DHMSA Course, Society of Apothecaries
Saturday 21 March 2015
History of Pharmacy
in Britain
Stuart Anderson
Centre for History of Public Health
London School of Hygiene & Tropical Medicine
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What does history of pharmacy cover?
Development of the profession
– Separation from medicine;
– Emergence of pharmaceutical institutions.
Location of practice
– Pharmacy in the community; chemists’ shops;
– Pharmacy in hospitals; prisons; military.
History of medicines
– Discovery, drug quality and safety;
– Dosage forms, pharmaceutical technology;
– rise of pharmaceutical industry.
Transmission of knowledge
– Education; Pharmacopoeias and formularies.
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Outline
1. The Origins of Pharmacy before 450 AD
2. Very Early Pharmacy 450 AD to 1231 AD:
Before the Edict of Palermo.
3. Early Pharmacy 1231 to 1617:
Before the Society of Apothecaries.
4. Early Modern Pharmacy 1617 to 1841:
Before the Pharmaceutical Society.
5. Modern Pharmacy 1841 to 1986:
Before the Nuffield Report.
6. The New Pharmacy from 1986 to 2010:
Before the General Pharmaceutical Council.
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Origins up to c.450 AD
• 2000 BC- China, Shen Nung, wrote native
herbal with 365 drugs, the Pen T’sao;
• 1500 BC- Egypt, Papyrus Ebers, 800 drugs;
• 300 BC- Greece, Theophrastus, father of
botany, wrote about medical uses of herbs;
• 50 AD-Greece, Diascorides, Materia Medica,
instructions how to prepare 500 remedies;
• 180 AD-Rome, Galen, defined drug as
anything working on body to produce change.
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Origins c.450 AD to 1231 AD
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8th century - Drug stores in Baghdad;
900 AD - Arabia, Rhazes, Liber Continens;
c.950 AD - Leech Book of Bald, England;
1000 AD - Persia, Avicenna, Canon Medicinae;
11th century - Pharmacy shops in Europe;
12th century - medicines in Britain supplied
by members of Guilds of Pepperers or Spicers.
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Early Pharmacy 1231 to 1617 AD
• 1231 – The Edict of Palermo:
– Clear distinction between responsibilities of
physicians and apothecaries;
– Applied to Sicily and southern Italy.
• 1490s -Guild of Grocers includes traders in
drugs and spices.
• 1498 – Nuevo Receptario (formulary);
• 16th century- apothecaries emerge as
significant group within Guild of Grocers.
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Early Modern Pharmacy 1617 to 1841
• 1617 – Society of Apothecaries founded;
• First London Pharmacopoeia 1618;
• Period characterised by a series of disputes
between physicians and apothecaries;
• 1701 Rose Case: confirmed right of apothecaries
to treat patients but could only charge for
medicines;
• 1700s-Emergence of chemists and druggists;
• 1815-Apothecaries Act: confirmed apothecaries
as general medical practitioners.
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Pharmacopoeias
London Pharmacopoeia: 1618; 1621; 1632;
1639; 1650; 1677; 1721; 1746; 1788; 1809;
1824; 1836; 1851 (thirteenth and last).
Edinburgh Pharmacopoeia: 1699; 1722; 1735;
1744; 1756; 1774; 1783; 1792; 1803; 1805;
1817; 1839; 1841 (twelfth and last).
Dublin Pharmacopoeia: 1807; 1826; 1850; 1856
British Pharmacopoeia: 1864; 1867; 1885;
1898; 1914; 1932; 1948; 1953; 1958 (5 years).
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Frontispiece of
London
Pharmacopoeia
1618
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Modern Pharmacy 1841 to 1986
1. 1841 - Foundation of the
Pharmaceutical Society of Great Britain;
2. 1841 to 1911 -the professionalisation of
pharmacy to beginning of the welfare
state;
3. 1911 to 1948 -National Insurance to
National Health;
4. 1948 to 1986 -Pharmacy in the NHS up
to publication of the Nuffield Report.
