PHARMACY FROM THE ANCIENT

WORLD TO 1100 AD

PHARMACY IN THE MEDIEVAL

WORLD

2012.04.24.

BPOP1.; Lecture 23. & 24.

History

History of:

Medicine

Pharmacy

People who use them

Different in each country

But it is partly similar history worldwide

1. Natural substances used by primitive man

2. Specialized individuals in communities

3. Early civilizations: physician-pharmacist Historical evolution connected with medicine

4. Developed civilizations: separation of professions Pharmacists

Physicians

Why do we need to talk about this?

History as heritage History of pharmacy = history of a profession Contribution of pharmacy to civilization.

Who became pharmacists and why?

What activities did they carry out?

What skills did they need to perform their duties?

Philosophy of the pharmacist’s role in society

Ways of thinking as a pharmacist

Narrative history Story of the past, appearance of pharmacy in different times

Great names, interesting stories

Lessons of history Medical literature

Policy making, disease control

Sources of history in pharmacy

Where can one find material about the history of pharmacy?

1. Publications: books and journals

2. Archives, letters

3. Prescription books

4. Oral history

5. Pharmacy illustrations (images) in

1. Books

2. Art

3. Photographs

4. Equipments and machines in industry

6. Pharmacy artefacts: early pestels and mortars, antiques

Products of pharmacists - nomenclature

Products are described by many names Drugs

Medicines

Pharmaceuticals

Therapeutic drugs

Drug Nowdays can be referred to illicit substances

Earlier it was used for active ingredients

Medicine Product in a finished form (like Panadol tablet)

Pharmaceutical Broader meaning including active ingredients, products,

vaccines, etc.

Interchangable?

Do they mean the same?

Pharmacy from the ancient world to 1100 AD

Pharmacy from the ancient world

Development of human species and civilizations

Prehistoric men: Hunter-gatherer - Food producer

Early civilizations in Babylonia, Egypt, China… 4000 B.C.

Discovery of tools, writing/symbols

Specialization

Disease, illness and accidents needed treatment

Selected specialists treated symptoms

Plants and minerals in nature (early folk medicine)

food-poison-drug?

Called „doctor”, „wise woman”, „medicine man”, „priest”

Mixture of: instinct + magic + confusion

Practiced „pharmaco-magic”

Later – instinct and magic changed to Empiricism (not science jet)

Careful observation, systematic observations, Trial and error method

Causes of illnesses were mostly unknown

Due to supernatural causes, evil or sins

Mesopotamian civilisations, 3000 BC – 539 BC

First urban civilisation around 4000 BC

Tigris and Euphrates rivers

Babylon (2200-1300 BC)

Babylonian – Assyrian medicine

Used plant drugs, wound washing, wines, oinments

Manufactured soap, vinegar, plant extracts

King Hammurabi (1795-1750 BC)

Hammurabi’s code regulated medical and surgical practice

Apothecaries: Separation of „diagnosis and treatment” from „preparation of medicines”

Mesopotomian drug formulas were not quantitative

Apothecary = perfumer Preparation of volatile oils and unguents

king Assur-Bani-Pal (668-627 BC)

Library in Ninive

Clay tablets: 800 fragments contain information on Babylonian medical treatments

Egyptian civilisations, 3000 BC – 1200 BC

Nile valley

Well documented history on:

tombs, ceramic and papyrus

Formulation of medicines

Wine, beer and honey as vehicles for liquid medicines

Honey for incorporation of solids in pills

Waxes for oinments

Papyrus Ebers (1500 BC) ~ 20mx30cm Medical-pharmaceutical „dissertation” ~ 4m

875 prescriptions, 700 drugs (plant, animal, mineral)

21 methods against coughing, 18 skin disorders, etc…

Dosage forms

Infusions , Decoctions, Pills, Suppositories

Recipes were stated quantitatevly

Use of: mortars, handmills, sieves and balances

Pastophor: preparer of medicines (separated from physicians)

Imhotep (2635 – 2595 BC)

Egyptian polymath, chancellor to the pharaoh and high priest, architect - Pyramid of Djoser

probably acoauthor of Edwin Smith papyrus

Anatomical observations and cures

Greeks identified him with Asklepios

God of medicine and healing

The rod of Asclepius, a snake-entwined staff, remains a symbol of medicine today.

twisting the worm around a stick may have inspired the symbol in case of dracunculiasis

Egyptian civilisations, 3000 BC – 1200 BC

Greek civilisations, 1250 BC – 285 BC

Crete – Bronze Age culture

Script for writing was developed

Iron melting

Greek empire

Mesopotamian and Egyptian culture had great influence

on Greek culture

Early philosophers’ theories

Heraclitus of Ephesus: all things were composed of two types of

opposites - wet/dry and hot/cold controlled by Logos

Empedocles: eveything is made up of four elements – fire, air,

water and earth

Greek civilisations, 1250 BC – 285 BC

Hippocrates (460-377 BC)

Hippocratean Corpus (collection of Ancient Greek medical works)

Theory of four liquid humours (humoralpathology) Blood

Phlegm

Yellow bile

Black bile

Disease was the result of excess of one of

these liquid humours, and the

treatment is to eliminate it from the body

Main principles for the practice medicine

Hippocratic Oath, primum nil nocere!

