The
Pharmaceutical Journal Vol 266 No 7129 p23-29
The availability of emergency hormonal contraception without prescription from community pharmacies is the latest development in a long association of pharmacy with sexual health products and services. This article demonstrates that since the beginning of the 20th century community pharmacists in Britain have played a significant part in the sexual health of the nation, while at the same time the provision of sexual health products and services has been seen by them as an important item of trade
The pharmacist, sex and education
Sale of contraceptive devices
The contraceptive pill
Pregnancy testing
Sale of abortifacients
Female disorders and sexual dysfunction
Aphrodisiacs and anaphrodisiacs
Products for sexual weakness
Sexually transmitted diseases
Conclusions
In its recent policy statement, the Council of the Royal Pharmaceutical Society of Great Britain concluded that "a significant improvement in public health in the area of contraception and sexual health could be made by developing the role of pharmacists working with other healthcare professionals".1 Furthermore, in its supporting discussion document, it identified four key areas2 in which it thought pharmacists could make a contribution. These were:
Such roles are possible because of changing public attitudes to contraception
and sexual health, and greater willingness among health professionals to work
together. Some of the initiatives are possible because of developments in drug
research and new technology; others represent the development of the pharmacist’s
extended role. Yet the community pharmacist has always had a small but significant
role in sexual health, and in many ways the Society’s policy represents a return
to the traditional role of the pharmacist. Abundant evidence for this role is
to be found in the pharmaceutical literature, as well as formal histories of
sexual health. Such evidence is supported by the oral testimony of retired pharmacists.
The purpose of this article is to provide a historical perspective to the debate
on the role of the community pharmacist in sexual health. It draws on documentary
sources, on the secondary literature in the history of sexual health, and on
an oral history of community pharmacy, involving life story interviews with
50 retired pharmacists.*
| * The oral history of community pharmacy study involved recorded life story interviews with 50 retired community pharmacists in Great Britain. Their experience represented a variety of locations (inner city to rural), of ownership (independent proprietors to large chains), and of customers (from the very rich to the very poor). Eleven of the participants were women, and the sample included representatives of the Jewish, Polish and Asian pharmaceutical communities. Interviews were recorded during 1995 by the author. |
Historically, the role of the community pharmacist in sexual health is characterised
by ignorance, embarrassment and moral judgment. But over an extended period
that role has none the less ranged from sex education and health information
to the supply of contraceptives: from the testing of pregnancy to the supply
of materials that might be used in the procurement of abortion. It has included
the supply of agents to decrease sexual desire (anaphrodisiacs) as well as those
claimed to increase it (aphrodisiacs), the supply of creams and tablets for
the treatment of impotence and frigidity, and a wide range of substances intended
to mitigate the consequences of unprotected sex, from pregnancy to sexually
transmitted diseases. The evidence presented here illustrates how the pharmaceutical
profession’s involvement and approach to sexual health has reflected changing
attitudes and prevailing norms during the course of the 20th century.
The widespread availability of information about sex and birth control is
a very recent phenomenon. Previous generations had to find out about both as
best they could, from a variety of sources. During the life of the Pharmaceutical
Society of Great Britain the role of pharmacists in this area has varied from
active participation to passive non-involvement. In the wake of publicity arising
from the notorious Bradlaugh-Besant trial of 1877, for example (in which the
right to distribute a pamphlet entitled "Fruits of philosophy" condemning the
use of the sheath was upheld, along with information about it), an avalanche
of leaflets and pamphlets provided elaborate information about all the contraceptive
methods then available. It was manufacturers, rubber shops, and pharmacies that
made what information there was publicly available, at least to certain sections
of society.3
Although it had been practised informally for centuries, birth control as a
conscious effort to limit the size of families originated in middle class families
from about the 1860s.4 The second half of the 19th
century saw a spread of knowledge about and use of contraception, and a decline
in the birth rate. Banks has argued that the practice was largely determined
by the costs of educating male children for entry to the professions rather
than anything else.5 The Bradlaugh-Besant trial
thus accelerated rather than initiated the spread of these practices. The working
classes (who together with the lower middle classes were the main clientele
of the corner pharmacy6) did not begin to use contraception
on a scale large enough to influence the birth rate until the end of the century.
