HISTORY OF PHARMACY (Milestones from Ancient Ages to Modern Times)

Prehistoric Pharmacy - how was disease and illness perceived?

Healers of prehistoric settlements placed disease within the context of their general understanding of the world around them—alive with good and evil spirits.

During these times, illness was explain in supernatural terms (as they did the other changes and disasters surrounding them).

how can spells of sorcerers be combatted?

Spells of sorcerers which were cast with the aid of magical substances, could be combatted with the same remedies.

Dual heritage out of these origins

Drugs as simple tools

Drugs as special substances with nearly supernatural powers

Shanidar

one of mankind's oldest settlements - ca 30,000 BCE

Excavations of Shanidar

provide basis that prehistoric people gathered plants for medicinal purposes

folk knowledge on the healing properties of certain natural substances grew by trial and error.

Pollen samples with long-known curative powers

1. Yarrow
2. Cornflower
3. Bachelor's Button
4. St. Barnbaby's Thistle
5. Ragwort or Groundsel
6. Grape Hyacinth
7. Joint Pine or Woody Horsetail
8. Holly hock

what are the long-known curative powers of pollen samples?

diuretics, stimulants, astringents and anti-inflammatory properties

Origin of the word Shaman

from the Turkic word šamán

Shamans or tribal healers

existence?

what did they guard?

recognition?

what was used for curing?

what did they do?

compounded to?

believed to have existed since the Stone Age

guarded the healing knowledge and the recognition of medicinal plants sometimes used as food, spices or charms

magical potions for curing

diagnosed and treated most serious or chronic illness

compounded the remedies needed to stave off the influences of evil spells or spirits

Concept that is considered one of humanity's greatest advances

Although only a small number of effective drugs were discovered by early people of the prehistoric era, the very concept of influencing bodily functions via an outside force must be considered one of humanity's greatest advances.

Antiquity: The Great Age

Changes in the concepts of disease and healing as civilizations emerged in the great fertile valleys of the Nile, the Tigris and Euphrates, the Yellow and Yangtze, and the Indus Rivers

Ancient records reveal a gradual separation of empirical healing from purely spiritual

Ancient Babylon

medical care was provided by two classes of practitioners

Asipu and Asu were not in direct competition and sometimes cooperated on difficult cases

Asipu (magical healers)

relied more heavily on spells and used magical stones far more than plant materials

Asu (empirical healers)

drew upon a large collection of drugs and manipulated them into several dosage forms still basic today, such as suppositories, pills, washes, enemas, and ointments

Ancient Assyria

Ashurbanipal

"The Assyrian Herbal: a Monograph on the Assyrian Vegetable Drugs" by R. Campbell Thompson 250

Ashurbanipal

King of the Neo-Assyrian empire.

warrior, scholar, empire builder, king slayer, lion hunter, librarian

outstanding contribution resulted from his academic interests

assembled in Nineveh the first systematically collected and cataloged library in the ancient Middle East

Royal Library of Ashurbanipal

collection of thousands of clay tablets (cuneiforms) and fragments containing texts of all kinds from the 7th century BC.

"The Assyrian Herbal: a Monograph on the Assyrian Vegetable Drugs" by R. Campbell Thompson

based in what archeological site?

how many types of sourced medicines?

based on materials found in the archaeological site of Kouyunjik (then ancient Nineveh, capital of Assyria) in northern Mesopotamia

250 vegetable-, 120 mineral- and 180 animal-sourced medicines

Instruction on how to prepare the medicine (e.g. pulverize the seed of the carpenter plant, the gum resin of the markasi plant and thyme; dissolve in beer and let the man drink)

R. Campbell Thompson

British archaeologist, Assyriologist, and cuneiformist

Babylonian-Assyrian Medicine

in terms of:
Disease
Priest as diviner
Treatment
Illness
healing
Medicine

▪ Disease - became primarily an omen
▪ Priest as diviner - exorcist
▪ Direct treatment of the disease
▪ Illness - divine punishment
▪ Healing - purification
▪ Medicine - catharsis

