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|Apothecaries etc ( Long and not really for the squeamish....)
Written by JulieW
(5/4/2007 8:59 a.m.)
in consequence of the missive, Ch. 7 Jane's violent cold..., penned by Moni
This picture is taken from my copy of A book of English trades being a Library of the Useful Arts (1805)
The book details what an apothecary did in the early 19th century, and if I may, I will quote it for you now:
The office of Apothecary is to attend on sick persons, and to prepare and to give them medicines, either on his own judgment, or according to the prescription of the Physician.
The Apothecaries, as a body, have a hall near Bridge Street, Blackfriars (London-JW), where there are two magnificent laboratories, out of which all the surgeons are supplied with medicines for the British Navy.
Here also, drugs of all sorts are sold to the public, which may be depended upon as pure and unadulterated. They are obliged to make up their medicines according to the formulas prescribed in the Dispensary, of the Royal College of Physicians, and are liable to have their shops visited by censors of the College, who are employed to destroy such medicines as they think not good.
In many places, and particularly in opulent cities, the first Apothecaries' shops were established at the public expense, and belonged in fact to the magistrates. A particular garden also was often appropriated to the use of the Apothecary, in order that he might rear in it the necessary plants.
What was the legal position of apothecaries in our era, as opposed to surgeons and physicians?
Look at this (long) passage form Dr Roy Porter’s excellent book on 18th century Medicine, Patient’s Progress: Doctors and Doctoring in 18th Century England (1989)
We might assume, along these lines, that a similar divide applied in medicine. Those who could afford to consulted a professional doctor when they fell sick; those who could not, treated themselves. But reality proves far more complicated.
For one thing, the decision in case of sickness whether to self-dose or to call the doctor typically hinged upon factors other than mere ability to pay: personal preferences and the perceived seriousness of the complaint, for instance. For another, it would be a major mistake to assume (as old-fashioned medical historians did) that in early modern England medical practitioners were few and far between, and that only the well-off could afford them (most of the populace being left to fend for themselves, or to resort to the ministrations of witches, layers-out, wise women and other such amateurs. )
Of course, this conventional picture contains a grain of truth: certain top medical practitioners cultivated practices amongst fashionable members of society, who could afford a guinea or more per consultation. Yet even they would also treat less affluent patients, charging a sliding scale of fees according to ability to pay.
Top physicians such as John Coakley Lettsom held charity surgeries for the poor. And it is wrong to assume - as has happened all too often - that medical practitioners were thin on the ground before the nineteenth century, and confined chiefly to London and a scatter of fashionable centres, corporate and cathedral cities.
This misconception arises from assuming that the ideal type of the tripartite professional hierarchy, commonly set out in medical propaganda from Tudor times onwards, corresponded with reality.
This schema presupposed a professional pyramid lorded over by a closed clique of physicians, liberally educated at Oxford and Cambridge, cultivating a gentlemanly ethos and dignified by fellowships at the Royal College of Physicians in London.
Such privileged physicians would look down upon their distant cousins, the surgeons, who had trained for their primarily manual craft through mere apprenticeship. The traditionally inferior status of surgery is indicated by the fact that until 1745, the Company of Surgeons had been formally yoked with the barbers' trade.
Lower still, and under the supervision of the College of Physicians, were the apothecaries, whose job was to dispense physicians' prescriptions: theirs was a trade reeking of the counter. It was not until the turn of the eighteenth century that apothecaries established the legal right to prescribe medicines in their own right.
Traditional histories emphasized how this hierarchical structure was regulated though three corporate bodies, regulating admission and the right to practice: the College of Physicians, the Corporation of Surgeons and the Society of Apothecaries….
Yet this neat and tidy picture of a hierarchically, organized, corporate profession, hardly corresponds to the reality, especially beyond the boundaries of the metropolis…In the 18th century the College of Physicians pettily excluded from its fellowship those without Oxbridge degrees, including the increasing numbers of highly trained, skilled and successful Scottish graduates…. The attempt to create a medical monopoly had already broken down in the 18th century. Following the Rose Case judgment in the House of Lords (1704) apothecaries basked in their newly-won right to prescribe (provided they maintained the legal fiction of charging only for their medicines NOT for their medical advice)
Moreover outside London practitioners never had existed in sufficient concentrations to make the tripartite hierarchical structure relevant of workable…the norm in the typical small market town as increasingly for medical practitioners to set up shop or put down roots wherever they felt the demands for their services existed or could be excited having an eye chiefly to market opportunity, regardless of formal jurisdiction
On to poor old Jane and her remedy of a "draught”.
