One of the unique characteristic of Homo sapiens is their struggle to treat ailments. From archeological evidences this urge is as old as humanity. Ancient man learned from 4 instincts, from observation of birds and beasts. Cool water, a leaf and mud was his first soothing application. By trial he learned which served him best. Eventually, he applied his knowledge for the benefit of others. It is a well known fact that medicines rarely occur in nature in their useful or palatable form. First the active ingredients or drugs must be collected, processed, for incorporation into medicaments.
This process , done since dawn of humanity, of preparing medicines is still central focus of practice of pharmacy. For today’s pharmacists it is essential that the role of drugs in human history must be understood. A basic introduction to the development of ideas concerning to drugs, as well as the evolution of the profession, increases the ability of pharmacists to adjust to the challenges presented as our professional roles expand. In this assignment two aspects will be cover: 1. How the concept of drug evolved over time. 5 2. How a separate profession arose to prepare medicines in the west.
Throughout the history drugs have played a special role. Drugs such as insulin have kept thousands alive, and antibiotics and chemotherapeutic agents have saved thousands more. Although pharmacy as a skill is perhaps as old as the making of stone implements, the practice of this singular art by a recognized specialist is only about 1000 years old. 2. PREHISTORIC PHARMACY Since humanity’s earliest past, pharmacy has been a part of everyday life. Excavations of some of mankind’s oldest settlements, such as Shanidar (30,000 BC) , support the contention that prehistoric people gathered plants for medicinal purposes.
By trial and error folk knowledge about healing properties of certain natural substances grew. When healers at Shanidar 6 or other prehistoric places approached disease, they placed it within context of their general understanding of world around them, which was alive with good and evil spirits. Early people describe disease in supernatural terms, as they did the other changes and disasters around them. The discovery that certain natural substances can ease the suffering of human’s existence, however, should not be trivialized.
Although early people discovered only small number of drugs but the discovery of this fact that human body function can be altered by an outside factor, considered as one of the greatest humanity’s achievement. 3. ANTIQUITY Antiquity also means ‘ancient times’. After the establi-shment of organized civilization, such as Nile and other, the concepts about drug and disease were also changed. Empirical healing was separated from spiritual healing. In 7 B-Babylonians two classes were providing magical healing: 1. The Asipu. 2. The Asu. The Asipu were magical healer who relied heavily on spells and used magical stones for healing purposes.
The Asu were empirical healer who drew upon large number of drugs and processed them into dosage forms that are still basic today, such as suppositories, washes, enemas, pills and ointments. These two types of healers were not in direct competition and also supported each other on several cases.
The root of modern Europe arose from Greek civilization. In Greek healers were curing diseases by developing a link between environment and humanity by connecting four elements of earth air, water and fire with four governing humors of the body: black bile, blood, yellow bile, phlegm. If these methods were failed they also used 8 their own drugs and passed these information’s to others.
Following were some of the prominent scientist of this period and their work is given in table: Table 3. 1 Scientists. ERA. WORK. Theophrastus. 370-285BC. He took first great study of plants. Dioscorides. 65AD. Published ‘Materia Medica’ which became first standard encyclopedia for drugs for even hundreds of years. Galen. 130-200AD. He used drugs of contrary nature to treat disease. Eg. To treat inflammation (external), he would suggest cucumber, a wet and cool drug. 9 4. THE MIDDLE AGES Middle ages are defined as the period between first fall of Rome to the fall of Constantinople.
The concept of drugs and disease again got a shift as Churches’ became centre for providing medical care. Sin and drug were related intimately. Monks published their own short version of medical text (epitomes) and planted gardens for obtaining herbs. As Western Europe struggled, Muslim civilazation arose as a holder of knowledge and science. Many renowned Muslim scientists not only translated Greek books of Galen and Dioscorides into their own language but also added very useful information regarding drugs. Table 4. 1 SCIENTISTS. ERA. WORK. Al-Razi (Rhazes). 860-932.
He was the first physician to distinguish smallpox and measles throug h his clinical characterization of the two diseases Abn-e-sina 980-1063. His most famous works are The Book of 10 (Avicenna). Healing, a vast philosophical and scientific encyclopedia. These scientists also develop dosage form elegant and palatable, through silvering and gilding of pills and by use of syrups.
