THE HISTORY OF PHARMACUTICAL COMPOUNDING

The History of the Pharmacy and Pharmacology dates back to the medieval times
with priests, both men and women, who ministered to the sick with religious rites as
well. Many peoples of the world continue the close association of drugs, medicine,
and religion or faith. Specialization first occurred early in the 9th century in the
civilized world around Baghdad. It gradually spread to Europe as alchemy,
eventually evolving into chemistry as physicians began to abandon beliefs that were
not demonstrable in the physical world. Physicians often both prepared and
prescribed medicines; individual pharmacists not only compounded prescriptions but
manufactured medicaments in bulk lots for general sale. Not until well into the 19th
century was the distinction between the pharmacist as a compounder of medicines
and the physician as a therapist generally accepted.

Pharmacy
phar·ma·cy (fär¹me-sê) noun
plural phar·ma·cies
Abbr. phar., Phar., pharm., Pharm.
1. The art of preparing and dispensing drugs.
2. A place where drugs are sold; a drugstore. In this sense, also called apothecary.
[Middle English farmacie, a purgative, from Old French, from Medieval Latin
pharmacìa, a medicine, from Greek pharmakeia, use of drugs, from pharmakon,
drug.
(The American Heritage® Dictionary of the English Language, Third Edition
copyright © 1992 by Houghton Mifflin Company. Electronic version licensed from
InfoSoft International, Inc. All rights reserved.)
The origin of the word "pharmacy" is generally ascribed to the Greek pharmakon
("remedy"). It has been suggested that there is a connection with the egyptian term
ph-ar-maki ("bestower of security"), which the god Thoth, patron of physicians,
conferred as approbation on a ferryman who had managed a safe crossing. The
notion of an Egyptian origin has a certain romantic appeal, but in all likelihood the
word "pharmacy" and its many cognates derive, like so many other scientific terms,
from the Greek.
As much as 80,000 years ago, people of the Paleolithic period were interested in the
flora around them to engrave a variety of plants, bones and deer antlers. It is
fruitless to try to determine when Pharmaceutical practice started because
Pharmacy in a rudimentry form existed before the word.
Combining different agents, or compounding, was considered an art form practiced
by Priests, and Doctors. The first known chemical processes were carried out by the
artisans of Mesopotamia, Egypt, and China. Most of these craftspeople were
employed in temples and palaces, making luxury goods for priests and nobles. In
the temples, the priests especially had time to speculate on the origin of the
changes they saw in the world about them. Their theories often involved magic, but
they also developed astronomical, mathematical, and cosmological ideas, which
they used in attempts to explain some of the changes that are now considered
chemical.
GREEK NATURAL PHILOSOPHY
The first culture to consider these ideas scientifically was that of the Greeks. From
the time of Thales, about 600 BC, Greek philosophers were making logical
speculations about the physical world rather than relying on myth to explain
phenomena. Thales himself assumed that all matter was derived from water, which
could solidify to earth or evaporate to air. His successors expanded this theory into
the idea that four elements composed the world: earth, water, air, and fire.
Democritus thought that these elements were composed of atoms, minute particles
moving in a vacuum. Others, especially Aristotle, believed that the elements formed
a continuum of mass and therefore a vacuum could not exist. The atomic idea
quickly lost ground among the Greeks, but it was never entirely forgotten. When it
was revived during the Renaissance, it formed the basis of modern atomic theory.
Today modern pharmacist deals with complex pharmaceutical remedies far different
from the elixirs, spirits, and powders described in the Pharmacopeia of London
(1618) and the Pharmacopeia of Paris (1639). In the U.S. today, major medicines,
those regarded as having the greatest therapeutic value, are selected for inclusion
in the Pharmacopeia of the United States, first published in 1820, by a Committee
on Revision on which all colleges of medicine and pharmacy, all state medical and
pharmaceutical associations, and the U.S. surgeon general are represented. After
the drugs have been chosen, the standards for quality and potency are formulated
by pharmacists and pharmaceutical chemists. Similar criteria for drugs regarded by
the committee as having less therapeutic value are set forth in the National
Formulary, published by the American Pharmaceutical Association (founded 1852)
since 1888. Any significant variation from pharmacopeia and formulary standards
may be prosecuted by the Food and Drug Administration under the Pure Food and
Drug Acts. Pharmacy, science of compounding and dispensing medication; also, an
establishment used for such purposes. Modern pharmaceutical practice includes the
dispensing, identification, selection, and analysis of DRUGS. Pharmacy began to
develop as a profession separate from medicine in the 18th cent., and in 1821 the
first U.S. school of pharmacy was established in Philadelphia. Pharmacology (fär
´me-kòl¹e-jê), study of the changes produced in living animals by DRUGS, chemical
substances used to treat and diagnose disease. It is closely related to other
scientific disciplines, particularly BIOCHEMISTRY and PHYSIOLOGY. Areas of
pharmacologic research include mechanisms of drug action, the use of drugs in
treating disease, and drug-induced side effects. Pharmacy, practice of compounding
and dispensing drugs; also the place where such medicinal products are prepared.
Pharmacy is an area of materia medica, that branch of medical science concerning
the sources, nature, properties, and preparation of drugs. Pharmacists share with
the chemical and medical profession responsibility for discovering new drugs and
synthesizing organic compounds of therapeutic value. In addition, the community
pharmacist, or druggist, is increasingly called upon to give advice in matters of
health and hygiene.

