Pharmacy

Pharmacy, a term which in the original Greek form signified the use of any kind of drug (46p,uaKov), potion or spell, and hence also poison and witchcraft. In the modern signification it is applied to the act of preparing, preserving and compounding medicines, according to the prescriptions of physicians. It was used first in this sense in 1597 In the earliest periods of the world's history of which we have any record, this art, like that of the perfumer, was practised by a special class of the priesthood, as in the case of Eleazar (Num. iv. 16), and that of medicine by another class (Lev. xiii.).

Egyptian inscriptions indicate that the physician-priests sent their prescriptions to be dispensed by the priests of Isis when, accompanied by the chanter of incantations and spells, they visited the sick'. A papyrus of Sent, 3300 B.C., gives directions as to the preparation of prescriptions. In the Ebers papyrus, 1550 B.C., mention is made of blisters, ointments, clysters, mineral and vegetable drugs. The art of the apothecary is alluded to very early in the Old Testament history (Exod. xxx. 25-35 and in xxxvii. 20) and again in the time of Solomon (Eccles. x. 9), but this word, which is translated par fumeur in the French version, only indicates that the preparation of fragrant unguents and incense formed, even at that early date, a part of pharmacy, since the drugs mentioned, viz. galbanum, myrrh, stacte, frankincense, calamus, cassia and cinnamon, were all of them used in perfumes, even the myrrh being probably the kind distinguished at the present time in the Bombay market as perfumed myrrh or bissabol, which still forms an ingredient of the joss sticks used as incense in the temples in China. The myrrh mentioned in Gen. xxxvii. 35 is described under another Hebrew word, and refers to ladanum, a fragrant resin produced in Cyprus, and the use of this drug, as well as that of cinnamon and cassia, indicates even at that early period a knowledge of the products of Somaliland, Arabia and the East Indies and the existence of trade between the farther East and Egypt. In China also at a very early period the art of pharmacy was practised. Ching-Hong, a contemporary of Menes I. of Egypt, was learned in the art, and made decoctions and extracts of plants. The materia medica of the Chinese at the present date affords an excellent illustration of the changes that have taken place in the use of drugs, and of the theories and superstitions that have guided the selection of these from the earliest ages, inasmuch as it still comprises articles that were formerly used in medicine, but have now been utterly discarded. Thus the doctrine of signatures is evident in the use of the celebrated Ginseng root of China, which, like that of the mandrake (Gen. xxx. 14-16), owed its employment to the fact that the root often divides into branches resembling the arms and legs of a man, and this resemblance gave rise to the belief that it conferred strength and virility. The same belief is shown in the botanical names applied to many plants, e.g. Pulmonaria, Hepatica, Scrophularia, and others.

The astrological belief that plants, animals and minerals are under the influence of the planets is shown in the older names of some of the metals, e.g. Saturn for lead, Venus for copper, and Mars for iron, and the belief that the colours of flowers ' The Egyptians believed that the medicinal virtues of plants were due to the spirits who dwelt within them.

