PHARMACEUTICAL HISTORY AND ITS SOURCES IN THE WELLCOME COLLECTIONS I. THE GROWTH OF PROFESSIONALISM IN NINETEENTH-CENTURY BRITISH PHARMACY* by J. K. CRELLIN WHILE the theme of this article is professionalism in nineteenth-century British pharmacy'itschiefpurposeis to draw attention tothepharmaceutical and associated collections in the Wellcome Historical Medical Museum and Library which are of valuefor studying this topic2. I will be stressing items other than printed books for itis oftenforgotten that objects and ephemera are as much historical documents as books. Nineteenth-century British pharmacy underwent even more radical changes than pharmacy is undergoing today and shows many contrasting features. Some ofthese I intend to emphasize not because they offer solutions for today's problems, but because they can help to highlight and define them. These radical changes were largely due to the curious situation which allowed the traditional pharmaceutical practitioners-the apothecaries-to become general medicalpractitionerswhotooklessandlessinterestinpharmacy.Thistransition,which developed in the seventeenth century, was quickened by the 1815 Apothecaries Act. By 1858 itwasmerely atriumph ofcommonsensethatanew MedicalAct, increating one register ofmedical practitioners, undermined the distinction between university- trained physicians (who generally treated the upper-class patient) and the apprentice- ship-trained apothecary general practitioner. But this did not mean that pharmacy passed entirely out ofthe hands ofthe medical profession for even towards the end ofthe century there were large numbers of'dispensing doctors'.8 It is ofinterest that the Society of Apothecaries did not give up its commercial activities in retail and manufacturing pharmacy until 1922.4* The full story of the nineteenth-century * Based on a lecture given to the Western Pharmacists' Association and Chelsea School of Pharmacy, 8 February 1967. 1Noaccount,however,hasbeentakenofdifferencesinthedevelopmentofpharmacyinScotland. For instance, C. G. Drummond in 'Pharmacy and medicine in Georgian Edinburgh' (Pharm. J., 1964, 192, 287-93) emphasised the close connection between pharmacy and surgery in Scotland when he stated that in 1833, out of70chemists, druggists and apothecariesno fewer than 43 were stillpractisingsurgeryaseither surgeon-druggists orsurgeon-apothecaries. 'See asterisked footnotes for information on the collections. The notes accompanied slides of objects,pamphletsandillustrationsetc.,allintheWellcomeHistoricalMedicalMuseumandLibrary. Theextensive Wellcomecollection ofillustrations-built up over many years-provides a valuable stimulusforhistoricalresearch. Listsofthemuseumholdingsoftheobjectsmentionedareavailable,orinthecourseofpreparation. 'Writingonthe'JubileeoftheNationalInsuranceAct'(Pharm.J., 1962,189,33-35)J.A.Stewart notedthat before 1913, around90%ofalldispensingtookplaceindoctors' surgeries, andthatone provincial chemistreported only43 prescriptions innineyears. 4* Two photographs were shown ofthe Society ofApothecaries' laboratory before its closure in 1922. 215 J. K. Crellin reputation and influence of the Society's manufacturing activities has not yet been told, but it was undoubtedly important; a number of chemists and druggists, for instance, advertised that their drugs and chemicals came from Apothecaries Hall.5* Chemists and druggists-a diverse group of pharmaceutical practitioners-whose increasing influence on pharmacy started, in the seventeenth century, with specializa- tion in chemical remedies and the wholesaling of crude drugs, increased rapidly in numbers during the first few decades of the nineteenth century. The developments from 1800, to take aconvenient date, that led to the chemists and druggists forming, in 1841, the Pharmaceutical Society of Great Britain, are probably more complex than is generally realized. While the Society's foundation was almost certainly precipitated by a Bill which proposed putting the control ofchemists and druggists in the hands of the apothecaries, the time had become ripe for an organization devoted entirely to the interests ofpharmacy. Since 1794 numerous short-lived organizations ofchemists and druggists had been formed when attempts were made to impose outside control on them.6 By 1839 the comparative strength and stability ofchemists and druggists as a group was reflected in the formation of 'The Druggists' Provident