Education and Practice

In the U.S., colleges of pharmacy offer 5-year undergraduate programs leading to
the degree of bachelor of science in the pharmaceutical sciences. All accept students
directly from high school and may grant advanced standing to college students or
graduates. Licenses are granted by states after the following requirements have
been met: graduation from one of the 72 colleges with programs accredited by the
American Council on Pharmaceutical Education; about 1500 hours of internship
under a registered pharmacist; satisfactory completion of a state examination.
Pharmacists may practice their profession in a pharmacy located in a hospital,
nursing home, or special area of a drugstore. They may also be employed by a
pharmaceutical company in scientific research or the development and production of
new pharmaceutical products.

WHAT HAPPENED TO THE NEIGHBORHOOD COMPOUNDING PHARMACY?

THE INDUSTRIAL REVOLUTION
The rapid change from hand methods to machine methods of production that
characterized the Industrial Revolution found a ready application in pharmacy,
especially under the impact of the scientific developments of the nineteenth century.
Phytochemistry and synthetic chemistry created new derivatives of old drugs and
new chemical entities of medicinal value that strained the capacity of the individual
pharmacy. Large scale drug manufacturing had its strong hold on society with the
advent of machines and patents.
The progress made by this new industry is demonstrated by the catalogue of the
American firm G.D. Searle, which by the late 1880’s listed 400 fluid extracts, 150
elixirs, 100 syrups, 75 powdered extracts, and 25 tinctures and other drug forms.

THE DECLINING ART OF THE APOTHECARY

Industrialization had an impact on every aspect of the activity of the pharmacist.
First, it led to the creation of new drugs, drugs that the individual pharmacist’s own
resources could not produce. Second, many drugs that the individual pharmacist
was able to produce could be manufactured more economically, and in superior
quality, by industry. Third, industry assumed responsibility traditionally vested in
the pharmacist for the quality of the medication. The plethora of proprietary
medicines, widely and often blatantly advertised, deprived the pharmacist of a
market for private specialties; it forced the pharmacist to become a vendor of
questionable merchandise; it opened the way to much broader competition from
merchants, grocers and pitchmen than the pharmacist had previously encountered.

THE COMMUNITY PHARMACY

The nineteenth century did not see the end of the art of compounding, but the art
did give way, however grudgingly, to new technology. It has been estimated that a
"broad knowledge of compounding" was still essential for 80 percent f the
prescriptions dispensed in the 1920s. Although pharmacists increasingly relied on
chemicals purchased from the manufacturer to make up prescriptions, there still
remained much to be done secundum Artem. They spread their own plasters,
prepared pills (of aloes and myrrh or quinine and opium, for example), prepared
powders of all kinds, and made up confections, conserves, medicated waters, and
perfumes. They put up tinctures (of laudanum, paregoric, and colchicum) in five
gallon demijohns. And they frequently combined into a single dosage from several
medicines, which normally today would be written and dispensed as separate
prescriptions. Further more, they were often called upon to provide first aid and
medicines for such common ailments as burns, frostbite, colic, flesh wounds,
poisoning, constipation, and diarrhea.
In addition to maintaining a prescription laboratory, pharmacists usually carried the
disliked but necessary patent and proprietary remedies along with herbs and locally
popular nostrums of their own compounding.

THE TWENTIETH CENTURY PHARMACIST

The most notable change in pharmacy in modern times has been the virtual
disappearance of the preparation and compounding of medicines. Whereas in the
1920s, 80 percent of the prescriptions filled in American pharmacies required a
knowledge of compounding, by the 1940s the number of prescriptions requiring
compounding had declined to 26 percent. As far back as 1971, only 1 percent, or
less, of all prescriptions combined two or more active ingredients. Moreover, the
pharmacist’s commitment to maintaining the quality of the drugs dispensed has
been reduced to knowing such facts as the length of shelf life and the effect of
exposure to light and judging the reliability and reputations of the manufacture.
All this meant that the pharmacist’s education and activities had to undergo change.
At the same time that the scientific education of pharmacists was steadily becoming
more demanding, their role in the provision of health care was becoming more and
more circumscribed. Moreover, they were increasingly subject to government and
institutional requirements that diminished the importance of the patient-pharmacist
relation. And, especially in the United States and Great Britain, competition from
prescription departments in chain and department stores tended to demean both
the role and the dignity of the pharmacist as a health-care professional. The urban
blight that attacked the neighborhoods was inevitably a threat to the friendly
neighborhood pharmacist.
The reaction to these conditions was apparent in the drop in the production of
graduates of American schools of pharmacy who were planning to go into the field
of community pharmacy. In 1947, about 90 percent of graduates planned to go into
some aspect of community pharmacy; in 1973, that figure had dropped to 76.6
percent; in 1988 it stood at 57.1 percent.

COMPOUNDING TODAY

Custom Compounding pharmacies are on the rise. Physicians, medical institutions

and patients are realizing more then ever the importance of tailoring an individuals
medications to specifically meet there needs. A majority of the Pharmacists that are
going back to compounding are doing so for the love of the science and interest in
the patients well being. Being able to be in the role of a problem solver opens the
doors to creativity and genius that the medical industry has been eagerly adopting
for the last decade.
Note: Most of the information detailed in this report was found in the definitive book
on the history of pharmacy; Pharmacy an illustrated history, by David L.
Cowen and William H. Helfand, published byHarry N Abrams, Inc., New
York. - ISBN 0-8109-1498-0 This is a beautifully illustrated, 250 page book that
was published in 1990.