Babylonian-Assyrian Medicine (3 Aspects)

1. Exorcism
2. Divination
3. Medical treatment by means of purification or catharsis

origin of the word exorcism

from Late Latin exorcismus , from Greek exorkizein to bind by oath

Exorcism

is the practice of evicting demons or other spiritual entities from a person or place which they are believed to have possessed by causing the entity to swear an oath.

origin of the word divination

from Latin divinare "to foresee, to be inspired by a god", related to divinus, divine

Divination

is the attempt to gain insight into a question or situation by way of a standardized process or ritual;

Divination can be seen as a systematic method with which to organize what appear to be disjointed, random facets of existence such that they provide insight into a problem at hand.

Divination vs Fortune Telling

divination has a formal or ritual and often social character, usually in a religious context, as seen in traditional African medicine;

fortune telling is a more everyday practice for personal purposes.

Particular divination methods vary by culture and religion.

Shen Nung: The Divine Husbandman

considered to be?
venerated as?
teaching?
investigated?
author of?

considered to be the Father of Chinese agriculture; venerated as the Father of Chinese medicine

legendary emperor taught his people how to cultivate grains as food, to avoid killing animals

sought out and investigated the medicinal value of several hundred herbs, many of which he tested on himself

assumed to be the author of Shen-nung pen ts'ao ching (Divine Husbandman's Materia Medica),

Divine Husbandman's Materia Medica

the earliest extant Chinese pharmacopoeia

includes 365 medicines derived from minerals, plants, and animals (podophyllum, rhubarb, ginseng, stramonium, cinnamon bark, ma huang)

Ancient Egypt

records?
medical texts?
recipes?

records of Egyptian medical practices demonstrate even greater pharmaceutical sophistication more dosage forms compounded from more detailed formulas

Egyptian medical texts show a close connection between supernatural and empirical healing

suggested recipes began with a prayer and incantation.

What was the main vehicle of healing power in Ancient Egypt?

plant drugs (mostly laxative and enemas)

how many formulas and drugs are mentioned in Ebers Papyrus or Papyrus Ebers?

contains the greatest numbers of drugs and formulas - more than 800 formulas or prescriptions being described and over 700 different drugs being mentioned

e.g. acacia, castor oil, sodium carbonate, etc.

Georg Ebers

discovered and partly translated by Georg Ebers

formulative vehicles of the day based on Ebers Papyrus

beer, wine, milk and honey

"polypharmacal"

type of preparation where in any of the pharmaceutical formulas employed two dozen or more medicinal agents

Mortar, sieves, balance

Materials used by the Egyptians in their compounding

Ancient Greece

pharmakon
Demiourgoi
Prometheus
Asklepios

φάρμακον or ' pharmakon

drug, magic spell, remedy, or poison

Demiourgoi

general term for artists and physicians, the latter described by Homer to have advanced to where they diagnosed natural causes for illness (but without rejecting the use of supernatural healing in conjunction with empirical remedies)

Prometheus

also known as?
contribution?

preparer of remedies;

gave humankind fire (stole it from Zeus).

taught humankind the arts of civilization, such as writing, mathematics, agriculture, medicine, and science

Asklepios

also known as?
parents?
meaning of name?
raised by?
legend?

the greatest of healing gods

son of Apollo (god of healing, truth, and prophecy) and Coronis (mortal princess)

"to cut open"

raised by Centaur Chiron; instructed him in the art of medicine

Legend: Centaur Chiron taught Asklepios his pharmaceutical knowledge aided by his two daughters, Hygeia and Panacea

"Staff of Asklepios"

official symbol of medicine all over the world

bowl and sacred serpent carried by Hygeia

international recognized symbol of pharmacy.

Hygeia is known as the

goddess of good health

Hippocrates of Cos (ca 425 BC)

also known as?
founded?
teaching?

Father of Medicine

Founded the Hippocratic School:

all illness was the result of an imbalance of the four humours in the body, which in health were naturally equal in proportion (pepsis).

