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In the Middle Ages pharmacists travelled from town to town as street traders, selling medicinal herbs, drugs and herbs. In the course of time they moved from market stalls to solid houses, with workshops and laboratories for the research and production of medicines. Industrialization made it possible to produce large quantities of medicine. The pharmaceutical industry was born. The education of medical doctors also became more professional. Progressive sanitary conditions improved hygiene and reduced disease. The death rate fell as a result of vaccinations and the fact that medical care was extended to the poor. Above all infant mortality and deaths from childbirth were reduced. From the mid-1870's medical care was also improved in the rural areas of the Rhineland.