A draught was a powder, which could be dissolved in water and then be taken by the patient in drink form.
In P+P Mr. Jones makes and prescribes a draught for Jane. (Charging for the medicine and not the advice remember!)
The 18th century was a time when “quack “ remedies were often sold “over the counter” without prescription and did more harm than good. I’ve posted about Jane’s prescribed medicine a little further down the board, which explains what form the draughts as prescribed by Mr. Jones may have taken.
However you might like to know a little more about Dr James powders. (Its not pretty so don’t read on if you are squeamish…!)
. Commercial nostrums gained ground amongst self- medicators. They had a twofold appeal. One was to the imagination, to day-dreams about health, longevity, fitness and beauty. Many preparations, such as Solomon's 'Balm of Gilead', promised the impossible - to restore youth, ensure fertility, recover potency. Resort to such nostrums left little mark in letters and diaries, presumably because people were ashamed to admit to their vanity or gullibility. Yet 'wonder drugs' of this kind, pandering to dreams, clearly sold well.
Second, shop-counter preparations rose in appeal because their effects could be particularly dramatic. Many nostrums, for example, contained potent mixtures of alcohol and opiates which would dull pain, reduce fever, soothe stomachs, quell diarrhoea, produce relaxation and induce sleep.
Opium found ardent advocates, none more so than the eccentric lay writer, Philip Thicknesse, who extolled it as little less than the elixir of life. The drug was not, he reassured friends and readers, seriously habit-forming; more than once, he had weaned himself off it. Thicknesse recommended twenty drops of laudanum a day to those wanting their 'days to be lengthened'.
Other relative newcomers to the medicine chest were bark (quinine), dramatically successful as a specific against ague (malaria), and ipecacuanha, which featured in many popular emetics, above all, Dover's Powders.
But the most widely used patent medicine was Dr James's Powders, a powerful febrifuge, built upon an antimony base. Some treated it as a cure-all, to be tried in any serious bout. 'James' Powder is my panacea', Horace Walpole confided to Sir Thomas Mann in 1764, 'I have such faith in these powders that I believe I should take them if the house were on fire.”
During the eighteenth century, for the first time ever, anyone with a couple of pounds to spare could arm himself with a battery of standardized, brand-name, prominently advertised nostrums, readily available through thousands of retail outlets. John Newberry, who doubled in the mid-eighteenth century as newspaper proprietor and medical entrepreneur, ran a 'medicinal warehouse' which tempted selfdosers with such delights
Dr James's Powder ,Arquebusade Water,
Purchasers of a handful of these would have the means (so the flyers claimed) to reduce fevers, numb rheumatic pains, settle stomachs, cure hangovers, clear up skin complaints, deal with menstrual problems (or, for those choosing to read between the lines, procure abortions), and many other wonders, not to mention the potential to make himself extremely ill!
However it is not beyond the bounds of probability that he sold to Jane a ready-made nostrum like Dr James powders.
Here is Fanny Burney’s account of dosing her ill son with Dr James’s powders:
Buyers were often aware that nostrums - cheap because made in bulk - contained ingredients essentially identical or comparable to the remedies doctors prescribed: both regular and quack analgesics typically contained opium; emetics contained ipecacuanha; laxatives, senna; stronger purges, mercury or calomel; and so forth. Indeed, regular doctors themselves routinely prescribed certain proprietary nostrums, such as the famous (or notorious) febrifuge, Dr James's Fever Powders. James's Powders were valued because, despite their well-known dangers, they did actually work .
Thus Fanny Burney, nursing her sick son, was most grateful to have the powders to hand, recording, almost as if penning a testimonial:
'Our dearest Boy [she told her husband] had so much fever, & so dreadful a Cough, which latter exercised every moment, that, after a second analeptic had failed of cure, though it had procured him, thank God, a good night, I gave him 1 grain of James's powder. This soon operated like magic in relieving his lungs, by stilling his Cough.”
The sick child made a splendid recovery, almost from death's door, it seems, thanks to these wonder proprietary powders: 'The whole day, however, his fever was too continual to permit me to let him rise, except to make his Bed, & he suffered so severely from his Cough during that interval, that I repeated the dose when I put him to Bed, & watched by him till midnight, when the soundness of his sleep, & the amendment of his pulse, encouraged me to go to Bed.”
Page 107: Patients Progress ,as above
As I said below, I'm just glad Jane survived her mothers scheming and the medicine prescribed …;-)
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