The extent to which birth control was used, by whom and when the practice spread
more widely in society, is in fact a matter of some debate among historians.
Evidence from historical studies of pharmacy practice can contribute to that
debate, by describing and quantifying the role of community pharmacists in sexual
health. But even with the limited publicity following the trial the level of
use of contraceptives at the turn of the century was low. This low level of
use among the working classes was not helped by their price: a pack of 12 cost
between two and ten shillings in the 1890s.7 Clearly,
other methods of birth control were used, including caps, coitus interruptus
and abortion. Szreter has argued that "the culture of abstinence" played a far
greater part in family planning than had hitherto been thought.8
Nevertheless, it is clear from written reminiscences and documentary sources
that many pharmacists saw the sale of contraceptives and related goods as a
worthwhile addition to their trade. It is also clear that many pharmacists continued
to distribute leaflets about contraceptives well into the 20th century. However,
not for the first time the professional body did not see this as a suitable
activity for its members. The Council of the Pharmaceutical Society deplored
the practice of unsolicited distribution of leaflets, and issued appropriate
instructions to its members. The 1941 Statement Upon Matters of Professional
Conduct included the statement: "Advertisements concerning contraceptives should
not be enclosed in a package with other goods without a request from the purchaser."9
For those brought up in the inter-war years there was an almost complete lack
of information, and pharmacists almost never received any instruction themselves
during or after apprenticeship to help them with such queries. Charles Robinson
began his apprenticeship in 1929 in a small pharmacy in Norwich. He recalls
that "the veil of secrecy, reluctance, distaste and illegality drawn over the
entire subject of common sexual problems prevented any discussion, and I finished
my apprenticeship with little more factual knowledge in this area of suffering
than I had started with, and that was negligible."10
Ignorance about sexual matters among newly married couples was frequently almost
complete, and this meant that the pharmacist in popular honeymoon spots, such
as seaside resorts, sometimes had to provide some basic lessons in sex education.
Ronald Crisp worked in a pharmacy in the seaside resort of Torquay in Devon
during the mid-1930s: "In those days, I mean you had young couples come to you,
and they would walk past, up and down; and eventually [they] came in to find
a man there, and they would ask him all sorts of questions. I have advised —
when I was a young man — I have advised many a person about when they have come
down on honeymoon to Torquay, what to do. Remarkable! Absolutely remarkable!
People would come down, and they didn’t know what the devil it all meant."11
But this situation continued well into the post-war period. It is only since
the "sexual revolution" of the 1960s that information about sexuality has been
widely available, in books, magazines and elsewhere: and only since the 1970s,
largely in response to very high levels of teenage pregnancy, that sex education
has been provided in schools. As a result the role of the pharmacist in this
area of sexual health is now largely redundant.
If sex education was in short supply earlier in the century the commodities
associated with sexual health could hardly be avoided. During the later decades
of the 19th century, both contraceptives and abortifacients were widely advertised
in newspapers and magazines. In towns and cities they were sold in barbers’
shops and rubber goods stores, as well as pharmacies. They were brought to villages
by itinerant pedlars, and to working class neighbourhoods by door-to door hustlers.12
Irish doctors arriving in London were astonished to find displays in pharmacists’
windows of "antigestatory appliances" and "orchitological literature".13
There is, however, little evidence that condoms, diaphragms and pessaries were
widely used. Indeed, it has been estimated that only 16 per cent of English
couples who married before 1910 used mechanical contraceptives,14
although this is considered by many historians to be a considerable underestimate.
Although sheaths (or French letters, as they were more usually known earlier
in the century) were available, there were three major barriers to their regular
use even when they were known about. First, they remained expensive, costing
two shillings and six pence for three in the 1930s; secondly, they were never
on display, so customers had to ask for them by name; and thirdly, even if someone
had plucked up courage to ask for them, the disapproval of the proprietor would
often be apparent.