Precise anamnesis (observation) of the patient

Greek civilisations, 1250 BC – 285 BC

Aristotle (384-322 BC)

Classification of animals to genera and species

Polymath: botany, physics, anatomy,

physiology, mathematics

Theophrastus (372-287 BC)

Established the discipline of botany

Attacking the thoory of four elements

Stressing

Empirical approach

Experimental evidence

Roman civilisations, 275 BC – 476 AD

Expansion of the Roman epire

Overruning two literate nations: Greeks and Hebrews

Advances in engineering (sewage disposal systems, aquaducts), law and govrenment

Adoptation of greek medicine

Disseminating medical knowledge in the empire

Celsus (20-50 AD)

Medical practioneer, encyclopaedist

Translated and edited other people’s work

De Medicina (8 books)

250 drugs, 100 surgical procedures

Roman civilisations, 275 BC – 476 AD

Dioscorides (50-100 AD)

Greek physician, pharmacologist and botanist

Surgeon of the emperor’s army

De Materia Medica ("Regarding Medical Materials")

List of materials of animal, plant and mineral origin

"precursor” to all modern pharmacopeias

It remained in use until about 1600 BC

It was circulated in Latin, Greek, and Arabic

For every illness there is a specific plant remedy

Roman civilisations, 275 BC – 476 AD

Galen (129-199 AD)

Physician and surgeon of gladiators

Experiments: dissected animals

Developed the humoral pathology scheme

Combining earlier theories like Hippocratic theory and the four temperaments of man

All illness is the result of imbalance between these elements

Apotheca = storeroom for drugs

Galenicals = creams and ointments

Four bodily fluids affect human

personality and behaviors

1. sanguine (pleasure-seeking

and sociable)

2. choleric (ambitious and

leader-like)

3. melancholic (introverted

and thoughtful)

4. phlegmatic (relaxed and

quiet)

Arabian civilisations, 400 AD – 1100 AD

Arab empire

Greek and Roman works were translated to Arabic

Apothecary shops appeared (850 AD)

Separation of medicine from pharmacy

Precise education

High code of ethics

Wide range of medicines

Movement of scholars from Persia

Religious oppression

To the west: Italy, France

Arabian civilisations, 400 AD – 1100 AD

Rhazes (865-925 AD)

(Mohammad-e Zakariā-ye Rāzi)

the „Persian Galen”

Physician at Baghdad’s great hospital

Writer, chemist and teacher

Well equiped laboratory

Book of Medicine

Encyclopedia derived from Greek, Arabic, Persian and Indian sources

Use of „pills”

differentiated smallpox from measles

Arabian civilisations, 400 AD – 1100 AD

Avicenna (980-1037 AD) (Ibn Sina)

Studied medicine at age 15

writing on philosophy, astronomy, alchemy, geology,

psychology, Islamic theology, logic, mathematics

Canon of Medicine (al-Qanum)

Containing teachings from Hippocrates, Galen and

Aristotle

5 books, 760 drugs and their antidotes

Translated to Latin

text-book in the universities of

medieval Europe

Silvering of pills

By the end of th 11th century

Basic conditions for the development of a separate profession were available:

Natural materials for medical use have been identified

Encyclopedias and writing was available to pass on knowledge

Technologies for processing of raw materials have been developed

First steps toward separation of professions have been taken

Science, culture and art evolved simultaneously

polymaths

Developments of… and the opposition to science

and experimental medicine in Europe

Advances of the Mesopotamian, Egyptian, Greek and Roman cultures resulted in:

Development of botany, biology, philosophy…

Medical theories

Experimental knowledge

Encyclopedias

Drugs and medications

Animal, Plant and Mineral substances

Formation of physician and drug manufacturer specialisation

Rise of the Christian religion

Churches enforced obedience to dogma

Natural philosophy was forbidden

Works of Hippocrates, Galen and Dioscorides were preserved in libraries of Christian monks

Dark Ages (735-1150 AD)

From 1100 to 1617 AD

Pharmacy in the medieval world

Medieval world

Constant wars

Frequent epidemics, infectious diseases

Black Death (Yersinia pestis)

estimated to have killed 30–60 % of Europe's population, reducing world population by 100 million

Majority of people lived a short life

Crusades (1095 and 1291)

series of religious expeditionary wars

Impact of the crusades

Spice and drug trade, commercial centers, weight and measure, coins for trading

Adaptation of new ideas:

Separation of pharmacy from medicine

Compounding drugs in large scale

Government officer inspection of shops run by pharmacists, herbalists

Medical schools

Developments in Europe

Centers of learning in Italy, Spain, France created

Medical school of Salerno (Scuola Medica Salernitana) - 1077

first medieval medical school

Meeting of different culture: Greek-Latin medical tradition merging with the Arab and Jewish medical traditions