indicated the particular planet they were under led to their use in diseases and for constitutions supposed to be under the same planet. Physicians to this day head their prescriptions with a sign that originally meant an invocation to Jupiter, but now represents the word recipe. The belief, which is still held by the Chinese, that the excrements of animals retain the properties and peculiarities of the animals from which they are derived, led to the use in medicine of these disgusting remedies, which are still sold in drug shops in China, and were only omitted from the English Pharmacopoeia as late as 1721. At that date the science of chemistry was very imperfectly known, and the real constituents of ordinary remedies so little understood that different virtues were attributed to different products containing the same constituents. Thus, prepared oystershells, coral, pearls, crabs' " eyes " and burnt hart's horn were regarded as specifics in different complaints, in ignorance of the fact that they all contain, as the chief ingredients, calcium phosphate and carbonate. The celebrated Gascoigne's powder, which was sold as late as the middle of the 19th century in the form of balls like sal prunella, consisted of equal parts of crabs' eyes," the black tips of crabs' claws, Oriental pearls, Oriental bezoar and white coral, and was administered in jelly made of hart's horn, but was prescribed by physicians chiefly for wealthy people, as it cost about forty shillings per ounce. Superstition also entered largely into the choice of remedies. Thus various parts of criminals, such as the thigh bone of a hanged man, moss grown on a human skull, &c., were used, and even the celebrated Dr Culpeper in the 17th century recommended " the ashes of the head of a coal black cat as a specific for such as have a skin growing over their sight." In course of time the knowledge of drugs, and consequently the number in use, gradually increased, and some of the preparations made in accordance with the art attained a celebrity that lasted for centuries. Thus diachylon plaster was invented by Menecrates in A.D. i, and was used by him for the same purposes as it is employed to-day. An electuary of opium, known as Mithradatum, was invented by Mithradates VI., king of Pontus, who lived in constant fear of being poisoned, and tested the effects of poisons on criminals, and is said to have taken poisons and their antidotes every day in the year. The prescription for the general antidote known as Mithradatum was found with his body, together with other medical MSS., by Pompey, after his victory over that king. The prescription was improved by Damocrates and Andromachus, body physicians to Nero. The first was subsequently known as Mithradatum Damocrates, and the second as Theriaca Andromachi, the name Theriaca or Tiriaca being derived from the snake called Tyrus, the flesh of which was added to it by Andromachus. The former contained 55, or, according to some formulae, 72 ingredients, and occurs in all the dispensatories, from that of Corvus Valerius up to the pharmacopoeias of the 19th century; and aromatic preparations of opium are still used, under the name of Theriaka in Persia. The Theriaca prepared at Venice had the highest reputation, probably because in Venice the component parts were exposed to the inspection of wise men and doctors for two months, to determine whether they were or were not fit for use. The apothecaries' ordinance at Nuremberg provided that no Theriaca should in future be branded with the seal of the city unless it had been previously examined and declared worthy of the same by the doctors of medicine, and that every druggist must know the age of the Theriaca he sold. Inasmuch as its action changed very materially with age, " the buyer should in all instances be informed, so that he may not be deceived." The last public preparation of Theriaca took place at Nuremberg in 1754.

In A.D. 77-7 8 Dioscorides of Anazarba, in Cilicia, wrote his great work on materia medica, which still remains the most important work on the plants and drugs used in ancient times (of which about 400 were enumerated) and until the 17th century was held as the most valuable guide to medicinal plants and drugs extant. Nearly ioo years afterwards Galen, the imperial physician at Rome (A.D. 131-200), who was learned in surgery, pharmacy and materia medica, added about 200 more plants to those described by Dioscorides.

Galen believed in the doctrine of humours originated by Hippocrates, which supposes the condition of the body to depend upon the proper mixture of the four elements, hot, cold, moist and dry, and that drugs possess the same elementary qualities, and that on the principle of contraries one or other was indicated, e.g. a cooling remedy for a feverish state. This doctrine was held for many centuries, and drugs are classed by all the old herbalists as having one or other of these qualities in a greater or less degree. Galen is said to have invented hiera-picra, which he employed as an anthelmintic; it is still used in England as a domestic remedy. In the 6th century Alexander of Tralles used colchicum for gout, iron for anaemia, and rhubarb in liver weakness and dysentery. The practice of pharmacy was extended by the Arabian physicians, and the separation of it from medicine was recognized in the 8th, and legalized in the i ith century. The practice of " polypharmacy," or the use of a large number of ingredients in prescriptions, which was common in the middle ages, was greatly due to the view enunciated by Alkekendo, and held by one of the Arabian schools of medicine: that the activity of medicine increases in a duplicate ratio when compounded with others; and it was only in the first half of the 18th century that the practice was altogether discontinued in the pharmacopoeias, although the theory was shown to be incorrect by Averroes in the 12th century.