Explained illness by forging a conceptual link between the environment and humanity by connecting the four elements (earth, water, air, fire) to four governing humors of the body (black bile, blood, yellow bile and phlegm)

Iatros

trained Greek Physicians who followed the Hippocratic method

favored dietary and life style adjustments

prepared medicines or left prescriptions behind for family members to compound and administer if conservative methods failed

Theophrastus (ca 370-285 BC)

student of?
also known as?
because of?

student of Aristotle and among the greatest early Greek philosophers and scientists

Father of Botany

prepared medicines from plants & conducted first great study on it

combined information from scholars, midwives, root diggers and travelling physicians

Mithridates VI Eupator

also known as?

Father of Empirical Toxicology

King of Pontus whose allies used grayanotoxin-containing honey ("mad honey") against the troops of Pompey the Great

conducted experiments on prisoners condemned to capital punishment to test poisons and antidotes

What did the allies of Mithridates VI Eupator used against Pompey the Great?

King of Pontus whose allies used grayanotoxin-containing honey ("mad honey") against the troops of Pompey the Great

mithridatizing

progressively took sublethal doses of poisons to protect himself against poisoning and eventually acquired resistance

Mithridatum

a general antidote whose recipe was found in his cabinet by Roman soldiers and carried to Rome by Pompey

Pedanius Dioscorides

Greek physician and botanist

first to deal with botany as an applied science of pharmacy; described the drugs of his time and explained their effect (arranged his description systematically)

what was the work of Pedanius Dioscorides

5 volume book in Greek Περί ύλης ιατρικής or the Latin translation De Materia Medica

De Materia Medica

standard encyclopedia of drugs for hundreds of years.

study is known today as pharmacognosy, pharmakon-drug and gnosis- knowledge

Galen

Greek physician practicing in Rome in the 2nd Century AD

What are the three approaches that he devised to restore the humoral balance

1. using drugs of a supposedly contrary nature. (e.g to treat external inflammation, a cool and wet drug is applied like cucumber)

2. bleeding, a favorite treatment to remove the apparent excess of blood that was causing the illness.

3. advocated the use of polypharmaceutical preparation ("shotgun prescriptions") to restore its humoral balance

tested the action of drugs both qualitatively and quantitatively

When did medicine reach its pinnacle in classic antiquity?

Medicine in classic antiquity reached its pinnacle with Galen
His influence was so pervasive among medical practitioners
Writers who followed tended to be compilers and commentators on his work

the basics of his healing approach (Galen)

the balance of the body's humors through contrary drugs - mixed with folklore and superstition guided the common folk in their own treatment of ailments

The Middle Ages

The period from the first fall of Rome (ca 400 AD) and the fall of Constantinople (1453)

what was the status of government in the Middles Ages?

Local feudalism replaced centralized government

what was the stabilizing cultural force?

church

what was the shift in terms if treatment? (2)

The use of drugs to treat illness underwent another shift: pagan temples closed (some of which had operated in conjunction with Greco-Roman healing methods)

Rational drug therapy declined in the West Church' teaching that sin and disease were related intimately

Saints Damian and Cosmas

known as the (2)?
became distirnguished where?
tortured under the rule of ?

Patron saints of Pharmacy

twins who became distinguished physicians in Cilicia, where their charity converted many to Christianity

"Silverless ones" - refused payment for their services

Imprisoned, tortured, and beheaded during the persecution of Christians by the Roman emperor Diocletian

Monasteries

became centers for healing, both spiritual and corporal

Monks

own short versions of medical texts (epitomes)
planted gardens to grow the medicinal herbs

where was the first privately owned drug store established?

Baghdad in the 8th century by the Arabs

What did the Arab physicians reject and how did they solve it?

Arab physicians rejected the old idea that foul-tasting medicines worked best.

Instead, they devoted a great deal of effort to making their dosage forms elegant and palatable, through the silvering and gilding of pills and the use of syrups.

The Middle Ages

new civilization?
nations of Islam conquered?
writings?

New civilization - followed the teachings of Mohammed (570-632)

The nations of Islam conquered huge areas of the Middle East and Africa, eventually expanding into Spain, Sicily and Eastern Europe.

