At a conference session on September 12 organised by the British Society for the History of Pharmacy, participants heard about a momentous day in the history of British pharmacy and about the long history of the Order of St John
January 15, 1913, marked entry into a new era for pharmacy in Britain, Dr John
Hunt (pharmaceutical historian) told the conference. On that day, new
legislation established the principle that the activities of prescribing and
dispensing should normally remain separate.
Dr Hunt began by explaining how the practice of pharmacy in England and Wales
had evolved differently from almost every other country in Europe, including
Scotland. At the beginning of the 20th century some 90 per cent of prescriptions
had been dispensed by the doctors who had written them, or by their staff. Many
pharmacists rarely, or never, dispensed a doctor’s prescription and candidates
for examination had often served apprenticeships in pharmacies that almost never
saw prescriptions.
This situation had come about because English apothecaries had been encouraged
to deal directly with patients by the “Rose” case of 1701, in which
an appeal to the House of Lords had ruled in favour of the apothecaries in a
dispute with the College of Physicians. Further encouraged by the Apothecaries
Act of 1815, apothecaries had progressively moved into the practice of diagnosis
and prescribing, while retaining their tradition of dispensing. Thus, they had
sought to attend patients, to prescribe and to dispense their own prescriptions,
despite opposition from the College of Physicians.
Chemists and druggists
These traditions had continued, and the apothecaries and surgeon-apothecaries
had evolved into the family doctors or general medical practitioners of today.
Meanwhile, the physicians, objecting strongly to the intrusion of the apothecaries
into what they regarded as their preserve, had frequently directed their prescriptions
to the emerging class of chemists and druggists. The latter had evolved into
the community pharmacists of today, but at the beginning of the 20th century
had been likely to receive physicians’ prescriptions only in the more affluent
locations in towns.
A Liberal government had come to power in December, 1911. During the period
leading to the 1914-19 war, it had introduced a range of social legislation
covering old age pensions, labour exchanges, school meals and the medical care
of schoolchildren and, in particular, the National Insurance Act of 1911. This
Act had included provision for free medical treatment, including medicines,
for employed persons who were insured under the scheme. When introducing the
Bill to Parliament in May, 1911, David Lloyd George, as Chancellor of the Exchequer,
had said: “I suggest that there should be a separation of drugs and doctors,
the doctors’ business being confined to prescribing, it should be for the
chemist to dispense. I believe that in Scotland, where they do most things well,
that is the practice at the present moment. . . . where there is a chemist available,
there should be separation.”
With this statement, there had begun intensive discussions between the government
and the Pharmaceutical Society. Pharmacy law at the time had related only to
the sale of poisons and, surprisingly, anyone had been able dispense prescriptions
without supervision, as this had not necessarily entailed a sale. On July 5,
1911, a meeting in London called by the Pharmaceutical Society had attracted
an attendance of over 1,000 — the largest meeting of pharmacists ever held
in Britain at that time. The meeting had agreed a policy based on seven resolutions.
This had been presented to Parliament by the Society’s parliamentary secretary,
William Glyn-Jones, who was also Liberal member of Parliament for Stepney and
later to become the Society’s Secretary and Registrar.
Because of these efforts, amendments to the Bill included a provision that medicines
prescribed under the Act were to be dispensed only at pharmacies authorised
under the Pharmacy and Poisons Act of 1908 and, with certain limited exceptions,
by or under the supervision of a pharmacist. Despite objections from some sections
of the medical profession, Lloyd George insisted that the activities of prescribing
and dispensing should remain separate, except in rural areas.
The Act had brought free medical attention to some 14 million employed persons
in Britain and had revolutionised the place of pharmacy in primary health care
in England and Wales. It had set the pattern of prescribing and dispensing,
which had later been expanded in 1948 under the National Health Service so as
to cover the entire nation, and so had established the place of pharmacy for
the rest of the century.
On January 25, 1913, The Pharmaceutical Journal had commented: “On Wednesday
last week the business of pharmacy entered a new era, and on that day many hundreds
of prescriptions which, prior to the full operation of the Act, would have been
dispensed by the doctors who wrote them, were dispensed by chemists.”
Various factors must have influenced Lloyd George in making such a major change
to the practice of pharmacy and medicine, said Dr Hunt. Not least of these had
been his interest in German political affairs and his study of the well established
medical insurance scheme in Germany, where the separation of prescribing and
dispensing had long been regarded as normal practice.
The long history of the Order of St John
The history of the Order of St John from the Crusades to the present day was
described to the history session by Dr A. Llewellyn Lloyd (knight of the Order
of St John).