Association', not formed to combat outside interference, but 'for the purpose of affording relief and assistance to its members, incases ofsickness anddistress, and ofgivinginformation topersons seek- ing to obtain situations in the trade.'7* Butmore significant andlyingbehindthis attemptatlimited self-government there had developed a need for specialist practitioners of pharmacy who were distinctly separatefrommedicalpractice. Apartfromthenecessityofovercomingsuchpractices asthewidespreadindiscriminate saleofdrugsbyquacks andgrocers etc., therewasa need for specialist pharmacists to assimilate and to put into practice the changes in materia medica and improvements in dispensing which were created by advances in botany and chemistry. Yetatthistimeapothecariesweredevotingmoretimetomedicinethantopharmacy, a situation not conducive to improvements in dispensing practice. In 1834 a Select Committee on Medical Education heard that dispensing in apothecaries' shops was often done bya'rawboy [an apprentice],justtaken from school'.8 Offsetting this the apprentice apothecary was occasionally under the supervision of a 'dispenser' employed bythe apothecary, but this only serves to illustrate the growing separation ofpharmacy and medicine. THE INFLUENCE OF THE PHARMACEUTICAL SOCIETY, INDIVIDUAL CHEMISTS AND DRUGGISTS, AND INDUSTRY INPROFESSIONALIZATION The growing need for specialist pharmaceutical practitioners undoubtedly helped the success ofthe Pharmaceutical Society in unifying thechemists and druggists into &*Two exmples ofchemists and druggists' trade cards stating that their chemicals and drugs camefromApothecariesHallwereshown.TheWellcomecollectionofovertwohundredtradecards throwsmuchlightonnineteenth-century p practice. See,forexample,L.G.Matthews,HistoryofPharmacyinBritain,Edinburgh, 1962,pp. 17-120. 7 ThefirstpageofalafletdescribingtheAssociationwasiustrted.Nostudyeverseemstohave been made ofthis Association. The leaflet is one ofa collection dealing with the organization of pharmacyinthenineteenthcentury, especiallywiththeformation ofthePharmaceutical Society. 'ReportfromtheSelectComrmitteeonMedicalEducation,London, 1834,Part 3,p. 29. 216 PharmaceuticalHistory arecognizedprofessionalbody. Itsmethodwas topromoteeducationandthepharma- ceutical sciences by opening a school (which encouraged research), by creating a museum and library, and by providing facilities for evening scientific meetings, conversaziones and research groups.9 The Pharmaceutical Journal echoed: 'pro- fessional character primd facie is supposed to result from liberal and scientific education'.10 Additionally the Society endeavoured, with only partial success, to obtain the backing of legal safeguards.11 Behind these activities lay the aim of making pharmacy a completely separate occupation from medicine, a point I will mention again. By so doing the pharma- ceuticalpractitionerwouldbeseentohaveaclear-cut,essentialandsociallyimportant function for which he had to use his specialist training-all features which must be considered characteristic ofa profession.12 It was believed that the activities of the Society, besides their tangible role in promoting theinterests ofmembers, wouldhavea 'moral influence' which could help to enhance professional standing. Jacob Bell writing on ethics stated: It was thought that any officious interference with the private arrangements of individuals would be inconsistent with thefunctions ofthe [Society's] Council, and likely to frustrate the [Society'sobjects] bygivingoffence. Thatwhichthelawofthelandorthelawsofanassociationcannoteffect,maybebroughtabout by the moral influence of a code of ethics voluntarily subscribed to, and recommended for general adoption. The Chemists having until lately been disunited, and ranked rather with the tradesthanthe professions, havenot had theadvantage ofthat discipline which is thenatural result oforganization andprofessional intercourse.1' It is often wrongly thought that the young Pharmaceutical Society was not con- cerned with the trading aspects ofpharmacy. But what the Society hoped was that these aspects would be checked by aprofessional conscience brought about not only byeducationbutalso bythe'force ofexampleandprecept, as setforthbytheleading andmostinfluentialmembersoftheSociety'.14ThismayseemtohavebeenaUtopian dream, butit should beremembered that sidelines, though extremely diverse, did not often extend outside the