A Scandalously Short Introduction to the History of Pharmacy

Chapter 9 - The Tools of the Pharmacist

It is in the Bible that we find the first mention of the Apothecary and his art. In Exodus Chapter 30, Verse 25, where the holy anointing oil is prescribed to be made "after the art of the Apothecary". Here the word Apothecary, should probably have been  more accurately translated as "perfumer".

This brief look at the raft of the Pharmacist or Apothecary and the tools that were used in everyday practice is not meant to represent a history of pharmacy and medicines.

Rather, these few examples are meant to illustrate how manipulative skills were part and parcel of pharmacy and also to give an impression of how in the past, art joined pharmacy as well. The influence of each upon the other led to the development of unique forms which often still reflect their utility. These notes can only briefly explain the function of the objects illustrated, but they are intended to contribute to a better understanding of pictures and texts that you may come across in your reading or browsing.

One of the earliest skills developed by man was the art of fashioning earthenware articles such as pots and jugs. Only simple techniques were required to make such receptacles, and the raw materials, clay, water and wood to provide heat to harden the pot, were readily at hand. Such vessels provided the means by which primitive man could collect and store roots, seeds, berries and herbal extracts for future use as remedies to relieve the irritations to his life inflicted by the hostile world about him.

In general, one can distinguish within the pharmaceutical realm between instruments and storage vessels. Among the instruments, the grinding bowl and the closely related mortar are the oldest tools for crushing and grinding.

The Pestle And Mortar

Stone, agate, ivory, glass and wood were used to make these mortars, but the most commonly used materials were bronze (a copper-tin alloy) or brass (copper-zinc). Older pictures clearly show that certain mortars were used with a pestle to crush fresh and dried plants and animal parts and to grind mineral substances.

Bronze mortars started to appear in practice from the 14th century on, and many brass and bronze founders produced mortars as they were made primarily by casting like bells and cannons.

The modern attribution of old pieces to particular craftsmen and patrons has a number of intrinsic uncertainties. As a rule, mortars can only be attributed to a specific craftsman when names, marks or inscriptions are present or when the patron has his name engraved in the piece. Most of the unsigned mortars from the 15th to the 18th century were probably not used in pharmacies, but served as household items, showpieces or gifts.

The mortar was as valuable to a pharmacist as a set of knives would be to a cook and often appeared on the inventory as part of the assets of a business. Another instrument as important to the pharmacist as his mortar, were the weighing scales.

Weights And Measures

Long before analytical and biochemical methods by which the content and activity of drugs and medicines could be made, it was the eye and the nose and the taste of the practitioner, together with the erudition of experience that was the only measure of freshness and purity. Attempts to achieve a uniform set of standards for weights and measures as far as trade in wine, beer wheat and other commodities occupied the kings of England since before the Norman conquest.
Pharmacy was left with some very strange legacies because we had two systems of wights and measures to deal with. The first troy pound was adopted as the legal standard by Henry VII, and the troy pound, ounce and pennyweight were to be applied not only for bullion and bread, but for all spices and apothecary ware. The Troy ounce was 480 grains and a pennyweight was the weight of 24 barleycorn grains.

The oldest form of the scales was the two-armed balance consisting of a beam and a pan connected to each end with string or cord. Initially, fabric or leather was used for the pans. Later, they were also made of wood and metal.

Even in the Egypt and Babylon of antiquity, a distinction was made between portable hand scales for precious goods such as gold, silver, gems, medicines and drugs - and, later, coins - and large, stationary scales used to weigh larger quantities.

In Roman times a second type appeared alongside the two-armed balance: the one-armed scale fitted with a sliding weight.

As illustrations from the 16th and 17th centuries show, apothecaries generally used hand scales to weigh medicines. These had a needle attached to the beam which pointed up; the pans were made of metals such as bronze, iron or copper, or of horn or ivory.

By the 17th century at the latest, scale stands mounted on the dispensing table had become a common aid. Several hand scales could be hung up on them. In the 17th century table balances came into use which had been developed from the assay balances of the 16th century. Later the table scales were placed in a wooden box to prevent external influences such as dust or moisture from affecting the weighing process. This further increased their accuracy.

Weights, of course, were a crucial part of any weighing device. Originally, natural measures were used.