The establishments for dispensing medicines at Cordova, Toledo and other large towns under Arab rule, were placed under severe legal restrictions. Frederick II. in A.D. 1233 passed a law, which remained in force for a long time in the two Sicilies, by which every medical man was required to give information against any pharmacist who should sell bad medicine. The pharmacists were divided into two classes, the stationarii, who sold simple drugs and non-magisterial preparations at a tariff determined by competent authorities, and the confectionarii, whose business it was to dispense scrupulously the prescriptions of medical men; all pharmaceutical establishments were placed under the surveillance of the college of medicine. In the monastic period pharmacy was to a great extent under the control of the religious orders, particularly the Benedictines, who, from coming into contact with the Arabian physicians, devoted themselves to pharmacy, pharmacology and therapeutics; but, as monks were forbidden to shed blood, surgery fell largely into the hands of barbers, so that the class of barber-surgeons came into existence, and the sign of their skill in blood-letting still appears in provincial districts in England in the form of the barber's pole, representing the application of bandages.

In England the separation between medicine and pharmacy was somewhat later than on the continent of Europe. The earliest record of an apothecary's shop in London was in 1345. The status of the apothecary, as subordinate to the physician in the time of Henry VIII., is evident from the following, out of 2 1 rules laid down by a prominent apothecary, who was a cousin of Anne Boleyn: " His garden must be at hand, with plenty of herbs and seeds and roots. He must read Dioscorides. He must have mortars, pots, filters, glasses and boxes clean and sweet. He must have two places in the shop, one most clean for physic, and the base place for chirurgic stuff. He is neither to increase nor to diminish the physician's prescription; he is neither to buy nor to sell rotten drugs. He is only to meddle in his own vocation; and to remember that his office is only to be the physician's cook." The drugs used by the physicians and apothecaries were purchased from the grossarii or sellers in gross, who were subsequently called 'grocers, some of whom specialized as druggists and others as chymists or chemists. The apothecaries, who were the pharmacists of those days, were not represented by any corporate body, but in the reign of King James I., in 1606, were incorporated with the Company of Grocers. This arrangement was not, however, approved of by the physicians, who obtained in 1617 a separate charter for the apothecaries, to the number of 114, which was the number of physicians then practising in London. At the same time it was enacted that no grocer should keep an apothecary's shop, and that no surgeon should sell medicines, and that the physicians should have the power to search the shops of the apothecaries within 7 m. of London under a penalty of ioo in case of a refusal to permit it. Soon after the apothecaries were formed into a separate company they took into consideration means to prevent the frauds and adulterations practised by the grocers and druggists, and, to remedy the evil, established a manufactory of their own in 1626 so that they might make preparations for their own members. The frauds and adulterations were probably due in part to the apothecaries, for Dr Merrit, a collegiate physician of London, stated that " such chymists which sell preparations honestly made complain that few apothecaries will go to the price of them." The medicinal preparations which required the aid of a furnace, such as mineral earths, were undertaken by the chymists, who probably derived their name from the Alchymists, who flourished from the 14th to the 16th centuries. When the word was discovered to be derived from an Arabic prefix and a Greek word the prefix was dropped. In the 19th century the word chymist became altered to chemist, although the original spelling is still continued to a small extent. The curious signs on the coloured carboys in chemists' windows, which were commonly to be seen until the middle of the 19th century, were signs used by the alchemists to indicate various chemical substances. In 1694 the apothecaries had increased from 114 to nearly 1000, and many of them, having acquired a knowledge of the uses of medicine, began to prescribe medicines for their customers and to assume the functions of the physician, who retorted in 1697 by establishing dispensaries, where medicines could be procured at their intrinsic value, or at cost price. The assistants employed at these dispensaries after a time appear to have gone into business on their own account, and in this way the dispensing chemists, as a class, appear to have originated.

