When I use a word . . . Medicines regulation—apothecaries, quacks, chemists, druggists, pharmacists

Apothecaries

In the 18th and 19th centuries, when the Medicines Stamp Acts were being passed,1 medical care other than surgery was available from a range of individuals. While poor people could consult cheaper practitioners, generally regarded as quacks, those who could afford to would consult a physician, whose prescription would be filled by an apothecary. The quality of the apothecaries’ goods was guaranteed by the power of the physicians, conferred upon them by Henry VIII, to inspect the goods and destroy any that were defective.2

Apothecaries originally purveyed non-perishable commodities—spices, drugs, comfits, preserves, and the like. They were members of the Guild of Grocers, classed with pepperers and spicers, but they gradually focused on drugs for medicinal purposes, and by about the middle of the 14th century an apothecary was one who prepared and sold such drugs. However, they continued to be associated with the grocers until King James I granted the foundation of the Worshipful Society of the Art and Mistery of Apothecaries.

In Greek, the verb ἀποτιθέναι meant to put something into storage, and the derived noun ἀποθήκη therefore meant a store-house. This came straight into Latin as apothēca, which arrived in English as apothec in the early 17th century, via the Old French apotheque, a shop or magazine. The form lingers on in words for a “pharmacy” in some European languages, including Danish (apotek), Dutch (apoteek), German (Apotheke), Norwegian (apotek), and Swedish (apotek).

Quacks

The Stamps Acts, originally passed in order to contribute funds to enable King George III to prosecute the American War of Independence, primarily targeted what were known as “quack medicines.”

Several pejorative names for doctors or peddlers of supposedly ineffective medicines relate to advertising. A mountebank, for example, was a man who climbed on to a soapbox (Italian: monte banco) to shout his wares at a fair. A charlatan was wont to prattle (Italian: ciarlare) about his medicines. And quacks were originally called quacksalvers, supposedly because they “quacked” or boasted about their salves. The doctor (actually a vet) that Groucho played in the Marx Brothers movie A Day at the Races was originally called Hugo Z Quackenbush, but when the scriptwriters discovered that there were over 30 doctors of that name in the USA, fearing litigation if they used it, they changed the name to Hackenbush.

Most definitions of the term “quack” in this context reflect its usual pejorative use. The Oxford English Dictionary (OED), for example, offers “A person who dishonestly claims to have medical or surgical skill, or who advertises false or fake remedies; a medical impostor.”3

However, as Roy Porter suggested in his history of quackery, Health for Sale (1989),4 it is the similarities rather than the differences between regular practitioners and quacks, whom he described as “less cheats than zealots,” that deserve to be highlighted. The government had been keen to exempt regular practitioners from the stamp tax that they imposed, preferring instead to tax the quacks. But many so-called quack remedies included ingredients that were also to be found in apothecaries’ formulations. James Adair, a Scottish physician, pointed out, for example, that quack medicines might contain conventional therapies (such as opium and ipecacuanha in Dover’s Powder), poisons (such as hemlock), or nothing of value whatsoever. After all, the inclusion of the word “mistery” in the name of the apothecaries’ society suggested that a bit of hocus-pocus might not go amiss in encouraging a therapeutic response in a susceptible individual. But Adair was scathing on the subject of quacks: “Many persons have been destroyed by quack drugs; but dead men tell no tales; and whilst the public is astonished by accounts of patients they never cured, it is ignorant of the number of persons they certainly killed.”5

Chemists and druggists

The word “chemist” comes from the Greek verb χεῖν, to pour, and the derived noun, χυμός, meaning juice or sap, from which we get the words chyme and parenchyma. A related noun, χυμεία, meant an act of pouring or infusion. In Hellenistic times this referred to the study of the juices or infusions of plants, or what we would call pharmaceutical chemistry. However, with the addition of the Arabic prefix al-, signifying the definite article, the, it entered Latin as alchymia and referred instead to alchemy. There may also have been confusion with another word, χημία, meaning transmutation into gold or silver, related to a word meaning Egypt, Χημία, with the implication that alchemy was an Egyptian art.

Whatever its true origin, when it entered English in the early 17th century the word “chemistry” originally referred to alchemy and was spelt with a y, as in “chymistry.” It also came to be used to refer to the iatrochemical theory of Paracelsus in the treatment of disease.6 By the mid-18th century it was being spelt “chemistry,” and referred to “the branch of science concerned with the substances of which matter is composed, the investigation of their properties and reactions, and the use of such reactions to form new substances.”7

A chemist was therefore an individual who practised any of these arts or sciences—alchemy, Paracelsian medicine, or chemistry in its modern sense. In about the middle of the 18th century “chemist” came to mean one who dispensed therapeutic medicines and in the UK it was largely used in that sense from then until about the end of the 20th, when it was replaced by “pharmacist.”