fields of chemistry, food and health. At the same time nineteenth-century pharmacy did not have the problem of chainstore pharmacies influencedbynon-pharmacistdirectors. Pharmacytoowas unfortunateinthat,amid a background of laissez-faire and free trade, strong legislation to help the Society's efforts was not forthcoming. The Society's educational activities were to the forefront of its endeavours and, by and large, extremely successful. Most conspicuous was its School of Pharmacy, opened in 1842, whichhad, throughout thecentury, many authorities on its staff, for ' One such research group was the Phytological Club, formed in 1853, for the promotion of pharnaceuticalbotany. See,forinstance,Pharm. J.&Trans., 1852-53, 12,486. 1sPharm. J.&Trans., 1849-50,9,345. I"There have been many straightforward accounts ofpharmaceutical legislation, but one ofthe moststimulatingdiscussionsisstillthatbyA.M.Carr-SaundersandP.A.WilsoninTheProfessions, Oxford, 1933,pp. 132-141. I' Averyhelpful introduction tothesubject ofprofessionalism inpharmacy isG. Sonnedecker's 'Tobeornottobe...professional',Am.J.Pharm., 1961,133,243-54. 1148Pharm. J. &Trans., 11885628-6593,, 12,3[26]9,. Pharm. J. &Trans., 10, 117. 217 J. K. Crellin example, AnthonyTodd Thomson, George Fownes, and Jonathan Pereira.15 In 1844 the School became the first in Britain to supplement chemistry lectures for full-time students with practical work in its own laboratory.l1* The School soon achieved marked success even though there were no compulsory examinations for entrance into pharmacy until the 1868 Pharmacy Act. But in an age when educational attain- ments were becoming more important the far-sighted student chemist and druggist couldseethatadvancededucationofferedadvantagesifonlybylookingatthesuccess of the more prominent chemists and druggists.l* Many, too, capitalized on their studies at the Society's school by mentioning them on their trade cards and advertisements.l"* The professional image ofpharmacy was, ofcourse, very much dependent on the calibre ofindividual practitioners. A strong core, especially in London, played their parttothefullinacquiringspecialistknowledgeandcreatingfirst-classestablishments. By so doing they underlined pharmacy's important function in Society and at the same time emphasized its professional status. Ithinkit isthought-provoking thatthe present-day retail pharmacist who is so frequently occupied with mechanical opera- tions, such as tablet counting and National Health Service administration, does not appear to be so irreplaceable as the nineteenth-century chemist and druggist with his wide-ranging dispensing activities-activities that can be readily seen from the numerous prescription books that have survived.l9* In his striving for professional standing the nineteenth-century chemist and druggist was also favoured by factors such as the absence ofa dominant pharmaceutical industry and by the fact that he could, with relatively little effort, make practical contributions to the improvement ofpharmacy. This last factor undoubtedly helped to create interest and raise pride in the pro- fession and deserves closer study. It is important to remember that shops, especially the better ones, were equipped with quite elaborate laboratories.so* The following description ofa laboratory is taken from Mohr and Redwood's PracticalPharmacy (1849),21 a book which the Pharmaceutical Journal enthusiastically recommended to the young chemist about to open a shop:22 15See, forexample,T.E.Wallis,HistoryoftheSchoolofPharmacy, UniversityofLondon,London, 1964. 16* Facilities forprivatelessons, were, ofcourse, available, beforethis. Anundatedadvertisement fromtheAldersgateSchool of Medicine (ca. 1841)wasshown. Thisannounced achemistrycourse for'ChemistsandDruggists,aswellasAmateurs',whichincludedpracticalwork. 17* Illustrated was the examination certificate, dated 1864 (i.e. before compulsory examinations) ofonestudentwhomadesplendiduseofhistaiing,E. M. Holmes. Muchofthepersonalmaterial ofthiseminent botanist/pharmacognosist isintheWellcomecollections. 10 AbottlelabelofP.Dowdeswel of39DudleyStreet,Wolverhampton was shown, bearing the words 'formerly student in the laboratory of the Pharmaceutical Society of Great Britain under ProfessorT. Redwood.' L9* Pages from a prescription book were illustrated. A useful survey ofthe entries in a series of prescription bookscanbefoundin'Earlynineteenth-enturypharmacy' byA. E. Bailey,Pharm. J., 1960, 185,208-12. '° Illustrations ofnineteenthcentury laboratories were shown, including many ofthe laboratory ofJohnBell'sfamousestablishment inOxfordStreet. ThefrontofBell'sshop waspurchasedby Sir HenryWellcomein 1909andisnowreconstructedintheWellcomeMuseum. 