The first units of weight can be found in Greece around 670 A.D.: the talent, mina, drachma, obolus, half obolus, and chalkus.

The Roman Empire's standard unit of weight was the pound (libra =327.45 g), which was subdivided according to the duodecimal system. The Roman monetary pound (pondus aurarium et argentum) was still in use in early modern Italy as a unit of weight.

Despite numerous suggestions for improvement, the system of apothecaries' weights was not standardised until early modern times.

Troy weight, so called because of its use in that city, though it did not originate there, has persisted throughout the ages and was legalised in England in 1497. Avoirdupois weight was not recognised by statute until 1532. The British Pharmacopoeia was not converted to the decimal system in use today, until 1914.

The weights themselves came in all shapes and sizes, and apart from the actual denomination of the weight, there were often maker's marks and when legislation to control weights and measures was introduced in most countries, inspector's stamps also appeared on the weight.

An interesting variant is the set of nesting weights produced by some of the brass and bronze founders of the day. These cone-shaped stacks of bronze weights consisted of a large number of bowl-shaped nesting weights. The sets were used both in commerce and, when their weight corresponded to the medicinal pound and its sub-units, in pharmacies.

If we had stuck to these apothecaries measures, that would have been simple, but liquids were measured in fluid drachms and fluid ounces, and the symbols used by prescribers for the quantities they wanted in a recipe, were the same. This is why the rule that solids by weight and liquids by volume, always applied. In the Avoirdupois system which was legalised in England in 1855, the pound was divided into 7000 grains, and with 16 ounces to the pound, the Avoirdupois ounce was therefore 437.5 grains. The grain was constant in both systems.

Before the adoption of the metric system in Australia, and around the world for scientific use, pharmacists had to often calculate the differences between the troy ounce of 480 grains and the avoirdupois ounce of 437.5grains when a preparation was ordered as a percentage weight in volume or volume in volume, or by parts. Because of the need to ensure that commerce was free from corruption, the legislation governing weights and measures in each State of Australia was enforced by inspectors who called on a regular basis to check and stamp all weights, measures and weighing instruments to ensure their accuracy and to safeguard the public. Because of the small volume of extemporaneous dispensing carried out in pharmacies today, little attention is paid to this routine, although it still remains on the statute books and every registered pharmacy must have the correct apparatus and reference books to enable a prescription to be dispensed. After all that is our calling and what we have been trained for. Would a carpenter go to work without his hammer and chisels?

Glass measures for pharmaceutical purposes have a long history but they were no doubt antedated by earthenware and metal. Metal measures of the older civilisations are plentiful but unless they bear specific markings or there are associated finds, it would be difficult to be certain that any particular surviving measure has been used by a pharmacist. Measures of glass of Roman times are not unusual. Some bear graduations and may, therefore, be associated with the work of the pharmacopolus.

Some of the difficulties which the rulers of England experienced in establishing a common and uniform system for liquid measurement have been noted. The College of Physicians, in the first London, Pharmacopoeia (1618) adopted as their liquid measures the broad divisions of the Roman gallon which had been in use throughout Europe for centuries.Vessels of brass, wood and pewter were perhaps better suited to the life of the pharmacy than earthenware, but all had this disadvantage: while satisfactory for a simple measure, such as the pint or quart, they could have been only moderately successful where graduations were needed. Even if the graduations could be marked upon the inside of the measure, the levels would have been difficult to read satisfactorily and errors would have been made. Translucent horn measures, marked with  graduations were more practical and were used before graduated glass measures made their appearance in the early 18th century.

By the 1830's lipped glass measures, graduated in minims, ounces or tablespoonfuls, were being offered as a regular part of a glass-house stock. They could be had with feet or without, and either cylindrical or conical. There was hardly any variety that could not be supplied by the middle of the 19th century. In the 1880's an opaque glass measure was introduced: this had a translucent panel which was claimed to facilitate reading the quantity required, since the level of the meniscus could be seen more clearly.
 
Two bulk liquid containers maintained their place for many years as stock bottles in the pharmacy--the Winchester quart bottle (of 80 Fl oz. capacity) and the Corbyn quart bottle (of 40 Fl oz.). The latter, in all probability, was introduced into the pharmacy by the old-established firm of Corbyn, Stacy and Company of London.

