Evolution of Pharmacy

By Robert A. Stevenson, D.D.S., R. Ph. Dental Therapy Editor

                The primary function of pharmacy is to prepare medicines for those who require them. It is, therefore, a highly specialized calling, which may rise to the dignity of a true profession or sink to the level of the lowest commercialism, according to the ideals, the ability, and the training of the one who practices it.

Embracing, as it does, a variety of knowledge, scientific and commercial, its contacts with other callings cover an exceedingly wide range. Magic and superstition dominated it at the beginning, conjointly, as a rule, with medicine and religion. Alchemy influenced it for more than a thousand years. Commercialism has always been a more or less important factor and in the present era seems to have reached the highest point possible.

In consequence of these facts pharmacy, in the minds of many observes, has been so obscured that its real value and function have frequently been overlooked except by the practitioners themselves, and they, for the most part, have been so much in ignorance of the history and traditions of their own calling that they have not realized the necessity of stressing their professionalism and making the real dignity and importance of much of their work apparent.

The earliest records of pharmacy go back to the days before Tutankhamen, who was laid away in regal splendor in the Valley of the Kings in that country where Isis and Osiris were the dominating deities. The oldest prescriptions are found in the hieratic writing (or writing of the priesthood) of ancient Egypt. There is some question whether those given in the Ebers Papyrus are older than the one on exhibition in the Department of Egyptology of the Metropolitan Museum in New York, written upon stone, although not in hieroglyphic characters. There are several medical prescriptions in the British Museum which have never been translated nor photographed, and which are said to date from the time of Cheops, about 3700 B. C.

The Ebers Papyrus 16th century B. C. contains a collection of prescription and formulas covering a wide range of uses. The date assigned to the Papyrus is about 1552 B. C.

At this time Moses was tending the flocks of his father-in-law. Jethro the Midianite, on the plains at the foot of Mount Horeb. This makes the recipes in the Ebers manuscript considerably older than few formulas given in the Book of Exodus for certain preparations which were directed to be made “according to the art of the apothecary.”

The Papyrus contains many invocations and conjuring forms for driving away disease, as well as specific recipes, calling, in many instances, for drugs which are in common use today.  Among those which have been identified are oil, wine, beer, yeast, vinegar, turpentine, figs, castor oil, myrth, mastic, frankincense, wormwood, aloes, opium, cumin, peppermint, cassia, caraway, coriander, anise, fennel, saffron, lotus flowers, linseed, juniper berries, ben-bane, mandragora, poppy, gentian, colchicum, squill, cedar, elderberries, hone, grapes, onion, and date blossoms—a fairly representative collection. The identification of many of these drugs is difficult because of the absence of any systematic nomenclature and because of the unusual figurative synonyms which were in vogue. Thus, fresh dill juice was called “the blood of the Ibes,” while dill seeds were known by the name of “hairs of kynocephalus.” The “ heart of Bubastis” was the designation of wormwood, while squill was picturesquely described as “the eye of Typhon.”

Among the mineral and metallic substances used by the Egyptians were iron, lead, bitumen, magnesia, niter, vermillion, copper sulphate, white lead, crude-sodium carbonate, and salt—a very limited number. Precious stones were employed in a finely divided condition and there were special distinctions, according to the ability of the patient to pay. Thus, emerald was used for the plutocrat and green porcelain for the proletariat; lapis lazuli and sapphire were replaced in a similar manner by blue glass have similar relative applications today, when used externally, but not for therapeutic reasons.

The Egyptian influence lasted for thousands of years, for much therapeutic value is value is attracted to precious stones in the pharmacopaeias of the seventeenth and eighteenth centuries.

The animal drugs included lizards’ blood swine’s teeth, putrid meat, stinking fat, moisture from pigs’ ears, milk, goose grease, asses’ hoofs, animal fats from various sources, excreta of various animals, including humans, donkey, antelopes, dogs, cats, and even flies. The influence of this group also persisted for more than three thousand years, as may be seen by referring to many pharmacopaeias of the sixteenth and seventeenth centuries.

Can you imagine an apothecary of today collecting fly-specks to fill a prescription? Shades of Ammon-Ra preserve us! This drug was used to prevent babies from crying and was mixed with the seeds of an unidentifiable plant—evidently the prototype of the soothing syrups of today.

