‘Pharmacy in History’
12th May 2009, Apothecaries Hall, Blackfriars Lane, London

On Tuesday 12th May, the Society held a joint meeting with the Royal Society of Chemistry Historical Group and the Faculty of the History and Philosophy of Medicine and Pharmacy at Apothecaries Hall, Black Friars Lane, London. The subject of the meeting was “Pharmacy in History”, and around 70 people attended.

After a brief introduction by Major General Alan Hawley OBE (Faculty President), the first speaker was Dr Peter Pormann (Warwick University) on the subject of “Medieval Arabo-Islamic Pharmacology: Between Continuity and Change”. Dr Pormann explained that, like Islamic medicine more generally, the pharmacological tradition in Arabic heavily relied on Greek models. But the medicinal plants and substances availble, for instance, in tenth-century Baghdad differed considerably from those found in classical Athens or Imperial Rome. Moreover, the physicians themselves innovated in a number of ways. Therefore, the story of Islamic pharmacology can paradoxically be told as one of both continuity and change.

He expanded on this by reference to a comparison of Dioscorides and Galen. Pedianus Dioscorides of Anazarbos (in modern Turkey), who lived in the middle of the first century AD, composed a work entitled On Medicinal Substances in five gooks. He organised his material according to types, and attributed certain qualities to each substance. Galen wrote a substantial monograph on the same subject, with the title On the Powers of Simple Drugs. Dr Pormann howed how he often took his cue from Dioscorides, but introduced an important innovation, classifying the qualities of Dioscorides into degrees according to their strength. Both these works were translated into Arabic in the ninth century and formed the basis of Islamic pharmacology. He also demonstrated, however, change and innovation in the pharmacological literature that developed in the lands of Islam. On a theoretical level, the ninth century polymath al-Kindi refined the classification system of Galen further. Where Galen had talked of qualities in the first, second, third and fourth degree, he had not specified how these qualities interacted with each other in compound drugs. Dr Pormann showed that Al-Kindi devised a system in which the power of the qualities grew exponentially (1, 2, 4, 8) and theorised how these different degrees of quality interacted in specific compound drugs. On the level of practice, he indicated, many new ingredients entered the formularies written in Baghdad during the ninth and tenth centuries, with ingredients from India proving especially popular. In this way, both new pharmacological ideas and new ingredients were incorporated into the Greek system, which was thus expanded and enhanced.

The second speaker was Dr Anna Simmons (The Open University), who spoke on “Extracts, Experiments and Education: Chemistry at the Society of Apothecaries in the Nineteenth Century”. Dr Simmons gave a brief account of the foundation and expansion of the Society of Apothecaries which, by the 19th century, was one of the largest manufacturers of pharmaceutical substances. Despite its long history of chemical activity, the Society is most familiar for its role in medical licensing in the nineteenth century and its activities as a livery company. This emphasis led to the importance of chemistry for the institution being overlooked. Chemistry was essential to the operation of the pharmaceutical trade at Apothecaries’ Hall. This had developed out of a laboratory founded in 1672 to manufacture chemical medicines and at the beginning of the nineteenth century the Society was one of the largest drug manufacturers in Britain, holding valuable monopolies with the Navy and the East India Company. The centre of chemical activity at Apothecaries’ Hall in the nineteenth century was the Great Laboratory. Constructed in 1822 to expand the Hall trade’s manufacturing capacity, this was an impressive building fifty feet long by thirty feet wide by thirty feet tall where all of the chemical operations requiring intense heat were performed.

Dr Simmons proceeded to show that, in addition to chemistry’s practical importance in drug manufacturing, the subject had many other uses for the Society. Through the research and consulting activities of the chemists working at Apothecaries’ Hall, the subject helped to shape the Society’s institutional profile. Chemistry also had an educational function as part of the curriculum for the Licence of the Society of Apothecaries (LSA) and a rhetorical function in raising the Society’s scientific status and intellectual authority. Additionally, through projects such as lectures and libraries, chemistry linked together the spaces and the objectives of the Society’s three roles. The way in which chemistry supported the Society’s intellectual and institutional aims was particularly important as the early nineteenth century was a demanding time for the Society of Apothecaries. Following the new responsibilities given to it in the 1815 Apothecaries’ Act, the Society faced criticisms about its drug trade detracting from its licensing role and its activities in chemistry could be used to counter these.