21F. Mohr and T. Redwood, PracticalPharmacy: The Arrangements, Apparatus, andManipula- tions,ofthePharmaceuticalShopandLaboratory,London, 1849,p. 21. " Pharm. J. &Trans., 1848-9,8,402. 218 PharmaceuticalHistory The essential fittings ofthe laboratory are-thefurnaces, stills, steam apparatus, refrigerators, and presses ... acapacious sink, with water laid on, and perforated shelves fixed over it, for drainingbottles; afixedsidetable,forperformingthesmalleroperationsupon,and,abovethis, a set of tests, test glasses, funnels, glass measures, and a perforated shelf, for supporting funnels ... a strong moveable table, which may be placed in any part ofthe laboratory; a druggist's root-cutting or slicing knife ... a large marble mortar, and an iron or bell-metal mortar. Many shops did notpossess these ideal conditions and many had no laboratory at all. The eminent scientist Edward Frankland recalledhisapprenticeship days around 1840 with horror, especially hisjob ofpowdering cantharides with a large pestle and mortar in a dark cellar.23 This operation had to be performed with a linen bagovermyhead and tied tightlyround my neck. Thus protected, I pounded away and sifted the fly dust through a sieve until, after five minutes orso,suffocationbecame imminent andthebaghadtoberemovedforafewminutes. Then,replacingit,Istartedagain.Ofcourse,noonecouldbeinthecellartohelpifIhadfallen downinafaint,becausetheywouldalsohaverequiredbagsontheirheadstoprotectthemfrom thepoisonousdust."' Itwasfromthelaboratoryandfrom'workingatthebench'thatproblemsfrequently presentedthemselves. Anexcellentexampleofaforgottenfigurewhomadesignificant contributions to pharmacy is Robert Alsop (1803-1876). Like so many who helped in the professionalization ofnineteenth-entury pharmacy, he was a quaker.25* After an apprenticeship and assistantship withJohn Bell he established himself, in 1826, as a chemist and druggist in what was remembered as an 'old-fashioned shop at the cornerofSloaneSquare,Chelsea,withitspalms,ferns,andtree-frogsinthewindow'.' Thebusiness prosperedwithanextensiveside-line ofsodaandmineral waterproduc- tion.27* Alsop's contributions to pharmacy were all of a practical character. For example heintroduced an infusionjug,28 and a minim measure,29* while his methods for preparing mercuric nitrate ointment and spirit of nitrous ether3 were used for manyyears. Space does notallowmeto saymoreaboutthisfascinatingfigureexcept thatitwas aloss to pharmacy whenhe gaveup practicein 1855 to devote himselfto philanthropic and religious activities. Otherchemists anddruggistsmademorewidelyknown contributions to pharmacy and medicine. For instance, Peter Squire made the ether inhalers* used in the first surgical operation under ether to be performed in this country, by Robert Liston on " Frankland, E.,SketchesfromtheLifeofEdwardFrankland, London, 1902,p. 26. u Druggrindingplayedasignificantpartinnineteenth-centurypharmac becauseofadulteration practices by drug grinders. An illustration ofdrug grinding apparatus from Mohr and Redwood's PracticalPharmacy was shown alongwitha small drug or spicemill from theWellcomecollection ofover70mills. Alsoavailablearesmallcollectionsofroot-cuttersandtincturepressesetc. "6*Aportrait of RobertAlsop was shown, takenfromC. R. AlsopA Tribute totheMemoryof RobertAlsop,London, 1879.Thebookisalmostwholelyconcenedwithhisnon-pharmaceuticallife. "Pharm. J.&Trans., 1875-76, 6, [31, 620. "7*Ablankinvoiceslipof'RobertAlsop,Chemist,SodaandMineralWaterManufacturer' listing variouswaterswasshown. ' Am. J. Pharm., 1836, 2, 89-91. See also Pharm. J. & Trans., 1841-42, 1, 56-60. Peter Squire (seebelow)producedamodifiedversionofAlsop'spot(seeMohrandRedwood,PracticalPharmacy, London, 1849, p. 39.) 2*Anadvertising leafletdescribing theminim measurewas shown. Cf. also Pharm.J. & Trans., 1841-42, 1, 326-27. ' 'On the preparation of Unguentum Hydrargyri Nitratis', Pharm. J. & Trans., 1841-42, 1, 100-105; and 'On SpiritusAetherisNitrici', ibid., 1843-44,3,425-28. *1*AfacsimileofSquire'sinhalerwasshown,partofalargecollectionofanaestheticapparatusin theWelcome Museum. 