In contrast to the apothecaries' instruments, their storage vessels came in an astonishing variety of forms. First and foremost, of course, we must mention the faiences, which originated in Persia. European production began in the 14th century in Spain. This "Hispano-Moresque" ware was exported from the island of Majorca to central Italy, where it was copied, particularly in the town of Faenza. The Arabian manner of producing pottery for household and commerce spread first from Faenza to Palermo and Venice and later to Lyon and Antwerp.

Italian faiences usually had polychrome decoration. They were marketed for general use as well as for the storage of simple medicines (simplicia) and compound medicines (composita). Italian pottery was then copied by northern European potters; Nuremberg potters probably first imitated Italian faiences around 1530. About 1600 Antwerp potters began to paint their white earthenware with cobalt-blue foliage designs and to coat it with a tin glaze. This method was adopted in the middle of the 17th century by factories in Delft.

The potteries also produced lavishly decorated tiles, which were used for rolling out pill masses or for decoration. Tiles were often emblazoned with the arms of the Worshipful Society of Apothecaries of London and in all probability were displayed by members of the Society in their pharmacies to proclaim to the public their professional standing , and to assert their superior status over chemists and druggists , who did not  have to undergo any formal training and therefore could not become members of the Society.

As well as their utilitarian function, pill tiles could be likened to the apothecary's shingle. today they are extremely valuable collector's items.

In the 19th century the flamboyant styles of Victorian England were also reflected in pharmacy decorations and a well dressed counter would have been adorned with a classic set of fine china vessels from the Staffordshire potteries labelled for Leeches, Honey and Tamarinds. Many pharmacists also used small dispensing pots, ointment pots and jars for cosmetics and dentrifices made of ceramic materials.

Pot lid graphics are a fascinating example of the vitality and rich inventiveness of Victorian and Edwardian advertising art. Monochrome and bi-colour lids with printed designs and advertising legends “burned in” under the glaze covered containers for bears grease, toothpaste, cold creams, pomades, ointments, shaving creams, and salves. They were manufactured in prolific quantities by most of the potteries of the day.

Reference has already been made to the symbols of Pharmacy  that have very ancient roots. The tools of the profession also provided  popular symbols to identify the business of a Chemist, particularly in places where the populace was largely illiterate.

The pestle and mortar is still the readily recognised symbol of Pharmacy, but two other objects that are still used today are the Carboy or show globe, and the Specie Jar or Decorated Urn.

The exhibition of distinctively shaped glass vessels filled with varied coloured liquids to distinguish the shops of druggists was probably adopted from the near east.There the open shop front of the drug seller was often surrounded with glass vessels and jars containing coloured liquids.

There is also a suggestion that it was the Great Plague in London (1665-66) which caused the London apothecaries to display bottles filled with red liquids and illuminated by lamps placed behind them in order to direct sick people to the apothecary shops. Since many of the physicians had fled the city, and to a largely illiterate population, this announcement of the places where at least some help was offered, would have been undoubtedly a public health measure.

The process of adapting one of the tools of the profession to one of its symbols was also how another glass vessel called a Specie Jar, came into existence. In the 18th & 19th centuries special glass vessels were used to show customers a sample or 'specie' of the drugs they would use in compounding medicines.

As the art of glass-blowing developed, so did the size of the vessels that could be made, and eventually they became a purely decorative item. 

What these early glass vessels lacked in quality, was more than made up for by elaborate labelling and decoration, so that as well as having a practical use for storing large volumes of dried drugs, they could also be displayed in the shop window to identify the type of business carried on within. Specie Jars were not always the exclusive province of the Chemist and Druggist, as various other health professions and societies of the day used their stylised armorial bearings in the designs. Many were lavishly gilded with 22ct gold. Apothecaries, Physicians and Surgeons were among those whose handsome coats of arms and heraldic styles appeared on Specie Jars, no doubt to match the advertising of professional rivals.

Another reflection of the practice of pharmacy are the shop bottles, which even well into this century, were the feature of every well stocked pharmacy. If we look at these humble shop bottles, or rounds (so designated because of their shape) with some sensitivity, we can appreciate their attractiveness .and also we find them yielding snippets of historical information. Their very size and shape can help--at least in conjunction with other historical data--to improve our understanding of everyday practice, not only in the context of the amount of usage of individual drugs and types of preparations, but also by sharpening our understanding of the contribution pharmacy has made to therapeutic effectiveness, especially in terms of the ethos and ambience of the pharmacy. Early bottles (eg. 18th century) were often attractively engraved with the name of the preparation. During the first half of the 19th century, however, labelling was often in black lettering on a gold background, painted  directly onto the container.