To prepare these drugs several special institutions developed which resulted in separation of Pharmacy and medicines and this concept later on passed over to west. For a change in Europe the scholastic approach has to be set aside and more skeptical, observational methodology had to be adopted. That was called as the renaissance which was then an experimental age. 5. THE RENAISSANCE AND EARLY MODERN EUROPE. The renaissance simply means the beginning of modern Europe.
This was the time to change the concept regarding disease and the ideas of Galen. 11 Table 5. 1 Scientist Era Work Andres Vesalius. 1514-1564. He is often referred to as the founder of modern human anatomy. The work of Vesalius and other scientists in this era did not influence the treatment of disease so much but of ‘Paracelsus’. He was a Swiss surgeon. The battle of Paracelsus against the static ideas of disease opened the window into the complicated mind towards renaissance.
He was important advocate of chemically preparing drugs from crude substances and mineral substances. He had his believe on observation yet also he preached ‘Doctorine of signature’, a belief that God has placed a sign on healing substances indicating their use against a specific disease. E. g. liverwort resembles liver so it must be used for liver ailments. Table 5. 2 12 Scientist. Era.
Work Paracelsus. 1493-1541 Pioneered the use of chemicals and minerals in medicine Chemical process such as distillation helped the followers of Paracelsus to isolate the healing substances of drugs, its quintessence. Thus a great leap in the history of pharmacy was occurred when chemistry (science) was applied to take drugs. Due to the cooperation between the pharmaceutical guilds and governmental bodies the trend led towards the standardization of medicines and publishing of Pharmacopeias.
The volume of chemical discoveries made by scientists in chemistry would fill many volumes, some of these are: Table 5. 3 Scientist. Era. Work. Martin klaproth. 1743-1817. Pioneer of analy-tical chemistry. 13 Wilhelm Scheele. 1742-1786. Discovered oxygen. Since most of the drugs were taken from plants so in this period pharmacists dominated the botanical studies. To search, characterize, process, and identify scores of chemical contained in a crude plant was a great challenge.
Discoveries resulted from hit and trial, Scheele separated citric acid from plant, similarly at same time morphine was extracted from opium. These discoveries opened the gate for other scientists to discover more chemicals and separate them from other. During the conflicts between prescribers and dispensers of drugs a situation led to the development of a unique profession that is called American Pharmacy.
6. AMERICAN PHARMACY When the colonies grew more prosperous, it attracted businessmen and apothecaries. Apothecaries are the people who are related 14 to preparation and sale of drugs. Previously they were using medicines which were being imported from Britain, but during the revolutionary war they had to prepare them by themselves which resulted in flourishing of Pharmacy and decreased the dependence on Britain for medicines.
These apothecaries are also known as the forerunners of modern day Pharmacists. In 1820 USP (United State Pharmacopeia) was published but it was not recognized as the official Pharmacopeia, but it rapidly accepted nationally as a primary guide for drugs. Different pharmacy schools were established which resulted in number of Pharmacists needed to established pharmaceutical societies.
7. ANTEBELLUM AMERICA Antebellum America means the period of America before civil war. In this period the boundaries which established between physician and pharmacists still exists today. 15 The physician fostered the pharmaceutical profession. Physician voiced forced the development of a separate profession of Pharmacy as ‘necessity of division of labor’ to meet the ‘growing demands of a community’.
As the quality of imported drugs declined they got the help of expert Pharmacists to check the quality of the drugs. The relation between physician and pharmacists become to sour in 1840. Physicians blamed the pharmacists of dispensing the drugs to patients without prescription of a physician, a practice called as counter prescribing. In this period American pharmacy sprang so much which drew a very bold line between pharmacists and physicians. 8. SEARCH FOR PROFESSIONA-LISM.
In 1852 small number of Pharmacists met in Philadelphia and established a society 16 named as APhA (American pharmacists Association). The held the promise to increase their professional stature by fostering the individual improvements and not by winning the favor of physician and government bureaucrats.