In most pharmacies the purchase of condoms was an embarrassing and humiliating
experience. Charles Robinson remembers that the "awkward customers" he saw during
his apprenticeship in Norwich in the early 1930s included those who wanted to
buy condoms. He recalls: "The awkwardness . . . arose from the ritual involved
in supplying them. A customer who did not already know first had the embarrassment
of finding out if the shop sold them. When a solitary man came in, asked loudly
for a tube of toothpaste and then lingered anxiously while the girl assistants
discreetly disappeared, you knew what he really wanted. The matter did not end
there. When at last he eventually found the courage to lean over the counter
and whisper, his requirement still had to be met. The articles were kept, no
less securely than the dangerous drugs, locked in the safe next to the cash
box. The junior apprentice was not really supposed to know, so the forbidden
word was passed quietly along the line to one of the pharmacists. Then, with
eyes averted and sometimes a slight reddening of the cheeks, he would grope
blindly on the top shelf of the safe, hastily wrap something up in plain white
paper, apply a blob of sealing wax, and hand it to the customer himself, saying
‘take two and sixpence, Charles’. It was all very awkward."
Not only pharmacists, but doctors, dispensaries (outpatient hospitals) and local
health officials all made it clear that they did not see it as their duty to
provide cheap contraceptive devices for the working classes. In fact, it was
a direct result of these attitudes that Marie Stopes opened her first Mothers’
Clinic in Holloway Road, London, in March, 1921.
Jesse Boot’s methodist principles played an important part in defining the pharmacy
response to the sale of contraceptives. This attitude meant that the sheath
could not be sold through any Boots branch, supposedly to avoid embarrassing
the staff, a policy which was only reversed in the 1960s.
Peter Homan worked as a Boots manager in the late 1950s: "Boots only sold contraceptive
pessaries. There were not many requests for the sheath — most people seemed
to know that Boots didn’t sell them. But occasionally we would get requests.
They would come in and say ‘packet of Durex please’. You would say ‘sorry, we
don’t sell them’. They would ask ‘why don’t you sell them?’. And we would say
that the company doesn’t allow us to sell them. ‘Why’s that then?’ ‘Because
they feel it’s embarrassing for the staff.’ ‘Well, it’s a darn sight more embarrassing
for the staff when I come in here and ask for them and they have to explain
to me why they can’t sell them.’ That’s the sort of reaction you would get.
So [the policy] was a lot more embarrassing for the staff. At least [if you
sold them] you could slip them into a bag and pass them over the counter; it
was a lot less fuss than trying to explain why you couldn’t sell them in the
first place’.15
Many independent pharmacists followed Boots’s example in not getting involved
in the supply of the sheath. As a result much of this business was lost to the
local barbers’ shops. Those pharmacists who did supply them did so very discreetly.
Brian Hébert, who worked as an apprentice in a pharmacy in Portsmouth in the
1930s, recalls the sale of French letters: "Oh, very, very, under the counter.
Only the pharmacists sold them. I wasn’t allowed to sell them [as an apprentice].
In fact, I was not shown where the Durex was kept. They were in a drawer. I
discovered that because I could go anywhere I liked, but I discovered those
on my own. That was rather like the whole conception of birth and everything
between parents and their children. You sort of grew into the knowledge, and
my apprentice master very much followed that. And no one sold Durex to the customers
except the pharmacist. The customers would come in and say ‘may I see Mr Elder,
please?’ or ‘may I see the pharmacist?’. Of course, every member of the staff
knew exactly what they wanted, but that was the attitude. Very much under the
counter’.16
This attitude was reinforced by directions from the Pharmaceutical Society,
which stated that where contraceptives were sold, only a small sign saying "family
planning requisites" could be displayed. It confirmed the role of the pharmacist
as source of supply rather than advice. Indeed, until at least the 1939-45 war,
working class women relied on neighbours for advice, and the pharmacist for
contraceptives. They did not feel at all comfortable discussing their fertility
either with a doctor, or with the staff at a birth control clinic.17
To do so with the pharmacist was unthinkable, particularly as most pharmacists
at that time were men.
