Recently, someone tweeted an image of a label of Victorian cough-medicine, showing its main ingredients were cannabis, cocaine and chloroform! I imagine it didn’t so much stop your cough as render you swiftly insensible to any kind of throat-tickle – and everything else as well. During the eighteenth century, most medicine was composed of little more than laudanum, hope and some fairly wild theories about what caused diseases in the first place.

This is not to look down my 21st-century nose at the efforts of our forebears. They did what they could with what was available to them. Along the way, they started to make some of the key discoveries on which modern medicine is based. However, the plain fact is that most university-trained physicians’ fees were far beyond the means of anyone but the gentry. Surgeons did what their name implies: they operated, without anaesthetics of course, and tended to be a place of last resort. For the rest, the ‘middling-sort’ and the artisans visited the local apothecary. The poor, lacking any means of cash payment, probably turned to a ‘wise woman’ for some herbal or other brew that might do them a little good, paying in kind with a few eggs, a poached rabbit or a handful of vegetables.

Patent Medicines and The Rise of ‘Snake Oil’

It may suit our romantic imaginations to envisage the apothecary toiling away at preparing some secret recipe of herbs and spices; or the ‘wise woman’ drawing on a deep well of folk medicine to prepare a recipe from natural ingredients. I’m sure both happened at times. But ‘wise women’ came in many degrees of wisdom and apothecaries were primarily businessmen, out to turn a profit. It wasn’t long, therefore, before all kinds of patent medicines became available, many heavily advertised in the newspapers now being printed in most towns of any size. Not only did these promise miracle cures, they also had the wonderful property of allowing the hard-pressed apothecary – or a mere chemist, with little or no qualifications or training – to meet much of the demand for common remedies without having to make them up himself. As The London Tradesman[1] remarked in 1747:

“This is the mere Apothecary – a Creature that requires very little Brains … There is no Branch of Business in which a Man requires less Money to set him up, than this very profitable Trade: Ten or twenty Pounds, judiciously applied, will buy Gallipots and Counters, and as many Drugs to fill them with as might poison the whole Island.”

The ‘Hard-sell’ Approach

When you take a look at the advertising for these patent remedies, you see at once that the hard-sell is far from being a modern phenomenon. Besides, with no legal restrictions on making claims about efficacy, the copy-writers of the time had a clear run at using their unfettered imaginations. Take this from The Norfolk Chronicle of December 2nd., 1797, advertising “…the GUTTA SALUTARIS or Diuretic Vegetable Drops…” as a cure for:

“VENEREAL and SCORBUTIC COMPLAINTS, VENEREAL RHEUMATISM, EVIL[2], CANCERS, AGUES, Ulcerated & Swelled LEGS, RUPTURES, and Weak and Debilitated CONSTITUTIONS.”

Not only was this a wonder-cure for all these (extremely different) conditions, it was claimed that:

“Many hundreds of both sexes, whose flesh and bones were so exceedingly offensive to their fellow-creatures, and even to themselves, with Venereal Ulcers, etc., [that] have been perfectly cured without taking any mercurials into the stomach[3], are now living witnesses to the great abilities, humanity, honour, and justice[4] of the Regular Practitioners of the Dispensary, No. 72, Hatton-Garden, Holborn: where may be had, as usual, the New-invented Two Spring Trusses, for reducing Ruptures; and the most inviolable secrecy may be depended upon.”

And thus it goes on, adding that those unlucky enough not to be able to consult with Dr. Freeman in person in Holborn, could obtain the same medicines at Messers Stevenson & Matchett, Norfolk Arms, Market-place, Norwich – presumably without any kind of consultation at all. Not only had GUTTA SALUTARIS been used by officers of the Royal Navy and Army (probably eager for cures for venereal diseases, I expect), it had “…cured 30,000 people in the previous 16 years…” and was available in various-sized bottles costing 22 shillings (£1.10p), 11 shillings and 6 pence (55.5p), 5 shillings and 5 pence (26p) and 2 shillings and 9 pence (13.5p). With an artisan likely earning 12–15 shillings or less per week, even these prices were probably out of their reach.

Wild Claims and Quiet Menace

Most advertisements added vague, supporting testimonials from patients and claims of many disinterested witnesses as an additional inducement to buy. Many more serious practitioners and apothecaries decried such wild claims as the one put forward in 1777 by a Francis Spilsbury, who offered special Anti- corbutic Drops:

“…for the radical cure of Scurvy, Gout, Rheumatism, Evil, Children’s Eruptions, Ulcers, Leprosy, Nervous Complaints, Humours after the Smallpox and Measles, etc.…”

Besides, this could be big business. Take Potter’s Pills, advertised as:

“… a certain Remedy for Indigestion, Loss of Appetite, Crudities in the Stomach, Costiveness, Sick Head Aches, Flatulencies arising from Bilious Humours, being a good aperient and cleanser of Sallow Complexions.”