In 1748 the Apothecaries' Corporation obtained a charter empowering them to license apothecaries to sell medicines in London, or within 7 m., and intended to use it to restrain chemists and druggists from practising pharmacy, and to prohibit physicians and surgeons from selling the medicines they prescribed; but the apothecaries, by paying increased attention to medical and surgical practice, had not only alienated the physicians and surgeons, but materially strengthened the position of chemists and druggists as dispensers of prescriptions. When a further attempt was made in 1815 to bring a bill into parliament including provisions for prohibiting the practice of pharmacy by uneducated persons, and giving power to examine dispensing chemists, the latter became alarmed, and, finding that the provisions of the bill were entirely in the interests of the apothecaries, and directed against chemists and druggists, the latter took measures to oppose it in parliament, which were so far successful as to prevent apothecaries from interfering in' any way with, or obtaining any control over, chemists and druggists. In 1841 another attempt was made by the apothecaries to control the trade of chemists and druggists on the ground that no adequate examination or education in pharmacy existed, and that such should be instituted, and be controlled by the apothecaries and physicians, but the latter disclaimed any desire to take an active part in the matter. The chemists and druggists, recognizing that no institution for the systematic education and examination of chemists and druggists existed in England, and that no proof could be given that each individual possessed the necessary qualifications, decided that this objection must be met, and that pharmacy must be placed upon a more scientific footing. They therefore resolved upon the foundation of a voluntary society, under the title of the Pharmaceutical Society of Great Britain, " for advancing the knowledge of chemistry and pharmacy, and promoting a uniform system of education for those who should practise the same, also for protecting the collective and individual interests and privileges of all its members, in the event of any hostile attack in parliament or elsewhere." This society was instituted in 1841, the original founders being chemists and druggists in the metropolis and provincial towns. On the 18th of February 1843 a royal charter of incorporation was granted to the society, and a permanent status was thus acquired. Chemists in business before the granting of the charter were entitled to join the society as members, but those who wished to join it subsequently could do so only on condition of passing an examination for the purpose of testing their knowledge of pharmacy. A school of pharmacy was instituted, and a museum and library were started. The chemical laboratory in connexion with the school was, when first instituted, the only one in England for teaching purposes, and the museum is now reputed to be the best pharmaceutical one in the world, the library now containing about 13,000 volumes.

The examinations are three in number. The first is of a preliminary character, qualifying for registration as a student or apprentice; in lieu of this examination, certificates of matriculation at a university, and those of certain other educational bodies, are accepted. The second examination qualifies for registration as a chemist and druggist. This is known as the minor examination, and must be passed before anyone can legally dispense, compound and sell scheduled poisons. The subjects included are systematic botany, vegetable morphology and physiology, chemistry, physics, materia medica, pharmacy, dispensing, posology, the reading of prescriptions, and a knowledge of poisons and their antidotes. The Poisons and Pharmacy Act of 1908 (section 4) has given the society power to regulate the preliminary training, arrange a curriculum, and divide the qualifying examination into two parts, so that an approximation to the standard of pharmaceutical education on the Continent is likely to take place within a short period. Degrees in science and pharmacy are granted by the universities of Manchester and Glasgow, and other universities were in 1910 considering the question of granting degrees.

The third, or major examination, which qualifies for registration as a pharmaceutical chemist, is not, like the minor, a compulsory one, but ranks as an honours examination. The education for this examination has kept pace with the rapid advances of science, all the following subjects now receiving attention: the microscopical structure of plants and drugs, so as to detect adulterations and impurities in powdered drugs; organic and quantitative analysis, including those of food and drugs, water, soils, gas and urine; optics, so as to enable them to carry out the prescriptions of oculists; spectrum analysis; the use of the polariscope and refractometer; the method of applying Röntgen rays; the preparation of glandular secretions and antitoxins; and the chemistry of remedies for the fungoid diseases and insect pests of plants.

Those who have passed this examination are competent to perform analysis of all kinds, and generally obtain the preference for various appointments, such as head dispensers in government or other large hospitals, or as analysts. The society has also established a chemical research laboratory, in which much useful work has been done in connexion with the national pharmacopoeia under the direction of the Pharmacopoeia Committee of the Medical Council.

A pharmacy act, which was passed in 1852, established a distinction between registered and examined, and unregistered and unexamined chemists and druggists, creating a register of the former under the name of pharmaceutical chemists, so that the public might discriminate between the two classes. A subsequent pharmacy act, passed in 1868, added a register of chemists and druggists, and rendered it unlawful for any unregistered person to sell or keep open shop for selling the poisons mentioned in the schedule of this act. The administration of the act was entrusted to the pharmaceutical society, and the duty of prosecuting unauthorized practitioners has been performed by the society ever since, without any pecuniary assistance from the state, although the legal expenses involved in prosecution amount to a considerable portion of its income.