Greek writings were translated into Arabic

Rhazes (Zakariya al-Razi)) (860-932) and Avicenna also known as the "Persian Galen" (980-1063)

Islamic medical men who added to the writings of the Greeks

Separation of Pharmacy and Medicine - who separated them?

Frederick II of Hohenstaufen (Emperor of Germany - 1240 AD): presented subject Pharmacists with the first European edict completely separating their responsibilities from those of Medicine, and prescribing regulations for their professional practice

The Renaissance

(Beginning of the Modern Period; The Experimental Age)
Then was a time for new ideas and explorations

Constantinople (Istanbul) in 1453

ell to the conquering Turks and remnants of the Greek scholarly community fled West

Johann Gutenberg

began printing with movable type and started an Information revolution

Columbus

discovered the New World

Vasco de Gama

found a sea route to India, commerce based on money and banking was established and syphilis raged through Europe

focus of printers in the Renaissance

Printers turned to medical and pharmaceutical works, especially those that could benefit from profuse and detailed illustrations:

Anatomical masterworks of Andres Vesalius (1514-1564) - De Corporis Fabrica

Illustrations of plants for the study of plant drugs

where did drugs come from in the renaissance

New drugs were arriving from far off lands

Nuovo Receptario

original?
published when and where?
result of?
guided by?

originally written in Italian

was published and became the legal standard for the city state of Florence in 1498

result of collaboration of the Guild of Apothecaries and the Medical Society (one of the earliest manifestations of constructive interprofessional relations) and the guidance of Savonarola, a powerful Dominican monk who was also a political leader in Florence at that time

Valerius Cordus (1515-1544)

wrote formula books Dispensatorium (1546)

Dispensatorium (1546)

became the official standard for the preparation of medicines in the City of Nuremberg

generally considered as the first Pharmacopeia as it was adopted by the government of Nuremberg, Germany in 1546

Philippus Aereolus Theophrastus Bombastus von Hohenheim (1493)

aka?
influence?

Swiss surgeon who called himself Paracelsus

He influenced the transformation of pharmacy from a profession based primarily on botanic science to one based on chemical science by chemically preparing drugs from crude plants and mineral substances

But also believed that the collection of those plants should be determined by astrology

Philippus Aereolus Theophrastus Bombastus von Hohenheim (1493)

doctrine?
advocacy?

Preached the "doctrine of signature" a belief that God had placed a sign on healing substances indicating their use against disease (eg . Liverwort resembles a liver; thus it must be good for liver ailments)

his advocacy sparked the growth of modern pharmaceutical sciences (e.g chemical processes like distillation, to isolate the healing principles of drugs - or its "quintessence")

Laudanum

a popular medicine that he developed Paracelusus

The Discovery of Oxygen

▪ Joseph Priestley - 1774 (published)
▪ Carl Wilhelm Scheele - 1773 (also discovered chlorine, glycerin, and several inorganic acids)

Late Modern Period

(Technical Innovations, Education, and Professionalization in Pharmacy)

1700s and 1800s

▪ Pharmacists dominated the investigation of botanical drugs (1700s and 1800s)

▪ Pharmacists documented the sources of plant drugs around the globe in collaboration with interested physicians

Paracelsians

▪ Pharmacists continued the search begun by the Paracelsians to find pure healing principles within medicinal plants using a more modern perspective aimed at isolating pure, crystalline chemicals that could be measured accurately and identified chemically

▪ Citric acid - Scheele (1784)
▪ Morphine
▪ Quinine

▪ Rapidly adopted by physicians because of their assured potency, and also the possibility of administering such drugs accurately during their research

Morphine

Friedrich Serturner, pharmacist (1805): considered as the single, most important breakthrough during the first decade of the 19th century; announcement of his method opened up the era of alkaloidal chemistry (resulted in the isolation of several pure drugs from crude preparations)

Qunine

Joseph Pelletier and Joseph Caventou, French pharmacists (1820)

1850s in late modern period

scientific disciplines of pharmacy?

establishment of?