Dr Lloyd said that the order’s history could actually be traced back to
AD600, when Pope Gregory the Great had established a hospice for pilgrims in
Jerusalem. After its destruction in 1012, it had been restored by the Republic
of Amalfi and served by Benedictine monks, who wore on their robes the eight-pointed
cross of Amalfi — now more commonly referred to as the Maltese cross.
Preaching by Pope Urban II at the Council of Clermont in 1095 had led to the
establishment of the first crusade, and Jerusalem had been conquered four years
later after a six-week siege. By 1113, a hospital had been built beside the
ancient monastery of St John the Baptist.
A separate Order of St John had been recognised by Pope Pascal III and led by
the “Blessed Gerard”, who had taken the vows of the Augustinian Order.
A military order had been established to give protection to pilgrims and, having
been granted part of a palace next to the site of the Temple of Solomon in Jerusalem,
the order had become the Order of the Templars. The Knights Hospitallers cared
for the sick.
Saladin had proclaimed holy war in 1187 and at the Battle of Hattin 230 captured
knights had been executed after refusing to adopt the Muslim faith. Three months
later Jerusalem had surrendered. Some fortresses on the pilgrim route had held
out, but with the fall of Acre in 1291, the knights had finally been removed
from the Holy Land.
They had then taken up residence at Kolossi Castle, near Limassol in Cyprus,
which was still owned by the Order of St John. With the capture of Rhodes in
1310, the Order had become a sea power in conflict with the Turks. But, in 1312,
the Templars, no longer needed to protect pilgrims in the Holy Land, had been
disbanded by Pope Clement V and their possessions transferred to the Knights
Hospitallers.
Rhodes had been besieged in 1480 and again in 1522. Following its surrender
Malta had been granted to the Knights Hospitallers by Emperor Charles V and
had remained its base until the Grand Master surrendered the island to Napoleon
in 1798. Its treasures had been carried off, only to be lost by Napoleon in
the engagement against Nelson in the Battle of the Nile.
After Malta’s capture by the British Navy in 1800, it had been restored
to the Knights under the Treaty of Amiens. In 1814, under the Treaty of Paris,
it was attributed to Britain until independence in 1964. The Order finally settled
in Rome as the Sovereign Military Order of Malta, said Dr Lloyd, and it remained
there, as a Catholic Order, to this day.
Clerkenwell priory
Meanwhile, in England, a priory had been built at Clerkenwell to provide a
headquarters, following a grant of land there in 1114. After it had been burnt
down during the rebellion led by Wat Tyler in 1381, when the Grand Prior had
been killed, rebuilding had taken place in 1399. The priory had been completed
in 1504 by the addition of a bell tower and gatehouse.
In 1540, Henry VIII had dissolved the Order of St John and all its assets had
been confiscated to the Crown. Only the gatehouse of the Priory now remained.
There had been a further reinstatement by Queen Mary, followed by confiscation
by Elizabeth I. The order had been revived in 1831, but since it was no longer
a Catholic order, Rome had refused recognition and the Order of St John in England
had become independent.
In 1872, at a time when industrial injuries had become commonplace, Surgeon
Major Hutton had established a “crusade for aid to the injured” to
industry throughout the Midlands and North. This had been followed in 1877 by
the formation of the St John Association as an arm of the order for the training
of first-aid. The first manual of first-aid had been published in 1878. The
uniformed St John Ambulance Brigade had been formed in 1887 to provide first-aid
for the public.
A great event had been the return of the Order to the Holy Land in 1882 by way
of the establishment of the St John ophthalmic hospital in Jerusalem. This had
been rebuilt on the West Bank in 1960 and was still active, seeing 55,000 patients
a year.
Queen Victoria had granted the order a Royal Charter in 1888 and since then
a member of the royal family had served as the Grand Prior of the Order. The
current Grand Prior was Prince Richard.
The Order of St John had established a reserve for the Royal Army Medical Corps
and a Royal Naval Auxiliary Sick Berth Reserve in 1903. It had established a
Priory for Wales in 1918 and the St John Ambulance Cadets in 1922. Recent air
travel initiatives had been the St John Air Wing, in which volunteer pilots
transported organs for transplant, and the St John Ambulance Aeromedical Service,
for the transport of patients taken ill abroad.
A St John “Badgers” section for young people aged six to 10 years
had been introduced in 1987 and there was a fellowship for retired members.
World-wide membership now exceeded 250,000 and the great principle of the order
continued — Pro fide: pro utilitate hominium (For the faith: for the service
of mankind)