However, Dr Simmons explained, the Society’s attempts to use chemistry in these ways did not necessarily have the impact it desired. Using a description of Apothecaries’ Hall which appeared in Household Words in 1856, she showed that, to many visitors, Apothecaries’ Hall seemed “composed of two distinct parts”, with the manufacturing premises where chemistry was utilised on one hand and the spaces used for the licensing and livery functions on the other. It is also difficult to determine the impact that the Society’s chemical activities had on the various audiences of its members, medical students and the wider London medical community. Nevertheless, Dr Simmons concluded, in using media compatible with the culture of public science that was prevalent at the time, the Society demonstrated the wide-ranging applications of chemistry. The subject was thus crucial to the Society’s institutional identity as it sought to raise its status as a learned organization. The third speaker, Professor Tilli Tansey (UCL) gave a talk entitled “Adventures in Pharmacy, by a Freeman of the Society of Apothecaries”. This talk centred on the life and career of Sir Henry Dale (1875-1936), Nobel Laureate in Physiology or Medicine in 1936. He was awarded the Society of Apothecaries’ highest honour, its Gold (Galen) Medal in 1932, and was made a Freeman of the Society in 1951.

Henry Dale was born and brought up in North London, attending a local school, and taking the exams of the independent examining board, the College of Preceptors when he was 14, and coming second over the entire country. He earned a £20 prize from Barclays Bank, and a career in the financial world beckoned. However, his father attended the annual Methodist conference that year, at which he met Dr F W Moulton, a noted Biblical scholar, who was also the headmaster of the Leys school in Cambridge. Moulton, hearing of the younger Dale’s exam success, suggested that he apply for a scholarship to continue his education at the school. This he did, and he entered the school in 1891. There he studied the sciences, and was influenced by visiting speakers from the University, to read Natural Sciences at Cambridge. Unable to remain in Cambridge after graduation to do research, as he wished, he returned to London to complete his medical qualifications at St Bartholomew’s Hospital. Just as a career in clinical practice seemed likely, a rare Scholarship in physiology, the George Henry Lewes studentship, became available. Dale applied for, and was awarded, the position, which enabled him to work with Professor Ernest Starling and his brother-in-law William Bayliss at University College London. In 1904 Starling was asked by the pharmaceutical manufacturer Henry Wellcome, to recommend a suitable man to work in his private laboratories, the Wellcome Physiological Research Laboratories (WPRL). Starling nominated Dale, who accepted the post, despite being warned by friends that he would be contaminated by association with a ‘tradesman’.

At the WPRL Dale began the research work that was to inform his entire career. At Wellcome’s suggestion he started to work on the pharmacology of ergot of rye, then in use as an obstetric preparation to speed up recalcitrant labours. He worked closely with chemists, particularly George Barger and Arthur Ewins. They isolated and refined numerous compounds from ergot, which Dale then tested physiologically. During the 10 years that Dale worked at the WPRL, he was associated with the discoveries of histamine, tyramine and acetylcholine, none of these substances being previously known to occur naturally. His work contributed to the discovery of several compounds that were marketed for obstetric use, and he also revealed that some chemicals mimicked the effects of sympathetic nervous stimulation, for which dale coined the word ‘sympathoimetic’, in addition he first reported the oxytocic effects of extracts of the posterior pituitary and elucidated some of the mechanisms of anaphylaxis.

In 1914 he was elected a Fellow of the Royal Society, a clear indication that association with a ‘tradesman’ did not preclude the production of first class science. He was the first person associated with the pharmaceutical industry to achieve this honour, and many of his Wellcome colleagues, including both Barger and Ewins, were also elected to the Fellowship in later years. 1914 was also the year in which Dale left the WPRL to join the newly created Medical Research Committee (later Council, the MRC) as Head of the Biochemistry department of their National Institute for Medical Research (NIMR). Based in Hampstead after the first world war, he continued the lines of work he began at the WPRL, and once again collaborations with chemists were extremely important. Working with one such, Harold Dudley, Dale discovered acetylcholine as a natural constituent of the animal body in 1929. The discovery focussed much of his research on the physiology and pharmacology of this substance, and in 1936 he shared the Nobel Prize for Physiology or Medicine for elucidating acetylcholine’s role in nervous transmission. In 1942 he retired from the NIMR, and by this time he was also President of the Royal Society, in which capacity he served as Scientific Secretary to the War Cabinet. He was one of the first Trustees of the Wellcome Trust, and was admitted to the Order of Merit in 1944. He died in 1968, having been awarded most distinctions and honours available to a scientist.