In 1799, according to an entry in the Ipswich Journal for 9th. November, one Pexall Forster, Bookseller [!] and Medicine Vender, decided to hand over the original recipe for these wonder pills to W. Middlewich, Chemist, whose address was the Patent Medicine Office in Brook Street, Ipswich. However, Mr. Middlewich had already got his distribution-chain in place, since the same notice lists 25 other businesses retailing these pills throughout Suffolk and Norfolk, all for 1 shilling per box. In the same issue of the paper, this Mr. Woolfrey Middlewich [What wonderful names these people had!] was also advertising the marvels of Dr. Velno’s Vegetable Pills, which he obtained from …“J. Pidding, late Surgeon in the Army, at his warehouse at No. 76, Oxford-Street, London …”. These must have been even better than Potter’s Pills, since they sold for 5 shilling the box! Nor were the virtues of hypochondria missed by advertisers. An announcement in The Norfolk Chronicle for 18th June, 1796, opens with a tone of menace:

“To preserve Health, and of course to prolong Life, nothing is so necessary as to pay attention to the slight indispositions to which all men are subject, and which, being considered as trifling, are too often disregarded, till by neglect they take deep root in the constitution, and become of serious and sometimes fatal consequence.”

The answer, of course, is another patent medicine: Dr. James’ Analeptic Pills. In this case, the physician really did heal himself, the advertisement claims, saying:

“… he exhibited in himself a memorable instance of their efficacy; for by the constant use of them, though a free-liver, he attained to the age of 75.”

Calls for Control

Attempts to control the practice of medicine were long hindered by the mutual suspicion between the various branches of the profession, with the university-trained physicians looking down on mere ‘barber-surgeons’ and apothecaries, whose training – if any – was gained through the traditional process of hands-on apprenticeships. However, public demand for some help in threading the maze of competing claims seems first to have been addressed by the publication of directories or registers of medical practitioners in the early 1780s.

In 1780, as expected, the ‘lower’ branches of the medical professionals greatly outnumbered those with more extensive training (and higher fees), but nowhere was the provision of medical advice and support anything like adequate. In East Anglia, there were seven surgeon-apothecaries (86.4 per cent of the recorded total) for every one physician (12.6 per cent), but still only a single practitioner of any type for every 2000 of the population.[5] It was no wonder that many poorer people relied on patent medicines or the advice of locals believed to have folk or inherited knowledge. In the end, it was commercial competition which brought about reform. As the physicians retreated further into their closed enclave of specialisms, rich patients and high fees, many apothecaries began to fill the gap left by acting more as GPs than just compounders of medicines. That left another gap below them, which was being filled by all kinds of chemists, druggists and even booksellers, peddling patent medicines without any medical or pharmaceutical training.

Alarmed by the threat to their own good name, the apothecaries emulated the physicians in constructing a closed-shop around their profession. The campaigning London apothecary John Mason Good co-founded the General Pharmaceutic Association of Great Britain in 1795, with the intention both of setting minimum standards and applying pressure for proper training and regulation of all who claimed the title of apothecary[6]. Even so, it took until 1815 for Parliament to take action to stem the dangerous free-for-all in handing out pharmaceuticals. While The Royal Colleges of Physicians and of Surgeons stayed on the sidelines, playing no role in establishing suitable regulation, a bill for regulation was passed, though not without great difficulty. Parliament merely agreed on a distant kind of control, establishing a legal framework within which The Society of Apothecaries was licensed by statute to establish a proper system of education, examination and registration for its members, and act thereafter as a self-regulating body for the profession[7]. Throughout the eighteenth century, apothecaries and surgeon-apothecaries acted as the front-line of professional health care, gradually extending their role from drug-makers and dispensers to GPs for a whole community. In doing so, they helped establish much of the pattern of the UK medical profession as it exists today, with its clear distinction between specialists and consultants, GPs and pharmacists. Though successive legislation has greatly restricted the range of medicines that may be sold freely by non-specialists, we still have hundreds of patent medicines available and many who rely on them for minor ailments. We even have something of the activity of those professing skill in folk-medicine and herbal remedies. So-called Alternative Medicine is, in many ways, a modern version of looking to traditional cures instead of the chemical-based pills and potions sold in every High Street chemist. Plus ça change, plus ç’est la même chose.