219 J.K. Crellin 21 December 1846. Squire's interest in etherinhalation reflected the contributions of anumber ofchemists anddruggists to this subject.2 Peter Squire also deserves to be mentionedasbeingthefirstchemistanddruggisttoreplace anapothecaryinholding the Royal Warrant-awarded to him in 1837-for supplying medicine. Squire's appointment owed much to the influence of Queen Victoria's physician Sir James Clark and further exemplifies the debt pharmacy owed to the individual first-class chemists and druggists in raising its prestige. A revealing letter in the Wellcome CollectionU from Clark to Squire about his appointment illustrates that the change from apothecaries to chemists and druggists was not taken lightly: Mondayevening MyDearSir, It has affordedmegreat pleasureto beuseful toyou, becauseI believe you to deserve it. The onlyreturnIaskisarigidattentiontotheprenration&dispensing oftheQueen'smedicines. Youknowtheresponsibilitythatattachestomeinappointingyou,&theobjectionsthatmight, & would be made, ifany serious mistake occurred, in the shop ofapublic chemist over the pivate&wellconductedshopofanapothecary.Itwillbe[to]yourinterestaswellasyourduty to have at all times one n ofthe best ofcharcter in your shop-one trustworthy man on whom youcouldplacecompletedependencewhenyouhappenedtobeabsentyourself. Ientreat you to take every precution to secure accuacy and uniformity in the preparation of Her Majesty'smedicnes.Thinkifsomeparticularmodemightnot be adopted toprevent thepossi- bility ofanymistake, [then] Iwillnot imagineanerror. IamDearSir, Verytrulyyours Ja.Clark The scientific and technical activities ofnineteenth-century chemists and druggists, many ofthemrelativelyunknownlikeAlsop, needtobefully studied, aswell astheir civic andcommunity activities, beforewe can obtain a full picture ofthe standing of nineteenth-century pharmacy." Such studies, too, should give us a fuller picture of developments in dispensing techniques, for example percolation,3a* the making of plasters,11" pills,a?* suppositories,'* and cachets.39* Whileitis right thatwe stress the contributions ofconscientious individuals to the improving image ofchemists and druggists, and hence pharmacy, the significance of the slowly growing pharmaceutical industry must not be forgotten. Many shops, of "See, for insta, Pharm. J. dE& Trans., 1846-47, 6, 350-59. B. M. Duncum (The Development ofInhaltion Anaesthesia, London, 1947, p. 18) quotes a statement that the 'ether practice' of a druggistwasastimulus totheimportant studiesofJohnSnow. The,manuscript lettercollection contains approximately 100,000 items. "Someattemptatexami the ingofLeicesterchemistsanddruggistshasbeen madeby J.K. Crllin, 'Leicesterandnineteenth-ceturyprovincialphamy',Pharm. J., 1965, 195,417-20. "* Nineteenth-cntury percolation tubes wero shown. A useful introduction to this subject is in G.Griffenhage'sToolsoftheApothecay,Washion, 1957,adocumentedbookletwhichincludes materialonotherapparatusmentionedinthisarticlesuchaspill-making machinesandsuppository moulds. "* ThesmallWellcomecollctionofplastersea rswasshown.Alsoadvertisementsformachine- spreadplasters. oExamples of early n enth-century English p-making machines were shown. Also six unusual pill- ider (eighteenth-nineteenth century). These rangd from knife-like implements to comb-like apparatus and a folding metal mould. as* presentation case advertising Henry Wellcome's (ater Sir Henry) torpedo-shaped sup- positorieswasshown. (Cf.Proc. Am.Pharm.Assn., 1893,41, 103-104).Thecollectionsalso include two wooden suppository moulds, an early ninteenth-ctury metal one, and early commercial apparatusforpreparingsuppositories, usedbyBurroughs,WellcomeandCo. 9*A cachet-making apparatus made to the specifications of Limousin's patent was shown. Limousinwastheinventorofcachets. 