The Pharmaceutical Society’s disapproval of the sale of condoms through pharmacies
continued well into the post-war period. The 1953 version of the Statement Upon
Matters of Professional Conduct included a specific section on contraceptives.18
"There should be no exhibition of contraceptives in a pharmacy, or any reference
(direct or indirect) by way of advertisement, notice, show-card or otherwise
that they are sold there, other than a notice approved by the Council bearing
the words ‘Family Planning Requisites’." This statement remained unchanged in
the 1964 version, and the open display of condoms in pharmacies and elsewhere
only came with the AIDS crisis in the early 1980s.19
The introduction of the contraceptive pill in the 1960s changed the role of
both pharmacists and doctors in this area. Oral contraception required professional
advice. It was this key factor which brought the medical profession into family
planning. The sheath was bought at the pharmacy, but the pill introduced hormones,
which were potentially dangerous and required a prescription —and prescriptions
needed to be dispensed by pharmacists. The oral contraceptive pill introduced
a new technology, which constituted a watershed in the history of sexual health.
Making it available only on prescription represented a shift towards the regulation
of an area of life not previously controlled. In many ways this mirrored the
control of narcotic agents for the first time under the Dangerous Drugs Act
of 1920. As with dangerous drugs the policy response from the government was
to introduce a system of medical regulation, with the pharmacist as a junior
player.20
At first the impact on pharmacy was negligible. In October, 1961, the medical
advisory committee of the Family Planning Association (FPA) recommended that
progesterone-oestrogen oral contraceptives, such as Conavid, should be available
in FPA clinics. This became the principal source of supply, but it was also
available from general medical practitioners on private prescription. Private
prescription numbers increased rapidly during the early 1960s. By 1964, 480,000
British women were on the pill.21–22 The shift
in responsibility for contraception from men to women meant that women rather
than men visited the pharmacy for this purpose. This provided a further advantage
of the pill over the sheath. Joyce Gilbert recalls: "People no longer needed
to feel embarrassed. They just handed in a prescription, and it was dispensed.
We had to make an entry in the prescription book. For us this was an extra chore,
which we could have done without. But for the patient it was no different to
any other prescription."23
Whereas in 1963 there were only five brands of the pill on the market, by 1966
the number had increased to 15.24 Patients increasingly
went to their GP asking about birth control pills and prescriptions for them.
By 1970 around 0.7 million of the five million married women aged 16 to 40 who
were on the pill obtained their supplies by means of a private prescription
written by their GP.25 Virtually all these prescriptions
were dispensed by community pharmacists. The impact was considerable. John Savage
recalls: "Oral contraceptives were only available on private prescription. The
increase in private dispensing due to it was tremendous. In fact, we kept a
separate prescription book just for oral contraceptives. The [Pharmaceutical]
Society recommended that you stored your piles of private scripts with the oral
contraceptive ones separated out. . . . They carried on as private prescriptions
until the mid-1970s, when oral contraceptives were made available free of charge.
By then there were 10 years’ worth of entries in prescription books. The Society’s
inspectors were very pleased when it became free. They were fed up with minor
infringements on entries in registers."26
By 1975, over two and a quarter million women were on the pill in Great Britain.
This rising demand, coupled with a shortage of doctors, gave rise to recommendations
to take the pill off prescription, and to involve more para-medical personnel.
The Lancet supported freeing the pill from prescription,27
whereas the British Medical Journal objected, and a number of distinguished
individuals advocated over-the-counter sale without medical supervision.28
By October, 1976, a Department of Health and Social Security working group had
recommended that, subject to safeguards, suitably trained nurses, midwives,
health visitors and some pharmacists (as well as doctors) should be able to
prescribe the pill to make it more accessible. However, concerns about the safety
of the pill, which surfaced the following year, put paid to any suggestion of
off- prescription supply at this time.
Contraceptive advice to the unmarried presented both a challenge and a dilemma
for the medical and pharmaceutical professions. By 1952, the Family Planning
Association had got round to giving contraceptive advice to girls who were about
to be married. But they were under pressure to extend the provisions of premarital
advice from their clinics. Obtaining contraceptives from pharmacies where they
were not known offered a distinct advantage to these patients. Audrey Leathard,
in her study of family planning services in Great Britain, found that "chemists
asked no questions: [whereas] doctors acted according to their own moral and
social outlook and the particular circumstances; the [Family Planning Association’s]
public answer was to accept those within four to eight weeks of their wedding
day".