Some of the prescriptions of the Ebers Papyrus are very simple. In those for purges they used a mixture of milk, yeast, and honey, or pills compounded of honey, wormwood, and onion. From the mildness of the doses we are compelled to the conclusion that the ancient Egyptians were not victims of chronic constipation. For headache there was used a prescription calling for frankincense, cumin, u’an berries (unidentifiable), and goose grease, which were to be boiled together and used as an external application. Again the compelling thought—were there no “morning after” headaches in the days of King Tut?

There is one headache remedy attributed to divine origin (Isis having prescribed it for Ra’s headache) which contains coriander, wormwood, juniper, honey, and opium, this would probably be effective, permanently so, if enough was taken.

As a prescription for a tonic there is recommended a preparation made by compounding figs, Assyrian plums, grapes, frankincense, cumin, wine, beer, yeast, and goose grease. If we leave out the goose grease and mix the other ingredients in such a way as to allow natural changes to take place, this tonic might even popular at the present time.

A prescription, annotated as having been prepared for Schesch (a queen of the third dynasty), consisted of equal parts of the heel of an Abyssinian greyhound, of date blossoms, and of asses’ hoofs, boiled in oil. This was for the purpose of making kind was handed down to the time of Cleopatra, when the use of cosmetics became popular. Certainly nothing even remotely resembling it is used today.

A remedy for baldness was prepared from a mixture of the fats of the horse, the crocodile, the hippopotamus, the, the snake, and the ibex, which was to be applied freely. This was probably as effective as many of the hair restorers of the present time, although not quite as easy to obtain.

Some of the prescriptions of the Ebers Papyrus exhibited a tendency toward polypharmacy. There is a poultice with thirty-five ingredients. The directions for compounding and preparing some of the remedies for administration were very complicated indeed.

The pharmacists of ancient Egypt must have carried a full supply of worm medicines, for the Ebers scroll contains prescriptions for hookworms, they were also called upon to supply infusions, decoctions, cataplasms, and poultries. One ancient remedy, comparatively little used at present, has once drawn to us through the centuries almost unchanged. This is a mixture of aloes and canella known by the Latin name of “hiers picra,” literally “sacred bitters.” While this attained prominence during the Grecian period, it probably came to them through the Egyptians.

The knowledge of anatomy of the early Egyptians was necessarily limited, owing to their reverence for the human body and the severe penalties inflicted upon any who practiced dissection. Even the priests themselves were not permitted to make the incision in the abdominal cavity which was necessary in their embalming process, and this office was performed by an individual called the ”paraschites,” whose position in the community was comparable to that of the executioner. Despite their limited  knowledge of anatomy, however, the Egyptians have recorded themselves as recognizing the pulse.

Herodotus, the Greek historian, writing in the fifth century B. C., says of the early Egyptians that “no doctor was permitted to practice any but his own branch,” which would indicate that there were specialists even at that remote period. Egyptian records state the fact that the doctors were all priests and that they were paid out of the royal treasury, but were permitted to take fees also, and that there were penalties provided for adding to, diminishing, or varying in any way, the ingredients of a perfect prescription, which indicates that substitution was even then a recognized evil.

The total number of drugs mentioned in this remarkable collection of prescriptions is more than 700.

The ancient character of these manuscripts may be appreciated by a comparison with the original manuscripts upon which the Bible is based. The oldest manuscript of the New Testament is a Greek one in the Vatican at Rome, which dates from the fourth century A. D., and the oldest manuscript of the Old Testament is one in a library at Leningrad (formerly St. Petersburg), which is attributed to the ninth and tenth century A. D.

Egyptian pharmacy must have been primitive and empirical to an extreme degree, and combines with a simple faith in magic spells and invocations augment the effectiveness of a remedy. We smile at their credulity and yet in our own time, as far as American and English prescription practice is concerned, we use an abbreviation, R, which is distinctly traceable to the pagan symbol for Jupiter, which is said to have been used as an invocation on recipes by Chaldean physicians, at a time when the alphabet used by us had not yet been evolved.

The symbol of the serpent, which has been adopted as the emblem of medicine in the “caduceus,” played a prominent part in the healing ritual of both the Egyptians and Babylonians, and dates back to at least 4000 B. C. Those who have erroneously attributed it to the Greek Hermes or Mercury probably did not know or had forgotten that Hermes was the god of thieves and traders, evidently synonymous in those days.

There is a pharmacopeia-like compilation in Chinese, called Pun Tsao or the Great Herbal. It consists of forty volumes and quotes from the works of nearly 1000 authors, many of whom date from a period far prior to the Christian era.