220 Pharmaceutical History course, had, in effect, small-scale manufacturing laboratories. John Bell's, which I have already mentioned, approached such proportions, and in fact, almost all the industrial concerns ofthe nineteenth century developed from retail establishments.40 I will, however, onlymentionhereT. N. R. Morsonwhodevelopedhis shopinto a manufacturing business following the realization ofthe commercial potential ofthe newly isolated alkaloids around 1-820.41* It was partly industrial practice that highlighted, during the early years of the century, the need to separate pharmacy from medicine. Jacob Bell, in 1841, when commenting on Richard Phillips' just criticisms of the London Pharmacopoeia remarked Dr. Powell, as a Physician, [and translator ofthe 1809 London Pharmacopoeia] could not be expected to compete in practical experience with the manufacturing Chemists, many ofwhom devoted their whole livestoa small section merely ofthe art ofpharmacy."' Therise ofindustrial pharmacyalso spotlightedtheneed fortests to determinethe quality oftheirproducts. Infact attempts tocontrol adulteration provided pharmacy with an important role in nineteenth-century science. Some industrial companies, of course, had an excellent reputation for the quality of their products.'3 It is in- teresting that, judging from trade cards and advertisements, many chemists and druggists supplied chemicals for the increasing numbers interested in practical chemistry."4* Many in fact made either the laboratory or a variety of chemical apparatus a feature of their trade cards, a reminder of their close connection with chemistry.45* The industry slowly expanded during the century and one consequence deserving special mention was its significant contributions to developments in single dose preparations. This is a reflection ofthe increasing concern with dosage which is also mirrored in the number of medicine measures that were produced.4* The most far-reaching single dose preparation was the compressed tablet which was patented by the artist/inventor William Brockedon47 in 1843, but probably only fully com- mercially developed about thirty years later. In fact many details of the nineteenth- century development ofcompressed tablets remain to be told."8* Thereislittledoubtthatmanyindividualchemistsanddruggists,fromtheacademic world, from industrial, retail and hospital practice-though the contributions of 40SeeG.Urdang, 'Retailpharmacyasanucleusofthepharmaceutical industry',Bull.Hist.Med., 1944, Supp. No. 3, 325-46. '10 Illustrated were some specimen tubes containing samples of alkaloids prepared by pioneers inalkaloidstudies. '2J.BellandT.Redwood, HistoricalSketchoftheProgressofPharmacyinGreatBritain,London, 1880,p.44. " See, for example, D. Chapman-Huston and E. C. Cripps Through a City Archway, the Story ofAllenandHanburys 1715-1954, London, 1954, p. 55. "* Illustrations of portable chemical chests, for which many chemists and druggists supplied materials, were shown. There is a small collection of nineteenth-century chemical chests in the Wellcomecollection. 45*Examplesofsuchtradecardswereshown. 46*Graduated medicine spoons and Proctor's graduated measures were illustrated. 47*Aportrait ofW. Brockedon wasshown. See Chem. & Drugg., 1954, 162,209. 48* Brockedonapparatus,consistingofdieandpunch,andanimplementformeasuringtheamount ofpowdertobecompressed, wasshown.Thereismuchmaterial intheWellcomecollectionrelevant tothestoryoftabletting, includingearlycommercialmachines. 221 J. K. Crellin hospital pharmacists were disappointing until this century49-did a great deal to enhance the standing ofpharmacy on the scientific and technical level in the decades following the formation of the Pharmaceutical Society. But the problem remained ofextending the improvement to the whole ofretail pharmacy. PROFESSIONALIZATION OF GENERAL PHARMACEUTICAL PRACTICE I have already indicated that the Society hoped 'improved education, and the moral influence ofa properly regulated Pharmaceutical Institution overits members' would be the most important force in improvement. It also stressed the invaluable influence of conscientious individuals and that pharmacy should be for qualified pharmacists only and medicine for qualified physicians only. But the problems to overcome in raising the general standard ofretail pharmacy were truly enormous. Even apart fromthe stigma ofit being associated with a trade, pharmacyhad, forthebenefitofthepublic,toclarifyitsfunctionandtounderlinethe necessity ofspecialist pharmaceutical practitioners. One ofthe biggest problems was the extensive counter prescribing which, it must be said, seems to have supplied a social need.50 This coupled with the dispensing ofmedicines by apothecaries created a confusing and unsatisfactory situation which, in the interests ofboth medicine and pharmacy had to be altered. The Society's clear and laudable view was shown by the PharmaceuticalJournalfirmly announcing, in 1845, that We look forward to the time, when it will be considered as much beneath the dignity of a Pharmaceutical