By the early 1960s the facilities needed for community pharmacists to carry
out pregnancy testing on their premises were already available. Some were beginning
to offer this service direct to patients, and it soon became a matter on which
the Pharmaceutical Society felt action was called for. Its decision was conveyed
to the membership in the 1964 version of the Statement Upon Matters of Professional
Conduct. This included the statement: "Specimens for pregnancy diagnosis should
only be accepted through a medical practitioner, to whom the report will be
sent by the pharmacist or independently. Such facilities should not be advertised."
This mirrored the prevailing medical view of pregnancy testing, but also represented
the deference of pharmacists to medical authority.
By 1970, pregnancy testing services were being provided from many community
pharmacies. The Pharmaceutical Society found it necessary to amend its response
to the advertising of such services. In the 1970 Statement Upon Matters of Professional
Conduct it indicated that although the dispensing of medicinal products, or
the professional services of a pharmacist, should not be advertised directly
or indirectly, an exception could be made for "a discreet notice, relating to
Pregnancy Testing Services, [which] may be exhibited at any pharmacy".
During the 1980s, pregnancy testing in pharmacies grew to the point where it
had become commonplace. By 1991, the now Royal Pharmaceutical Society had come
to the conclusion that "pregnancy testing is a professional service offered
by many community pharmacists. With the increase in control on expenditure in
National Health Service hospitals, it is likely that more pharmacists will wish
to offer such a service." Today, the Society’s approach is to provide detailed
guidance notes on issues such as confidentiality, advertising, facilities for
carrying out the test, record keeping, and communication of the result through
the channel of its ‘Medicines, ethics and practice: a guide for pharmacists’.29
By 1993, the Royal Pharmaceutical Society had found it necessary to give guidance
to its members on the giving of contraceptive advice or pregnancy testing for
a girl under the age of 16 years. This indicated that when giving such advice
"efforts should be made to establish whether the girl is under 16 years of age.
If this is the case, the pharmacist should strongly urge her to seek advice
from her general practitioner, parent or similar responsible adult. In deciding
whether to provide contraceptive advice, regard should be paid to the maturity
of the girl and the consequences of unprotected intercourse taking place. Information
concerning a positive pregnancy test result should not normally be referred
without the girl’s consent."
Within a period of less than 30 years, then, the profession’s position had shifted
from only reporting the results of pregnancy tests to medical practitioners,
to not reporting the result to anyone (including the medical practitioner) without
the patient’s consent.
For much of the century, when pregnancy did occur it was frequently both unplanned
and unwanted. Although there is no hard statistical evidence available on the
numbers of abortions carried out, in 1910 doctors asserted that up to a quarter
of all conceptions were terminated.30 There were
only too many people ready to offer help, at a price. Quacks and abortionists
advertised their products and services extensively, and enormous profits could
be made. At the trial in Exeter in 1897 of Louisa Fenn, who sold abortifacient
pills under the name of "Madame Douglas", it was revealed that she had spent
£600 (roughly 12 times the annual wage of a working man) on advertising in just
six months.31 Before spending their money on such
pills most women would have first tried hot baths, gin and strenuous walks.
In England, lead in the form of diachylon pills was consumed in large quantities
with the same intention.
High levels of abortion and attempted abortion continued well into the 20th
century, and were still high at the time of the Abortion Law Reform Act in 1967.
Abortion related deaths helped to push up maternal mortality rates in England
from 3.91 per thousand births in 1921 to 4.41 per thousand in 1934.32–34
Marie Stopes wrote to the Times in 1931 that in a single three-month period
she had received 20,000 requests for help with abortion.35
Sometimes, requests would be received by the pharmacist for materials that could
possibly be used to perform an abortion. Such requests presented considerable
difficulties to pharmacists, particularly in those cases where the material
concerned might have equally legitimate alternative uses. This was certainly
the case with regard to slippery elm bark, which had an entirely legitimate
use as a health food. But the advice to members of the pharmacy profession from
its professional body was perfectly clear: "If it is suspected, even on the
most slender of evidence, that the purchaser requires a particular substance
for this purpose (ie, to bring about the miscarriage of any woman), then the
only possible action on the part of the seller is the refusal of the sale."