Among the ancient Hebrews we have no very clear concept of pharmacy. In neither the Bible nor the Talmud is any great amount of attention given to either pharmacy or medicine. The most frequently quoted reference is that of Exodus xxx-34: “ And the Lord said unto Moses, Take unto thee sweet spices, with pure frankincense; of each shall there be a like weight: and thou shall make it a perfume, a confection after the art of the apothecary, tempered together, pure and holy.”

The aborigines of America, the Amerinds, the Aztecs, and the Incas, all had their combination of priest-prophet-physician-pharmacist. They pursued many practices which, while crudity carried out, has a basis of scientific truth. Thus they were familiar with the tanning effect of oak bark and the cleansing properties of wood ashes. They used fish bladder and fish scales for making glue, and pitch and resin for water-proofing purposes. They knew the art of making pottery and the use of pigments. They employed hundreds of indigenous plants as foods, as flavors or condiments, or as drugs. In the former groups are the potato, the tomato, maize, chocolate, capsicum, and vanilla; in the latter group we owe to the new world the drugs coca, cinchona, jalap, gaultheria, sanguinaria, lobelia, hydrastis, podophyllum, and many others.

Pliny says of the Greeks: “The first Herborist and Apothecarie, renowned for the knowledge of simples and composition of medicines was Chiron, son of Saturn and Phylliria.”

Chiron was reputed to have been the teacher of pharmacy to Achilles, Aesculapius, Jason, Odysseus, and others. Aesculapius and Hercules are said to be the forebears of Hippocrates, who was a real character of the fifth century B. C., and from whose period the history of medicine and pharmacy may be said to begin.

Bacchus or Dionysius, the father of vine; Ammon, whose name is a reminder of the fact that salamoniac  was first produced from camels’ urine in the Libyan Desert near the temple erected to that deity; and Zoroaster, the founder of the fire-worshipping religious system of Persia, have also been credited with having originated the healing arts.

Aesculapius is credited with having a lot of children, of whom the most notable was Hygeia, representing health, and Panacea, representing medicine.

Greek medicine really began with Hippocrates, who was born on the island of Cos in 460 B. C. The Greeks had learned more about anatomy than the Babylonians or the Egyptians, probably because of their frequent contact with severe wounds and broken bones received in the sanguinary wars for which they were famous. Even at this early period (the fifth and sixth centuries B. C.) there were several schools of medicine in Greece, quacks and charlatans were prevalent, and there are known to have been bone-setters, oculists and dentist. Some wealthy practitioners had dispensaries and private hospitals of their own.

Physic was even at that time divided into three schools. One school pinned its faith to medicines, one to diet, and one to physical manipulations. Compare these with the regulars, the food faddist, and bone bouncers of today. Have the more than twenty-four centuries made much change in this respect?

The later Aesclepiades (for this sect and the temples of Aesculapius, as well, persisted for some centuries) used music, bathing, and massage in addition to vegetable drugs, which were usually administered in wine.

Dissection of the human body was still forbidden in his time and he was compelled to base his knowledge and comparisons upon operations confined to the lower animals. He introduced clinical records such as are in use today. His recognition of disease as a natural phenomenon, and his practice of diagnosis and prognosis as we understand then now entitle him to be recognized as the Father of Medicine. Some of his surgical methods are followed today with little or no change in procedure. That he appreciated the doubtful value in which the services of the physician are sometimes held is shown by the following quotations from one of his works; “The physician visits a patient suffering from fever or wound and prescribes for him. On the next day, if the patient feels worse the blame is laid upon the physician; if on the other hand, he feels better, nature is extolled and the physician reaps no praise.”

In the writings of Hippocrates nearly 400 simples are named as medicinal substances. According to the writings of Galen at a later period, Hippocrates is credited with showing much interest in pharmacy and to have said in this connection: “We know the nature of medicaments and simples and make many different preparations with them, some in one way and some in another.” He made and used fomentations, poultices, and inhalations. He had no knowledge of distillation. According to Galen, Hippocrates prepared his own medicines, and he practiced pharmacy as well as medicine. He was the first authority on record who wrote especially on the subject of diet and who insisted upon it as being an important aid to recovery from illness.

Hippocrates died at the age of ninety years, full of honors.

In the post-Hippocratic period arose many sects and schools of medicine, among which were the Dogmatics, the Stoics, the Empirics, the Methodists, and the Eclectics. Some of these were still further subdivided, so that the complexity was evidently as great as is complained of at the present. The Dogmatics corresponded to the regular school of medicine today. The Empirics introduced the famous tripod, or necessary factors for success in medicine, which consisted of observation, history, and analogy.