The Poisons and Pharmacy Act of 1908 extended the schedule of poisons instituted by the act of 1868, and it now includes arsenic, aconite, aconitine and their preparations; all poisonous vegetable alkaloids, and their salts and poisonous derivatives; atropine and its salts and their preparations; belladonna and all preparations or admixtures (except belladonna plasters) containing 0.1% or more of belladonna alkaloid; cantharides and its poisonous derivatives; any preparation or admixture of coca-leaves containing 0.1% or more of coca alkaloids; corrosive sublimate; cyanide of potassium and all poisonous cyanides and their preparations; tartar emetic, nux vomica, and all preparations or admixtures containing 0.2% or more of strychnine; opium and all preparations and admixtures containing 1% or more of morphine; picro-toxine; prussic acid and all preparations and admixtures containing oi % or more of prussic acid; savin and its oil, and all preparations or admixtures containing savin or its oil. None of these may be sold to any person who is unknown to the seller, unless introduced by a person known to the seller, and not until after an entry is made in a book kept for the purpose, stating, in the prescribed form, the date of sale, name and address of purchaser, the name and quantity of the article sold, and the purpose for which it is stated by the purchaser to be required. The signature of the purchaser and introducer (if any) must be affixed to the entry.

The following poisons may not be sold, either retail or wholesale, unless distinctly labelled with the name of the article, and the word poison, with the name and address of the seller: Almonds, essential oil of (unless deprived of prussic acid). Antimonial wine. Cantharides, tincture and all vesicating liquids, preparations or admixtures of. Carbolic acid, and liquid preparations of carbolic acid and its homologues containing more than 3% of those substances, except preparations for use as sheep-wash or for any other purpose in connexion with agriculture or horticulture, contained in a closed vessel distinctly labelled with the word " poisonous," the name and address of the seller, and a notice of the special purposes for which the preparations are intended. Chloral hydrate. Chloroform, and all preparations or admixtures containing more than 20% of chloroform. Coca, any preparation or admixture of, containing more than 0.1% but less than 1 of coca alkaloids. Digitalis. Mercuric iodide. Mercuric sulphocyanide. Oxalic acid. Poppies, all preparations of, excepting red poppy petals and syrup of red poppies (Papaver Rhoeas). Precipitate, red, and all oxides of mercury. Precipitate, white. Strophanthus. Sulphonal. All preparations or admixtures which are not included in part 1 of the schedule, and contain a poison within the meaning of the pharmacy acts, except preparations or admixtures, the exclusion of which from this schedule is indicated by the words therein relating to carbolic acid, chloroform and coca, and except such substances as come within the provisions of section 5 of the act.

It has been erroneously represented by interested persons that the Pharmaceutical Society desires a monopoly of the sale of poisons. This is not the case. Any poisonous substance that is not included in the schedules can be sold by anyone, as, for instance, red lead, sulphate of copper, &c. The duty of the Pharmaceutical Society is a purely legal one, and relates only to the schedules of poisons framed by the government to protect the public by rendering it a difficult matter to obtain the poisons most frequently used for criminal purposes. In continental countries the laws are even more stringent.

In response to an agitation originated by certain manufacturers (one of whom was a member of parliament), who were prosecuted for omitting to label arsenical and nicotine preparations as poisons, as required by the Pharmacy Act of 1868, a new act was passed in 1908, by which persons, without any training in toxicology, and being neither pharmaceutical chemists, nor chemists and druggists, may be granted licences by local authorities to sell poisonous substances used exclusively in agriculture or horticulture, for the destruction of insects, fungi or bacteria, or as sheep dips or weedkillers, but which are poisonous by reason of containing the scheduled poisons, arsenic or nicotine, &c. One condition concerning the granting of such licences has been, it is said, deliberately ignored in many towns, viz. that the local authority, before granting a licence, " shall take into consideration whether, in the neighbourhood, the reasonable requirements of the public are satisfied with regard to the purchase of poisonous substances, and also any objections they may receive from the chief officer of police, or from any existing vendors of the substances to which the application relates." It is left to the Pharmaceutical Society to take legal action against any infringement of the law, although it is obvious that this should be carried out at the government expense, since it is for the benefit of a section of the public, and obviously to the loss of the members of the Pharmaceutical Society. Moreover, the present act nullifies the object of the previous act of 1868, which was to reduce the facilities for obtaining poisons. The fact that a voluntary society with limited funds must contest the illegal decisions of local councils, without government support, seems likely to render this portion of the act of 1908 a dead letter.