Pharmacists received little in the way of formal training in such matters. Charles
Robinson, during his apprenticeship in Norwich in 1929, recalls: "Products known
as ‘female pills’ were widely advertised for menstrual troubles: but it was
fairly certain that they and a variety of other products were being used in
excessive doses in the hope of inducing abortion. It was no part of my instruction
to learn about these things. All I could see were desperate looking women inquiring
about a variety of potentially dangerous devices, and the grave shaking of a
pharmacist’s head as they went sadly on their way."10
Evidence collected in the oral history study suggests that a great deal of ingenuity
went into the procurement of such agents, that a wide range of materials were
used for this purpose, and that pharmacists were often only too willing to supply
them, albeit within the guidelines laid down by the Society. A woman would rarely,
of course, request such an item on her own behalf. The messenger was sometimes
a man, frequently a child, and occasionally an older woman. In some areas, such
requests would be surprisingly frequent.
Brian Hébert recalls working in a pharmacy in Portsmouth in the 1930s: "Oh yes,
and I mean the big joke — well I don’t know if it was much of a joke, but we
thought it was funny at the time. Slippery elm was the requested item, and of
course we followed the Pharmaceutical Society’s instructions of breaking it
up into, I think it was described as less than two inch lengths then, but certainly
short lengths. You break it all up, and sell it to the child. It was always
a child who would come in for it. And, er, sure enough, within two minutes the
child would be back and say ‘mummy says have you got the bigger pieces?’ and
that was commonplace, quite commonplace. And then pennyroyal pills, and all
the rest of it, were asked for."
For women who could afford to go to the doctor one possible course of action
was a prescription for an ergot preparation. Alan Kendall recalls that "one
doctor prescribed mist ferri aperiens with liquid extract of ergot’.36
A casual examination of prescription books from the time indicates a significant
proportion of ergot preparations. Clearly, some sympathetic ears were to be
found. But this level of unwanted pregnancy was of course a reflection of the
level of ignorance at the time about sexual matters in general, and about contraception
in particular.
At the turn of the century, a very large number of quack remedies were available to women to cure disorders of the "female sexual instinct", including sterility.37 In 1903, for example, Mrs Arons’s women’s remedies ("made by a woman for women") promised to "remove the irregularities and barriers which troubled young, unmarried women, and also to strengthen and invigorate the sexual organs of women of mature years in the change of life and those of barren women".38 When the British Medical Association carried out its survey of secret remedies in 1909, and again in 1912, it found that "female medicines" constituted one of the largest classes of proprietary nostrum.39 It listed 30 such preparations with names like Nurse Powell’s Corrective Pills or Kearsley’s Original Widow Welch’s Female Pills, and which frequently contained either oil of pennyroyal or quinine. In reality most of these were directed at the thousands of desperate women who feared they might be pregnant and were anxious to procure an abortion.
The list of preparations with supposed aphrodisiac properties is extremely
long.40 However, the principal source of supply
of at least some of these has been community pharmacies. For much of the century
yohimbine was considered to be a powerful aphrodisiac. Yohimbine remained in
the British Pharmaceutical Codex until 1949, and was originally sold under the
brand name Aphrodine.41 A number of proprietary
preparations containing it were sold through pharmacies. These included Potensan,
which contained 5mg of yohimbine, 0.75mg of dexamphetamine and 15mg of amylobarbitone,
and Potensan Forte, which contained 5mg of yohimbine and 5mg of methyltestosterone.
Other products available in the pharmacy with legitimate therapeutic purposes
found themselves open to more creative uses. Peter Homan worked in a Boots branch
in south London that had a predominantly black population in the early 1970s.
He remembers: "We sold a lot of Capsylum ointment. It was intended for rheumatism,
and it produced a very hot feeling. It was used because it stimulated the blood
supply, and, applied to the right parts, it produced an increased sensation."15
The success of her books and her frequent travels around the country meant that
thousands of women wrote to Marie Stopes seeking advice on sexual matters. To
her astonishment she found that working class women wanted to know how to make
their husbands less rather than more passionate. She wrote: "The demand for
a simple pill or drug to solve such troubles is astonishingly widespread. After
lecturing to working class audiences, in the question time, and even more when
talking individually to members of the audience afterwards, I am surprised by
the prevalence of the rumour that there are drugs which can safely be taken
to reduce the man’s virility, and that such drugs act directly and only on the
sex organs. I think it may not be out of place, even in a book specifically
addressed to educated people, to explode this popular fallacy, and warn everyone
that no reliable drug of this nature exists."34
Yet bromides were a popular ingredient of many prescriptions during the inter-war
period, and their sedative properties were widely known. Alan Kendall worked
in a pharmacy in Yorkshire in the late 1930s. He recalls: "We did some bulk
preparations in 80 ounce Winchesters ready for dispensing. The most common were
mist pot brom, and mist pot brom with nux vomica. This was used as a tonic.