During the tea interval, Mrs D Cook, Archivist of the Society of Apothecaries, gave a short talk on “A brief History of the Society of Apothecaries and its Hall”. She touched, amongst other things, on the origins of the Society of Apothecaries in the Peppers and Spicers companies, the reason why the Society is the only livery company calling itself a ‘Society’, and on the disputes between the Society and the College of Physicians. She also gave those present an informative account of the history of Apothecaries Hall, including a variety of fires, one Great and many small (so many that the Society had its own fire brigade and fire engine), its ceremonial barge, the origins of Chelease Physic Garden, much of which related to the Hall as it was rebuilt after the Great Fire in 1668 and 1672, and as it remains today as the oldest extant livery company hall in the City of London.

The final, and keynote speaker was Dr Robert Bud (The Science Museum and Queen Mary University of London), who spoke on “Wonder Drugs, Technical Fixes and Modernity”. He began with the claim that modernity is hard to live in, and change is always challenging. The use of the description ‘Miracle’ drug with its connotation of folk culture as well as huge potential was a way of winning acceptance for modern medicines at the turn of 20th century. Paul Ehrlich identified his revolutionary Salvarsan in terms of the traditional German category of ‘Magic Bullet’ and the name heroin resonated in a Germany adulatory of ‘heroes’. By the early interwar period the stratagem was already suspect: the 1919 play ‘das Wundermittel’ (wonder drug) was a parody. When the sulphonamides were discovered in the early 1930s considerable effort was put into proving that they really did have wonderful potential. Certainly British breakthrough sulphonamide M&B693 was described by the press at the time as a ‘miracle drug’.

So, the cultural framework was quite ready when penicillin emerged during the Second World War. Soon it too was described as a miracle drug. The faith in this medicine came to resonate with the very modern belief in a technical fix for an enduring problem. One can see in the 1950s sincere beliefs in a number of technologies not just as good technical solutions to specified technical problems, but further to major political and social challenges. Atomic power stations could make up for oil shortage and nuclear bombs were more than a match for Russian tanks. Protein from oil would feed a hungry world.

Within such a framework antibiotics as speedy cures, rather than prevention by changing behaviour was seen as the effective response to infection. No longer was illness seen as the result of culpable behaviour. No longer was the patient to ‘blame’. When resistance emerged as a widespread problem in the 1950s, the Beecham Company developed methicillin, a semi-synthetic penicillin which could not be destroyed by the bacteria. We can see penicillin and antibiotics generally becoming a powerful ‘brand’. Such brands, not all of course trademarked items, combine particular technical qualities with cultural associations. These brands became remarkably strong and much loved across the world. Other drugs were also emerging of course. The use of chlorpromazine to treat victims of schizophrenia emptied the mental hospitals and vaccines such as the polio vaccine promised to wipe out childhood diseases which hitherto had blighted lives.

As early as 1962 the use of the technical fix came into question. Atomic tests were blamed for spreading the radioactive isotope Strontium-90 into babies’ milk, fluoridation of water was suspected, the use of DDT was castigated by Rachel Carson and thalidomide was exposed as the cause of infant malformation. Doctors were blamed for unauthorised use of patients as ‘medical guinea pigs’. So when in 1967 an outbreak of antibiotic resistant E. coli in Middlesbrough hospitals was blamed for the deaths of eleven infants the abuse of antibiotics was now blamed. There was a chance that the resistance in the bacteria had spread from animals fed low doses of antibiotics to promote growth and larger doses to combat infection caused by miserable conditions. The Swann Committee was established to investigate use of antibiotics on animals. It recommended banning the use of certain important human medications as growth promoters. Still the brand’s value and use in humans was not addressed.

By the 1990s much of the Staphylococcus aureus encountered in hospitals was resistant to even to methicillin. Now no longer could we trust to the brand to rescue us from infection. Only changing behaviour would work. More careful use of antibiotics by patients and doctors and greater cleanliness in hospitals were called for. These were not just individual techniques; they challenged the way we thought about antibiotics. No longer could the sophisticated citizen of the 21st century resort to the innocent brand of ‘miracle drugs’ and theirs magical connotations. Rebranding has been required, to make patients collaborators with doctors in understanding the strengths and limitations of the valuable but complex tools that antibiotics really are.