Chapter 1 History of Medicine and Pharmacy Copyright © 2004 by Elsevier Inc. All rights reserved. Ancient Beliefs and Treatments • Medicine has been practiced for thousands of years • Remedies such as herbals have been used throughout history • Many popular beliefs have disappeared, for example: Trephining–a cut made into the skull to give disease a portal to leave through Copyright © 2004 by Elsevier Inc. All rights reserved. Ancient Beliefs and Treatments • Severe illnesses caused by evil spirits • Tribal shamans (medicine men) had gift of being able to communicate with spirits • Other illnesses cured by the placebo effect–patients believed so strongly in the treatment rendered that they were cured Copyright © 2004 by Elsevier Inc. All rights reserved. The Medical Staff • Aesculapius–Greek God of medicine • His symbol–a staff with a snake wrapped around it • Treatments for illnesses were based on dreams and visions of the believers • Authoritarians–set forth dogmatic beliefs like gods being able to cure illnesses Copyright © 2004 by Elsevier Inc. All rights reserved. Medicine in Its Infancy • Plagues killed many people • Microbes not known to be responsible for many diseases • Prayer–most common form of treatment Copyright © 2004 by Elsevier Inc. All rights reserved. Medicine in Its Infancy • Hippocrates–3rd generation physician • Believed life consisted of a balance of four elements linked to qualities of good health: wet, dry, hot, cold • Illnesses resulted in imbalance of four humors–blood, phlegm, yellow bile, black bile Copyright © 2004 by Elsevier Inc. All rights reserved. Medicine in Its Infancy • Four humors were linked to the four elements: – Blood = air – Phlegm = water – Yellow bile = fire – Black bile = earth • Treatment: bloodletting, laxatives Copyright © 2004 by Elsevier Inc. All rights reserved. Medicine in Its Infancy • Hippocrates–responsible for advancements in medicine • His observations included effects of food and climate • First physician to record patient’s medical illnesses • Promoted rest and eating light foods Copyright © 2004 by Elsevier Inc. All rights reserved. Medicine in Its Infancy • Corpus Hippocratum–documentation of Hippocrates’ writings • Hippocratic oath–“Doctors act only for the good of their patients and keep confidential what they learn about their patients.” • Hippocrates–known as the Father of Medicine Copyright © 2004 by Elsevier Inc. All rights reserved. Medicine in Its Infancy • Aristotle–Greek philosopher and scientist • Responsible for many advancements in biology and medicine • Studied and classified various organisms • Described human anatomy from observations after dissecting animals Copyright © 2004 by Elsevier Inc. All rights reserved. Medicine in Its Infancy • Claudius Galen–followed many of Hippocrates’ beliefs like eating a balanced diet, exercise, and good hygiene • Contributed greatly to study of medicine • Wrote on topics such as physiology, anatomy, pathology, diagnosis, and pharmacology Copyright © 2004 by Elsevier Inc. All rights reserved. Medicine in Its Infancy • Roger Bacon–philosopher and alchemist • Refined and explained the importance of the experimental methods Copyright © 2004 by Elsevier Inc. All rights reserved. Medicine in Its Infancy • Paracelsus–Swiss physician and alchemist • Believed in treating illnesses with one medicine at a time • Produced many nontoxic medications • Introduced Laudanum–popular tonic to deaden pain Copyright © 2004 by Elsevier Inc. All rights reserved. Ancient Herbal Remedies • Prevalent treatments–multiple mixtures of plants, roots, and other concoctions • Belief held that digesting the type of plant resembling organ affected by the disease cured the illness Copyright © 2004 by Elsevier Inc. All rights reserved. Prevalent Ancient Herbal Remedies • Examples of prevalent treatments: – Garlic–inflammation of bronchial tubes – Liverwort plant–for liver problems – Wine and pepper–stomach ailments – Onions–worms – Tiger fat–joint pain Copyright © 2004 by Elsevier Inc. All rights reserved. Medicine in the Fourteenth Century • Belief that evil spirits caused disease • Treatments through trial and error– some were effective; some caused death • New scientists emerged and new methods were devised to test hypotheses, which gave way to advancements Copyright © 2004 by Elsevier Inc. All rights reserved. Medicine in the Eighteenth Century • Religious leaders became very active in researching medicinal remedies to treat the sick • Gregor Mendel–famous scientist and monk–found the basis of genetics and how genes are woven into heredity • Known as the Father of Genetics Copyright © 2004 by Elsevier Inc. All rights reserved. Medicine in America • Early America–immigrants brought diseases from other parts of the world • Doctors–responsible for diagnosing conditions and preparing remedies to cure patients • First druggists were doctors Copyright © 2004 by Elsevier Inc. All rights reserved. Medicine in America • Early American remedies: – Cinchona bark (quinine)–malaria – Mercury–syphilis (very toxic and caused deaths) • Average life expectancy–40 years • Childhood diseases–no vaccines available Copyright © 2004 by Elsevier Inc. All rights reserved. Medicine in America • Most treatments were concoctions handed down through family tradition • There were few doctors and fewer hospitals throughout the colonies • Civil War–brought about a clear division between physicians and pharmacists Copyright © 2004 by Elsevier Inc. All rights reserved. The Use of Opium and Alcohol • Most popular tonic for medicinal use; very addictive • Given as a sedative to dull the sensation of pain • Civil War–used to treat painful wounds Copyright © 2004 by Elsevier Inc. All rights reserved. The Use of Opium and Alcohol • Households–used it for less severe problems and depression • Addiction–alarming rate • Absinthe–alcohol-based liquid; herb mixed with alcohol; served with water and sugar for tapeworms Copyright © 2004 by Elsevier Inc. All rights reserved. Early Pharmacists • Apothecaries (pharmacies)–sprung up after the Civil War • Manufacturing plants were built • Training took place to give medications accurately • Pharmacists moved into the role of druggists Copyright © 2004 by Elsevier Inc. All rights reserved. Early Pharmacists • First Pharmacy School–Philadelphia College of Pharmacy and Sciences (1821) • 1800s–Pharmacists compounded nearly every drug ordered by physicians • Cisterns–large ornate jars used to store various herbs and ingredients Copyright © 2004 by Elsevier Inc. All rights reserved. Early Pharmacists • Recipe book–where remedies were contained • Examples: chalk–for heartburn; rose petals–for headaches • Apothecary–filled with oils, herbs, and spices Copyright © 2004 by Elsevier Inc. All rights reserved. Early Pharmacy Technicians • First pharmacy technicians–family members of the pharmacists who owned the corner drugstore • Wives–helped behind the counter and waited on customers • Older children–filled in as clerks, waited on customers, and stocked shelves Copyright © 2004 by Elsevier Inc. All rights reserved. Early Pharmacy Technicians • Clerk training–filling medication drawers, profiling doctor’s orders, compounding simple mixtures • Early clerks–became pharmacy technicians Copyright © 2004 by Elsevier Inc. All rights reserved. The Soda Fountain/Pharmacy in America • Early pharmacists played a minimal role in healthcare • 1800 to 1900–soda fountain became an extension of a town’s drugstore • Mineral water–became treatment for different ailments Copyright © 2004 by Elsevier Inc. All rights reserved. The Soda Fountain/Pharmacy in America • Pharmacists–sold soda and ice cream, worked the lunch counter, and filled the day’s prescriptions • Pharmacy setting–promoted trust in the pharmacist Copyright © 2004 by Elsevier Inc. All rights reserved. Changing Pharmacy • Doctor of pharmacy degree (PharmD) required in United States • Today’s druggist–needs in-depth and broad communication skills with doctors and customers • Today’s technicians–required to get education in addition to on-the-job training in some states Copyright © 2004 by Elsevier Inc. All rights reserved. Changing Pharmacy • Technician duties–preparing prescriptions and compounding • Hospital duties–supply floorstock, prepare parenteral medications, transcribe doctor’s orders, fill patient’s cassettes • Specialized technicians–order drugs and supplies Copyright © 2004 by Elsevier Inc. All rights reserved. Changing Pharmacy • Technicians need strong communication skills • Pharmacists–can also specialize in interpreting lab results, oncology, and compounding, to name a few Copyright © 2004 by Elsevier Inc. All rights reserved. Protocol • A set of standardized rules that are agreed on within a pharmacy setting • Drug Education Coordinators (DECs)– meet to discuss new medications, review them, and determine if they are better and cost effective; also consider new literature from drug companies Copyright © 2004 by Elsevier Inc. All rights reserved. Trust in Pharmacist/Trust in Technicians • Pharmacists–can be trusted to provide truthful information and be a confidant • Clinical pharmacist–works alongside doctors to prescribe medications and dosages • Community pharmacy–pharmacists required to counsel patients; technicians trusted to provide the best care by filling the correct medication Copyright © 2004 by Elsevier Inc. All rights reserved. Technicians of the Twenty-First Century and Beyond • Pharmacists–moving into a more highly clinical role not only counseling but also working with medical staff • Technicians–moving into transcribing orders, pulling medications, and filling prescriptions Copyright © 2004 by Elsevier Inc. All rights reserved.