By the late 1850s a major change had begun with the introduction of the glass-fronted label in America. This was curved to fit the shape of the bottle, lettered and gilded on the back, and cemented in place. A further refinement was a recess in the glass to protect the labels from damage in use.

POISON BOTTLES

The concern with improving the professional image of pharmacy was a complex matrix of many factors, of which we can only hint at one facet. The totally new products appearing on the market like acetanilide, amyl nitrite, chloral hydrate, paraldehyde, and salol could only be dispensed in glass bottles, and poisonous substances required specially shaped and moulded containers which could be distinguished by touch.

Moreover, many new ways of preparing established drugs became popular, for example, pills, cachets, powders, capsules and tablets. These developments created an exciting time for pharmacy and much can be said for calling the last decades of the 19th century a "golden age of pharmacy."
Certainly, the sets of bottles on dark wooden shelves reflect a view that making premises more attractive was part of "modernising" in the last years of the 19th century.

Further refinements to containers for dispensed medicines were the individually branded containers that some pharmacists used to not only to add a touch of elegance to the finished prescription, but also to emphasise their dispensing skills with a very subtle form of professional advertising. Today technological progress has banished the artistic apothecary jars and stunning glassware from the pharmacy, except as a collector's item.

Yet, they are not merely antiques or art museum pieces; they are truly meaningful symbols of the past   Each jar, bottle or vase with its characteristic shape, decoration and curious label, has its own significance and each has its own appeal. The history of containers for drugs tells of both the history of drug therapy and of the development of the art of ceramics and glass.

Leech Jars were mentioned  earlier. They were a common item in many Pharmacies here in Perth.

Hirudo, the Latin name for Leech was the only living organism listed in the British Pharmacopoeia up until 1898. The five striped Australia Leech Hirudo quinquestriata was official for the Australian colonies at the time. Alan McWhinney's book, "A History of Pharmacy in Western Australia" is a masterful work which you should all endeavour to read. In it he describes how Leeches were dispensed for Royal Perth Hospital as well as for the Kalgoorlie and Albany Hospitals. It was the job of the apprentice to pack the order for Leeches in moist cotton wool and sawdust and then run across to the Railway Station at the last minute before the train left and to give the parcel of live Leeches to the guard to look after during the journey. The Leeches were gathered by an aboriginal man at Lake Monger by simply wading into the water and letting the Leeches stick to his legs.

There is a nice story about an English woman who kept live Leeches as pets, and every 3 or 4 months she would give them a feed of animal blood in a condom. The Leeches can engorge at least double their body weight of blood, and this is why they are valuable aids to healing in microsurgery, even today.The various other chemicals in their saliva which act as a local anaesthetic and an anticoagulant also have exciting prospects for use in human medicine to prevent blood clots and subsequent strokes.

DISPENSING THE PRESCRIPTION

In passing I mentioned "the golden age of pharmacy", which was the time when dispensing required a totally different range of manipulative skills than you are taught today, and most prescriptions were extemporaneously prepared. In those days it was not "ten minutes for ten tablets", because often the ingredients themselves had to be prepared from crude botanical drugs in leaf, seed or root form. Many pharmacists would prepare their own TINCTURES in the dispensary and after the drug had been macerated in an alcoholic solution for about a week, the solution was poured off and filtered, whilst the drug was pressed in a Tincture Press to get as much active ingredient in solution as was possible.

Such preparations were never standardised and there would be great variances in the amount of active principle in each batch as the drug itself varied from its sources and also the season in which it was grown and harvested.
 
Other forms of  drugs used in dispensing were Extracts and Infusions. These were also prepared by maceration of the drug by an aqueous vehicle. FRESH INFUSIONS were prepared like cups of tea in an infusion jug, and extracts were made by concentrating the infused or percolated liquid by heating. Again standards were haphazard and thus responses by the patients were also unpredictable.
 