▪ The scientific disciplines of pharmacy began to become more professionalized - decline in drug shop science as pharmacists interested in research left the shop behind for the institutional laboratory

▪ Establishment of laws governing the number and location of pharmacies, as well as the requirements for education and licensure for pharmacy in some states of the European continent

19th century

elevation?
evolution?
chemists and druggists?
issues?

▪ elevation of pharmacists throughout much of Europe to a social position similar to that of physicians

▪ Apothecaries evolved into a second group of medical practitioners and catered to those who could not afford the high fees demanded by university-educated physicians.

▪ Chemists and druggists rose up to take over the open pharmaceutical niche

▪ Issues on the boundaries between the physicians, apothecaries, chemists, and druggists

Revolutionary War

▪ proved to be critical in the development of a separate pharmaceutical occupation in America

what did American druggist need to learn in the Revolutionary war?

American druggists (wholesalers of drugs) had to learn how to manufacture their own chemically based drugs and how to make common preparations of the crude drugs previously obtained from Britain

The Marshall Apothecary

▪ apothecary shop established in Philadelphia in 1729 by Christopher Marshall

▪ leading retail store, nucleus of large-scale chemical manufacturing, practical training school for pharmacists, and supply depot during the revolution

Pharmacopoeia of the United States of America (USP) in 1820

experience of Physicians?

concern?

state guide?

reflects?

▪ Physicians gained their clinical experience in hospitals and dispensaries which allowed them to write out prescriptions, thereby stimulating the growth of pharmacy

▪ Concern over the consistency with which prescriptions for apothecaries to dispense were compounded

▪ Massachusetts Medical Society published a state guide to drug standards which, although not immediately recognized as official by the federal government, was rapidly accepted nationally as the primary guide to drugs

▪ Reflected both the growing amount of prescription writing and the medical profession's increasing reliance on pharmacists

1820s to 1830s

east coast?
small cities?

East Coast apothecary shops became more standardized in their appearance and in the stock they carried
▪ Drugs
▪ Medicines
▪ Surgical supplies
▪ Artificial teeth and limbs
▪ Dyestuffs
▪ Essences
▪Chemicals

▪ Drugstores in small cities and towns: more general articles such as glass, paint, varnishes, oils

1840s
advocacy?
role of pharmacy practitioners?
american apothecaries?
re-emergence?

▪ Physicians advocated for the growth of an independent profession of pharmacy as a "necessity for a division of labor" to meet the "growing demands" of their communities.

▪ Physicians relied on the expertise of pharmacy practitioners to detect adulterated or low-potency drugs

▪ American apothecaries refilled prescriptions without physician authorization or directly treated customers (counter-prescribing)

▪ Re-emergence of doctor's shops in the large cities

1850s to 1860s
acceleration?
development?

▪ Acceleration in the growth of American pharmacy

▪ Development of the pharmaceutical industry entry of less-skilled men into the ranks of pharmacy as mass-manufacturers began producing drug preparations in the late 1850s


▪ Competition between pharmacists and physicians

physician in the 1860s

"It is an admitted and lamentable fact that many of those now practicing pharmacy are totally incompetent to fulfill the responsibilities of the true apothecary. They know nothing of the science of preparing medicines."

Competition between pharmacists and physicians:

: threatened the integrity of the boundaries that had developed to separate the two professions
▪ Pharmacists - attributed their difficulties to dispensing physicians and doctor's shops
▪ Physicians - complained about counter-prescribing

▪ Boundaries between the professions were only drawn more clearly after the Civil War

The American Pharmaceutical Association (APhA)

founded by?
saw the gains made by pharmacy?
need?
membership?

▪ founded by a group of 20 elite druggists and apothecaries in Philadelphia in 1852

▪ saw the gains made by pharmacy in the 1830s and 1840s being swept away by a rising tide of destructive competition

▪ need for better communication among pharmacists, standards for education and apprenticeship, and quality control of drugs

▪ opened membership to "all pharmaceutists and druggists" of good character who subscribed to its Constitution and to its Code of Ethics