ChemisttobecomeanirregularMedicalPractitioner,asit wouldbederogatory to aPhysician topracticePharmacy." A greater problem-which again needed to be resolved by specialization-was the enormous variety ofpractitioners calling themselves chemists and druggists, which, ifnothingelse,ledtoproblemsoverprice-cutting. Thedifficulty oftheproblemiswell summarized in the followingpassagefrom thePharmaceuticalJournalalthough other occupations such as book selling-admittedly not so common-might have been mentioned: The indiscriminate saleofdrugsbyunqualifed personswouldproducemuchlessinjury tothe credit and interests oftheregular Druggists, ifthe public had the means offorming a correct estimate ofthevalue ofthearticles theypurchase, andofthequalifations ofthepartiescon- cerned.ButunfortunatelyinmostcountrytownsnotonlyiseveryGrocerandOilmanaDruggist, but almost every Druggist is a Grocer and Oilman. The Druggist has no badge orcredentials to designate his superior qualification; in fact, he is not ofnecessity more qualified than the Grocer. The blue and red bottles in the windows arecommon to all; and this is the criterion understood by the public as indicating what is caled 'a doctor's shop'.6" Nevertheless there is little evidence that, unlike nowadays, there was an extensive 4" There wereofcourseexceptions; see H. Skinner 'Hospital pharmacy in thecentennial period', Pharm.J., 1941,146, 145-46.T.D.Whittet,('AhistoryofpharmacyatUniversityCollegeHospital', Chem. &Drugg., 1953, 159, 619, 644, 670; 160, 17,43)describestheworkofthenineteenth-century eminentphannacistsatthathospital. '0This question has not been fully studied as it deserves; there are numerous statements in the press, andpharmaceuticaljoumals, indicatingthevalueofchemistsanddruggists' moderatecounter prescribing. &1Pharm. J. &Trans., 1844-45,4,251. 5" Pharm J &Trans.,1843-44,3, 101. 222 Pharmaceutical History range ofsidelines outsidethehealth, foodandchemistryfields.53 Certainlyin London with its large number offirst-class establishments there was a clearer demarcation of pharmacy. There was, too, the enormous problem ofquackery: asthelawnowstands [statedthePharmaceuticalJournalJ,everymanwhohasa'doctor'sshop,' withcolouredbottles,isaChemistandDruggist.Theitinerantquackdoctors...are,according to law, Chemists and Druggists. Although they periodically frequent the markets, they [alsol haveDruggist's shops, and enjoythe samelegalprivilegesas a Member ofthe Pharmaceutical Society.54 Quackery was in many ways a greater source of confusion than the problems of counter prescribing and uneducated chemists and druggists. It created, for instance, strains ofconscience over the sale ofcertain 'patent' medicines, sales ofwhich were undoubtedly encouraged by high profit InsA5 The story of how quackery affected nineteenth-century pharmacy remains to be told, and I can do no more here than outline the problem. It must be remembered that the limitations ofnineteenth- century medicine allowed much headroom for irregular medicine. These limitations were highlighted, for example, by the tragic cholera epidemics. The horrors created by these outbreaksisreflectedinhistorical sources suchasillustrations,6* posters,s7* and the cholera medicine chests sold by Godfrey and Cookein 1848-49.58* The con- tents ofthese chests were undoubtedly believed to be effective, as were many ofthe widely used domestic remedies. Herbal and domestic remedies rarely perturbed the medical profession, for, at least,theyrarelydidconspicuousharm.Butherbalismsometimesborderedonrampant quackery as when it was promoted by A. I. Coffin in the 1840s and 1850s.A9* In his popularteachingknownasCoffinismheadvocatedtwomainremediesonly,Lobelia°* and Cayenne pepper, but deaths following the use ofLobelia helped to bring the movement into disrepute. In retrospect the dividing line between quack preparations and preparations of doubtful value, but sold in good faith is not always easy to draw. The bottling of sea-waterl* andpackagingofseaandmineralsaltsa2* formedicinal use, forexample, were probably well intentioned, but the full, fascinating story oftheir use remains to be told. " Firmevidence on the introduction ofnon-traditional sidelines isnoteasyto gather. However, A. M. Carr-Saunders and P. A. Wilson in The Professions, Oxford, 1933, p. 137, quotes a 1919 MemorandumbytheScottishPharmaceutical Federationtotheeffectthatthescopeofsidelineshad widened. " Pharm. J. &Trans., 1845-46,5, 193. 