It was coloured red. Bromides were used for people with epilepsy. The only other
drug available was phenobarbitone."36 Chloral,
too, was an ingredient of many preparations, and it seems highly likely that
some of these products were used in this way, although the evidence for this
is so far entirely anecdotal.
The inter-war period was a very significant one in terms of developments in
reproductive physiology and pharmacology. Indeed, the 1920s and 1930s have been
described as the "heroic age" of reproductive physiology, during which scientists
competed in an "endocrinological gold rush".42
A science of organotherapy developed, in which individual organs from non-human
sources were prescribed as treatments for a wide range of conditions. But more
often, non-human organs were combined in "pluriglandular" tonics for the treatment
of conditions supposed to result from general glandular insufficiency. Pluriglandular
preparations for the treatment of sterility could be bought from pharmacies
without a doctor’s prescription.
A large number of such products were available. Fertilinets were advertised
for use in female disorders, menstrual and climacteric disturbances and frigidity.
Pregnantol was available to combat barrenness and miscarriage, influence the
natural events of fertilisation, regulate the course of pregnancy, and ensure
healthy offspring.43 A range of hormone beauty
baths, bust development glands, slimming glands, gland tablets for male and
female impotence, and sterility gland tablets for barrenness, were sold under
the brand name Juvigold by the Middlesex Laboratory of Glandular Research.44
Bioglan Laboratories marketed Bioglan L as useful in amenorrhoea, infantile
uterus, sterility, menopausal syndrome and sexual frigidity.45
But for the well-informed who could also afford it, a whole world of sexual
paraphernalia was available. Indeed, there were some pharmacies that catered
almost exclusively for this market, particularly in cities. E. J. Willis worked
at the flagship shop of Heppell & Co, on the corner of Piccadilly and St James
Street in London, in 1932. He recalls: "Most of the goods sold in the shop were
sexually slanted: morning tonics at the soda fountain; Amber Moon at 4s 6d a
tot, or twice as much for a double; Elixir de Vie for a little less. There were
aphrodisiacs, anti-infectives, and, of course, condoms. Condoms came in all
colours, shapes and sizes, and the specialities of the house were called Abyssinians
(pink) and Egyptians (blue). They were packed in handsome leather wallets of
two dozen lined with oilskin (no splits). Outsiders off the street who came
in for three of a well known brand did not usually come back a second time."46
In 1941, the Pharmaceutical Society found it necessary to include in its Statements
Upon Matters of Professional Conduct an instruction to the effect that "advertisements
of medicines should not be issued to the public referring to sexual weakness".
By 1953, this had been extended to other areas, and had been elaborated to indicate
what the appropriate response of the pharmacist should be. The Statement then
read: "No material should be displayed which makes a reference to sexual weakness,
premature ageing or loss of virility, or any reference to complaints of a sexual
nature in terms which lack the reticence proper to the subject."
The community pharmacy was also a place where patients would come seeking
advice about the treatment of venereal disease. This was another difficult area
for pharmacists, whose possible courses of action were severely limited by the
Venereal Disease Act of 1917, which was designed to prevent the treatment of
venereal disease other than by a qualified medical practitioner, and to control
the supply of remedies for it. The advice given to pharmacists was a masterpiece
in balancing the demands of trade, professionalism and the law. Should a person
ask for a particular preparation by name only, that person could legally be
supplied. But if the person inquired as to its efficacy for the treatment of
some form of venereal disease, any discussion on the merits or otherwise of
the preparation immediately rendered the supply illegal. The supply had now
introduced a "knowledge" possessed by the supplier. Similarly, supply was forbidden
when the prospective purchaser asked "for something (not known to himself) good
for the treatment" of the disease. The only action possible was to refer the
person to a medical practitioner or to the local clinic.