Although we now use the words “drug” and “medicine” interchangeably, they were once distinct. From its introduction into English in the early 15th century to about the middle of the 18th, the word “drug” meant “any substance, of animal, vegetable, or mineral origin, used as an ingredient in pharmacy, chemistry, dyeing, or various manufacturing processes”8; it then gradually became synonymous with “medicine,” which implied a therapeutic application.

Thus, the combined term “chemist and druggist” started to be used increasingly from the start of the 19th century to refer to what nowadays we would call a pharmacist, although the term “pharmaceutical chemist” was also used from about the 1820s. Indeed, the numbers of chemists and druggists grew much more rapidly than the parallel increase in the numbers of physicians at that time. For example, between 1790 and 1870, in the Yorkshire city of Wakefield and market town of Huddersfield, the number of shops run by chemists and druggists grew from four to 40, while at the same time the number of physicians grew from 11 to 39,9 even though many physicians also dispensed medicines. In addition, chemists and druggists sold not only medicines, both as prescribed by doctors and also over the counter, but also a wide range of non-pharmacological commodities. These included such items as toilet articles, cosmetics, hair dyes, and perfumes; tobacco and snuff; tea, coffee, herbs, spices, pickles, sauces, and other foodstuffs; and oils and candles. In some cases, they also undertook other professional activities, such as grocery, bookselling, insurance agencies, and selling paints. They did this to the extent that some dispensed very little in the way of medicines.9

Later, the Pharmaceutical Society, which had been founded in 1841 by a group of chemists and druggists,10 established two levels of pharmacist, defined in the 1868 Poisons and Pharmacy Act: the chemist and druggist, who had passed a minor examination, and the pharmaceutical chemist, who had passed a higher examination. The society also then restricted its membership to two categories: (a) pharmaceutical chemists and (b) chemists and druggists who had been in business before the 1868 Act was passed.

Pharmacists

The 1953 Pharmacy Act abolished the category of chemists and druggists. The title “pharmaceutical chemist” was applied to all and was generally shortened to “chemist,” certainly when later the term also came to be used to describe a scientist who develops medicines in a laboratory. For example, the company now known as Boots UK Limited was, before 2007, known by other names following its foundation in 1849, including Boots Cash Chemists, the Boots Pure Drug Company, the Boots Company Limited, and most recently Boots the Chemist.

The word “pharmacy” comes from the Greek word ϕαρμακεία, meaning the use of drugs, from ϕάρμακον, a medicine. First recorded in English towards the end of the 14th century, it originally meant simply a medicine, and more specifically a purgative. It could also mean the administration of a medicine, a meaning that survives only in the term “polypharmacy.” By the middle of the 17th century it had come to mean the preparation and dispensing of medicines and then, in the early 19th century, a place where that was done.

Thus, the term “pharmacist” is first recorded in the early 18th century. However, it did not become the main designation for what had originally been called an apothecary or a [pharmaceutical] chemist until much later, becoming the common designation in the UK at about the end of the 20th century, although it had been in use in the USA for much longer. For example, Merriam-Webster’s dictionary describes a pharmacist as “a health-care professional licensed to engage in pharmacy11 and lists three definitions of the word “chemist”12:

● the obsolete meaning “alchemist”;

● “one trained in chemistry”; and

● “British: pharmacist.”

Note the word “British.”

Definitions

In studying the terms “apothecary,” “quack,” “chemist,” “druggist,” and “pharmacist,” I have been struck by the difficulties in tying down precisely what they meant at different times during their historical development. If one goes by the dates of the earliest recorded instances of each, as listed in the OED, the difficulties start to become clear:

● apothecary—1366

● quack—1638

● chemist (=pharmacist)—1744

● druggist—1608

● chemist and druggist—1748

● pharmacist—1721

The antiquity of “apothecary” is no surprise, but one is struck by the relative contemporaneity of the other terms, given the different ways in which they appear to have been used over the centuries, and in particular the early appearance of “pharmacist.”

In some cases the definitions themselves are also confusing. For instance, the OED defines “pharmacist” as “A person engaged in the practice of pharmacy; a person who is professionally qualified to prepare and dispense medicinal drugs.”13 And it defines “chemist and druggist” as “A pharmacist; spec[ifically] one who has passed the minor examination of the Pharmaceutical Society.”14 However, it also cites a comment from the Review of British Pharmacy from 1898: “The Pharmacopoeia, generally a stickler in legality, speaks of ‘pharmacists’, which, strictly speaking, chemists and druggists are not.” While this may not be entirely contradictory, the get-out in the definition of “pharmacist” being “professionally qualified,” it does illustrate at least one definitional difficulty.

Nevertheless, despite such difficulties, an exploration of the meanings and uses of these terms does throw light on the ways in which medicines were prepared and dispensed over the years, and by whom, since physicians first sought to exert power over the apothecaries.