65 An+arlynineteenth-centurysatiricalprintonthesaleof'patent' medicineswasshown.'Patent' medicineswerewidelysoldandadvertisedbychemistsanddruggists. 6" An illustration ofburningclothesduringthe 1832Exetercholera outbreak wasshown. 57* Ilustrated wasaposter, dated 1831, addressed totheinhabitants ofthe ParishofClerkenwell warning about the 'alarming approach ofthe Indian Cholera'. 58*Twosuchchestswereexhibited. Thecontentsweremostlydraughtsandpowdersofastringent and opiatepreparations. Descriptiveleaflets, describing thechestswerealsoshown. 6" Illustrated was Coffin's portrait. Also shown was a bronze medal advertising Coffinism. 60*Lobelia inflata was illustrated to draw attention to the large materia medica collection-over 6,000 specimens-in the Wellcome Museum. *I* A siphon ofsea-water and seaweed from a nineteenth-century sea-water clinic was shown. SU Abottleof'NaturalKarlsbadSprudelSalt'wasshown. 223 J. K. Crellin Related to the use of sea-water is the nineteenth-century popularity of spas for treatment and for convalescence. Charles Darwin-who was virtually a semi-invalid from abouttheage ofthirty"*-givesus someideaofthereasonsfortheirpopularity. Writing to J. D. Hooker in 1849 he remarked: having heard, accidentally, oftwo personswho had received muchbenefit from thewater-cure, I got Dr. Gully's book, and made further enquiries, and at last started here [at the Malvern Hydropathic Institution] with wife, children and all our servants. We have taken a house for two months, and have beenhere afortnight. I am already a little stronger ... Dr. Gully feels pretty sure he can do me good, which most certainly the regular doctors could not . . . I feel certain thatthewater-cure is no quackery." Darwin's career was almost changed by another popular school of thought- Lavater's idea that facial features revealed character. When Darwip was interviewed by CaptainFitzRoyabouthiswishto becomenaturalist onthesailing shiptheBeagle, FitzRoyhad qualms aboutthe shape ofDarwin's nose thinkingit suggested hewould be a bad companion on the voyage. Fortunately for science FitzRoy decided his fears were groundless and Darwin went on the voyage that was to lead him to his theory of evolution. Similar to Lavater's physiognomy was phrenology whereby character was thought to be indicated by cranial features. Phrenology achieved considerable popularity in the first half of the century partly through the use of teaching aids such as charts65* and marked heads.66* Oneunorthodox system-homeopathy-founded byHahnemann becameespecially popular in Britain from the 1840s and 1850s, noticeably amid the middle and upper classes. Judging from advertisements and homeopathic medicine chests that have survived67* it is clear that many chemists and druggists soon dealt in homeopathic remedies. One squabble over the sale of these medicines developed when the Lancet grumbled that Lea and Perrin (the chemist and druggist originators of Worcester sauce) were supplying homeopathic remedies at Malvern, around the time of Darwin's visit to the spa, but the Pharmaceutical Journal rightly stated that the blame should be placed at the feet ofthe physicians who prescribed the remedies."s I have already indicated the various forces forimprovement ofpharmacy amid this diverse background, and I have stressed the important role of the responsible, conscientious chemist anddruggist. Butthe style and appearance ofhis establishment was obviously ofgreatimportance to the question ofpublicimage. It is certain that the better class establishments were extremely elegant; they reflected the pharmaceutical activities ofthe proprietor and did muchto enhancethe image ofpharmacy. Just how many first-class establishments there were is difficult to say, but, judging from surviving illustrations-such as cartoons, trade card en- gravings, paintings and photographs, there were a sufficient number, at least in '* Amanuscript postscript from a letter written byDarwin was shown which begins: 'My health keepsmuch as it was: I never escape for a whole day without much discomfort'. "4F. Darwin, (ed.), TheLifeandLetters ofCharles Darwin, 1888, vol. 1, p. 373. 66* Examples of charts were shown; for example those issued by F. Bridges, a well-known phrenologist. "6*Examples from the large collection of pottery phrenological heads were illustrated. 67 Chests from the Weilcome collection wereshown. 68 Pharm. J. & Trans., 1851-52, 11, 290-91. 224