In the First Edition of the APF, a formula for "Liquor Opii Sedativus" directs that after pressing the marc, that the resultant liquid be set aside for 6 months, to "mature" before filtering.

Making OINTMENTS AND CREAMS were very much manipulative skills for a Pharmacist and spatulas and an ointment slab can still be found in every pharmacy today, although most would be covered in dust as very few extemporaneous preparations are dispensed now.

Some of the skills that have disappeared completely are those involved with making an attractive and palatable medicine.
 
Take for example a prescription for 12 POWDERS, individually wrapped. A skilled pharmacist could divide the total amount manually without weighing each one, and the folding of the papers containing the powder was done in the twinkling of an eye.

Elegance in presentation has always been the hallmark of a professional pharmacist and it is just as important today to have pride in the way our work is finished off so that the patient can appreciate the care that was taken to dispense their medication.

Another dose form that was almost universally used was the PILL. The term pill is rather loosely used today to describe most forms of oral medication made by machine, but my father's generation of pharmacists knew the pill as a spherical hand rolled mass, usually coated with gum, sugar or foil to make the bitter tasting ingredients more palatable.   
 
Another presentation that was very popular until about the fifty years ago was the CACHET. These were like little round Raviolis, and they were prepared in a special cachet machine.

They were used for bulky powders or to mask a bitter taste and a popular drug to pack in cachets was charcoal powder for flatulence, and we more popular in Europe than in England or Australia. They were hazardous to prepare and required skill to ensure that the drug didn't get wet or leak out of the seal.

Capsules were a lot easier to cope with when dispensing.

Before large scale manufacturing  of prescription drugs took away the skills of the individual pharmacist in compounding, and the traditional forms of pills, powders and cachets etc. all disappeared, some pharmacists also manufactured TABLETS by hand and even filled GELATIN CAPSULES after they were invented. Tabletting was done in a triturate mould or by a hand press and both processes were very slow and laborious.

Another drug form that was very popular was the lozenge or pastille. Made from a glycerin & gelatin base and flavours such as rosewater or tolu syrup, they were formed in a small mould or a hand turned machine. After removal from the mould the lozenges were dusted with powdered sugar to avoid adhesion. You have probably all been given an exercise to make SUPPOSITORIES, but they were widely used in all shapes and sizes and the well equipped dispensary had to have a selection of different shapes and sizes for bougie and urethral suppositories. Machines to "cold mould" the suppositories were also used.

When all of the dispensing processes were completed, it was then necessary to reinforce the skill and art of the dispensing with the presentation. Pills, Capsules Suppositories and even hand made tablets would be packed in small wooden or cardboard boxes, carefully endorsed with a handwritten label.

Mixtures would be packed in the embossed private name prescription bottles, and corked. The cork was often squeezed in a CORK PRESS to get a good fit in the bottle neck, and then it would be wrapped carefully in white paper, tied with pink string and sealed with a drop of sealing wax. Some pharmacists even had their own SEALS to add the final touch.

How much better the patient would have felt, when they went to take the first dose and they could see in their hand a carefully compounded prescription that would certainly make them feel better, regardless of what active ingredients it actually contained.

This is but a brief sample of the many other drug forms that pharmacists dispensed in days gone by.

The list in Appendix 1 " Secundem Artem" gives a very good idea of the range of prescriptions that could be presented to a pharmacist. In many cases the prescriber left the method of preparation entirely to the pharmacist who would then use his or her knowledge to prepare an elegant preparation for the customer. When extemporaneous dispensing occupied most of a pharmacist's time, there was no such thing as expiry dates on medicines or any guarantee of sterility in preparations such as eye drops and ointments. If injections were dispensed at all, simple autoclaves or pressure cookers would have been used to obtain some level of sterility, but again there would have been no batch testing or other accepted forms of quality control. Also a pharmacist knew what a finished prescription should look like and taste like, and whilst there was always the risk of a miscalculation or the selection of the wrong ingredient from the shelf, there was by no means the prevalence of drug interactions that are seen with modern day medications. Whilst the role of the pharmacist has changed dramatically over the past 100 years or so, there is still the underlying skill and professionalism that the public have learnt to accept and trust, and when one reflects on how Pharmacy has evolved, it is not hard to understand why the pharmacist holds the community standing we enjoy today.