The other professions such as engineering attracted the attention of pharmacists, who then struggled to also raise the standard of their profession by improving the educational curriculum and exams standard. 9. LEGISLATION. First of all, we define that what the meaning of legislation is. The word legislation means preparation & enactment of law. In short we can say law which is approved by government. The APhA (American Pharmacist Association) play a leading role to the progress of Pharmacy.
In 1860s the 17 APhA increased public protection & occupational security through law by publishing a model Pharmacy act. At that time the Physicians & bureaucrats want to take proper authority over Pharmacists. They show a negative view towards Pharmacists they want to take authority over Pharmacists via state Inspectors or licensing boards. To protect the profession the APhA empowered a committee to draw up a model law. The APhA published & distributed their model law without any act. In 1870s the law began considering in earnest pharmacy bill sponsored by nonpharmacists.
After that Pharmacists organized statewide ass-osiation to coordinate support for their own bill. The eventual success of Pharmacists by the efforts of APhA from 1870s to1890s. After all that Pharmacists sought a new ways to demonstrate their competence 18 and to separate themselves from ignorant drug sellers. 10. TRANSITION TO A MODERN PROFESSION The period between 1870s and 1920s was transition for both Pharmacy and Pharmaceutical education.
Before the Civil War (the war between the people of same country e. g. war in America from1820-1830) approx 1 in 20 Pharmacists had finished formal schooling in Pharmacy; now we will discuss that what is meant by formal schooling in Pharmacy?
It was consisted of night courses to supplement apprenticeship training. By the passage of time after 1870s Pharmacy became part of the wave of professionalization sweeping across American society. Firstly this profession was based on their claims of status on their diplomas 19 and licenses, not their products. Pharmacy got caught in this trend, and even though state laws did not require a Pharmacy school diploma for licensure until the early 20th century.
If we discuss about the role of larger university communities, the leader of university faculties helped to transform Pharmaceutical education from a vocational to a scientific orientation through Pharmacy programs that was consisted of laboratory study and coursework. During this period Pharmacy`s part in health care solidified, as the dispensing of medicines by Physicians declined.
In these 50 years (1870-1920) increased economic pressure on this profession more importantly, on the chain drug store and on the cut-rate drugstore. Although the pharmacist relied on prescription compounding for his professional identity, this provide only 20 a small fraction of his income. To protect this independent and uniquely American style of practice from the incursion of larger retailers, the NARD (National Association Of Retail Druggist) was founded in 1898.
At first APhA welcomed and cooperated with the new national organization, but the split that eventually developed between the APhA, which was oriented to scientific and professional advancement, and NARD, which concentrated on the individual commercial success of owners. It was an exciting time in medicine, with therapeutics undergoing a transformation.
The germ theory of disease represented by laboratory scientists such as Louis Pasteur and Robert Koch, resulted in significant immunological(a drug used to treat immune system) advances in the 1880s and 1890s. Pateur`s rabies(a disease caused by the bite of mad 21 dog, fox etc)vaccine and Emil von Behring`s diphtheria(a disease of upper respiratory tract characterized by a sore throat)antitoxin demonstrated that cures for infectious diseases could arise from the laboratory .
Paul Ehrlich transcended the biological efforts of his predecessors when he introduced Salvarsan(an organoarsenic compound that was once used in the treatment of syphilis; the first chemotherapeutic agent)in 1910. Salvarsan did inspire others to search for drugs with chemotherapeutic potential. Industrial research on drugs produced several new agents, such as analgesic and antipyretic aspirin or the sedative chloral hydrate (that reduce the pain and suffering).
As scientific pharmacology explained how the drugs worked on a cellular and organ system level, the concept of 22 drugs and their actions held by professionals and laypeople diverged. The 1906 Food and Drugs Act, passed mainly in response to poor food-production methods, also addressed problems in the drug trade. The 1906 act did establish the United State Pharmacopeia as well as the National Formulary of the APhA as official compendia, providing the US with truly national drug standards for the first time.
