Victorian Pharmacy

                                                                Public Health

At the start of Queen Victoria's reign, the public had long been in the habit of self-medicating. This was partly because of the scarcity of public health provision, but principally because most people simply did not have the pennies to spare on physicians or apothecaries. Many people, notably the working class, had a deep mistrust of physicians, whose cures were often as bad, if not worse, than the original problem. Illnesses were managed rather than cured, and it was not until the end of the nineteenth century that real advances were made in the understanding of the causes of ill health, as well as its management and treatment. Medical thinking was still dominated by the theories of Hippocrates (460-c.370 BC). He suggested that illness was caused by an imbalance in the four humors - blood, phlegm, black bile and yellow bile. This approach began to be revised only after 1860. Treatments to 'rebalance the humours' and clear the 'miasma of bad air' were vigorous - and not for the faint-hearted. The principal therapy was blood-letting, but purging and laxative treatments were popular, as were enemas and blistering plasters. The latter were applied to various parts of the body with the intent of causing irritation to the skin; it was common, for example, to fix them behind the ears as a means of alleviating toothache. Medicenes and ointments frequently contained highly toxic substances such as antimony, mercury and arsenic. These tortuous therapies were commonplace and left patients debilitated or created an addiction. Napoleon Bonaparte (1769-1821) remarked that medicene is 'a collection of uncertain prescriptions the results of which, taken collectively, are more fatal than useful to mankind.'

                                                           Blistering Ointment

                                                  Cantharides in coarse powder 600 grammes 
                                                        Powdered euphorbium 200 grammes
                                             Black pitch and yellow resin, of each 400 grammes
                                                                    Yellow wax 300 grammes
                                                                    Olive oil 1000 grammes

Mix the wax, pitch and resin at a gentle heat; add the oil, constantly stirring; strain through cloth. Put the cantharides and the euphorbium in the vessel and damp with water. Add, little by little, half the resinous mixture, and heat to evaporate the water. Then add the rest of the mixture; heat for a few seconds; withdraw from the fire, and stir well till quite cold.

                                                         The Cities And Disease

The living conditions in Victorian Britain gave rise to many of the underlying health problems. Of particular significance was the huge shift from rural to urban life. In 1801, only one-fifth of the population lived in towns and cities; by 1850, the figure had risen to approximately half of the population; and by 1901, the ratio had shifted again with four-fifths residing in urban enviroments. Towns and cities offered employment and escape from rural poverty, but conditions were shocking. 
Rapid urban development had been unregulated, and the ramshackle, severely overcrowded housing left inhabitants more susceptible to infectious diseases. Access to fresh water was limited, with water companies providing a supply only two to three times a week for just a few hours at any one time. This was a situation that did not improve until halfway through Victoria's reign: it was not until 1870 that a continuous supply of water was made available to Londoners for the first time, though for the majority of people this still meant using a street pump. Refuse was either stored in the home or left in piles for the scavengers' cart to collect. The dustbin did not make an appearance in Britain until after 1900. As well as being littered with rubbish, the streets were full of horse manure, so there were flies everywhere in summer. The removal of horse manure was almost as big a problem as that of human waste. Indeed, the management of human sewage was primitive: latrines and cesspits were common, and in the towns and cities a night soil collector made the rounds for those who used only pails. Tons and tons of human waste were removed from the city and despatched to the countryside by boat or train, where it was spread on the fields, thus neatly extending the range of waterborne diseases. The first public water closets were seen at The Great Exhibition at Crystal Palace in 1851. To use them, you had to spend a penny - hence the phrase. Theoretically, flush toilets resolved the sewage dilemma, albeit for only the fortunate few. But the disposal of flushed waste was no more ethical; it was pumped into the sewer, and then directed straight into the nearest river - the source of drinking water. As a result, and typhoid, waterborne diseases, were transmitted through contaminated faeces - a fact that was not recognized until the 1850s. Legislation to improve London's water supply was implemented in 1855, and for the first time water was drawn from outside the city and filtered. The government was forced to take further action after the Great Stink of 1858. In an unusually hot summer, the River Thames and its tributaries overflowed with raw sewage creating an unbearable stench. The following year, the civil engineer Sir Joseph Bazalgette (1819-1891) started work on the construction of the central London sewage system. The rest of the country followed London's lead to improve water quality, at least in the towns, after 1870.

Lemon Wash Balls

A lovely lemon-scented soap for handwashing clothing.

Cut 6lbs of soap into very small pieces; melt it into a pint of water in which 6 lemons have been boiled. When melted, withdraw the soap from the fire and add 3lbs of powdered starch and a little essence of lemon; knead the whole into a paste and form into balls of the required size.

