Table Of ContentA Social History of Medicines
in the Twentieth Century
To Be Taken Three Times a Day
A Social H'istory of Medicines
in the Twentieth Century
To Be Taken Three Times a Day
John K. Crellin
informa
healthcare
New York London
Published by
Phannaceutical Products Press®, an imprint of The Haworth Press, Inc., 10 Alice Street, Binghamton,
NY 13904-1580.
© 2004 by The Haworth Press, Inc. All rights reserved. No part of this work may be reproduced or
utilized in any form or by any means, electronic or mechanical, including photocopying, microfilm,
and recording, or by any information storage and retrieval system, without permission in writing
from the publisher. Printed in the United States of America. Reprint 2006
PUBLISHER'S NOTE
This book has been published solely for educational purposes and is not intended to substitute
for the medical advke of a treating physician. Medicine is an ever-changing science. As new
research and clinical experience broaden our knowledge, changes in treatment may be required.
While many potential treatment options are made herein, some or aJl of the options may not be
applicable to a particular individual. Therefore, the author, editor, and publisher do not accept
responsibility in the event of negative consequences incurred as a result of the information presented
in this book. We do not claim that this information is necessarily accurate by the rigid scientific and
regulatory standards applied for medical treatment. No warranty, expressed or implied, is furnished
with respect to the material contained in this book. The reader is urged to consult with his/her
personal physician with respect to the treatment of any medical condition.
Cover design by Mary louise E. Doyle.
''To Anni Besant, Marie Stopes"-Reprinted from, CMAJ 1966, Volume 64, Page 1015 by permis-
sion of the publisher, © 1966 Canadian Medical Association.
Library of Congress Cataloging-in-Publication Data
Crellin, J. K.
A social history of medicines in the twentieth century : to be taken three times a day I John
K. Crellin.
p. em.
Includes bibliographical references and index.
ISBN 0-7890-1844-6 (hard : alk. paper)-ISBN 0-7890-1845-4 (soft : alk. paper)
1. Drugs-North America-History-20th century. 2. Drugs--Great Britain-History-20th
century. 3. Drug utilization-North America-History-20th century. 4. Drug utilization--Great
Britain-History-20th century.
[DNLM: 1. Prescriptions, Drug-history--Canada. 2. Prescriptions, Drug-history-Great
Britain. 3. Prescriptions, Drug-history-United States. 4. Drug Therapy-history-Canada.
5. Drug Therapy-history--Great Britain. 6. Drug Therapy-history-United States. 7. History of
Medicine, 20th Cent. -Canada. 8. History of Medicine, 20th Cent--Great Britain. 9. History of
Medicine, 20th Cent-United States. 10. Social Change-history-Canada. 11. Social Change-
history--Great Britain. 12. Social Change-history-United States. QV 711 AAI C915s 2004]
I. Title.
RM45. C74 2004
615' .1'0973-dc2l
2003012397
To JDC for healthy skepticism and a whole lot more.
ABOUT THE AUTHOR
Dr. John K. Crellin holds British qualifications in both medicine and
pharmacy. He also holds a PhD in the history and philosophy of sci-
ence. His principal interest is self-care, particularly the role of com-
plementary medicine. Dr. Crellin has taught undergraduate, graduate,
medical, and complementary/alternative medical students in the United
Kingdom, the United States, and Canada. His present position is John
Clinch Professor of the History of Medicine at Memorial University
of Newfoundland; he gives frequent public and professional talks on
complementary/alternative medicine.
Dr. Crellin's publications range widely on the history of medicine
and pharmacy, as well as on herbal medicine and home medicine in
general. His books include Professionalism and Ethics in Comple-
mentary and Alternative Medicine (Haworth, with F. Ania), "By the
Patient and not by the Book": Constancy and Change in Small Town
Doctoring (with P.I. Crellin); Herbal Medicine Past and Present
(with J. Philpott); Home Medicine: The Newfoundland Experience;
Alternative Health Care in Canada: Nineteenth- and Twentieth-Cen-
tury Perspectives (co-edited with R. Andersen and J. Connor); and
Healthways: Newfoundland Elders, Their Lifestyles and Values (with
R.R. Andersen and B. O'Dwyer).
CONTENTS
Preface and Acknowledgments ix
Chapter 1. The Big Canvas: Issues and Context 1
Some Key Questions 1
Social Validation of Medicines 3
Regionalism in the Story of Medicines 6
Organization of the Book 8
Rural Scenes 9
Public/Community Health 15
Colonialism 17
Writing the Story 20
Chapter 2. Prelude: Seventeenth to Nineteenth Centuries 31
Introduction 31
An Early Search for New Remedies 32
Interfaces: Conventional Medicines, Self-Care,
and Commercialism 40
Chapter 3. Medicines for Weakness: 1900 to c. 1950 51
Weakness and Social Conditions 51
Prevention and Treatment 54
The Medicines 58
Pharmacological Effects, "Cascades," and Social
Validation 90
Chapter 4. Authority and Gatekeeping: 1900 to c. 1950 95
Authority and Patients' Faith 96
Authority and Prescription Medicines 108
Authority, Gatekeeping, and Responsibilities 114
Authority: The Druggists' Role 130
ChapterS. Certainty? Maybe, Maybe Not: 1950 to 2000 143
The Challenges of Change 143
Validation, Rejection, Ambivalence, and Four Themes 146
Theme 1: Accommodating New Medicines 151
Theme 2: Patients' Dependence and Professional
Gatekeeping 163
Chapter 6. Hope Amid Uncertainty: 1950 to 2000 191
Theme 3: Public Confidence: Challenges
and Responses 191
Theme 4: Changing Relationships-From Compliance
to Concordance 226
Epilogue. Do We Need a "New" Therapeutics? 243
Notes 247
Index 331
Preface and Acknowledgments
A Social History of Medicines in the Twentieth Century: To Be
Taken Three Times a Day is written for everyone who has wondered
how they came to be taking one medicine rather than another, either
as self-care or a doctor's prescription. This includes all those who are
additionally involved in the complex business of prescribing, dis-
pensing, advising on, and administering modern medicines. Today,
expectations are that everyone takes an increasing responsibility for
his or her health and is sufficiently knowledgeable about these medi-
cations. It is a time, too, when countless concerns exist regarding
poor patient compliance with prescription medication directions.
Before discussing this dilemma, the reader is taken through a com-
plexity of issues to explore why, throughout the twentieth century,
physicians and sick people on both sides of the Atlantic prescribed or
chose a particular medicine-perhaps validated it-often when oth-
ers felt it was of little or no value or remained uncertain of it.
Historical explorations can serve many purposes. One hope is that
the perspectives in this book, dealing with everyday usage rather than
discovery, will help readers to sharpen their thinking and ponder
questions about how we reached a situation in which medicines have
become so dominant, not only in public worries about rising health
care costs, but also in the lives of countless individuals.
The writing of this book was prompted by a series of oral histories
taken from retired pharmacists and the need to place the information
in historical and social context. From there, in the absence of a general
account of the everyday use of medicines in the twentieth century, it
grew into the present work that examines medical, pharmaceutical,
and sociocultural influences.
Particular thanks go to many people who, wittingly and often un-
wittingly, have helped in many ways. Living in England, the United
States, and Newfoundland, Canada, over the years allowed me to im-
bibe understandings and perspectives from three countries. Educa-
tion in both pharmacy and medicine at the University of London initi-
ated my firsthand exploration of attitudes toward medicines in the
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