Medical schools

France: Montpellier

Spain: Cordova

Developments regarding pharmacy

Distillation

Stressing the value of chemistry

First formal separation of pharmacy from

medicine in Europe - 1231

Idea of separation introduced by the Arabs into Sicily

Edict(=regulation) of Frederik II of Hohenstaufen (1231)

Emperor of Germany and king of Sicily

Created clear distinction between the responsibilities of physicians and those of apothecaries

Laid down regulations for their professional practice

Particular skills and responsibilities were required Druggist – confectionarii

Apothecary -stationarii

Avoid the expliotation of the sick

Government supervision of pharmacy, controlled prices

Had to stock certain drugs

Can not store them for more than 1 year

This idea spread across Europe

Basel – Switzerland: Apothecaries Oath (1271)

„no physician shall own an apothecary’s business”

The Guilds

Traders were organising themselves into craft and

merchant guilds (like Guild-Merchant, wool traders)

For the interest of its members

Exluding strangers

Pharmacy was also a trading activity at that time

Decree of King Edward III. (1363)

Every craftsmen had to enrolled in a guild = registration

Traders of drugs and spices

Were guild members

Had pharmaceutical knowledge

Medieval hospitals

Pharmacy was also practiced in hospitals

Hospitals

Early Roman military hospitals

Later also for travelers (guesthouse and therapy)

Special institutions outside cities

Leper houses (Mycobacteriom leprae)

Pets houses (Yersinia pestis)

Respective roles of physicians and apothecaries

Pharmacists (apothecaries) were practicing

In retail premises (shops)

Public institutions (hospitals)

Benedictine Abbey and Monastery in Pécsvárad

Founded in – 1015 AD

•Pharmacy

•Garden for herbs

Sources of medical knowledge

Medical universities from 14th century in Europe

Slow spreading of knowledge = no printed books

Monks hand copied and translated manuscripts, painted illustrations

Herbals

Medical literature about medicines, drugs, plants

Sources of information on preparing medicines

De Materia Medica by Dioscorides (100)

Woodcuts

Printed books

De Viribus Herbarium by Macer Floridus (1477)

Development of pharmacopoeias

Herbals were often diferent in content and

inconsistent

Plants were difficult to identify

Need for standardisation and official publications

Nuovo Receptario (1498)

Florence – Italy

Published by the Guild of Apothecaries and the

Medical Society

London Pharmacopoeia (1618)

Standards for the whole country

Contained salts, chemicals and metals

Renaissance

Paracelsus (1493-1541) German-Swiss physician, botanist, alchemist,

astrologer

Philippus Aureolus Theophrastus Bombastus von Hohenhe

"Paracelsus” is meaning "equal to or greater than Celsus" Questioned works of Avicenna and Galen

publicly burned traditional medical books

Belief in chemical and mineral remedies mercury, lead, sulphur

Medical use of opium pills and tincture

New dosage forms: extracts and tinctures

„only the dose determined if a substance was poisonous or not”

Foundation of the Society of Apothecaries

Sale of medicines was a business for long time

Apothecaries were members of the Grocers’

Company

King James I (Charter of 1617)

„The Worshipful Society of the Art and Mystery of

the Apothecaries”

Complete independence for apothecaries just like

for physicians

Important landmark of the profession of pharmacy

7 years training with a master apothecary

Oral examination: Preparation, dispensing, handling and

compounding of medicines

PHARMACY IN THE

MODERN WORLD

FROM 1600’ –

UNTIL THE XX. CENTURY

PREPARATION FOR FINAL TEST

2012.05.02.

BPOP1.; Lecture 25. & 26.

Europe and England in the 1600’s

Growth of population

Different living conditions

Rich: large houses separated

Poor: terrible conditions

Streets covered in sewege, rats

Spread of diseases and plagues

Smallpox, dysentery, typhus, tubercolosis

High infant mortality

Medical practice in the 1600’ and 1700’

Largely based on system of Hippocrates and Galen

Disease is caused by the body’s four humours

Physicians examined which humour is in excess

Treatments included

Bleeding

Pugratives

Diaphoretics (promoting sweating)

Medical service providers:

Physicians – healing, expensive, only for the rich

Apothecary – dispensing/preparing medicines according to prescription

Also gave advice on treatment (no charge) middle class, poor

Traveling salesman

Family, Religious ministers, Wise woman – poor people

Prayers

Medical plants

Pharmaceutical practice in the 1700’

Development of printed formularies and pharmacopoeias

Growing understanding of medicines

Rejecting principles of humoral pathology

New drugs in pharmacopoeias

Ferrous sulphate, Benzoic acid

Apothecaries became legitimised practioneers of

medicine

formation of the Pharmaceutical Society of Great

Britain- 1841

Register of pharmacists,

Rise of welfare and national insurance

Development of Friendly societies

People join together for a common financial or social purpose

Working people pay small amount of money regularly

Societies pay for medical service in time of need

Rise of welfare in the XX. century

Public education

Old age pension

Unemployment pay and sick pay

National insurance and health service

More dispensing according to prescriptions

Administrative duties (doctors prescriptions, insurance companies)

Standardisation of common remedies, no „secret medicines” accepted