In reality a whole range of products were available for sale from pharmacies
for the treatment of venereal diseases. Victor Hammond recalls working in a
pharmacy in Formby near Liverpool in the 1930s: "We sold a large volume of contraceptives,
but we also sold a lot of gonorrhoea bags. There was a lot of VD around then.
It was a gauze bag which fitted over the penis. We sold them the bags and then
referred them to hospital."47
Before the days of penicillin the main treatment for VD was arsenic, which was
only available on prescription. Tony Sheridan undertook his apprenticeship in
a pharmacy in north London in the late 1930s. He recalls: "As an apprentice
I saw lots of prescriptions for arsenical compounds, in some of which the arsenic
content got pretty high. This continued until penicillin arrived [in the late
1940s]. We had cases of people coming in saying ‘I’ve got crabs. What have you
got for it?’. Usually we would supply benzoyl benzoate."48
One group of preparations which were sold from pharmacies for the treatment
of syphilis contained mercury. Bill Adlington worked in a pharmacy in Liverpool
in the late 1940s. He recalls: "We saw a certain amount of VD. We did a steady
trade in mercury ointment, which was sold in three inch tins. No prescription
was necessary."49
It is clear, therefore, that despite the best intentions of the Venereal Disease
Act of 1917, pharmacists were still able to continue with a little trade in
remedies for VD. It was only with the coming of the special clinics based in
hospital outpatient departments that visits to the pharmacy for this purpose
finally ceased.
This article has demonstrated that, throughout the 20th century the community
pharmacist in Great Britain has played a significant part in the sexual health
of the nation. This has varied from the supply of contraceptives to the provision
of pregnancy testing services, and occasionally sex education. What is clear
is that pharmacists throughout the century have found the supply of sexual requisites
and the provision of pregnancy testing services to be a useful item of trade.
The key areas identified in the Society’s recent discussion document represent
at least in part an extension to this supply function: this is the case, for
example, with extending access to emergency hormonal contraception, and with
plans to improve the management of oral contraceptives. But other areas (providing
high quality advice about forms of contraception, and making inputs into effective,
evidence-based strategies on contraception and sexual health) represent a further
shift in the delicate balance between trade and profession which characterises
pharmacy. The challenge for the profession is in identifying its unique selling
point in relation to these advisory functions, given the abundance of high quality
advice which is already available about forms of contraception, and given the
number of agencies and health professionals who are already contributing to
local and national strategies.
Historically, it seems that the contribution made by community pharmacists to
the sexual health of the nation appears to have been significant despite the
difficulties which pharmacists themselves placed in the availability of contraceptive
devices, and in the provision of information about sexual matters. In her analysis
of the place of family planning clinics in the early 1970s, Audrey Leathard
concludes that: "The first key point was that family limitation had been achieved
largely by male methods, by men who had never been near a family planning clinic
in their lives. In a sense one could argue that the most important place in
the history of British birth control was the chemist (or barber’s shop), not
the clinic."50
That importance was due to the key supply function of the pharmacist, a function
facilitated by their ready accessibility and widespread availability. In developing
its strategy for an expanded role for community pharmacists in sexual health,
involving as it does a multidisciplinary approach, the Society’s Council would
be well advised not to ignore the centrality of the supply function. At the
same time it can, perhaps, afford to be a little more modest in its aspirations
for the future than the exalted place history gave it in 1980, with or without
the aid of the barbers.
Acknowledgments
The research on which this article is based was funded by the Wellcome Trust,
through a project grant in the history of medicine awarded to Professor Klim
McPherson and Professor Virginia Berridge at the London School of Hygiene and
Tropical Medicine. Quotations from recorded interviews are used by kind permission
of the participants. The tapes now constitute part of the National Life Stories
Collection of the National Sound Archive at the British Library in London. Thanks
to Virginia Berridge and Kaye Wellings at the London School of Hygiene and Tropical
Medicine for commenting on earlier drafts of this article. Particular thanks
are due to the participants in the oral history study for permission to quote
from recorded interviews.
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Stuart Anderson is senior lecturer in public health and policy and teaching programme director at the London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT. He is also currently vice-president of the British Society for the History of Pharmacy