still, self-medication with homemade drugs was probably the most common form of treatment.

Proprietary medicines seem to have become increasingly popular, though, in the seventeenth century, as Louise Hill Curth infers from their frequent advertisements in almanacs, the then leading form of mass media. Products such as Bateman's Scurvy Grass or Buckworth's Lozenges were heavily advertised and obtainable from a variety of retail outlets (including bookshops and pubs) or through the post.

A rich supply network of pharmaceuticals is described by Steven King for eighteenth century Lancashire and Northamptonshire, the former an early industrializing and urbanizing region, the latter still a more rural area. Improved transportation and communication meant that the prescriptions of doctors, apothecaries' pharmaceuticals, and quack medicines became widely accessible, although their cost remained an issue for many, including the middling sort. The expenditure by counties for drugs under the Old Poor Law was substantial.

Hilary Marland shows, for the northern manufacturing districts of England, especially the towns of Wakefield and Huddersfield, how in the nineteenth century chemists and druggists usurped the market for pharmaceuticals, their shops becoming the key retail outlets as well as places for over-the-counter prescribing and advising, which included the unregulated supply of customers with opium preparations and abortifacients.

Stuart Anderson's subsequent essay examines the influence of British drug legislation, from the Arsenic Act of 1851 to the Medicines Act of 1968, on the retailing of medicines. An important shift from pharmaceutical regulation to control by doctor's prescription came with the Dangerous Drugs Act of 1920. Moreover, the introduction of the National Health Service in 1948 led to a massive increase in prescribed medicines, now typically "off-the peg" drugs supplied by large pharmaceutical manufacturers. Judy Slinn traces these developments to the present, discussing the marketing strategies of pharmaceutical companies, the influence of the "therapeutic revolution" (e.g., antibiotics, receptor-specific drugs), as well as the concerns about drug safety and cost containment in the second half of the twentieth century.

Collectively, the contributions of this volume add a much-needed economic perspective to the history of pharmacotherapy, although the limitation to the English regional or British national level seems to have precluded, at least for the earlier periods, an engagement with more international studies. These include, for example, Renate Wilson's on the trade of the orphanage pharmacy in Halle, Germany, in the eighteenth century, which extended to the American colonies (Pious Traders in Medicine: a German Pharmaceutical Network in Eighteenth-Century North America, 2000). Also, despite the book's title, there is rather too little on the connections between the rise of experimental pharmacology in the eighteenth and nineteenth centuries and the prescribing habits of medical practitioners.