Malnourishment And Pollution

But if water supplies and water quality are not what we are used to today, neither was the food. There was little legislation to control the sale of consumables: meat was often rotten and foodstuffs contaminated with dangerous additives as manufacturers competed to produce the cheapest goods. Bakers added alum or chalk to their flour, and mashed potatoes, plaster of Paris or sawdust to increase the weight of their loaves. Brewers added bitter substances, such as strychnine, to their beer to improve taste and save on the cost of hops. People developed a taste for adulterated food, and even principled purveyors were forced to adopt less upright practices because consumers complained that their food didn't 'taste right' without the additives. Legislative controls were not implemented until the Food, Drink and Drugs Act of 1872. Many working class families were therefore malnourished. Women and children suffered the worst with a diet comprising of bread, margarine and tea with sugar. A survey conducted by Charles Booth over a period of 17 years, and published in 1889, revealed that 35 per cent of London's population lived in abject poverty. Surveys from other cities revealed much the same picture. The memoir Mrs John Brown: 1847-1935 describes a typical tragedy from the late 1800s:

In the bed was a young woman, wan and dazed. She was holding a week-old baby to her empty breast. It was so pitiful I did not know what to say. 'I thought there were two children.' 'There was three days to ago,' the woman said. 'Show her, Jem.' The man got up heavily and opened the bottom drawer of a rickety chest, and there lay a little dead child of about two. I gasped. He said, 'We be waiting for the parish to come and bury her.' The mother said, 'We couldn't put her upstairs, alone, in the empty room.' I stood still, sobbing, but the parents shed no tears, nor said a word, except when Jem closed the drawer. 'She were a nice little lass, she were,' he said.

Pollution was a further problem. The air in towns and cities was heavy with smoke from coal fires, which provided the only means of cooking, hot water and heating. It has been estimated that about two-and-a-half million tons of soot were produced annually by domestic consumption alone. This made day-to-day life squalid and dirty for most people, no matter how hard they might try to keep up appearances. More importantly, the soot contributed to the famous London fogs, or London Peculiars, where visibility was reduced to a couple of feet. They were not, however, limited to the capital; towns all over Britain were plagued by them. The fog was thick and brownish yellow in colour, with a sulphurous, sooty, smoky smell. Unlike most fogs, they did not diminish as the sun rose, but became thicker. Horse-drawn coaches and omnibuses had to be led by men carrying torches to warn of their approach. The respiratory diseases that followed were a major source of ill-health and death. In December 1873, the Medical Times and Gazette described a recent fog as 'one of the most disastrous this generation has known. . . . To persons with cardiac and respiratory disease it has in numerous instances proved fatal.' The fogs would not abate until the 1960s. Indeed, the last of the great London fogs went on for four days in December 1952, and is estimated to have killed 4000 people.
This air pollution was also implicated in the high incidence of rickets. Children were more susceptible to this nutritional disease, because thick pollution reduces exposure to sunlight. Rickets were first noted in Britain back in the 1600s, but by the nineteenth century it was widespread. The disease causes softening of the bones, leading to fractures and deformity. A survey undertaken by the British Medical Association in the 1880s revealed a sharp difference between the high incidence of rickets in the urban centres and its virtual absence from small towns, villages and the countryside.
Curiously, bread was implicated. The incidence of rickets was higher in the smoky south because coal was expensive, meaning that it was cheaper for people to buy their bread. Commercially prepared bread was commonly adulterated with alum, an ingredient believed to increase susceptibility to rickets. In the smoky north, where bread was home-baked, children were less susceptible to the disease.

                                                                     SELF-HELP

In the second quarter of the nineteenth century, it began to dawn on doctors and scientists that this devastating combination of enviromental problem was the root cause of many epidemics.
Progress was slow, however, and the sick face a dilemma: to bankrupt themselves consulting a qualified physician or apothecary, who anyway had little real understanding of disease; or to consult a chemist and druggist for a fraction of the price. For the most of the nineteenth century, the chemist and druggist, or pharmacist, was the main source of medical provision for poor and rich alike.
Mrs Beeton's Book of Household Management, first published in 1859, gives some idea of the lengths to which the ordinary housewife was prepared to go when it comes to First Aid. She was advised to keep the following items at home in case of emergenices:

The London illustrated News of 1847 reveals the severity of the thick, sulphurous fogs which caused many deaths.

Antimonial Wine, Antimonial Powder, Blister Compound, Blue Pill, Calomel, Carbonate of Potash, Compound Iron Pills, Nitre, Oil of Turpentine, Opium (powdered), Laudanum, Sal-Ammoniac, Senna Leaves, Soap Liniment, Opoldeldoc, Sweet Spirits of Nitre, Turner's Cerate. To which should be added: Common Adhesive Plaster, Isinglass Plaster, Lint, a pair of small Scales with Weights, an ounce and a drachm Measure-glass, a Lancet, a Probe, a pair of Forceps, and some curved Needles.

Many of these medicenes contain lead, mercury and antimony, all of which are highly toxic. As for the forceps and needles, the average housewife was equipping herself with the means to haul a baby into the world, and to stitch up a wound, should the occasion demand. It's an approach more robust than that of the shrinking violet more commonly associated with Victorian womanhood. And it's approach that was cultivated out of necessity. Even amongst what we would now call healthcare professionals, there was still very little real understanding of the cause of illness and disease - and only a rather hazy understanding of anatomy. Healthcare was a private business, a commercial enterprise like any other and it operated much as it had for centuries. (There was no National Health Service until 1948). The only free medical care came from charity hospitals, such as the Royal Free Hospital in Hampstead and some teaching hospitals. Friendly Societies sprang up in the late eighteenth century. Members made regular payments in return for which they received help with the cost of paying for a doctor or, indeed, for a funeral. By the end of the ninteenth century, there were more than 30,000 Friendly Societies, which offered working men and women some security in times of need and protected them from debt through illness, death or old age.