As concern to the education, Pharmacy education adapted gradually to the change. The professional credentials of American pharmacists were strengthened in 1932 when a 4-year BSc degree became standard for licensure. For the next three decades pharmacy schools graduated pharmacists who could claim to the chemists on the corner. 23 11. THE ERA OF COUNT AND POUR The middle third of the 20th century was a time of dramatic change for all medical care especially in the field of Pharmacy.
In therapeutics, many of the great illness of humanity were to gain through the introduction of antibiotic. As the first the phenomenon of antibiosis had been observed by Pasteur in the 1870s, the first significant antibiotic substance was not discovered until Alexander Fleming noticed the effects of a colony of penicillium mold on a misplaced Petri dish in 1928. After World War American pharmaceutical firms applied high technology to the production of medicines and rapidly became one of the most advanced industries in the world.
From the early 1900s of physicians shifting away from 24 prescribing complex mixtures of ingredients toward ready-made, single entity medicines mass manufactured by large companies. Pharmacists, were however, were not a loss for work. Chain stores and others large retailers rushed into drug business, displacing the independent corner drugstore as a typical purveyor of pharmaceutical services, especially at outside areas.
The sale of prescription drugs increased faster than out-front sales of over-the-counter medicines (the drugs which is taken without the prescription of any doctor, physician& health care unit) In 1970 Drug Abuse Act, law regulating drugs of high abuse potential were update through this act, which was subsequently enforced through the Drug Enforcement Agency. 25 Proposal for 6-years Doctor of Pharmacy degrees to raise the professional standing of pharmacy gained interest in a few places, with the first such program initiated at a University of Southern California in 1950.
But as a whole, pharmaceutical educators compromised and selected a 5-years Bachelor of science in pharmacy as the standard degree beginning in 1960. There were some restricted role which were applied by the Code of Ethics of APhA, which was in effect from its adoption in 1952 until its revision in 1969.
“The pharmacist does not discuss the therapeutic effects or composition of a prescription with a patient when such a questions are asked, he suggests that the qualified practitioner (i. e. physician or 26 Dentists) is the proper person with whom such matters should be discussed” 12. THE EMERGENCE OF CLINICAL PHARMACY First we will discuss about that what we meant by clinical pharmacy. Clinical pharmacy may be defined as ‘the science and practice of rational use of medication and devices’ .
The concept of clinical pharmacy sprang from a combination of factors, including the development of the sub discipline of hospital pharmacy since the 1920 the
growth of clinical pharmacy since the 1940. Outwardly, the practice of pharmacy today differs little in appearance from that of 60years ago. An individual hand over a small slip of paper received from a physician to a pharmacists who then treats in to work area and appears later with a container of medicine. 27 Pharmacists, traditionally conservative in the face of technologies innovation, adapted computer technologies to their work as quickly as any other profession of the late 20th century. 13. THE FUTURE It is clear that pharmacists had played very important role in the history.
Two full generations of pharmacists had been educated and trained after the general adaption of the aim of clinical pharmacy. In the midst of a harsh economic and regulatory climate, only time will tell if the often divided and divisive pharmaceutical profession will unite and continue its progress toward greater societal responsibility for the ancient tool we call medicines. EYEBIRD VIEW ON SCIENTIST WORK 28 Scientists. Era. Theophrastus. 370-285BC. Dioscorides. 65AD. Galen. 130-200AD. He used drugs of contrary nature to treat disease. Eg. To treat inflammation (external), he would suggest cucumber, a wet and cool drug. Al-Razi (Rhazes). 860-932.
He was the first physician to distinguish Abn-e-sina (Avicenna). 980-1063. His most famous works are Andres Vesalius. 1514-1564. He is often referred to as the founder of modern human anatomy. Paracelsus. Pioneered the use of chemicals and minerals in medicine Martin klaproth. 1743-1817. Wilhelm Scheele. 1742-1786. Louis Pasteur 1822-1895 Emil-von Behring`s 1854-191 7 Discused about diphtheria. Paul Ehrlich 1854-191 5 Discovered first chemotherapeutic agent; 29 14. REFERENCES •Remington, the Science and Practice of Pharmacy, 21st Edition: Vol. 1, Chapter 2. •Washington State University, College of Pharmacy.