The Methodists pursued a middle course; the Eclectics based their superiority on the selection of what was best on all other sects; the Stoics were more or less indifferent to all human ills and infirmities and corresponded most closely with the faith healers of the present time.

In Alexandrian and Roman Pharmaceuticle practice they used infusions, decoctions, plasters, ointments, pessaries, powders, snuffs, troches, and other classes of preparations called malagma were non-fatty compounds of the consistency of ointments, for external application. Ointments called eucharesta were applied as embrocation. The term katapotia or catapotia as applied to pills or small dosage forms of solid medicines. Collyria were used as eye preparations, as we do now, but the word also denoted a suppository-like form of medication.

Fees for medical and surgical services were fairly high. We have little or no knowledge of the pharmacist’s prices, but it is practically certain that there were not cut-rate drug-stores, for there were not nationally advertised specialties and each practitioner developed his art individually, with such guidance as he could obtain from the manuscripts and volumes of former times.

Under Julius Caesar, citizenship had been granted to all physicians practicing in Rome. As the Roman race deteriorated physically, the physicians increased in power and numbers, until at the time of Galen, they were also granted immunity from taxes and military services trained in emergency work corresponding closely to our Red Cross and Hospital Corps divisions.

The Arabians preserved the pharmaceutics art and carried the torch of professional and scientific knowledge from the sixth to the thirteenth centuries.

It was in this period that there appeared the first establishments in which pharmacy was practiced as a profession separate from that of healing, although this was by no means universal.

In medieval times the Renaissance was profound in its effect upon pharmacy, for it brought about a fusion of Arabian learning with the empiric practices based upon the folk lore and tradition in central and northwestern Europe, and stimulated into activity certain cultural factors that had lain dormant for centuries.

Under Charlemagne, medicine was taught under the name of physicus, hence the origin of our name physician for one who practices medicine.  Charlemagne had in his Capitulaires prescribed a list of medicinal plants which were to be cultivated in gardens. From this modest beginning came the idea of botanical or plant gardens, which was to culminate hundreds of years later, when in the sixteenth century many of the famous botanical gardens of the world were instituted.

During this period of monkish medicine some of our plant and drug names came into use, such as rosemary (literally, the Rose of St. Mary), St. Johnswort, and others.

A great deal of pseudo-religious medical and pharmaceutical hocus-pocus originated about this time and left its influence for many centuries in pharmaceutical formularies and pharmacopaeias. For instance, there was the “ointment of the twelve apostles,” which had twelve important ingredients, and the practice of repeating a particular psalm or prayer while not so much for the purpose of asking divine intercession on behalf of the patient as to regulate the time of application.

The cultivation of medicinal herbs in the monastery gardens during the eight and tenth centuries laid the foundations of the science of botany, although it did not contribute much of value to the vegetable material medica, because of the blind faith which was reported in simples, irrespective of their demonstrable effects. About the same time the word “drug” appears in literature. It is of Teutonic origin, and simply meant a “dry herb” in its original significance. The word “druggist” applies to sellers of drugs, did not appear in common use until about the sixteenth century.

Thus we could follow with La Wall pharmacy and medicine step by step from the days of magic and superstition to the present day of scientific achievements. To use the words in the closing paragraph of Four Thousand Years of Pharmacy:

“Every calling, trade, art, profession, has a history. The influence of the past upon the present is in direct proportions to the wealth of tradition and of history that has been handed down through successive generations. Progress is frequently measured in terms of respect for those who have preceded us and who have left us landmarks to guide our way. Let us not be vain-glorious in the pride of our present achievements. Let us not look with disdain or ridicule upon the ignorance and credulity of much of the past. Let us rather keep in mind a quotation from Paris’ Pharmacologia of almost exactly a century ago:

“What pledge can be afforded that the boasted remedies of the present day will not, like their predecessors, fall into disrepute, and in their turn serve only as humiliating memorials of the credulity and infatuation of the physicians who commended and prescribed them?”

Bibliography

Four Thousand Years of Pharmacy. An Outline History of Pharmacy and the Allied Sciences, by Charles H. LaWall, Ph. M., Phar. D., Sc, D., F. R. S. A.  Published in 1927 by J. B. Lippincott Company, Philadelphia.

October 7, 2017 · jagdish1 · No Comments