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Jacob Bell
1810-1859
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Foundation of the Pharmaceutical Society of
Great Britain 1841: Aims
• To benefit the public, and elevate the
profession of pharmacy, by furnishing the
means of proper instruction;
• To protect the collective and individual
interests and privileges of all its members,
in the event of a hostile attack in
Parliament or otherwise;
• To establish a club for the relief of decayed
or distressed members.
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Registration of pharmacists
• Pharmacy Act 1852:
– Registration of pharmaceutical chemists;
– Register kept by Pharmaceutical Society (not
Pharmacy Board);
• Pharmacy and Poisons Act 1868:
– Additional register of Chemists and Druggists;
• Separate Registers continue to 1954;
• Registration of pharmacy technicians;
• Separate Pharmacy Board (GPhC) in 2010.
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Pharmaceutical Society v. The London and
Provincial Supply Association 1880
• The origin of chain pharmacy or multiples
• Pharmacy and Poisons Act 1868;
• Act referred to ‘a person’; case tested whether
restrictions applied also to a company;
• 1878 sale of Oxalic Acid - £5 fine;
• Business converted to a limited company;
• Challenged – unlawful sale of poisons;
• House of Lords: A company can carry on a pharmacy
business provided a ‘qualified person’ is employed
for the sale of poisons.
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Multiples in Community Pharmacy
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Jesse Boot
(Lord Trent)
1850-1931
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William
Glyn-Jones
1869-1927
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The Growth of the Welfare State: National
Health Insurance Act 1911
• 19th Century – Friendly Societies;
• Poor Law institutions;
• National Health Insurance applied to workers
aged over 16;
• Less than £160 pa;
• Dependants not covered, but received
support payments;
• Included costs of medicines.
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Pharmacy’s Seven Principles
1. No agreement for supply of medicines should be
made except with a person, firm or corporate
body entitled to carry on the business of a
pharmaceutical chemist or chemist & druggist;
2. Dispensing under the Act should be done under
the direct supervision of a pharmacist;
3. The control of medical and pharmaceutical
services to insured persons should be in the
hands of the county insurance committees,
NOT under the control of Friendly Societies;
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Pharmacy’s Seven Principles (con’t)
4. A panel of all qualified pharmacists in a particular
district willing to supply medicines under the
scheme should be set up; (no registration);
5. Remuneration for pharmacists should be on a
scale system, and not on a per capita basis;
6. Pharmacy should be represented on the county
health committees, the advisory committees, and
the Insurance Commission; and
7. Medical benefit should not be extended to persons
earning more than £160 per annum.
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Impact of National Health Insurance on
Community Pharmacy 1913
• Distinction made between prescribing and
dispensing for first time;
• Salaried service for dispensing National
Insurance prescriptions rejected;
• Companies as well as proprietors able to
contract to provide dispensing services;
• Within one year number of prescriptions
presented at pharmacies had tripled.
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Pharmaceutical Society v. Jenkin 1920
• Proposed Joint Industrial Council to regulate
wage rates and other conditions of service;
• Opposed by Boot and Scottish pharmacists;
• Arthur Henry Jenkin – injunction;
• Judgement: ‘the Society does not have powers
to regulate wages, hours of business, prices, or
provide insurance or legal services’;
• 1920 - Retail Pharmacists Union;
• 1923 – Guild of Public Pharmacists.
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‘Redefining Purpose’ 1920 to 1948
The Pharmacy and Poisons Act 1933:
– Membership of Pharmaceutical Society
compulsory;
– Inspection of premises;
– Statutory Committee;
– Statement upon Matters of Professional
Conduct 1944.
‘the triumph of professional regulation
over protection and trade unionism.’
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National Health Service Act 1946
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•
Implemented 5 July 1948;
Services available to all;
- Unemployed men, women and children.
•
Free at time of need;
- National Insurance contributions +
taxation.
•
Free medicines;
- prescription charges introduced 1952.