At the time of the passing of the Pharmacy Act of 1852 co-operative associations did not come under consideration, and no provision was made concerning them as regards the title of chemist, or as to any action such associations might take to evade the law. It has been decided in the law courts that a limited liability company is not a person in the eye of the law, and therefore does not come under the operation of the act of 1868. The result of this decision was that any chemist who failed to pass the qualifying examination could constitute himself with a few others, even if ignorant of pharmacy, into a limited liability company, which would then have been outside the powers of the act, and not subject to its provisions. This false position was remedied by the act of 1908, which brings companies into line with individuals.

On the continent of Europe the dispensing of prescriptions is confined to pharmacists (pharmaciens and apothe- hers). They are not allowed to prescribe, nor the medical men to dispense, except under special licence, and then only in small villages, where the pharmacist could not make a living. The principle of " one man one shop " is general; a pharmacist may not own more than one shop in the same town. In Holland he may not enter into any agreement, direct or indirect, with a medical man with regard to the supply of medicines. In Austria, Germany, Italy, Rumania and Russia the number of pharmacies is limited according to the population. In France, Switzerland, Belgium and Holland the number is not limited, and every qualified pharmacist has the right to open a shop or buy a pharmacy. Where the number of pharmacies is limited by law prescriptions may only be dispensed at these establishments. The original prescription is kept by the pharmacist for either three or ten years, according to the country, and a certified copy given to the patient, written on white paper if for internal use, or on coloured paper (usually orange yellow) if for external use. The price of the drugs and the tariff for dispensing prescriptions is fixed by government authority. In Russia a prescription containing any of the poisons indicated in the schedules A and B in the Russian pharmacopoeia may not be repeated, except by order of the doctor. The use of pharmacopoeia preparations made by manufacturers is allowed, but the seller is held responsible for their purity and strength. The prices charged for dispensing are lower in countries where the number of pharmacies is limited by law, the larger returns enabling the profit to be lessened.

The educational course adopted in different countries varies as to the details of the subjects taught. The preliminary, or classical examination, is usually that of university matriculation, or its equivalent. The period of study is eighteen months in Denmark or Norway, and two in Austria, Finland, Germany, Portugal, Russia, Sweden and Switzerland, three in Belgium, France, Greece and Italy, four to six in Holland, and five in Spain. In Great Britain the period of study is voluntary, and usually occupies only one year. Two or three years of apprenticeship is required in most countries, including Great Britain, but none in Belgium, Greece, Italy or Spain.

The subject of patent medicines is but little understood by the general public. Any medicine, the composition of which is kept secret, but which is advertised on the label for the cure of diseases, must in Great Britain bear a patent medicine stamp equal to about one-ninth of its face value. The British Medical Association published in 1907 a work on Secret Remedies; what they cost and what they contain. The analyses published in this work show that nearly all the widely advertised secret remedies contain only well-known and inexpensive drugs. The Pharmaceutical Society on the other hand has also published a Pharmaceutical Journal Formulary, including several hundred formulae of proprietary medicines sold by pharmacists, so that it is now possible for any medical man to ascertain what they contain. The government accepts all the therein published formulae as " known, admitted and approved " remedies, and therefore not requiring a patent medicine stamp. In this way widely advertised secret remedies can be replaced by medicines of known composition and accepted value in any part of the world. Most continental countries have issued stringent laws against the sale of secret remedies, and these have been lately strengthened in Germany, France and Italy. In Switzerland secret remedies cannot be advertised without submitting the formula and a sample of the remedy to the board of health. (E. M. H.)