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Impact of National Health Service on
Community Pharmacy 1948
• Prescription numbers virtually quadrupled
from 70 million to 250 million per year;
• Existing shop floor space used to enlarge
dispensaries;
• Dispensing of prescriptions becomes principal
source of income & main business;
• Most pharmacists undertake dispensing
themselves.
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Pharmaceutical Society v. Dickson 1965
Attempt to control ‘non-professional’ business;
Society proposes that new pharmacies:
– be situated in physically distinct premises;
– confine their trading activity to the sale of
pharmaceuticals, professional and
‘traditional’ chemist’s goods (toiletries,
cosmetics and photographic items).
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The Dickson Judgement 1965
• ‘it is not within the powers of the Society to
enforce the provisions of the motion; the said
provisions are in restraint of trade;’
• 1965 Court of Appeal confirmed decision;
• 1968 House of Lords: ‘not within the Society’s
main object of ‘maintaining the honour and
safeguarding and promoting the professional
interests of members;’
• Society did not have power to control
commercial aspects of pharmacy.
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‘Disappearing Pharmacist’ 1948-81
• Pharmacist ‘hidden’ in dispensary at back of
shop dispensing prescriptions;
• Only emerges when asked to do so;
• Becomes ‘normalised’: new entrants see role
of pharmacist as ‘backroom’ person;
• Nature of dispensing changes: reduced need
of extemporaneously prepared medicines.
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British Pharmaceutical Conference 1981
‘one knew there was a future for hospital
pharmacists, one knew there was a
future for industrial pharmacists, but one
was not sure that one knew the future
for the general practice pharmacist.’
Dr Gerard Vaughan, Minister of Health
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The New Pharmacy 1986 to 2010
1. 1986 to 2010 -the emergence of the ‘new
pharmacy’;
2. 2010 – Creation of General Pharmaceutical
Council;
3. 2010- Royal Pharmaceutical Society becomes
Professional Leadership Body;
4. 2013- RPS establishes Faculty;
5. Beyond 2013–transition or transformation?
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The Nuffield Report 1986:
Terms of reference
‘to consider the present and future
structure of the practice of pharmacy
in its several branches and its potential
contribution to health care and to
review the education and training of
pharmacists accordingly’
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The Nuffield Report 1986:
Recommendation
‘we believe that the pharmacy
profession has a distinctive and
indispensable contribution to make
to health care that is capable of still
further development’
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Department of Health and pharmaceutical
profession Joint Working Party 1990
Terms of reference
‘to consider ways in which the National
Health Service community
pharmaceutical services might be
developed to increase their
contribution to health care; and to
make recommendations’.
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‘Pharmaceutical Care: the Future for
Community Pharmacy’ 1992
• increasing the range of medicines available for
sale by pharmacists;
• the maintenance of patient medication records by
pharmacists;
• the extension of needle and syringe exchange
schemes;
• participation in health promotion campaigns;
• having separate areas for providing advice and
counselling.
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Pharmacy post-2010
• Regulatory and representative functions
of Pharmaceutical Society separated;
• General Pharmaceutical Council
established 2010;
• Professional Leadership Body set up;
• ‘akin to a Royal College?’
• Voluntary Membership;
• Role of other pharmacy organisations;
• Transition or transformation?
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Conclusions: Change
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Shift to be more accessible to public;
First port of call;
Extended role as skill substitution;
Taking on roles previously undertaken by
doctors;
• De-regulation of medicines;
• Move towards pharmacist prescribing.
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Conclusions: Continuity
• Ready accessibility throughout
community;
• Available during normal shop hours;
• Accessible without appointment;
• No charge for advice;
• Supply of low cost medicines.
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Themes in Pharmacy’s History
• Conflict over professional boundaries;
• Changes in how society defines harmful
substances;
• Tension between pharmacy as trade and
pharmacy as profession;
• Shifts in remuneration arrangements;
• Shift from product focus to patient focus.
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